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Jörres RA, Buess C, Piecyk A, Thompson B, Stanojevic S, Magnussen H. The total-breath method yields higher values of DLCO and TLC than the conventional method. BMC Pulm Med 2024; 24:127. [PMID: 38475751 PMCID: PMC10936061 DOI: 10.1186/s12890-024-02932-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 02/26/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND The 2017 ATS/ERS technical standard for measuring the single-breath diffusing capacity (DLCO) proposed the "rapid-gas-analyzer" (RGA) or, equivalently, "total-breath" (TB) method for the determination of total lung capacity (TLC). In this study, we compared DLCO and TLC values estimated using the TB and conventional method, and how estimated TLC using these two methods compared to that determined by body plethysmography. METHOD A total of 95 people with COPD (GOLD grades 1-4) and 23 healthy subjects were studied using the EasyOne Pro (ndd Medical Technologies, Switzerland) and Master Screen Body (Vyaire Medical, Höchberg, Germany). RESULTS On average the TB method resulted in higher values of DLCO (mean ± SD Δ = 0.469 ± 0.267; 95%CI: 0.420; 0.517 mmol*min-1*kPa-1) and TLC (Δ = 0.495 ± 0.371; 95%CI: 0.427; 0.562 L) compared with the conventional method. In healthy subjects the ratio between TB and conventional DLCO was close to one. TLC estimated using both methods was lower than that determined by plethysmography. The difference was smaller for the TB method (Δ = 1.064 ± 0.740; 95%CI: 0.929; 1.199 L) compared with the conventional method (Δ = 1.558 ± 0.940; 95%CI: 1.387; 1.739 L). TLC from body plethysmography could be estimated as a function of TB TLC and FEV1 Z-Score with an accuracy (normalized root mean square difference) of 9.1%. CONCLUSION The total-breath method yielded higher values of DLCO and TLC than the conventional analysis, especially in subjects with COPD. TLC from the total-breath method can also be used to estimate plethysmographic TLC with better accuracy than the conventional method. The study is registered under clinicaltrial.gov NCT04531293.
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Affiliation(s)
- Rudolf A Jörres
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), Ziemssenstraße 5, Munich, 80336, Germany.
| | | | | | - Bruce Thompson
- Melbourne School of Health Science, The University of Melbourne, Victoria, Australia
| | - Sanja Stanojevic
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Nova Scotia, Canada
| | - Helgo Magnussen
- Pulmonary Research Institute at LungenClinic Grosshansdorf, Grosshansdorf, Germany
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2
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Yildirim S, Saygili SM, Süneçli O, Kirakli C. Comparison of the effects of open and closed aspiration on end-expiratory lung volume in acute respiratory distress syndrome. Korean J Anesthesiol 2024; 77:115-121. [PMID: 37211764 PMCID: PMC10834727 DOI: 10.4097/kja.23194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/21/2023] [Indexed: 05/23/2023] Open
Abstract
BACKGROUND Alveoli tend to collapse in patients with acute respiratory distress syndrome (ARDS). Endotracheal aspiration may increase alveolar collapse due to the loss of end-expiratory lung volume (EELV). We aimed to compare the loss of EELV after open and closed suction in patients with ARDS. METHODS This randomized crossover study included 20 patients receiving invasive mechanical ventilation for ARDS. Open and closed suction were applied in a random order. Lung impedance was measured using electric impedance tomography. The change in end-expiratory lung impedance end of suction and at 1, 10, 20, and 30 min after suction, was used to represent the change in EELV. Arterial blood gas analyses and ventilatory parameters such as the plateau pressure (Pplat), driving pressure (Pdrive), and compliance of the respiratory system (CRS) were also recorded. RESULTS Less volume loss was noted after closed suction than after open suction (mean ΔEELI: -2661 ± 1937 vs. -4415 ± 2363; mean difference: -1753; 95% CI [-2662, -844]; P = 0.001). EELI returned to baseline 10 min after closed suction but did not return to baseline even 30 min after open suction. After closed suction, the Pplat and Pdrive decreased while the CRS increased. Conversely, the Pplat and Pdrive increased while the CRS decreased after open suction. CONCLUSIONS Endotracheal aspiration may result in alveolar collapse due to loss of EELV. Given that closed suction is associated with less volume loss at end-expiration without worsening ventilatory parameters, it should be chosen over open suction in patients with ARDS.
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Affiliation(s)
- Süleyman Yildirim
- Intensive Care Unit, University of Health Sciences Turkey, İzmir School of Medicine, Dr. Suat Seren Chest Disease and Surgery Training and Research Hospital, İzmir, Turkey
| | - Saba Mukaddes Saygili
- Intensive Care Unit, University of Health Sciences Turkey, İzmir School of Medicine, Dr. Suat Seren Chest Disease and Surgery Training and Research Hospital, İzmir, Turkey
| | - Onur Süneçli
- Department of Physiotherapy, University of Health Sciences Turkey, İzmir School of Medicine, Dr. Suat Seren Chest Disease and Surgery Training and Research Hospital, İzmir, Turkey
| | - Cenk Kirakli
- Intensive Care Unit, University of Health Sciences Turkey, İzmir School of Medicine, Dr. Suat Seren Chest Disease and Surgery Training and Research Hospital, İzmir, Turkey
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Keleher E, Iftikhar H, Schulz LF, McCanny P, Austin D, Stewart A, O'Regan W, Hallbäck M, Wallin M, Aneman A. Capnodynamic monitoring of lung volume and pulmonary blood flow during alveolar recruitment: a prospective observational study in postoperative cardiac patients. J Clin Monit Comput 2023; 37:1463-1472. [PMID: 37243954 DOI: 10.1007/s10877-023-01033-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 05/08/2023] [Indexed: 05/29/2023]
Abstract
Alveolar recruitment manoeuvres may mitigate ventilation and perfusion mismatch after cardiac surgery. Monitoring the efficacy of recruitment manoeuvres should provide concurrent information on pulmonary and cardiac changes. This study in postoperative cardiac patients applied capnodynamic monitoring of changes in end-expiratory lung volume and effective pulmonary blood flow. Alveolar recruitment was performed by incremental increases in positive end-expiratory pressure (PEEP) to a maximum of 15 cmH2O from a baseline of 5 cmH2O over 30 min. The change in systemic oxygen delivery index after the recruitment manoeuvre was used to identify responders (> 10% increase) with all other changes (≤ 10%) denoting non-responders. Mixed factor ANOVA using Bonferroni correction for multiple comparisons was used to denote significant changes (p < 0.05) reported as mean differences and 95% CI. Changes in end-expiratory lung volume and effective pulmonary blood flow were correlated using Pearson's regression. Twenty-seven (42%) of 64 patients were responders increasing oxygen delivery index by 172 (95% CI 61-2984) mL min-1 m-2 (p < 0.001). End-expiratory lung volume increased by 549 (95% CI 220-1116) mL (p = 0.042) in responders associated with an increase in effective pulmonary blood flow of 1140 (95% CI 435-2146) mL min-1 (p = 0.012) compared to non-responders. A positive correlation (r = 0.79, 95% CI 0.5-0.90, p < 0.001) between increased end-expiratory lung volume and effective pulmonary blood flow was only observed in responders. Changes in oxygen delivery index after lung recruitment were correlated to changes in end-expiratory lung volume (r = 0.39, 95% CI 0.16-0.59, p = 0.002) and effective pulmonary blood flow (r = 0.60, 95% CI 0.41-0.74, p < 0.001). Capnodynamic monitoring of end-expiratory lung volume and effective pulmonary blood flow early in postoperative cardiac patients identified a characteristic parallel increase in both lung volume and perfusion after the recruitment manoeuvre in patients with a significant increase in oxygen delivery.Trial registration This study was registered on ClinicalTrials.gov (NCT05082168, 18th of October 2021).
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Affiliation(s)
- E Keleher
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - H Iftikhar
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - L F Schulz
- Intensive Care Unit, Liverpool Hospital, South Western Sydney Local Health District, Sydney, NSW, Australia
| | - P McCanny
- Intensive Care Unit, Liverpool Hospital, South Western Sydney Local Health District, Sydney, NSW, Australia
| | - D Austin
- Intensive Care Unit, Liverpool Hospital, South Western Sydney Local Health District, Sydney, NSW, Australia
| | - A Stewart
- Intensive Care Unit, Liverpool Hospital, South Western Sydney Local Health District, Sydney, NSW, Australia
| | - W O'Regan
- Intensive Care Unit, Liverpool Hospital, South Western Sydney Local Health District, Sydney, NSW, Australia
| | | | - M Wallin
- Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden
| | - A Aneman
- Intensive Care Unit, Liverpool Hospital, South Western Sydney Local Health District, Sydney, NSW, Australia.
- Southwestern Clinical School, University of New South Wales, Sydney, NSW, Australia.
- Ingham Institute for Applied Medical Research, Sydney, NSW, Australia.
- Intensive Care Unit, Liverpool Hospital, Locked Bag 7103, Liverpool BC, NSW, 1871, Australia.
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Tsuchiya N, Xu YY, Ito J, Yamashiro T, Ikemiyagi H, Mummy D, Schiebler ML, Yonemoto K, Murayama S, Nishie A. Chronic thromboembolic pulmonary hypertension is associated with a loss of total lung volume on computed tomography. World J Radiol 2023; 15:146-156. [PMID: 37275304 PMCID: PMC10236971 DOI: 10.4329/wjr.v15.i5.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 04/04/2023] [Accepted: 04/24/2023] [Indexed: 05/23/2023] Open
Abstract
BACKGROUND Although lung volumes are usually normal in individuals with chronic thromboembolic pulmonary hypertension (CTEPH), approximately 20%-29% of patients exhibit a restrictive pattern on pulmonary function testing.
AIM To quantify longitudinal changes in lung volume and cardiac cross-sectional area (CSA) in patients with CTEPH.
METHODS In a retrospective cohort study of patients seen in our hospital between January 2012 and December 2019, we evaluated 15 patients with CTEPH who had chest computed tomography (CT) performed at baseline and after at least 6 mo of therapy. We matched the CTEPH cohort with 45 control patients by age, sex, and observation period. CT-based lung volumes and maximum cardiac CSAs were measured and compared using the Wilcoxon signed-rank test and the Mann-Whitney u test.
RESULTS Total, right lung, and right lower lobe volumes were significantly reduced in the CTEPH cohort at follow-up vs baseline (total, P = 0.004; right lung, P = 0.003; right lower lobe; P = 0.01). In the CTEPH group, the reduction in lung volume and cardiac CSA was significantly greater than the corresponding changes in the control group (total, P = 0.01; right lung, P = 0.007; right lower lobe, P = 0.01; CSA, P = 0.0002). There was a negative correlation between lung volume change and cardiac CSA change in the control group but not in the CTEPH cohort.
CONCLUSION After at least 6 mo of treatment, CT showed an unexpected loss of total lung volume in patients with CTEPH that may reflect continued parenchymal remodeling.
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Affiliation(s)
- Nanae Tsuchiya
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Nishihara 903-0125, Okinawa, Japan
| | - Yan-Yan Xu
- Department of Radiology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Junji Ito
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Nishihara 903-0125, Okinawa, Japan
| | - Tsuneo Yamashiro
- Department of Radiology, Yokohama City University, Yokohama 2360027, Japan
| | - Hidekazu Ikemiyagi
- Department of Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus, Nishihara 9030125, Okinawa, Japan
| | - David Mummy
- Center for In Vivo Microscopy and Department of Radiology, Duke University, Durham, NC 27710, United States
| | - Mark L Schiebler
- Department of Radiology, University of Wisconsin-Madison, Madison, WI 53792, United States
| | - Koji Yonemoto
- Department of Biostatistics, School of Health Sciences, Faculty of Medicine, University of the Ryukyus, Nishihara 903-0215, Okinawa, Japan
| | - Sadayuki Murayama
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Nishihara 903-0125, Okinawa, Japan
| | - Akihiro Nishie
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Nishihara 903-0125, Okinawa, Japan
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Yamada Y, Chubachi S, Yamada M, Yokoyama Y, Tanabe A, Matsuoka S, Niijima Y, Murata M, Fukunaga K, Jinzaki M. Comparison of Lung, Lobe, and Airway Volumes between Supine and Upright Computed Tomography and Their Correlation with Pulmonary Function Test in Patients with Chronic Obstructive Pulmonary Disease. Respiration 2022; 101:1110-1120. [PMID: 36353776 PMCID: PMC9811423 DOI: 10.1159/000527067] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 09/10/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Correlations between upright CT and pulmonary function test (PFT) measurements, and differences in lung/lobe/airway volumes between supine and standing positions in patients with chronic obstructive pulmonary disease (COPD) remain unknown. OBJECTIVES The study aimed to evaluate correlations between lung/airway volumes on both supine and upright CT and PFT measurements in patients with COPD, and compare CT-based inspiratory/expiratory lung/lobe/airway volumes between the two positions. METHODS Forty-eight patients with COPD underwent both conventional supine and upright CT in a randomized order during inspiration and expiration breath-holds, and PFTs within 2 h. We measured the lung/lobe/airway volumes on both CT. RESULTS The correlation coefficients between total lung volumes on inspiratory CT in supine/standing position and PFT total lung capacity and vital capacity were 0.887/0.920 and 0.711/0.781, respectively; between total lung volumes on expiratory CT in supine/standing position and PFT functional residual capacity and residual volume, 0.676/0.744 and 0.713/0.739, respectively; and between airway volume on inspiratory CT in supine/standing position and PFT forced expiratory volume in 1 s, 0.471/0.524, respectively. Inspiratory/expiratory bilateral upper and right lower lobe, bilateral lung, and airway volumes were significantly higher in the standing than supine position (3.6-21.2% increases, all p < 0.05); however, inspiratory/expiratory right middle lobe volumes were significantly lower in the standing position (4.6%/15.9% decreases, respectively, both p < 0.001). CONCLUSIONS Upright CT-based volumes were more correlated with PFT measurements than supine CT-based volumes in patients with COPD. Unlike other lobes and airway, inspiratory/expiratory right middle lobe volumes were significantly lower in the standing than supine position.
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Affiliation(s)
- Yoshitake Yamada
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan,*Yoshitake Yamada,
| | - Shotaro Chubachi
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan,**Shotaro Chubachi,
| | - Minoru Yamada
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Yoichi Yokoyama
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Akiko Tanabe
- Department of Clinical Laboratory, Keio University Hospital, Tokyo, Japan
| | - Shiho Matsuoka
- Department of Clinical Laboratory, Keio University Hospital, Tokyo, Japan
| | - Yuki Niijima
- Office of Radiation Technology, Keio University Hospital, Tokyo, Japan
| | - Mitsuru Murata
- Department of Laboratory Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Koichi Fukunaga
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Masahiro Jinzaki
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan,***Masahiro Jinzaki,
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Negroni D, Zagaria D, Paladini A, Falaschi Z, Arcoraci A, Barini M, Carriero A. COVID-19 CT Scan Lung Segmentation: How We Do It. J Digit Imaging 2022; 35:424-431. [PMID: 35091874 PMCID: PMC8796745 DOI: 10.1007/s10278-022-00593-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 01/18/2022] [Accepted: 01/19/2022] [Indexed: 12/15/2022] Open
Abstract
The National Health Systems have been severely stressed out by the COVID-19 pandemic because 14% of patients require hospitalization and oxygen support, and 5% require admission to an Intensive Care Unit (ICU). Relationship between COVID-19 prognosis and the extent of alterations on chest CT obtained by both visual and software-based quantification that expresses objective evaluations of the percentage of ventilated lung parenchyma compared to the affected one has been proven. While commercial applications for automatic medical image computing and visualization are expensive and limited in their spread, the open-source systems are characterized by not enough standardization and time-consuming troubles. We analyzed chest CT exams on 246 patients suspected of COVID-19 performed in the Emergency Department CT room. The lung parenchyma segmentation was obtained by a threshold-based method using the open-source 3D Slicer software and software tools called "Segment Editor" and "Segment Quantification." For the three main characteristics analyzed on lungs affected by COVID-19 pneumonia, a specifical densitometry value range was defined: from - 950 to - 700 HU for well-aerated parenchyma; from - 700 to - 250 HU for interstitial lung disease; from - 250 to 250 HU for parenchymal consolidation. For the well-aerated parenchyma and the interstitial alterations, the procedure was semi-automatic with low time consumption, whereas consolidations' analysis needed manual interventions by the operator. After the chest CT, 13% of the sample was admitted to intensive care, while 34% of them to the sub-intensive care. In patients moved to intensive care, the parenchyma analysis reported a higher crazy paving presentation. The quantitative analysis of the alterations affecting the lung parenchyma of patients with COVID-19 pneumonia can be performed by threshold method segmentation on 3D Slicer. The segmentation could have an important role in the quantification in different COVID-19 pneumonia presentations, allowing to help the clinician in the correct management of patients.
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Affiliation(s)
- Davide Negroni
- Department of Radiology, “Maggiore Della Carità” Hospital, AOU Maggiore Della Carità, Corso Mazzini 18, Novara, Italy
| | - Domenico Zagaria
- Department of Radiology, “Maggiore Della Carità” Hospital, AOU Maggiore Della Carità, Corso Mazzini 18, Novara, Italy
| | - Andrea Paladini
- Department of Radiology, “Maggiore Della Carità” Hospital, AOU Maggiore Della Carità, Corso Mazzini 18, Novara, Italy
| | - Zeno Falaschi
- Department of Radiology, “Maggiore Della Carità” Hospital, AOU Maggiore Della Carità, Corso Mazzini 18, Novara, Italy
| | - Anna Arcoraci
- Department of Radiology, “Maggiore Della Carità” Hospital, AOU Maggiore Della Carità, Corso Mazzini 18, Novara, Italy
| | - Michela Barini
- Department of Radiology, “Maggiore Della Carità” Hospital, AOU Maggiore Della Carità, Corso Mazzini 18, Novara, Italy
| | - Alessandro Carriero
- Department of Radiology, “Maggiore Della Carità” Hospital, AOU Maggiore Della Carità, Corso Mazzini 18, Novara, Italy
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Inoue A, Takahashi H, Ibe T, Ishii H, Kurata Y, Ishizuka Y, Hamamoto Y. Comparison of semiquantitative chest CT scoring systems to estimate severity in coronavirus disease 2019 (COVID-19) pneumonia. Eur Radiol 2022; 32:3513-3524. [PMID: 35020014 PMCID: PMC8753957 DOI: 10.1007/s00330-021-08435-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 10/07/2021] [Accepted: 10/23/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To compare the clinical usefulness among three different semiquantitative computed tomography (CT) severity scoring systems for coronavirus disease 2019 (COVID-19) pneumonia. METHODS Two radiologists independently reviewed chest CT images in 108 patients to rate three CT scoring systems (total CT score [TSS], chest CT score [CCTS], and CT severity score [CTSS]). We made a minor modification to CTSS. Quantitative dense area ratio (QDAR: the ratio of lung involvement to lung parenchyma) was calculated using the U-net model. Clinical severity at admission was classified as severe (n = 14) or mild (n = 94). Interobserver agreement, interpretation time, and degree of correlation with clinical severity as well as QDAR were evaluated. RESULTS Interobserver agreement was excellent (intraclass correlation coefficient: 0.952-0.970, p < 0.001). Mean interpretation time was significantly longer in CTSS (48.9-80.0 s) than in TSS (25.7-41.7 s, p < 0.001) and CCTS (27.7-39.5 s, p < 0.001). Area under the curve for differentiating clinical severity at admission was 0.855-0.842 in TSS, 0.853-0.850 in CCTS, and 0.853-0.836 in CTSS. All scoring systems correlated with QDAR in the order of CCTS (ρ = 0.443-0.448), TSS (ρ = 0.435-0.437), and CTSS (ρ = 0.415-0.426). CONCLUSIONS All semiquantitative scoring systems demonstrated substantial diagnostic performance for clinical severity at admission with excellent interobserver agreement. Interpretation time was significantly shorter in TSS and CCTS than in CTSS. The correlation between the scoring system and QDAR was highest in CCTS, followed by TSS and CTSS. CCTS appeared to be the most appropriate CT scoring system for clinical practice. KEY POINTS • Three semiquantitative scoring systems demonstrate substantial accuracy (area under the curve: 0.836-0.855) for diagnosing clinical severity at admission and (area under the curve: 0.786-0.802) for risk of developing critical illness. • Total CT score (TSS) and chest CT score (CCTS) were considered to be more appropriate in terms of clinical usefulness as compared with CT severity score (CTSS), given the shorter interpretation time in TSS and CCTS, and the lowest correlation with quantitative dense area ratio in CTSS. • CCTS is assumed to distinguish subtle from mild lung involvement better than TSS by adopting a 5% threshold in scoring the degree of severity.
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Affiliation(s)
- Akitoshi Inoue
- Department of Radiology, Shiga University of Medical Science, Ōtsu, Japan.,Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Hiroaki Takahashi
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Tatsuya Ibe
- Department of Pulmonary Medicine, National Hospital Organization Nishisaitama-Chuo National Hospital, Tokorozawa, Saitama, Japan
| | - Hisashi Ishii
- Department of Pulmonary Medicine, National Hospital Organization Nishisaitama-Chuo National Hospital, Tokorozawa, Saitama, Japan
| | - Yuhei Kurata
- Department of Pulmonary Medicine, National Hospital Organization Nishisaitama-Chuo National Hospital, Tokorozawa, Saitama, Japan
| | - Yoshikazu Ishizuka
- Department of Radiology, National Hospital Organization Nishisaitama-Chuo National Hospital, Tokorozawa, Saitama, Japan
| | - Yoichiro Hamamoto
- Department of Pulmonary Medicine, National Hospital Organization Nishisaitama-Chuo National Hospital, Tokorozawa, Saitama, Japan
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Scharm SC, Schaefer-Prokop C, Willmann M, Vogel-Claussen J, Knudsen L, Jonigk D, Fuge J, Welte T, Wacker F, Prasse A, Shin HO. Increased regional ventilation as early imaging marker for future disease progression of interstitial lung disease: a feasibility study. Eur Radiol 2022; 32:6046-6057. [PMID: 35357537 PMCID: PMC9381456 DOI: 10.1007/s00330-022-08702-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 02/07/2022] [Accepted: 02/28/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Idiopathic pulmonary fibrosis (IPF) is a disease with a poor prognosis and a highly variable course. Pathologically increased ventilation-accessible by functional CT-is discussed as a potential predecessor of lung fibrosis. The purpose of this feasibility study was to investigate whether increased regional ventilation at baseline CT and morphological changes in the follow-up CT suggestive for fibrosis indeed occur in spatial correspondence. METHODS In this retrospective study, CT scans were performed at two time points between September 2016 and November 2020. Baseline ventilation was divided into four categories ranging from low, normal to moderately, and severely increased (C1-C4). Correlation between baseline ventilation and volume and density change at follow-up was investigated in corresponding voxels. The significance of the difference of density and volume change per ventilation category was assessed using paired t-tests with a significance level of p ≤ 0.05. The analysis was performed separately for normal (NAA) and high attenuation areas (HAA). RESULTS The study group consisted of 41 patients (73 ± 10 years, 36 men). In both NAA and HAA, significant increases of density and loss of volume were seen in areas of severely increased ventilation (C4) at baseline compared to areas of normal ventilation (C2, p < 0.001). In HAA, morphological changes were more heterogeneous compared to NAA. CONCLUSION Functional CT assessing the extent and distribution of lung parenchyma with pathologically increased ventilation may serve as an imaging marker to prospectively identify lung parenchyma at risk for developing fibrosis. KEY POINTS • Voxelwise correlation of serial CT scans suggests spatial correspondence between increased ventilation at baseline and structural changes at follow-up. • Regional assessment of pathologically increased ventilation at baseline has the potential to prospectively identify tissue at risk for developing fibrosis. • Presence and extent of pathologically increased ventilation may serve as an early imaging marker of disease activity.
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Affiliation(s)
- Sarah C. Scharm
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str.1, 30625 Hannover, Germany
| | - Cornelia Schaefer-Prokop
- Department of Radiology, Radboud University, Nijmegen, The Netherlands ,Department of Radiology, Meander Medical Center, Amersfoort, The Netherlands
| | - Moritz Willmann
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str.1, 30625 Hannover, Germany
| | - Jens Vogel-Claussen
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str.1, 30625 Hannover, Germany ,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research, Hannover, Germany
| | - Lars Knudsen
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research, Hannover, Germany ,Institute of Functional and Applied Anatomy, Hannover Medical School, Hannover, Germany
| | - Danny Jonigk
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research, Hannover, Germany ,Institute of Pathology, Hannover Medical School, Hannover, Germany
| | - Jan Fuge
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research, Hannover, Germany ,Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Tobias Welte
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research, Hannover, Germany ,Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Frank Wacker
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str.1, 30625 Hannover, Germany ,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research, Hannover, Germany
| | - Antje Prasse
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research, Hannover, Germany ,Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Hoen-oh Shin
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str.1, 30625 Hannover, Germany ,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research, Hannover, Germany
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Kang HJ, Lee SS. Comparison of Predicted Postoperative Lung Function in Pneumonectomy Using Computed Tomography and Lung Perfusion Scans. J Chest Surg 2021; 54:487-493. [PMID: 34815369 PMCID: PMC8646060 DOI: 10.5090/jcs.21.084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/07/2021] [Accepted: 10/08/2021] [Indexed: 11/17/2022] Open
Abstract
Background Predicting postoperative lung function after pneumonectomy is essential. We retrospectively compared postoperative lung function to predicted postoperative lung function based on computed tomography (CT) volumetry and perfusion scintigraphy in patients who underwent pneumonectomy. Methods Predicted postoperative lung function was calculated based on perfusion scintigraphy and CT volumetry. The predicted function was compared to the postoperative lung function in terms of forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1), using 4 parameters FVC, FVC%, FEV1, and FEV1%. Results The correlations between postoperative function and predicted function based on CT volumetry were r=0.632 (p=0.003) for FVC% and r=0.728 (p<0.001) for FEV1%. The correlations between postoperative function and predicted postoperative function based on perfusion scintigraphy were r=0.654 (p=0.002) for FVC% and r=0.758 (p<0.001) for FEV1%. The preoperative Eastern Cooperative Oncology Group (ECOG) scores were significantly higher in the group in which the gap between postoperative FEV1 and predicted postoperative FEV1 analyzed by CT was smaller than the gap analyzed by perfusion scintigraphy (1.2±0.62 vs. 0.4±0.52, p=0.006). Conclusion This study affirms that CT volumetry can replace perfusion scintigraphy for preoperative evaluation of patients needing pneumonectomy. In particular, it was found to be a better predictor of postoperative lung function for poor-performance patients (i.e., those with high ECOG scores).
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Affiliation(s)
- Hee Joon Kang
- Department of Thoracic and Cardiovascular Surgery, Yeungnam University College of Medicine, Daegu, Korea
| | - Seok Soo Lee
- Department of Thoracic and Cardiovascular Surgery, Yeungnam University College of Medicine, Daegu, Korea
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Ippolito D, Ragusi M, Gandola D, Maino C, Pecorelli A, Terrani S, Peroni M, Giandola T, Porta M, Talei Franzesi C, Sironi S. Computed tomography semi-automated lung volume quantification in SARS-CoV-2-related pneumonia. Eur Radiol 2021; 31:2726-2736. [PMID: 33125559 PMCID: PMC7596627 DOI: 10.1007/s00330-020-07271-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 08/20/2020] [Accepted: 09/08/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVES To evaluate a semi-automated segmentation and ventilated lung quantification on chest computed tomography (CT) to assess lung involvement in patients affected by SARS-CoV-2. Results were compared with clinical and functional parameters and outcomes. METHODS All images underwent quantitative analyses with a dedicated workstation using a semi-automatic lung segmentation software to compute ventilated lung volume (VLV), Ground-glass opacity (GGO) volume (GGO-V), and consolidation volume (CONS-V) as absolute volume and as a percentage of total lung volume (TLV). The ratio between CONS-V, GGO-V, and VLV (CONS-V/VLV and GGO-V/VLV, respectively), TLV (CONS-V/TLV, GGO-V/TLV, and GGO-V + CONS-V/TLV respectively), and the ratio between VLV and TLV (VLV/TLV) were calculated. RESULTS A total of 108 patients were enrolled. GGO-V/TLV significantly correlated with WBC (r = 0.369), neutrophils (r = 0.446), platelets (r = 0.182), CRP (r = 0.190), PaCO2 (r = 0.176), HCO3- (r = 0.284), and PaO2/FiO2 (P/F) values (r = - 0.344). CONS-V/TLV significantly correlated with WBC (r = 0.294), neutrophils (r = 0.300), lymphocytes (r = -0.225), CRP (r = 0.306), PaCO2 (r = 0.227), pH (r = 0.162), HCO3- (r = 0.394), and P/F (r = - 0.419) values. Statistically significant differences between CONS-V, GGO-V, GGO-V/TLV, CONS-V/TLV, GGO-V/VLV, CONS-V/VLV, GGO-V + CONS-V/TLV, VLV/TLV, CT score, and invasive ventilation by ET were found (all p < 0.05). CONCLUSION The use of quantitative semi-automated algorithm for lung CT elaboration effectively correlates the severity of SARS-CoV-2-related pneumonia with laboratory parameters and the need for invasive ventilation. KEY POINTS • Pathological lung volumes, expressed both as GGO-V and as CONS-V, can be considered a useful tool in SARS-CoV-2-related pneumonia. • All lung volumes, expressed themselves and as ratio with TLV and VLV, correlate with laboratory data, in particular C-reactive protein and white blood cell count. • All lung volumes correlate with patient's outcome, in particular concerning invasive ventilation.
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Affiliation(s)
- Davide Ippolito
- Department of Diagnostic Radiology, San Gerardo Hospital, University of Milano-Bicocca, Via Pergolesi 33, Monza, MB, 20900, Italy.
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, Monza, MB, 20900, Italy.
| | - Maria Ragusi
- Department of Diagnostic Radiology, San Gerardo Hospital, University of Milano-Bicocca, Via Pergolesi 33, Monza, MB, 20900, Italy
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, Monza, MB, 20900, Italy
| | - Davide Gandola
- Department of Diagnostic Radiology, San Gerardo Hospital, University of Milano-Bicocca, Via Pergolesi 33, Monza, MB, 20900, Italy
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, Monza, MB, 20900, Italy
| | - Cesare Maino
- Department of Diagnostic Radiology, San Gerardo Hospital, University of Milano-Bicocca, Via Pergolesi 33, Monza, MB, 20900, Italy
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, Monza, MB, 20900, Italy
| | - Anna Pecorelli
- Department of Diagnostic Radiology, San Gerardo Hospital, University of Milano-Bicocca, Via Pergolesi 33, Monza, MB, 20900, Italy
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, Monza, MB, 20900, Italy
| | - Simone Terrani
- Philips Healthcare, Viale Sacra 235, Milan, MI, 20126, Italy
| | - Marta Peroni
- Philips Healthcare, Viale Sacra 235, Milan, MI, 20126, Italy
| | - Teresa Giandola
- Department of Diagnostic Radiology, San Gerardo Hospital, University of Milano-Bicocca, Via Pergolesi 33, Monza, MB, 20900, Italy
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, Monza, MB, 20900, Italy
| | - Marco Porta
- Department of Diagnostic Radiology, San Gerardo Hospital, University of Milano-Bicocca, Via Pergolesi 33, Monza, MB, 20900, Italy
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, Monza, MB, 20900, Italy
| | - Cammillo Talei Franzesi
- Department of Diagnostic Radiology, San Gerardo Hospital, University of Milano-Bicocca, Via Pergolesi 33, Monza, MB, 20900, Italy
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, Monza, MB, 20900, Italy
| | - Sandro Sironi
- Department of Diagnostic Radiology, San Gerardo Hospital, University of Milano-Bicocca, Via Pergolesi 33, Monza, MB, 20900, Italy
- Department of Diagnostic Radiology, H Papa Giovanni XXIII, Piazza OMS 1, Bergamo, BG, 24127, Italy
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Silva M, Milanese G, Sestini S, Sabia F, Jacobs C, van Ginneken B, Prokop M, Schaefer-Prokop CM, Marchianò A, Sverzellati N, Pastorino U. Lung cancer screening by nodule volume in Lung-RADS v1.1: negative baseline CT yields potential for increased screening interval. Eur Radiol 2021; 31:1956-68. [PMID: 32997182 DOI: 10.1007/s00330-020-07275-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/21/2020] [Accepted: 09/09/2020] [Indexed: 12/17/2022]
Abstract
Objectives The 2019 Lung CT Screening Reporting & Data System version 1.1 (Lung-RADS v1.1) introduced volumetric categories for nodule management. The aims of this study were to report the distribution of Lung-RADS v1.1 volumetric categories and to analyse lung cancer (LC) outcomes within 3 years for exploring personalized algorithm for lung cancer screening (LCS). Methods Subjects from the Multicentric Italian Lung Detection (MILD) trial were retrospectively selected by National Lung Screening Trial (NLST) criteria. Baseline characteristics included selected pre-test metrics and nodule characterization according to the volume-based categories of Lung-RADS v1.1. Nodule volume was obtained by segmentation with dedicated semi-automatic software. Primary outcome was diagnosis of LC, tested by univariate and multivariable models. Secondary outcome was stage of LC. Increased interval algorithms were simulated for testing rate of delayed diagnosis (RDD) and reduction of low-dose computed tomography (LDCT) burden. Results In 1248 NLST-eligible subjects, LC frequency was 1.2% at 1 year, 1.8% at 2 years and 2.6% at 3 years. Nodule volume in Lung-RADS v1.1 was a strong predictor of LC: positive LDCT showed an odds ratio (OR) of 75.60 at 1 year (p < 0.0001), and indeterminate LDCT showed an OR of 9.16 at 2 years (p = 0.0068) and an OR of 6.35 at 3 years (p = 0.0042). In the first 2 years after negative LDCT, 100% of resected LC was stage I. The simulations of low-frequency screening showed a RDD of 13.6–21.9% and a potential reduction of LDCT burden of 25.5–41%. Conclusions Nodule volume by semi-automatic software allowed stratification of LC risk across Lung-RADS v1.1 categories. Personalized screening algorithm by increased interval seems feasible in 80% of NLST eligible. Key Points • Using semi-automatic segmentation of nodule volume, Lung-RADS v1.1 selected 10.8% of subjects with positive CT and 96.87 relative risk of lung cancer at 1 year, compared to negative CT. • Negative low-dose CT by Lung-RADS v1.1 was found in 80.6% of NLST eligible and yielded 40 times lower relative risk of lung cancer at 2 years, compared to positive low-dose CT; annual screening could be preference sensitive in this group. • Semi-automatic segmentation of nodule volume and increased screening interval by volumetric Lung-RADS v1.1 could retrospectively suggest a 25.5–41% reduction of LDCT burden, at the cost of 13.6–21.9% rate of delayed diagnosis. Electronic supplementary material The online version of this article (10.1007/s00330-020-07275-w) contains supplementary material, which is available to authorized users.
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O'Sullivan R, Carrier J, Cranney H, Hemming R. Effect of Lung Volume Recruitment on Pulmonary Function in Progressive Childhood-Onset Neuromuscular Disease: A Systematic Review. Arch Phys Med Rehabil 2021; 102:976-83. [PMID: 32882219 DOI: 10.1016/j.apmr.2020.07.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 07/24/2020] [Accepted: 07/29/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The focus of this systematic review was to consider whether lung volume recruitment (LVR) has an effect on pulmonary function test parameters in individuals with progressive childhood-onset neuromuscular diseases. The review was registered on PROSPERO (No. CRD42019119541). DATA SOURCES A systematic search of the CINAHL, MEDLINE, AMED, EMCARE, Scopus, and Open Grey databases was undertaken in January 2019 considering LVR in the respiratory management of childhood-onset neuromuscular diseases. STUDY SELECTION Studies were included if either manual resuscitator bags or volume-controlled ventilators were used to perform LVR with participants older than 6 years of age. Critical appraisal tools from the Joanna Briggs Institute were used to assess the quality of studies. Nine studies were identified, 6 of which were of sufficient quality to be included in the review. DATA EXTRACTION Data extraction used a tool adapted from the Cochrane effective practice and organization of care group. DATA SYNTHESIS Results were compiled using a narrative synthesis approach focused on peak cough flow, forced vital capacity, and maximum inspiratory capacity outcomes. CONCLUSIONS Limited evidence suggests an immediate positive effect of LVR on peak cough flow and a potential long-term effect on the rate of forced vital capacity decline. Considering the accepted correlation between forced vital capacity and morbidity, this review suggests that LVR be considered for individuals with childhood-onset neuromuscular diseases once forced vital capacity starts to deteriorate. This review is limited by small sample sizes and the overall paucity of evidence considering LVR in this population group. Controlled trials with larger sample sizes are urgently needed.
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Yamada Y, Yamada M, Yokoyama Y, Tanabe A, Matsuoka S, Niijima Y, Narita K, Nakahara T, Murata M, Fukunaga K, Chubachi S, Jinzaki M. Differences in Lung and Lobe Volumes between Supine and Standing Positions Scanned with Conventional and Newly Developed 320-Detector-Row Upright CT: Intra-Individual Comparison. Respiration 2020; 99:598-605. [PMID: 32640453 DOI: 10.1159/000507265] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 03/16/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND No clinical studies to date have compared unilateral lung or lobe volumes between the supine and standing positions. OBJECTIVES To compare lung/lobe volumes on computed tomography (CT) between these two positions and evaluate the correlation between the total lung volume and total lung capacity (TLC) on pulmonary function tests (PFTs). METHODS Thirty-two asymptomatic volunteers underwent both conventional CT (supine position) and upright CT (standing position), during deep inspiration breath-hold, and PFTs on the same day. We measured lung/lobe volumes on CT in each position. Paired t tests were used for statistical analysis. RESULTS The volumes of the total lung (10.9% increase), right lung (10.3% increase), right upper lobe (8.6% increase), right lower lobe (14.6% increase), left lung (11.6% increase), left upper lobe (7.1% increase), and left lower lobe (16.0% increase) were significantly greater in the standing position than in the supine position (all p < 0.0001). The right middle lobe volume was similar between the two positions (p = 0.16). Intraclass correlation coefficients for agreement between total lung volumes on CT in the supine/standing positions and the TLC on PFT were 0.891/0.938, respectively. CONCLUSIONS While the volumes of the bilateral upper and lower lobes and bilateral lungs were significantly greater in the standing than in the supine position, with lower lobes showing larger changes, the right middle lobe volume did not change significantly between positions. The total lung volume on upright CT in the standing position was more similar to TLC on PFT than that in the supine position.
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Affiliation(s)
- Yoshitake Yamada
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan,
| | - Minoru Yamada
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Yoichi Yokoyama
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Akiko Tanabe
- Department of Clinical Laboratory, Keio University Hospital, Tokyo, Japan
| | - Shiho Matsuoka
- Department of Clinical Laboratory, Keio University Hospital, Tokyo, Japan
| | - Yuki Niijima
- Office of Radiation Technology, Keio University Hospital, Tokyo, Japan
| | - Keiichi Narita
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Takehiro Nakahara
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Mitsuru Murata
- Department of Laboratory Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Koichi Fukunaga
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Shotaro Chubachi
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Masahiro Jinzaki
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
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Guo L, Yang Y, Liu F, Jiang C, Yang Y, Pu H, Li W, Zhong Z. Clinical Research on Prognostic Evaluation of Subjects With IPF by Peripheral Blood Biomarkers, Quantitative Imaging Characteristics and Pulmonary Function Parameters. Arch Bronconeumol 2019; 56:365-372. [PMID: 31740085 DOI: 10.1016/j.arbres.2019.08.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 08/25/2019] [Accepted: 08/29/2019] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Idiopathic pulmonary fibrosis (IPF) is an irreversible and progressive fatal interstitial lung disease with a poor prognosis. The aim of this study is to investigate the predictive value of combined blood biomarkers, pulmonary function and quantitative monitoring by computer-aided diagnosis (CAD) system in IPF patients. METHODS Pulmonary baseline function and pathological features of 126 patients with IPF were analyzed using spirometry and chest X-ray. Patients were divided into survival group and non-survival group after 5 years follow-up. The relationships the levels of peripheral blood biomarkers, quantitative imaging characteristics and pulmonary function were analyzed between the two groups. RESULTS The baseline level of serum Krebs von den Lungen-6 (KL-6) and C-X-C motif chemokine 13 (CXCL13) were moderately or highly correlated with annual changes in forced vital capacity (FVC), carbon monoxide diffusing capacity (DLCO), total lung capacity (TLC), total interstitial lung disease (ILD) lesions, and the volume changes of reticular. The baseline level of serum KL-6 was higher than the cut-off value of 800.0U/ml and baseline level of serum CXCL13 was higher than the cut-off value of 62.0pg/ml. IPF patients with baseline levels of serum KL-6 and CXCL13 lower than the cut-off value had longer median survival time. CONCLUSIONS Serum KL-6 and CXCL13 may be predictive biomarkers for the outcomes of patients with IPF patients and their baseline levels were related to the progression of pulmonary function and quantitative monitoring by CAD system.
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Affiliation(s)
- Lu Guo
- Division of Pulmonary and Critical Care Medicine, Sichuan Academy of Medical Science, Sichuan Provincial People's Hospital, University Hospital of Electronic Science & Technology of China, Chengdu, PR China
| | - Yan Yang
- Division of Pulmonary and Critical Care Medicine, Sichuan Academy of Medical Science, Sichuan Provincial People's Hospital, University Hospital of Electronic Science & Technology of China, Chengdu, PR China
| | - Feng Liu
- Thoracic surgery, Wuxi People's Hospital affiliated to Nanjing Medical University, Chengdu, PR China
| | - Caiyu Jiang
- Division of Pulmonary and Critical Care Medicine, Sichuan Academy of Medical Science, Sichuan Provincial People's Hospital, University Hospital of Electronic Science & Technology of China, Chengdu, PR China
| | - Yang Yang
- Division of Pulmonary and Critical Care Medicine, Sichuan Academy of Medical Science, Sichuan Provincial People's Hospital, University Hospital of Electronic Science & Technology of China, Chengdu, PR China
| | - Hong Pu
- Radiology Department, Sichuan Academy of Medical Science, Sichuan Provincial People's Hospital, University Hospital of Electronic Science & Technology of China, Chengdu, PR China
| | - Weimin Li
- Division of Pulmonary and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, PR China
| | - Zhendong Zhong
- Institute for Laboratory Animal Research, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, PR China.
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Sun J, Chen C, Peng Y, Zhang Y, Tian H, Yu J, Cao J, Zeng Q. Comparison of magnetic resonance imaging and computed tomography to measure preoperative parameters of children with pectus excavatum. Pediatr Investig 2019; 3:102-109. [PMID: 32851300 PMCID: PMC7331316 DOI: 10.1002/ped4.12132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Accepted: 03/05/2019] [Indexed: 01/02/2023] Open
Abstract
IMPORTANCE Pectus excavatum (PE) is the most common thoracic wall deformity in children, we need a method which could be used to evaluate pulmonary functions and effects on development. OBJECTIVE To evaluate the use of 3D T1-weighted (3DT1) and mDIXON magnetic resonance imaging (MRI) sequences for measuring the thoracic parameters and morphology of children with PE, comparing the measurements with those made on computed tomography (CT). METHODS This is a retrospective study of children with thoracic deformities who were hospitalized at the Department of Thoracic Surgery of the Heart Center, Beijing Children's Hospital, between June 2014 and June 2015. Chest CT was performed first, with the MRI scanning then being performed 0-3 days later. The mDIXON sequences were obtained in inspiratory and expiratory phases and the 3DT1 sequences were obtained during free breathing. Thoracic volume was measured using the acquired images. RESULTS The lung volumes measured on mDIXON MRI and CT were highly correlated, with the Haller index not being significantly different between the two methods. Bland-Altman analyses showed that lung, cardiac, and retrosternal parameters were similar between the two methods. Pulmonary parameters were higher with the end-inspiratory phase mDIXON images than with the end-expiratory phase images, as expected, while cardiac parameters were unaffected by the respiratory phase. INTERPRETATION Thoracic volumes measured on mDIXON MRI in combination with held respiration could reflect lung volume functions and help in observing the movement functions of the lungs and heart. The method could be used instead of CT, avoiding subjecting the patient to potentially harmful radiation.
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Affiliation(s)
- Jihang Sun
- Imaging CenterBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
| | - Chenghao Chen
- Department of Thoracic SurgeryBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
| | - Yun Peng
- Imaging CenterBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
| | - Yue Zhang
- Imaging CenterBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
| | - Hongwei Tian
- Imaging CenterBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
| | - Jie Yu
- Department of Thoracic SurgeryBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
| | - Jun Cao
- Department of OrthopedicsBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
| | - Qi Zeng
- Department of Thoracic SurgeryBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
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Nguyen AH, Perez-Rovira A, Wielopolski PA, Hernandez Tamames JA, Duijts L, de Bruijne M, Aliverti A, Pennati F, Ivanovska T, Tiddens HAWM, Ciet P. Technical challenges of quantitative chest MRI data analysis in a large cohort pediatric study. Eur Radiol 2019; 29:2770-82. [PMID: 30519932 DOI: 10.1007/s00330-018-5863-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 08/25/2018] [Accepted: 10/25/2018] [Indexed: 11/30/2022]
Abstract
Objectives This study was conducted in order to evaluate the effect of geometric distortion (GD) on MRI lung volume quantification and evaluate available manual, semi-automated, and fully automated methods for lung segmentation. Methods A phantom was scanned with MRI and CT. GD was quantified as the difference in phantom’s volume between MRI and CT, with CT as gold standard. Dice scores were used to measure overlap in shapes. Furthermore, 11 subjects from a prospective population-based cohort study each underwent four chest MRI acquisitions. The resulting 44 MRI scans with 2D and 3D Gradwarp were used to test five segmentation methods. Intraclass correlation coefficient, Bland–Altman plots, Wilcoxon, Mann–Whitney U, and paired t tests were used for statistics. Results Using phantoms, volume differences between CT and MRI varied according to MRI positions and 2D and 3D Gradwarp correction. With the phantom located at the isocenter, MRI overestimated the volume relative to CT by 5.56 ± 1.16 to 6.99 ± 0.22% with body and torso coils, respectively. Higher Dice scores and smaller intraobject differences were found for 3D Gradwarp MR images. In subjects, semi-automated and fully automated segmentation tools showed high agreement with manual segmentations (ICC = 0.971–0.993 for end-inspiratory scans; ICC = 0.992–0.995 for end-expiratory scans). Manual segmentation time per scan was approximately 3–4 h and 2–3 min for fully automated methods. Conclusions Volume overestimation of MRI due to GD can be quantified. Semi-automated and fully automated segmentation methods allow accurate, reproducible, and fast lung volume quantification. Chest MRI can be a valid radiation-free imaging modality for lung segmentation and volume quantification in large cohort studies. Key Points • Geometric distortion varies according to MRI setting and patient positioning. • Automated segmentation methods allow fast and accurate lung volume quantification. • MRI is a valid radiation-free alternative to CT for quantitative data analysis. Electronic supplementary material The online version of this article (10.1007/s00330-018-5863-7) contains supplementary material, which is available to authorized users.
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DeArmond DT, Das NA, Restrepo CS, Johnson SB, Michalek JE, Hernandez BS. Pleural electrical impedance is a sensitive, real-time indicator of pneumothorax. J Surg Res 2018; 231:15-23. [PMID: 30278922 DOI: 10.1016/j.jss.2018.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 02/21/2018] [Accepted: 05/04/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Chest tube management protocols, particularly in patients with alveolar-pleural air leak due to recent surgery or trauma, are limited by concerns over safety, especially concerns about rapid and occult development of pneumothorax. A continuous, real-time monitor of pneumothorax could improve the quality and safety of chest tube management. We developed a rat model of pneumothorax to test a novel approach of measuring electrical impedance within the pleural space as a monitor of lung expansion. MATERIALS AND METHODS Anesthetized Sprague-Dawley rats underwent right thoracotomy. A novel impedance sensor and a thoracostomy tube were introduced into the right pleural space. Pneumothorax of varying volumes ranging from 0.2 to 20 mL was created by syringe injection of air via the thoracostomy tube. Electrical resistance measurements from the pleural sensor and fluoroscopic images were obtained at baseline and after the creation of pneumothorax and results compared. RESULTS A statistically significant, dose-dependent increase in electrical resistance was observed with increasing volume of pneumothorax. Resistance measurement allowed for continuous, real-time monitoring of pneumothorax development and the ability to track pneumothorax resolution by aspiration of air via the thoracostomy tube. Pleural resistance measurement demonstrated 100% sensitivity and specificity for all volumes of pneumothorax tested and was significantly more sensitive for pneumothorax detection than fluoroscopy. CONCLUSIONS The electrical impedance-based pleural space sensor described in this study provided sensitive and specific pneumothorax detection, which was superior to radiographic analysis. Real-time, continuous monitoring for pneumothorax has the potential to improve the safety, quality, and efficiency of postoperative chest tube management.
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Affiliation(s)
- Daniel T DeArmond
- Department of Cardiothoracic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
| | - Nitin A Das
- Department of Cardiothoracic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Carlos S Restrepo
- Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Scott B Johnson
- Department of Cardiothoracic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Joel E Michalek
- Department of Epidemiology & Biostatistics, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Brian S Hernandez
- Department of Epidemiology & Biostatistics, University of Texas Health Science Center at San Antonio, San Antonio, Texas
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Sheng LF, Yan M, Zhang FJ, Ren QS, Yu SH, Wu M. [The value of brachial artery peak velocity variation during the Valsalva maneuver to predict fluid responsiveness]. Zhonghua Yi Xue Za Zhi 2018; 97:434-437. [PMID: 28219130 DOI: 10.3760/cma.j.issn.0376-2491.2017.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To evaluate whether brachial artery peak velocity variation(ΔVp) during a Valsalva maneuver(VM) could predict fluid responsiveness in spontaneously breathing patients. Methods: Ninety-six patients required radial artery catheter for elective surgery of Ningbo Yinzhou People's Hospital from December 2014 to June 2016 were enrolled. The brachial artery Doppler signal was recorded to measure the ΔVp while the VM was performed.Then doing the volume expansion (VE) , the cardiac output variation (ΔCO) before and after VE were measured.Pearson correlational analyses were conducted between ΔVp and ΔCO. Also the sensitivity and specificity of ΔVp were determined in predicting fluid responsiveness by the receiver operating characteristic (ROC) curve. Results: Patients were classified as group responders (n=24) and group non-responders (n=72). Responder was defined as cardiac output increased≥15% after VE.The ΔVp correlated well with ΔCO (r=0.792, P<0.01). The area under ROC curve was 0.903, with the ΔVp cut-off of 33%, the sensitivity of 87% and the specificity of 82%(P<0.01). Conclusion: Brachial artery peak velocity variation during a valsalva maneuver is a feasible method for predicting fluid responsiveness in spontaneously breathing patients.
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Affiliation(s)
- L F Sheng
- Department of Anesthesia, Second Affiliated Hospital of Zhejiang University, Hangzhou 310009, China
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Winck AD, Heinzmann-Filho JP, Soares RB, da Silva JS, Woszezenki CT, Zanatta LB. Effects of obesity on lung volume and capacity in children and adolescents: a systematic review. Rev Paul Pediatr 2016; 34:510-517. [PMID: 27130483 DOI: 10.1016/j.rpped.2016.02.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 02/23/2016] [Accepted: 02/28/2016] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To assess the effects of obesity on lung volume and capacity in children and adolescents. DATA SOURCE This is a systematic review, carried out in Pubmed, Lilacs, Scielo and PEDro databases, using the following Keywords: Plethysmography; Whole Body OR Lung Volume Measurements OR Total Lung Capacity OR Functional Residual Capacity OR Residual Volume AND Obesity. Observational studies or clinical trials that assessed the effects of obesity on lung volume and capacity in children and adolescents (0-18 years) without any other associated disease; in English; Portuguese and Spanish languages were selected. Methodological quality was assessed by the Agency for Healthcare Research and Quality. DATA SYNTHESIS Of the 1,030 articles, only four were included in the review. The studies amounted to 548 participants, predominantly males, with sample size ranging from 45 to 327 individuals. 100% of the studies evaluated nutritional status through BMI (z-score) and 50.0% reported the data on abdominal circumference. All demonstrated that obesity causes negative effects on lung volume and capacity, causing a reduction mainly in functional residual capacity in 75.0% of the studies; in the expiratory reserve volume in 50.0% and in the residual volume in 25.0%. The methodological quality ranged from moderate to high, with 75.0% of the studies classified as having high methodological quality. CONCLUSIONS Obesity causes deleterious effects on lung volume and capacity in children and adolescents, mainly by reducing functional residual capacity, expiratory reserve volume and residual volume.
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Affiliation(s)
| | | | - Rafaela Borges Soares
- Pontifícia Universidade Católica do Rio Grande do Sul (PUC-RS), Porto Alegre, RS, Brasil
| | | | | | - Letiane Bueno Zanatta
- Instituto Cenecista de Ensino Superior de Santo Ângelo (Iesa), Santo Ângelo, RS, Brasil
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Winck AD, Heinzmann-Filho JP, Soares RB, da Silva JS, Woszezenki CT, Zanatta LB. Effects of obesity on lung volume and capacity in children and adolescents: a systematic review. ACTA ACUST UNITED AC 2016. [PMID: 27130483 PMCID: PMC5176074 DOI: 10.1016/j.rppede.2016.03.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To assess the effects of obesity on lung volume and capacity in children and adolescents. DATA SOURCE This is a systematic review, carried out in Pubmed, Lilacs, Scielo and PEDro databases, using the following Keywords: Plethysmography; Whole Body OR Lung Volume Measurements OR Total Lung Capacity OR Functional Residual Capacity OR Residual Volume AND Obesity. Observational studies or clinical trials that assessed the effects of obesity on lung volume and capacity in children and adolescents (0-18 years) without any other associated disease; in English; Portuguese and Spanish languages were selected. Methodological quality was assessed by the Agency for Healthcare Research and Quality. DATA SYNTHESIS Of the 1,030 articles, only four were included in the review. The studies amounted to 548 participants, predominantly males, with sample size ranging from 45 to 327 individuals. 100% of the studies evaluated nutritional status through BMI (z-score) and 50.0% reported the data on abdominal circumference. All demonstrated that obesity causes negative effects on lung volume and capacity, causing a reduction mainly in functional residual capacity in 75.0% of the studies; in the expiratory reserve volume in 50.0% and in the residual volume in 25.0%. The methodological quality ranged from moderate to high, with 75.0% of the studies classified as having high methodological quality. CONCLUSIONS Obesity causes deleterious effects on lung volume and capacity in children and adolescents, mainly by reducing functional residual capacity, expiratory reserve volume and residual volume.
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Affiliation(s)
| | | | - Rafaela Borges Soares
- Pontifícia Universidade Católica do Rio Grande do Sul (PUC-RS), Porto Alegre, RS, Brasil
| | | | | | - Letiane Bueno Zanatta
- Instituto Cenecista de Ensino Superior de Santo Ângelo (Iesa), Santo Ângelo, RS, Brasil
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Thacher JD, Emmelin A, Madaki AJK, Thacher TD. Biomass fuel use and the risk of asthma in Nigerian children. Respir Med 2013; 107:1845-51. [PMID: 24094943 DOI: 10.1016/j.rmed.2013.09.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Revised: 08/27/2013] [Accepted: 09/11/2013] [Indexed: 01/28/2023]
Abstract
BACKGROUND Biomass fuel smoke exposure contributes to respiratory infections in childhood, but its association with asthma has not been established. We studied the relationship of biomass fuel use with asthma symptoms and lung function in Nigerian children. METHODS A cross-sectional study was performed in 299 village children aged 5-11 years in North Central Nigeria. Data were collected regarding the cooking fuels used and duration of daily smoke exposure in the cooking area. Asthma symptoms were assessed with a modified International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire, and lung function was assessed with spirometry. RESULTS The prevalence of a lifetime history of wheeze was 9.4% (95% CI: 6.3%-13.2%). Fourteen children (4.7%) had airway obstruction (FEV1/FEV6 <85%). Female subjects had lower FEV1 and FEV6 (110 % and 120% percent predicted, respectively) than males (121% and 130%, respectively, P <0.001 for both differences). Advancing age was associated with a relative decline in the predicted value of FEV1 of 7.8 % per year (r = -0.61; P < 0.001). Children in families that used firewood daily did not have a significantly increased likelihood of asthma-related symptoms (OR = 2.36, 95% CI: 0.66-8.44). Similarly, airway obstruction did not differ significantly between children in households that did and did not use firewood daily (mean FEV1/FEV6 of 0.95 and 0.97, respectively; P = 0.41). CONCLUSION Reported smoke exposure was not associated with an increased risk of asthma symptoms or airway obstruction. However, lifetime smoke exposure may explain the reduction in spirometric values in female subjects and with advancing age.
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Affiliation(s)
- Jesse D Thacher
- Institute of Environmental Medicine, Karolinska Institutet, Nobels Väg 13, 17177 Stockholm, Sweden.
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Jacobson GC, Herson M. The percentage of inspired oxygen at different flow rates during nebulisation. Aust J Physiother 1990; 36:12-16. [PMID: 25025763 DOI: 10.1016/s0004-9514(14)60515-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The aim of this study was to determine the mean value for the fraction of inspired oxygen (FiO2) in normal subjects at oxygen flow rates of 2L/min, 4L/min and 6L/min during mouthpiece nebulisation. The FiO2 was defined as the fractional extraction of oxygen at the mouth. The variation in the FiO2 during normal and deep breathing was also studied in order to assess whether a significant difference in the FiO2 occurred. Breathing at a normal tidal volume, the values of the FiO2 were 27.5 per cent, 30.8 per cent and 34.9 per cent respectively. The values during deep breathing were 24.4 per cent, 27.9 per cent and 31.3 per cent respectively. It was clearly evident that the FiO2 during deep breathing was approximately 3 per cent less than that during normal tidal breathing.
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