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Bulletin of the NYU Hospital For Joint... 2007High-altitude illness is a growing concern in sports medicine that affects persons shortly after they have climbed to a new high-altitude level to which their body is... (Review)
Review
High-altitude illness is a growing concern in sports medicine that affects persons shortly after they have climbed to a new high-altitude level to which their body is not acclimatized. With the increasing popularity of extreme sports, such as high-altitude mountaineering, skiing, and snowboarding, the incidence of complications arising from sports activities at high altitudes is increasing. High-altitude pulmonary edema and high-altitude cerebral edema are potentially fatal conditions. The study of high-altitude muscle physiology has broad ramifications in creating training programs for elite endurance athletes. A thorough understanding of the pathophysiology, presentation, treatment, and prevention of high-altitude illness is necessary for the treatment of these patients.
Topics: Altitude; Anti-Inflammatory Agents; Brain Edema; Calcium Channel Blockers; Dexamethasone; Humans; Nifedipine; Oxygen; Pulmonary Edema; Risk Factors
PubMed: 17539764
DOI: No ID Found -
Andes Pediatrica : Revista Chilena de... Apr 2021High-altitude pulmonary edema (HAPE) occurs when a person without adequate pulmonary adap tation ascends above 2500 meters above sea level. Usually, it is more frequent...
INTRODUCTION
High-altitude pulmonary edema (HAPE) occurs when a person without adequate pulmonary adap tation ascends above 2500 meters above sea level. Usually, it is more frequent among those living at low altitudes, however, it can occur in people who live at high altitudes and descend to lower ones for a short time, which is called re-entry HAPE.
OBJECTIVE
To describe the clinical course, diagnosis, and management of re-entry HAPE in pediatric patients, and to achieve an early approach to reduce complications.
CLINICAL CASES
We present 6 cases of pediatric patients diagnosed with re-entry HAPE in a fourth level hospital in Bogotá, Colombia, between 2013 and 2018. All patients resided in Bogo tá, 5/6 were male, the median age was 11 years, 4/6 had a history of lung disease, and 5/6 required a high-flow oxygen device. In all cases, the chest X-ray reported opacities and 2/6 showed pulmonary hypertension on the echocardiogram. All patients were initially treated for bacterial pneumonia or asthma and, although they progressed adequately, these inadequate treatments can cause compli cations.
CONCLUSION
The diagnosis, treatment, and prevention of HAPE are important since it is usually confused with infectious pulmonary pathologies due to its similar clinical course, which leads to inadequate treatment and can generate complications. The suggestion is that HAPE should be con sidered as a differential diagnosis in patients with a recent history of ascending to high altitude cities.
Topics: Altitude; Child; Colombia; Female; Humans; Hypertension, Pulmonary; Male; Pulmonary Edema; Travel-Related Illness
PubMed: 34106165
DOI: 10.32641/andespediatr.v92i2.2977 -
Swiss Medical Weekly Nov 2003In patients with acute lung injury (ALI) or acute respiratory distress syndrome (ARDS), extensive damage to the alveolar epithelial and endothelial barrier is observed,... (Review)
Review
In patients with acute lung injury (ALI) or acute respiratory distress syndrome (ARDS), extensive damage to the alveolar epithelial and endothelial barrier is observed, resulting in the influx of protein-rich oedema fluid into the air spaces. Efficient alveolar epithelial repair is crucial to ALI/ARDS patients' recovery. Future therapeutic strategies may therefore include acceleration of the epithelial repair process in the injured lung. However, a better understanding of the cellular and molecular mechanisms that promote alveolar epithelial repair is needed if novel therapeutic strategies are to be developed. Pulmonary oedema fluid from patients with ALI/ARDS and from patients with hydrostatic oedema as control was obtained, and the effect on alveolar epithelial repair in vitro using our alveolar epithelial wound repair bioassay was studied. In contrast to the initial hypothesis, pulmonary oedema fluid from ALI/ARDS patients increased alveolar epithelial repair in vitro by an interleukin-1beta (IL-1beta)-dependent mechanism, demonstrating a novel, possibly beneficial role for IL-1beta in patients with ALI/ARDS. Further studies using primary alveolar epithelial cells from rats revealed that IL-1beta induced alveolar epithelial repair by an epidermal growth factor (EGF)/transforming growth factor-alpha (TGF-alpha)-dependent pathway. Besides EGF and TGF-alpha, keratinocyte growth factor (KGF) and hepatocyte growth factor (HGF)--both present in pulmonary oedema fluid obtained from patients with ALI/ARDS--stimulate alveolar epithelial repair in vitro. Further experimental and clinical studies will show whether acceleration of alveolar epithelial repair by modulating cytokines and growth factors in the injured lung represents a promising new therapeutic strategy in patients with ALI/ARDS.
Topics: Animals; Cells, Cultured; Epithelial Cells; Growth Substances; Humans; Interleukin-1; Pulmonary Alveoli; Pulmonary Edema; Rats; Respiratory Distress Syndrome
PubMed: 14745653
DOI: 10.4414/smw.2003.10267 -
Archives of Emergency Medicine Jun 1984The resuscitation of a 21-year-old man after submersion in fresh water for at least 5 min is described. On admission to hospital the patient appeared dead with fixed...
The resuscitation of a 21-year-old man after submersion in fresh water for at least 5 min is described. On admission to hospital the patient appeared dead with fixed dilated pupils, deep cyanosis and asystole. Twenty min later the patient was transferred to the intensive care unit with a recordable blood pressure. On arrival there he was breathing spontaneously and so was not ventilated. A few hours later he developed pulmonary oedema and died.
Topics: Adult; Drowning; Humans; Male; Pulmonary Edema; Resuscitation; Time Factors
PubMed: 6536271
DOI: 10.1136/emj.1.2.113 -
Tidsskrift For Den Norske Laegeforening... Dec 2014Morphine is still used in Norway and the rest of Europe as part of the treatment for pulmonary oedema, but the scientific basis for this is tenuous. In this article we... (Review)
Review
BACKGROUND
Morphine is still used in Norway and the rest of Europe as part of the treatment for pulmonary oedema, but the scientific basis for this is tenuous. In this article we assess the literature that supports and challenges the use of morphine in cases of pulmonary oedema.
MATERIAL AND METHOD
The article is based on a literature search in Medline and EMBASE and on the articles which form the basis of Norwegian and international guidelines.
RESULTS
Morphine has been used for several decades in cases of pulmonary oedema due to the anxiolytic and vasodilatory properties of the drug. Vasodilation caused by morphine has been described in other patient groups, but there is little evidence in the literature to suggest that morphine causes vasodilation in patients with pulmonary oedema. Non-specific depression of the central nervous system is probably the most significant factor for the changes in haemodynamics in pulmonary oedema. Retrospective studies have shown both negative and neutral effects in acute decompensated heart failure. There are no reliable clinical studies that document better prognosis from the use of morphine.
INTERPRETATION
Based on the available studies, the possibility cannot be excluded that the use of morphine results in increased mortality among patients with acute pulmonary oedema. In addition, there is little evidence that the vasodilatory properties of morphine are of any significance for this condition. The benefits and risks of using morphine in cases of acute pulmonary oedema are still unclear, but so far there is little evidence to support the beneficial use of the drug.
Topics: Acute Disease; Algorithms; Evidence-Based Medicine; Humans; Morphine; Pulmonary Edema; Vasodilator Agents
PubMed: 25492336
DOI: 10.4045/tidsskr.14.0359 -
Medizinische Klinik, Intensivmedizin... Apr 2022Peripartum emergencies that require intensive medical care represent a major challenge for the interdisciplinary treatment team. Due to physiological changes in...
Peripartum emergencies that require intensive medical care represent a major challenge for the interdisciplinary treatment team. Due to physiological changes in pregnant women symptoms can be masked and the initiation of treatment is delayed. Peripartum sepsis has a relatively high incidence. The anti-infective treatment depends on the spectrum of pathogens to be expected. Endocrinological emergencies are rare but can be fulminant and fatal. The development of ketoacidosis is favored by decreased bicarbonate buffer and placental hormones. In the case of thyrotoxicosis, propylthiouracil and thiamazole are available for treatment depending on the stage of gestation. Sheehan's syndrome is an infarction of the anterior lobe of the pituitary gland during a hemorrhage. Due to the loss of production of vital hormones, this can be fatal. The development of pulmonary edema is just as acute. This is favored by physiological changes during pregnancy. The differentiation between hypertensive and hypotensive pulmonary edema is important for the causal treatment.
Topics: Emergencies; Female; Humans; Hypopituitarism; Peripartum Period; Placenta; Pregnancy; Pulmonary Edema; Sepsis
PubMed: 35312817
DOI: 10.1007/s00063-022-00910-y -
British Journal of Sports Medicine Dec 1995
Topics: Altitude; Animals; Cold Temperature; Heart Failure; Horse Diseases; Horses; Humans; Physical Conditioning, Animal; Physical Exertion; Pulmonary Edema; Risk Factors
PubMed: 8808531
DOI: 10.1136/bjsm.29.4.218 -
Kardiologia Polska 2013Acute heart failure (AHF) is a life-threatening condition associated with poor prognosis.
BACKGROUND
Acute heart failure (AHF) is a life-threatening condition associated with poor prognosis.
AIM
To investigate the long term prognosis and identify prognostic factors among patients who were discharged after an episode of cardiogenic pulmonary oedema.
METHODS
We enrolled 84 patients (M: 56%, n = 47) who were discharged with cardiogenic pulmonary oedema as a diagnosis. Clinical, biochemical and echocardiographic variables were collected and analysed. The completeness of two- and five-year follow-up was 100% and 96%, respectively.
RESULTS
The median (IQR) age was 74 years (64-81), left ventricular ejection fraction was 35% (27-45), blood pressure on admission was 140/90 mm Hg (115-180/70-100), estimated glomerular filtration rate was 60 mL/min/1.73 m2 (45-73). Forty per cent (n = 34) of the patients had a history of atrial fibrillation (AF), however, AF was directly involved with pulmonary oedema only in 4% (n = 3) of the cases. Acute myocardial infarction (AMI) accounted for 34% (n = 29) of all the causes of pulmonary oedema and was associated with a better two-year prognosis compared to other causes of pulmonary oedema (p = 0.018). Two- and five-year mortality was 45% (n = 38) and 72% (n = 58), respectively. Co-morbidities were common. Ischaemic heart disease and arterial hypertension were present in 83% and 70% of the patients, respectively. Multivariable analysis identified increased left ventricular mass (RR 3.609, 95% CI 1.235-10.547, p = 0.017) and treatment with long-acting vasodilator drugs (LAVDs) (RR 4.881, 95% CI 1.618-14.727, p = 0.004) as independent negative prognostic factors, whereas in-hospital therapy with beta-blockers created a distinctly protective effect (RR 0.123, 95% CI 0.033-0.457, p = 0.002) in the two-year follow-up. Five-year mortality was independently associated with older age (RR 1.08, 95% CI 1.02-1.14, p = 0.005) and treatment with LAVDs (RR 6.4, 95% CI 1.47-28.14, p = 0.012), while percutaneous coronary intervention (RR 0.17, 95% CI 0.05-0.58, p = 0.004) significantly decreased the risk.
CONCLUSIONS
AHF is a heterogeneous syndrome with a very high remote mortality. LAVDs administered during the hospital stay as well as older age on admission correlate with higher long-term overall mortality. In the age of percutaneous coronary intervention, AMI aetiology of pulmonary oedema is no longer a negative prognostic factor for the long-term prognosis.
Topics: Aged; Aged, 80 and over; Follow-Up Studies; Heart Failure; Humans; Middle Aged; Prognosis; Pulmonary Edema; Regression Analysis; Risk Factors; Time Factors
PubMed: 23907904
DOI: 10.5603/KP.2013.0158 -
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 -
BMJ Case Reports Oct 2013A previously completely fit and well 62-year-old man presented with a 4-week history of lethargy and increasing shortness of breath. This had been preceded by a flu-like...
A previously completely fit and well 62-year-old man presented with a 4-week history of lethargy and increasing shortness of breath. This had been preceded by a flu-like illness that had been treated in the community with ciprofloxacin to no effect. There was no history of smoking, tuberculosis exposure or significant exposure to birds. Clinically the patient appeared well and was comfortable and conversant with no peripheral oedema. Chest auscultation revealed normal breath sounds and a loud pansystolic murmur over the cardiac apex. A chest radiograph and a subsequent CT scan showed widespread fibrotic and bronchiectatic changes, predominantly in the right upper lobe, with bilateral pleural effusions. Echocardiography revealed a posterior mitral valve prolapse. He was treated with loop diuretics and a mitral valve repair that resolved his symptoms and radiographic findings. This is the first English language case report of pulmonary oedema causing bronchiectatic lung appearances.
Topics: Bronchiectasis; Diagnosis, Differential; Diagnostic Imaging; Diuretics; Furosemide; Humans; Male; Middle Aged; Mitral Valve Prolapse; Pulmonary Edema; Respiratory Function Tests; Ultrasonography
PubMed: 24099758
DOI: 10.1136/bcr-2013-009720