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Infection Feb 2022Fluid management is challenging in malaria patients given the risks associated with intravascular fluid depletion and iatrogenic fluid overload leading to pulmonary... (Observational Study)
Observational Study
PURPOSE
Fluid management is challenging in malaria patients given the risks associated with intravascular fluid depletion and iatrogenic fluid overload leading to pulmonary oedema. Given the limitations of the physical examination in guiding fluid therapy, we evaluated point-of-care ultrasound (POCUS) of the inferior vena cava (IVC) and lungs as a novel tool to assess volume status and detect early oedema in malaria patients.
METHODS
To assess the correlation between IVC and lung ultrasound (LUS) indices and clinical signs of hypovolaemia and pulmonary oedema, respectively, concurrent clinical and sonographic examinations were performed in an observational study of 48 malaria patients and 62 healthy participants across age groups in Gabon.
RESULTS
IVC collapsibility index (CI) ≥ 50% on enrolment reflecting intravascular fluid depletion was associated with an increased number of clinical signs of hypovolaemia in severe and uncomplicated malaria. With exception of dry mucous membranes, IVC-CI correlated with most clinical signs of hypovolaemia, most notably sunken eyes (r = 0.35, p = 0.0001) and prolonged capillary refill (r = 0.35, p = 0.001). IVC-to-aorta ratio ≤ 0.8 was not associated with any clinical signs of hypovolaemia on enrolment. Among malaria patients, a B-pattern on enrolment reflecting interstitial fluid was associated with dyspnoea (p = 0.0003), crepitations and SpO ≤ 94% (both p < 0.0001), but not tachypnoea (p = 0.069). Severe malaria patients had increased IVC-CI (p < 0.0001) and more B-patterns (p = 0.004) on enrolment relative to uncomplicated malaria and controls.
CONCLUSION
In malaria patients, POCUS of the IVC and lungs may improve the assessment of volume status and detect early oedema, which could help to manage fluids in these patients.
Topics: Humans; Malaria; Point-of-Care Systems; Prospective Studies; Pulmonary Edema; Ultrasonography; Vena Cava, Inferior
PubMed: 34110570
DOI: 10.1007/s15010-021-01637-2 -
British Medical Journal Jun 1978
Topics: Humans; Hydrostatic Pressure; Lung; Osmotic Pressure; Pulmonary Edema
PubMed: 656817
DOI: No ID Found -
Thorax Apr 1988The occurrence of pulmonary oedema was studied retrospectively in 243 patients who underwent pneumonectomy in one hospital from 1975 to 1984. Pulmonary oedema developed...
The occurrence of pulmonary oedema was studied retrospectively in 243 patients who underwent pneumonectomy in one hospital from 1975 to 1984. Pulmonary oedema developed in eight of 113 patients who had a right sided pneumonectomy and in three of 130 patients undergoing a left sided procedure. It occurred more commonly in patients requiring a second thoracotomy because of blood loss (in three out of seven patients). There were no significant differences preoperatively in pulmonary function, lung perfusion scans, or cardiovascular condition between patients who subsequently developed pulmonary oedema and those who did not. Postoperative fluid balance was significantly more positive in patients developing pulmonary oedema than in those not developing oedema. Thus pulmonary oedema was associated with right sided pneumonectomy, repeat thoracotomy, and more positive fluid balance.
Topics: Female; Humans; Lung Volume Measurements; Male; Middle Aged; Pneumonectomy; Pulmonary Edema; Retrospective Studies; Water-Electrolyte Balance
PubMed: 3406920
DOI: 10.1136/thx.43.4.323 -
Asian Journal of Surgery Mar 2023
Topics: Humans; Pulmonary Edema; Liver Transplantation; Pleural Diseases; Fistula
PubMed: 36064484
DOI: 10.1016/j.asjsur.2022.08.043 -
Cardiology Journal 2013Transfusion-related acute lung injury (TRALI) is one of the leading causes of death associated with transfusion of blood and blood components. The understanding of the... (Review)
Review
Transfusion-related acute lung injury (TRALI) is one of the leading causes of death associated with transfusion of blood and blood components. The understanding of the etiology and pathophysiology of this syndrome has much improved during the last decades, nevertheless numerous issues are still unresolved and symptomatic treatment remains the cornerstone of medical management. Consequently more attention is directed at primary as well as secondary prevention. The awareness of the problem within the medical society is still unsatisfactory which results in a high number of unrecognized cases or of inaccurate diagnoses one of which is cardiogenic pulmonary edema. The aim of this review is to make the TRALI syndrome more familiar to clinicians and to emphasize how significant proper medical management is both for the patients presenting TRALI symptoms as well as for future recipients of blood components.
Topics: Acute Lung Injury; Diagnosis, Differential; Diagnostic Errors; Humans; Predictive Value of Tests; Pulmonary Edema; Risk Factors; Transfusion Reaction
PubMed: 23913451
DOI: 10.5603/CJ.2013.0091 -
Journal of Feline Medicine and Surgery Dec 2022The aims of this study were to describe the radiographic features of cardiogenic pulmonary oedema (CPE) in a large group of cats with left-sided cardiac disease, and to...
OBJECTIVES
The aims of this study were to describe the radiographic features of cardiogenic pulmonary oedema (CPE) in a large group of cats with left-sided cardiac disease, and to determine the association between the radiographic features of CPE and the underlying cardiac disease.
METHODS
Thoracic radiographs of cats with CPE and echocardiographic evidence of left-sided cardiac disease and left atrial enlargement (LAE) were reviewed, and cardiac silhouette, pulmonary vessels and pulmonary parenchyma evaluation were performed. Interstitial and/or alveolar patterns were classified according to their distribution (ie, diffuse, multifocal or focal) and location (ie, craniodorsal, cranioventral, caudodorsal, caudoventral and perihilar). A Student's -test and Mann-Whitney U-test, or the two-proportion z-test, were used to compare continuous or categorical variables, respectively, between cats affected by the two most represented cardiac diseases, namely hypertrophic cardiomyopathy (HCM) and restrictive cardiomyopathy (RCM).
RESULTS
Seventy-one cats were included; among them, 46 (64.7%) and 13 (18.3%) had presented for HCM and RCM, respectively. Subjective and objective cardiomegaly, and subjective and objective LAE were detected in 97.2% and 91.9% of cats and in 80.3% and 40.6% of cats, respectively. Pulmonary artery abnormalities, in particular caudal pulmonary artery dilation, were found in 77.5% of cats. Pulmonary artery to pulmonary vein ratio = 1 was found in 71.8% and 55% cats on right lateral and ventrodorsal or dorsoventral views, respectively. Interstitial (57.8%) and mixed interstitial-alveolar (38%) pattern, multifocal (84.5%) and symmetrical (75%) distribution with prevalent ventrocaudal (65.6% of cats) and ventrocranial (60.9% of cats) locations were most frequently observed. No difference was found for any of these radiographic features between cats with HCM and RCM.
CONCLUSIONS AND RELEVANCE
Moderate-to-severe cardiomegaly and LAE, caudal pulmonary artery and vein dilation, as well as a ventral, multifocal and symmetrical interstitial pulmonary pattern, were the main radiographic features of CPE in evaluated cats. Underlying cardiac disease did not influence the aforementioned radiographic features.
Topics: Cats; Animals; Pulmonary Edema; Heart Diseases; Cat Diseases
PubMed: 36350302
DOI: 10.1177/1098612X221121922 -
Circulation Journal : Official Journal... Nov 2010Heart failure (HF) is a highly prevalent disease that leads to significant morbidity and mortality. There is increasing evidence that the symptoms of HF are exacerbated... (Review)
Review
Heart failure (HF) is a highly prevalent disease that leads to significant morbidity and mortality. There is increasing evidence that the symptoms of HF are exacerbated by its deleterious effects on lung function. HF appears to cause airway obstruction acutely and leads to impaired gas diffusing capacity and pulmonary hypertension in the longer term. It is postulated that this is the result of recurrent episodes of elevated pulmonary capillary pressure leading to pulmonary oedema and pulmonary capillary stress fracture, which produces lung fibrosis. It is likely that impaired lung function impairs the functional status of HF patients and makes them more prone to central sleep apnoea.
Topics: Airway Obstruction; Heart Failure; Humans; Hypertension, Pulmonary; Lung; Pulmonary Edema; Pulmonary Fibrosis; Sleep Apnea Syndromes
PubMed: 21041971
DOI: 10.1253/circj.cj-10-0869 -
Revista de Neurologia Apr 2019Postictal neurogenic pulmonary oedema is an infrequent condition of varying severity, probably related to sudden unexpected death in epilepsy (SUDEP). It is more... (Review)
Review
INTRODUCTION
Postictal neurogenic pulmonary oedema is an infrequent condition of varying severity, probably related to sudden unexpected death in epilepsy (SUDEP). It is more frequent in patients with generalised tonic-clonic seizures of long duration or with status epilepticus.
AIM
Based on a review of the literature, the aim is to describe the clinical characteristics, pathophysiology, radiological findings, treatment and prognosis of patients with postictal pulmonary oedema.
DEVELOPMENT
A search of the literature was performed in the PubMed, Embase, Cochrane Database of Systematic Reviews and BVS databases using a combination of free terms. The limits of the search applied were: papers published between 1 January 2000 and 26 April 2018, and papers for which the abstract was available. Altogether 23 papers were found, most of which were clinical cases, and used to extract the information needed to carry out the review.
CONCLUSIONS
In postictal pulmonary oedema, generalised tonic-clonic seizures are the most frequently reported type. The most common clinical manifestations were dyspnoea and tachycardia appearing within a few minutes after the seizure. Among the paraclinical findings the most frequent was leukocytosis. In general terms, a good prognosis was found in most cases, with improvement of the oedema within a period of between 12 and 96 hours. Only two of the 21 patients reported died. In addition, in a clinical pathology study in patients with SUDEP, pulmonary oedema appeared in most cases.
Topics: Adolescent; Adult; Aged; Capillary Permeability; Child, Preschool; Combined Modality Therapy; Epilepsy; Epilepsy, Tonic-Clonic; Female; Humans; Infant; Male; Middle Aged; Prognosis; Pulmonary Circulation; Pulmonary Edema; Seizures; Sudden Unexpected Death in Epilepsy; Vasoconstriction; Young Adult
PubMed: 30963531
DOI: 10.33588/rn.6808.2018356 -
The European Respiratory Journal Apr 2000Postpneumonectomy pulmonary oedema (PPO) develops in approximately 5% of patients undergoing pneumonectomy or lobectomy, and has a high associated mortality (>50%). In... (Review)
Review
Postpneumonectomy pulmonary oedema (PPO) develops in approximately 5% of patients undergoing pneumonectomy or lobectomy, and has a high associated mortality (>50%). In its extreme form, PPO follows a clinical and histopathological course indistinguishable from acute respiratory distress syndrome. Perioperative fluid overload, impaired lymphatic drainage following node dissection and trauma caused by surgical manipulation have been implicated in the pathogenesis of PPO. However, PPO more probably represents the pulmonary manifestation of a panendothelial injury consequent upon inflammatory processes induced by the surgical procedure, which involves collapse and re-expansion of the operative lung to permit hilar dissection and pulmonary resection. High inspired oxygen concentrations are required to overcome the effects of shunt. Animal studies have shown that pulmonary ischaemia/reperfusion can result in oedema formation, possibly due to the generation of pro-oxidant forces. Moreover, plasma taken from patients undergoing lobectomy or pneumonectomy (but not lesser resections) shows evidence of oxidative damage. Such evidence suggests either that the high inspired oxygen concentrations associated with one-lung ventilation, or ischaemia/reperfusion injury, may modulate post-pneumonectomy pulmonary oedema. Mechanisms by which redox imbalance may result in tissue damage and postpneumonectomy pulmonary oedema are discussed.
Topics: Female; Humans; Incidence; Infant, Newborn; Male; Pneumonectomy; Prognosis; Pulmonary Edema; Respiratory Distress Syndrome; Risk Factors; Survival Rate
PubMed: 10780775
DOI: 10.1034/j.1399-3003.2000.15d26.x -
The European Respiratory Journal May 2008Patients with acute respiratory distress syndrome and high-altitude pulmonary oedema build up excess lung fluid, which leads to alveolar hypoxia. In patients with acute... (Review)
Review
Patients with acute respiratory distress syndrome and high-altitude pulmonary oedema build up excess lung fluid, which leads to alveolar hypoxia. In patients with acute respiratory distress syndrome and hypoxia, there is a decrease in oedema fluid clearance, due in part to the downregulation of plasma membrane sodium-potassium adenosine triphosphatase (Na,K-ATPase). In alveolar epithelial cells, acute hypoxia promotes Na,K-ATPase endocytosis from the plasma membrane to intracellular compartments, resulting in inhibition of Na,K-ATPase activity. Exposure to prolonged hypoxia leads to degradation of plasma membrane Na,K-ATPase. The downregulation of plasma membrane Na,K-ATPase reduces adenosine triphosphate demand, as part of a survival mechanism of cellular adaptation to hypoxia. Hypoxia has also been shown to disassemble and degrade the keratin intermediate filament network, a fundamental component of the cell cytoskeleton, affecting epithelial barrier function. Accordingly, better understanding of the mechanisms regulating cellular adaptation to hypoxia may lead to the development of novel therapeutic strategies for acute respiratory distress syndrome and high-altitude pulmonary oedema patients.
Topics: Cell Membrane; Epithelial Cells; Humans; Hypoxia; Intermediate Filaments; Pulmonary Alveoli; Pulmonary Edema; Respiratory Distress Syndrome; Sodium-Potassium-Exchanging ATPase
PubMed: 18448505
DOI: 10.1183/09031936.00155507