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Mattson JR, Gada KD, Jawa R, Zhang X, Ahmad S. Impact of Humidification Modality on Incidence of Endotracheal Tube Occlusion in COVID-19 Patients. J Intensive Care Med 2024:8850666241246969. [PMID: 38634177 DOI: 10.1177/08850666241246969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Background: Endotracheal tube (ETT) occlusion is reported at a higher frequency among coronavirus disease-2019 (COVID-19) patients. Prior to the COVID-19 pandemic, literature examining patient and ventilator characteristics, including humidification, as etiologies of ETT occlusion yielded mixed results. Our study examines the relationship of humidification modality with ETT occlusion in COVID-19 patients undergoing invasive mechanical ventilation (IMV). Methods: We conducted a retrospective chart review of COVID-19 patients requiring IMV at a tertiary care center in New York from April 2020 to April 2021. Teleflex Neptune heated wire heated humidification (HH) and hygroscopic Intersurgical FiltaTherm and Sunmed Ballard 1500 heat and moisture exchangers (HME) were used. Episodes of ETT occlusion were recorded. Univariate and multivariable logistic regression models were used to investigate the relationship between humidification modality and the occurrence of ETT occlusion. Findings: A total of 201 eligible patients were identified. Teleflex HH was utilized in 50.2% of the population and the others Intersurgical and Sunmed HME devices. Median age was 62 years and 78.6% of patients had at least one medical comorbidity. Precisely, 24% of patients experienced an ETT occlusion after a median of 12 days. The HME group was younger (58.5 vs 64 years), predominantly male (75% vs 59.4%), and experienced more total ventilator days than the HH group (24 vs 12). Those using the studied HME devices had significantly higher odds of ETT occlusion (OR 4.4, 95% CI 1.8-10.6, P = .0011). Three patients (6.1%) experienced cardiac arrest as a consequence of their occlusion. There were no deaths directly attributed to ETT occlusion. Conclusions: The studied HME devices were significantly associated with higher odds of ETT occlusion in COVID-19 patients requiring invasive mechanical ventilation. These events are not without significant clinical consequences. Prolonged use of under-performing HME devices remains suspect in the occurrence of ETT occlusions.
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Affiliation(s)
| | - Kunal Dhiren Gada
- Department of Medicine, Stony Brook University Hospital, Stony Brook, NY, USA
- Division of Pulmonary, Critical Care and Sleep Medicine, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Randeep Jawa
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Xiaoyue Zhang
- Biostatistical Consulting Core, Department of Family, Population and Preventative Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Sahar Ahmad
- Department of Medicine, Stony Brook University Hospital, Stony Brook, NY, USA
- Division of Pulmonary, Critical Care and Sleep Medicine, Stony Brook University Hospital, Stony Brook, NY, USA
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2
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de Miguel-Balsa E, Blasco-Ruso T, Gómez-Medrano N, Mirabet-Guijarro M, Martínez-Pérez A, Alcalá-López A. Effect of the duration of prone position in ARDS patients during the SARS-CoV-2 pandemic. Med Intensiva 2023; 47:575-582. [PMID: 37147214 PMCID: PMC10110926 DOI: 10.1016/j.medine.2023.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 02/10/2023] [Accepted: 03/06/2023] [Indexed: 05/07/2023]
Abstract
OBJECTIVE To describe the characteristics of patients with acute respiratory distress syndrome (ARDS) due to bilateral COVID-19 pneumonia on invasive mechanical ventilation (IMV), and to analyze the effect of prone position >24 h (prolonged) (PPP) compared to prone decubitus <24 h (PP). DESIGN A retrospective observational descriptive study was carried out, with uni- and bivariate analyses. SETTING Department of Intensive Care Medicine. Hospital General Universitario de Elche (Elche, Alicante, Spain). PARTICIPANTS Patients with SARS-CoV-2 pneumonia (2020-2021) on IMV due to moderate-severe ARDS, ventilated in prone position (PP). INTERVENTIONS IMV. PP maneuvers. MAIN VARIABLES OF INTEREST Sociodemographic characteristics, analgo-sedation, neuromuscular blockade (NMB), PD duration, ICU stay and mortality, days of IMV, non-infectious complications, healthcare associated infections. RESULTS Fifty-one patients required PP, and of these, 31 (69.78%) required PPP. No differences were observed in terms of patient characteristics (gender, age, comorbidities, initial severity, antiviral and antiinflammatory treatment received). Patients on PPP had poorer tolerance to supine ventilation (61.29% vs 89.47%, p = 0.031), longer hospital stay (41 vs 30 days, p = 0.023), more days of IMV (32 vs 20 days, p = 0.032), longer duration of NMB (10.5 vs 3 days, p = 0.0002), as well as a higher percentage of episodes of orotracheal tube obstruction (48.39% vs 15%, p = 0.014). CONCLUSIONS PPP was associated with greater resource use and complications in patients with moderate-severe ARDS due to COVID-19.
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Affiliation(s)
- Eva de Miguel-Balsa
- Department of Intensive Care Medicine, Hospital General Universitario de Elche, Elche, Alicante, Spain; Department of Clinical Medicine, Faculty of Medicine, Universidad Miguel Hernández de Elche, Elche, Alicante, Spain.
| | - Teresa Blasco-Ruso
- Department of Clinical Medicine, Faculty of Medicine, Universidad Miguel Hernández de Elche, Elche, Alicante, Spain
| | - Norma Gómez-Medrano
- Department of Intensive Care Medicine, Hospital General Universitario de Elche, Elche, Alicante, Spain
| | - María Mirabet-Guijarro
- Department of Intensive Care Medicine, Hospital General Universitario de Elche, Elche, Alicante, Spain
| | - Alba Martínez-Pérez
- Department of Intensive Care Medicine, Hospital General Universitario de Elche, Elche, Alicante, Spain
| | - Adoración Alcalá-López
- Department of Intensive Care Medicine, Hospital General Universitario de Elche, Elche, Alicante, Spain
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3
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Mikami Y, Grubb BR, Rogers TD, Dang H, Asakura T, Kota P, Gilmore RC, Okuda K, Morton LC, Sun L, Chen G, Wykoff JA, Ehre C, Vilar J, van Heusden C, Livraghi-Butrico A, Gentzsch M, Button B, Stutts MJ, Randell SH, O’Neal WK, Boucher RC. Chronic airway epithelial hypoxia exacerbates injury in muco-obstructive lung disease through mucus hyperconcentration. Sci Transl Med 2023; 15:eabo7728. [PMID: 37285404 PMCID: PMC10664029 DOI: 10.1126/scitranslmed.abo7728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 05/17/2023] [Indexed: 06/09/2023]
Abstract
Unlike solid organs, human airway epithelia derive their oxygen from inspired air rather than the vasculature. Many pulmonary diseases are associated with intraluminal airway obstruction caused by aspirated foreign bodies, virus infection, tumors, or mucus plugs intrinsic to airway disease, including cystic fibrosis (CF). Consistent with requirements for luminal O2, airway epithelia surrounding mucus plugs in chronic obstructive pulmonary disease (COPD) lungs are hypoxic. Despite these observations, the effects of chronic hypoxia (CH) on airway epithelial host defense functions relevant to pulmonary disease have not been investigated. Molecular characterization of resected human lungs from individuals with a spectrum of muco-obstructive lung diseases (MOLDs) or COVID-19 identified molecular features of chronic hypoxia, including increased EGLN3 expression, in epithelia lining mucus-obstructed airways. In vitro experiments using cultured chronically hypoxic airway epithelia revealed conversion to a glycolytic metabolic state with maintenance of cellular architecture. Chronically hypoxic airway epithelia unexpectedly exhibited increased MUC5B mucin production and increased transepithelial Na+ and fluid absorption mediated by HIF1α/HIF2α-dependent up-regulation of β and γENaC (epithelial Na+ channel) subunit expression. The combination of increased Na+ absorption and MUC5B production generated hyperconcentrated mucus predicted to perpetuate obstruction. Single-cell and bulk RNA sequencing analyses of chronically hypoxic cultured airway epithelia revealed transcriptional changes involved in airway wall remodeling, destruction, and angiogenesis. These results were confirmed by RNA-in situ hybridization studies of lungs from individuals with MOLD. Our data suggest that chronic airway epithelial hypoxia may be central to the pathogenesis of persistent mucus accumulation in MOLDs and associated airway wall damage.
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Affiliation(s)
- Yu Mikami
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Barbara R. Grubb
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Troy D. Rogers
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Hong Dang
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Takanori Asakura
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Pradeep Kota
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Rodney C. Gilmore
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Kenichi Okuda
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Lisa C. Morton
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Ling Sun
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Gang Chen
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Jason A. Wykoff
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Camille Ehre
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Juan Vilar
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Catharina van Heusden
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | | | - Martina Gentzsch
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Brian Button
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - M. Jackson Stutts
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Scott H. Randell
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Wanda K. O’Neal
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Richard C. Boucher
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
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4
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Diaz Milian R. Endotracheal Tube Exchange. N Engl J Med 2023; 388:e71. [PMID: 37224218 DOI: 10.1056/nejmc2304779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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5
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Kato T, Asakura T, Edwards CE, Dang H, Mikami Y, Okuda K, Chen G, Sun L, Gilmore RC, Hawkins P, De la Cruz G, Cooley MR, Bailey AB, Hewitt SM, Chertow DS, Borczuk AC, Salvatore S, Martinez FJ, Thorne LB, Askin FB, Ehre C, Randell SH, O’Neal WK, Baric RS, Boucher RC. Prevalence and Mechanisms of Mucus Accumulation in COVID-19 Lung Disease. Am J Respir Crit Care Med 2022; 206:1336-1352. [PMID: 35816430 PMCID: PMC9746856 DOI: 10.1164/rccm.202111-2606oc] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 07/06/2022] [Indexed: 01/27/2023] Open
Abstract
Rationale: The incidence and sites of mucus accumulation and molecular regulation of mucin gene expression in coronavirus (COVID-19) lung disease have not been reported. Objectives: To characterize the incidence of mucus accumulation and the mechanisms mediating mucin hypersecretion in COVID-19 lung disease. Methods: Airway mucus and mucins were evaluated in COVID-19 autopsy lungs by Alcian blue and periodic acid-Schiff staining, immunohistochemical staining, RNA in situ hybridization, and spatial transcriptional profiling. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected human bronchial epithelial (HBE) cultures were used to investigate mechanisms of SARS-CoV-2-induced mucin expression and synthesis and test candidate countermeasures. Measurements and Main Results: MUC5B and variably MUC5AC RNA concentrations were increased throughout all airway regions of COVID-19 autopsy lungs, notably in the subacute/chronic disease phase after SARS-CoV-2 clearance. In the distal lung, MUC5B-dominated mucus plugging was observed in 90% of subjects with COVID-19 in both morphologically identified bronchioles and microcysts, and MUC5B accumulated in damaged alveolar spaces. SARS-CoV-2-infected HBE cultures exhibited peak titers 3 days after inoculation, whereas induction of MUC5B/MUC5AC peaked 7-14 days after inoculation. SARS-CoV-2 infection of HBE cultures induced expression of epidermal growth factor receptor (EGFR) ligands and inflammatory cytokines (e.g., IL-1α/β) associated with mucin gene regulation. Inhibiting EGFR/IL-1R pathways or administration of dexamethasone reduced SARS-CoV-2-induced mucin expression. Conclusions: SARS-CoV-2 infection is associated with a high prevalence of distal airspace mucus accumulation and increased MUC5B expression in COVID-19 autopsy lungs. HBE culture studies identified roles for EGFR and IL-1R signaling in mucin gene regulation after SARS-CoV-2 infection. These data suggest that time-sensitive mucolytic agents, specific pathway inhibitors, or corticosteroid administration may be therapeutic for COVID-19 lung disease.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Stephen M. Hewitt
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Daniel S. Chertow
- Critical Care Medicine Department, National Institutes of Health Clinical Center, Bethesda, Maryland; and
| | | | | | | | - Leigh B. Thorne
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Frederic B. Askin
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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6
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Arsanious MN, Ambrasas E, Phull M, Wickrama T. Congestion in the tube: air trapping in a ventilated patient with COVID-19 secondary to mucinous valves. BMJ Case Rep 2022; 15:15/4/e245625. [PMID: 35418374 PMCID: PMC9013956 DOI: 10.1136/bcr-2021-245625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A woman in her 50s was admitted to the intensive therapy unit with acute hypoxaemic respiratory failure secondary to COVID-19 pneumonitis. The patient was intubated on admission and worsening gas exchange necessitated multiple rounds of proning . She later improved, and her ventilation was switched to spontaneous mode. However, the patient started to develop air trapping with subsequent respiratory and cardiovascular compromise. Routine investigations showed no clear cause for her sudden deterioration and a suction catheter passed easily through the endotracheal tube. Bronchoscopy revealed mucinous/phlegmatic membranes had developed across the inner diameter of the endotracheal tube. This had created a one-way valve that allowed positive pressure ventilation through the tube into her lungs but only allowed a fraction of air to passively escape in expiration. This case report highlights a less commonly regarded complication associated with long-term intubation and lack of circuit humidification in the context of productive lung pathology.
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Affiliation(s)
- Mina Nasr Arsanious
- Anaesthetics and Critical Care, The Royal London Hospital, London, UK .,Intensive Care, Barking Havering and Redbridge Hospitals NHS Trust, Romford, UK
| | - Eduardas Ambrasas
- Intensive Care, Barking Havering and Redbridge Hospitals NHS Trust, Romford, UK
| | - Mandeep Phull
- Intensive Care, Barking Havering and Redbridge Hospitals NHS Trust, Romford, UK
| | - Thusith Wickrama
- Intensive Care, Barking Havering and Redbridge Hospitals NHS Trust, Romford, UK
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7
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Coelho Dos Reis JGA, Ferreira GM, Lourenço AA, Ribeiro ÁL, da Mata CPDSM, de Melo Oliveira P, Marques DPDA, Ferreira LL, Clarindo FA, da Silva MF, Filho HPP, Oliveira NRR, Sodré MMD, Gadelha SR, Albuquerque GR, Maciel BM, Mariano APM, Silva MDM, Fontana R, Marin LJ, Carlos RSA, Lopes ATS, Ferreira FB, Dos Santos UR, Santana ÍTSD, Fehlberg HF, Rezende RP, Dias JCT, Gross E, Goulart GAC, Santiago MG, de Lemos APML, da Conceição AO, Romano CC, de Carvalho LD, Martins Filho OA, Quadros CA, Morris DL, Valle SJ. Ex-vivo mucolytic and anti-inflammatory activity of BromAc in tracheal aspirates from COVID-19. Biomed Pharmacother 2022; 148:112753. [PMID: 35272139 PMCID: PMC8872962 DOI: 10.1016/j.biopha.2022.112753] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 02/21/2022] [Accepted: 02/23/2022] [Indexed: 11/05/2022] Open
Abstract
COVID-19 is a lethal disease caused by the pandemic SARS-CoV-2, which continues to be a public health threat. COVID-19 is principally a respiratory disease and is often associated with sputum retention and cytokine storm, for which there are limited therapeutic options. In this regard, we evaluated the use of BromAc®, a combination of Bromelain and Acetylcysteine (NAC). Both drugs present mucolytic effect and have been studied to treat COVID-19. Therefore, we sought to examine the mucolytic and anti-inflammatory effect of BromAc® in tracheal aspirate samples from critically ill COVID-19 patients requiring mechanical ventilation. Method Tracheal aspirate samples from COVID-19 patients were collected following next of kin consent and mucolysis, rheometry and cytokine analysis using Luminex kit was performed. Results BromAc® displayed a robust mucolytic effect in a dose dependent manner on COVID-19 sputum ex vivo. BromAc® showed anti-inflammatory activity, reducing the action of cytokine storm, chemokines including MIP-1alpha, CXCL8, MIP-1b, MCP-1 and IP-10, and regulatory cytokines IL-5, IL-10, IL-13 IL-1Ra and total reduction for IL-9 compared to NAC alone and control. BromAc® acted on IL-6, demonstrating a reduction in G-CSF and VEGF-D at concentrations of 125 and 250 µg. Conclusion These results indicate robust mucolytic and anti-inflammatory effect of BromAc® ex vivo in tracheal aspirates from critically ill COVID-19 patients, indicating its potential to be further assessed as pharmacological treatment for COVID-19.
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Affiliation(s)
- Jordana Grazziela A Coelho Dos Reis
- Basic and Applied Virology Laboratory, Department of Microbiology, Institute for Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil.
| | - Geovane Marques Ferreira
- Basic and Applied Virology Laboratory, Department of Microbiology, Institute for Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Alice Aparecida Lourenço
- Basic and Applied Virology Laboratory, Department of Microbiology, Institute for Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Ágata Lopes Ribeiro
- Basic and Applied Virology Laboratory, Department of Microbiology, Institute for Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | | | - Patrícia de Melo Oliveira
- Basic and Applied Virology Laboratory, Department of Microbiology, Institute for Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Daisymara Priscila de Almeida Marques
- Basic and Applied Virology Laboratory, Department of Microbiology, Institute for Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Linziane Lopes Ferreira
- Basic and Applied Virology Laboratory, Department of Microbiology, Institute for Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Felipe Alves Clarindo
- Basic and Applied Virology Laboratory, Department of Microbiology, Institute for Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Murillo Ferreira da Silva
- Department of Biological Sciences, Santa Cruz State University, Ilhéus, BA, Brazil; Laboratory of Pharmacogenomics and Molecular Epidemiology (LAFEM), Santa Cruz State University (UESC), Ilhéus, BA, Brazil
| | | | | | - Maisah Meyhr D'Carmo Sodré
- Laboratory of Pharmacogenomics and Molecular Epidemiology (LAFEM), Santa Cruz State University (UESC), Ilhéus, BA, Brazil
| | - Sandra Rocha Gadelha
- Department of Biological Sciences, Santa Cruz State University, Ilhéus, BA, Brazil; Laboratory of Pharmacogenomics and Molecular Epidemiology (LAFEM), Santa Cruz State University (UESC), Ilhéus, BA, Brazil
| | - George Rego Albuquerque
- Laboratory of Pharmacogenomics and Molecular Epidemiology (LAFEM), Santa Cruz State University (UESC), Ilhéus, BA, Brazil; Department of Agricultural and Environmental Sciences (DCAA), Santa Cruz State University (UESC), Ilhéus, BA, Brazil
| | - Bianca Mendes Maciel
- Department of Biological Sciences, Santa Cruz State University, Ilhéus, BA, Brazil; Laboratory of Pharmacogenomics and Molecular Epidemiology (LAFEM), Santa Cruz State University (UESC), Ilhéus, BA, Brazil
| | - Ana Paula Melo Mariano
- Department of Biological Sciences, Santa Cruz State University, Ilhéus, BA, Brazil; Laboratory of Pharmacogenomics and Molecular Epidemiology (LAFEM), Santa Cruz State University (UESC), Ilhéus, BA, Brazil
| | - Mylene de Melo Silva
- Laboratory of Pharmacogenomics and Molecular Epidemiology (LAFEM), Santa Cruz State University (UESC), Ilhéus, BA, Brazil
| | - Renato Fontana
- Department of Biological Sciences, Santa Cruz State University, Ilhéus, BA, Brazil; Laboratory of Pharmacogenomics and Molecular Epidemiology (LAFEM), Santa Cruz State University (UESC), Ilhéus, BA, Brazil
| | - Lauro Juliano Marin
- Laboratory of Pharmacogenomics and Molecular Epidemiology (LAFEM), Santa Cruz State University (UESC), Ilhéus, BA, Brazil; Department of Health Sciences (DCS), Santa Cruz State University (UESC), Ilhéus, BA, Brazil
| | | | - Amanda Teixeira Sampaio Lopes
- Laboratory of Pharmacogenomics and Molecular Epidemiology (LAFEM), Santa Cruz State University (UESC), Ilhéus, BA, Brazil
| | - Fabrício Barbosa Ferreira
- Laboratory of Pharmacogenomics and Molecular Epidemiology (LAFEM), Santa Cruz State University (UESC), Ilhéus, BA, Brazil
| | | | | | - Hllytchaikra Ferraz Fehlberg
- Laboratory of Pharmacogenomics and Molecular Epidemiology (LAFEM), Santa Cruz State University (UESC), Ilhéus, BA, Brazil
| | | | - João Carlos T Dias
- Department of Biological Sciences, Santa Cruz State University, Ilhéus, BA, Brazil
| | - Eduardo Gross
- Department of Biological Sciences, Santa Cruz State University, Ilhéus, BA, Brazil
| | - Gisele Assis Castro Goulart
- Department of Pharmaceuticals, Faculty of Pharmacy, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Marie Gabriele Santiago
- Department of Pharmaceuticals, Faculty of Pharmacy, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | | | - Aline O da Conceição
- Department of Biological Sciences, Santa Cruz State University, Ilhéus, BA, Brazil
| | | | | | - Olindo Assis Martins Filho
- Grupo Integrado de Pesquisas em Biomarcadores, Instituto René Rachou, Fiocruz Minas, Belo Horizonte, MG, Brazil
| | | | - David L Morris
- Mucpharm Pty Ltd, Sydney, NSW, Australia; University of New South Wales, St George & Sutherland Hospital Clinical School, Sydney, NSW, Australia; Department of Surgery, St George Hospital, Sydney, NSW, Australia.
| | - Sarah J Valle
- Mucpharm Pty Ltd, Sydney, NSW, Australia; University of New South Wales, St George & Sutherland Hospital Clinical School, Sydney, NSW, Australia.
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8
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Lellouche F, Lavoie-Bérard CA, Rousseau E, Bouchard PA, Lefebvre JC, Branson R, Brochard L. How to avoid an epidemic of endotracheal tube occlusion. THE LANCET RESPIRATORY MEDICINE 2021; 9:1215-1216. [PMID: 34739886 PMCID: PMC8563017 DOI: 10.1016/s2213-2600(21)00404-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/26/2021] [Accepted: 09/01/2021] [Indexed: 11/19/2022]
Affiliation(s)
- François Lellouche
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Quebec City, QC G1V 4G5, Canada; Département d'anesthésiologie et de soins intensifs, Division de soins intensifs, Université Laval, Quebec City, QC G1V 4G5, Canada.
| | - Carole-Anne Lavoie-Bérard
- Département d'anesthésiologie et de soins intensifs, Division de soins intensifs, Université Laval, Quebec City, QC G1V 4G5, Canada
| | - Emilie Rousseau
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Quebec City, QC G1V 4G5, Canada
| | - Pierre-Alexandre Bouchard
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Quebec City, QC G1V 4G5, Canada
| | - Jean-Claude Lefebvre
- Département d'anesthésiologie et de soins intensifs, Division de soins intensifs, Université Laval, Quebec City, QC G1V 4G5, Canada
| | - Richard Branson
- Department of Surgery, Division of Trauma and Critical Care, University of Cincinnati, Cincinnati, OH, USA
| | - Laurent Brochard
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada; Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada
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9
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Ntiamoah P, Mukhopadhyay S, Ghosh S, Mehta AC. Recycling plastic: diagnosis and management of plastic bronchitis among adults. Eur Respir Rev 2021; 30:30/161/210096. [PMID: 34407979 DOI: 10.1183/16000617.0096-2021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 05/26/2021] [Indexed: 11/05/2022] Open
Abstract
Plastic bronchitis is a rare, underdiagnosed and potentially fatal condition. It is characterised by the formation and expectoration of branching gelatinous plugs that assume the shape of the airways. These airway plugs differ from the allergic mucin that characterises allergic bronchopulmonary aspergillosis and mucoid impaction of the bronchi. Plastic bronchitis is most often encountered in the paediatric population following corrective cardiac surgery, such as the Fontan procedure. It also occurs in adults. Plastic bronchitis in adults is rare, heterogeneous in its aetiology, and can lead to respiratory distress or even life-threatening airway obstruction. Plastic bronchitis in adulthood should not be overlooked, particularly in patients with chronic inflammatory lung diseases. This review presents current understanding of the presentation, aetiology, pathogenesis, pathology and management of plastic bronchitis in adults.
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Affiliation(s)
- Prince Ntiamoah
- Dept of Pulmonary and Critical Care Medicine, Cleveland Clinic, Cleveland, OH, USA
| | | | - Subha Ghosh
- Diagnostic Radiology, Cleveland Clinic, Cleveland, OH, USA
| | - Atul C Mehta
- Dept of Pulmonary and Critical Care Medicine, Cleveland Clinic, Cleveland, OH, USA
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