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BMC Pulmonary Medicine Aug 2021The aim of the study is to estimate the prevalence of atelectasis assessed with computer tomography (CT) in SARS-CoV-2 pneumonia and the relationship between the amount...
BACKGROUND
The aim of the study is to estimate the prevalence of atelectasis assessed with computer tomography (CT) in SARS-CoV-2 pneumonia and the relationship between the amount of atelectasis with oxygenation impairment, Intensive Care Unit admission rate and the length of in-hospital stay.
PATIENTS AND METHODS
Two-hundred thirty-seven patients admitted to the hospital with SARS-CoV-2 pneumonia diagnosed by clinical, radiology and molecular tests in the nasopharyngeal swab who underwent a chest computed tomography because of a respiratory worsening from Apr 1 to Apr 30, 2020 were included in the study. Patients were divided into three groups depending on the presence and amount of atelectasis at the computed tomography: no atelectasis, small atelectasis (< 5% of the estimated lung volume) or large atelectasis (> 5% of the estimated lung volume). In all patients, clinical severity, oxygen-therapy need, Intensive Care Unit admission rate, the length of in-hospital stay and in-hospital mortality data were collected.
RESULTS
Thirty patients (19%) showed small atelectasis while eight patients (5%) showed large atelectasis. One hundred and seventeen patients (76%) did not show atelectasis. Patients with large atelectasis compared to patients with small atelectasis had lower SatO/FiO (182 vs 411 respectively, p = 0.01), needed more days of oxygen therapy (20 vs 5 days respectively, p = 0,02), more frequently Intensive Care Unit admission (75% vs 7% respectively, p < 0.01) and a longer period of hospitalization (40 vs 14 days respectively p < 0.01).
CONCLUSION
In patients with SARS-CoV-2 pneumonia, atelectasis might appear in up to 24% of patients and the presence of larger amount of atelectasis is associated with worse oxygenation and clinical outcome.
Topics: Aged; COVID-19; COVID-19 Testing; Female; Humans; Hypoxia; Intensive Care Units; Length of Stay; Lung; Lung Volume Measurements; Male; Pneumonia, Viral; Prevalence; Pulmonary Atelectasis; Respiration, Artificial; Retrospective Studies; SARS-CoV-2; Severity of Illness Index; Spain; Tomography, X-Ray Computed
PubMed: 34404383
DOI: 10.1186/s12890-021-01638-9 -
Minerva Anestesiologica Jun 2008
Review
Topics: Humans; Intraoperative Complications; Postoperative Complications; Pulmonary Atelectasis
PubMed: 18500199
DOI: No ID Found -
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 -
Annals of Palliative Medicine Oct 2021In clinical general thoracic surgery, the prevalence of atelectasis is relatively high. Perioperative interventions can affect the probability of patients with... (Meta-Analysis)
Meta-Analysis
BACKGROUND
In clinical general thoracic surgery, the prevalence of atelectasis is relatively high. Perioperative interventions can affect the probability of patients with atelectasis after surgery. Therefore, the incidence of perioperative intervention to prevent atelectasis after thoracic surgery was discussed using meta-analysis in this study.
METHODS
The articles were searched in the English database PubMed and Chinese databases including China National Knowledge Infrastructure (CNKI), VIP, and China Journal Full-text Database (CJFD). The duration for publication time of the articles was from the database inception to March 2021, and the articles were required to be randomized controlled trials (RCTs) using interventions [such as changing the dose of general anesthesia, continuous positive end expiratory pressure (PEEP), non-invasive pressure support ventilation, and physical therapy] after thoracic surgery (such as pulmonary lobectomy, sternum surgery, and lung cancer surgery) for the treatment of atelectasis. The software RevMan 5.3 provided by the Cochrane Collaboration was used for meta-analysis.
RESULTS
A total of 5 articles were obtained, including 375 cases in the control group and 268 cases in the intervention treatment group. A meta-analysis was performed on the included articles, combined effect model analysis results showed that compared with the control group, the use of PEEP during mechanical ventilation can significantly reduce the incidence of atelectasis [odds ratio (OR) =0.46; 95% confidence interval (CI): 0.31-0.67; Z=3.94; P<0.0001].
DISCUSSION
Perioperative intervention was more effective for postoperative atelectasis and other complications.
Topics: Humans; Positive-Pressure Respiration; Postoperative Complications; Pulmonary Atelectasis; Thoracic Surgery; Thoracic Surgical Procedures
PubMed: 34763434
DOI: 10.21037/apm-21-2441 -
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 -
Anesthesiology Nov 2020Pulmonary atelectasis is frequent in clinical settings. Yet there is limited mechanistic understanding and substantial clinical and biologic controversy on its...
BACKGROUND
Pulmonary atelectasis is frequent in clinical settings. Yet there is limited mechanistic understanding and substantial clinical and biologic controversy on its consequences. The authors hypothesize that atelectasis produces local transcriptomic changes related to immunity and alveolar-capillary barrier function conducive to lung injury and further exacerbated by systemic inflammation.
METHODS
Female sheep underwent unilateral lung atelectasis using a left bronchial blocker and thoracotomy while the right lung was ventilated, with (n = 6) or without (n = 6) systemic lipopolysaccharide infusion. Computed tomography guided samples were harvested for NextGen RNA sequencing from atelectatic and aerated lung regions. The Wald test was used to detect differential gene expression as an absolute fold change greater than 1.5 and adjusted P value (Benjamini-Hochberg) less than 0.05. Functional analysis was performed by gene set enrichment analysis.
RESULTS
Lipopolysaccharide-unexposed atelectatic versus aerated regions presented 2,363 differentially expressed genes. Lipopolysaccharide exposure induced 3,767 differentially expressed genes in atelectatic lungs but only 1,197 genes in aerated lungs relative to the corresponding lipopolysaccharide-unexposed tissues. Gene set enrichment for immune response in atelectasis versus aerated tissues yielded negative normalized enrichment scores without lipopolysaccharide (less than -1.23, adjusted P value less than 0.05) but positive scores with lipopolysaccharide (greater than 1.33, adjusted P value less than 0.05). Leukocyte-related processes (e.g., leukocyte migration, activation, and mediated immunity) were enhanced in lipopolysaccharide-exposed atelectasis partly through interferon-stimulated genes. Furthermore, atelectasis was associated with negatively enriched gene sets involving alveolar-capillary barrier function irrespective of lipopolysaccharide (normalized enrichment scores less than -1.35, adjusted P value less than 0.05). Yes-associated protein signaling was dysregulated with lower nuclear distribution in atelectatic versus aerated lung (lipopolysaccharide-unexposed: 10.0 ± 4.2 versus 13.4 ± 4.2 arbitrary units, lipopolysaccharide-exposed: 8.1 ± 2.0 versus 11.3 ± 2.4 arbitrary units, effect of lung aeration, P = 0.003).
CONCLUSIONS
Atelectasis dysregulates the local pulmonary transcriptome with negatively enriched immune response and alveolar-capillary barrier function. Systemic lipopolysaccharide converts the transcriptomic immune response into positive enrichment but does not affect local barrier function transcriptomics. Interferon-stimulated genes and Yes-associated protein might be novel candidate targets for atelectasis-associated injury.
Topics: Animals; Female; Immunity, Cellular; Lung Volume Measurements; Pulmonary Atelectasis; Sheep; Transcriptome
PubMed: 32796202
DOI: 10.1097/ALN.0000000000003491 -
Journal of Perinatology : Official... Feb 2022To assess the impact of gravity and time on the changes in the distribution patterns of loss of aeration and atelectasis development in very preterm infants. (Observational Study)
Observational Study
OBJECTIVE
To assess the impact of gravity and time on the changes in the distribution patterns of loss of aeration and atelectasis development in very preterm infants.
STUDY DESIGN
Preterm infants less than 32 weeks gestation were included in this prospective, observational study. Infants were assessed via serial lung ultrasound (LUS) score in four lung zones, performed on days 7, 14, 21, and 28 after birth.
RESULT
Eighty-eight patients were enrolled. There was a significant main effect of gravity (P < 0.001) and time (P = 0.01) on the LUS score between gravity-dependent lungs and non-dependent lungs. Moreover, there was a significant main effect of gravity (P = 0.003) on atelectasis development between the lungs.
CONCLUSION
Gravity and time have an impact on the changes in the distribution patterns of gravity-induced lung injuries in preterm infants.
Topics: Humans; Infant; Infant, Newborn; Infant, Premature; Lung; Prospective Studies; Pulmonary Atelectasis; Ultrasonography
PubMed: 34417561
DOI: 10.1038/s41372-021-01189-1 -
Anesthesiology Oct 2019Positive end-expiratory pressure (PEEP) increases lung volume and protects against alveolar collapse during anesthesia. During emergence, safety preoxygenation... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Positive end-expiratory pressure (PEEP) increases lung volume and protects against alveolar collapse during anesthesia. During emergence, safety preoxygenation preparatory to extubation makes the lung susceptible to gas absorption and alveolar collapse, especially in dependent regions being kept open by PEEP. We hypothesized that withdrawing PEEP before starting emergence preoxygenation would limit postoperative atelectasis formation.
METHODS
This was a randomized controlled evaluator-blinded trial in 30 healthy patients undergoing nonabdominal surgery under general anesthesia and mechanical ventilation with PEEP 7 or 9 cm H2O depending on body mass index. A computed tomography scan at the end of surgery assessed baseline atelectasis. The study subjects were thereafter allocated to either maintained PEEP (n = 16) or zero PEEP (n = 14) during emergence preoxygenation. The primary outcome was change in atelectasis area as evaluated by a second computed tomography scan 30 min after extubation. Oxygenation was assessed by arterial blood gases.
RESULTS
Baseline atelectasis was small and increased modestly during awakening, with no statistically significant difference between groups. With PEEP applied during awakening, the increase in atelectasis area was median (range) 1.6 (-1.1 to 12.3) cm and without PEEP 2.3 (-1.6 to 7.8) cm. The difference was 0.7 cm (95% CI, -0.8 to 2.9 cm; P = 0.400). Postoperative atelectasis for all patients was median 5.2 cm (95% CI, 4.3 to 5.7 cm), corresponding to median 2.5% of the total lung area (95% CI, 2.0 to 3.0%). Postoperative oxygenation was unchanged in both groups when compared to oxygenation in the preoperative awake state.
CONCLUSIONS
Withdrawing PEEP before emergence preoxygenation does not reduce atelectasis formation after nonabdominal surgery. Despite using 100% oxygen during awakening, postoperative atelectasis is small and does not affect oxygenation, possibly conditional on an open lung during anesthesia, as achieved by intraoperative PEEP.
Topics: Adult; Aged; Female; Humans; Male; Middle Aged; Positive-Pressure Respiration; Postoperative Complications; Pulmonary Atelectasis; Tomography, X-Ray Computed
PubMed: 31107276
DOI: 10.1097/ALN.0000000000002764 -
Jornal Brasileiro de Pneumologia :... May 2023
Topics: Humans; Lung; Pulmonary Atelectasis
PubMed: 37194819
DOI: 10.36416/1806-3756/e20230064 -
Minerva Anestesiologica Sep 2023
Topics: Humans; Pulmonary Atelectasis
PubMed: 37676174
DOI: 10.23736/S0375-9393.23.17465-7