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Samadi Takaldani AH, Latifi K, Salmani A, Negaresh M. Negative pressure pulmonary edema following laryngospasm after dental abscess: A case report. Heliyon 2024; 10:e28470. [PMID: 38571620 PMCID: PMC10988006 DOI: 10.1016/j.heliyon.2024.e28470] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 03/15/2024] [Accepted: 03/19/2024] [Indexed: 04/05/2024] Open
Abstract
Negative pressure pulmonary edema (NPPE), also known as post-obstructive pulmonary edema, is a rare and life-threatening condition. It occurs when a person breathes against an obstructed glottis, causing negative thoracic pressure in the lungs. This negative pressure can lead to fluid accumulation in the lungs, resulting in pulmonary edema. The obstructed glottis might be caused by laryngospasm, which occurs when the muscles around the larynx involuntarily spasm and can lead to complete upper airway occlusion. This report shares the case of a 33-year-old woman hospitalized for periapical dental abscess, facial swelling, and shortness of breath. The patient exhibited signs of poor oral hygiene. After the exacerbation of her symptoms, she showed signs of asphyxia and decreased oxygen saturation, which led to her intubation. Imaging revealed bilateral pleural effusion and patchy ground glass opacities favoring NPPE. After three days of treatment with diuretics and other conservative measures, her condition was alleviated, and she was extubated. Laryngospasm in the presence of a dental abscess is uncommon. Identification of imaging favoring NPPE in this setting is even more rare. In cases of laryngospasm, prompt intubation is crucial. Therapy with diuretics and other conservative measures can effectively treat NPPE following laryngospasm.
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Affiliation(s)
- Ali Hossein Samadi Takaldani
- Department of Internal Medicine (Pulmonology Division), School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Kaveh Latifi
- Department of Anesthesiology and Pain Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Asma Salmani
- Department of Internal Medicine, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Mohammad Negaresh
- Department of Internal Medicine, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
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Nii M, Oda T, Morikawa M, Nakabayashi Y, Adachi T, Kobayashi T, Itakura A. Changes in use and outcomes after fibrinogen concentrate insurance coverage for critical obstetrical hemorrhage: a nationwide questionnaire survey in Japan. Sci Rep 2024; 14:6711. [PMID: 38509152 PMCID: PMC10954662 DOI: 10.1038/s41598-024-57244-2] [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: 09/12/2023] [Accepted: 03/15/2024] [Indexed: 03/22/2024] Open
Abstract
Fibrinogen concentrate (FC) for acquired hypofibrinogenemia associated with critical obstetrical hemorrhage (COH) was covered by public medical insurance in September 2021 in Japan. We aimed to investigate changes in the policy of FC use and its effect on COH after insurance coverage. A primary survey covering September 2020 to August 2021 and a secondary survey covering September 2021 to August 2022 were conducted at 428 higher-level medical facilities. We investigated the policy of FC use in transfusion strategy and the maternal outcomes in COH. Among the hospitals that responded to both surveys, the number of facilities that use FC increased from 51.5 (101/196) to 78.6% (154/196) (P < 0.0001). The number of COH cases treated using FC increased from 14.3 to 24.3% (P < 0.0001) and that transfused with ≥ 10 units of red blood cells (RBCs) decreased from 36.8 to 29.8% (P = 0.001). The incidence of pulmonary edema reduced by 3.7-2.0% (P = 0.021), and transfusion-induced allergy by 1.9-0.7% (P = 0.008). No changes were observed in the incidence of thromboembolism, arterial embolization, or hysterectomy. The increased use of FC after insurance coverage led to changes in the transfusion strategy, which may be associated with decreases in transfusions of RBCs, pulmonary edema, and transfusion-induced allergies.
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Affiliation(s)
- Masafumi Nii
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Tsu, Japan.
- The Japan Society of Obstetrical, Gynecological and Neonatal Hematology (JSOGNH), Kitakyushu, Japan.
| | - Tomoaki Oda
- The Japan Society of Obstetrical, Gynecological and Neonatal Hematology (JSOGNH), Kitakyushu, Japan
- Department of Obstetrics and Gynecology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Mamoru Morikawa
- The Japan Society of Obstetrical, Gynecological and Neonatal Hematology (JSOGNH), Kitakyushu, Japan
- Department of Obstetrics and Gynecology, Kansai Medical University, Osaka, Japan
| | - Yasushi Nakabayashi
- The Japan Society of Obstetrical, Gynecological and Neonatal Hematology (JSOGNH), Kitakyushu, Japan
- Department of Obstetrics and Gynecology, Nakabayashi Hospital, Tokyo, Japan
| | - Tomoko Adachi
- The Japan Society of Obstetrical, Gynecological and Neonatal Hematology (JSOGNH), Kitakyushu, Japan
- Department of Obstetrics and Gynecology, Aiiku Hospital, Tokyo, Japan
| | - Takao Kobayashi
- The Japan Society of Obstetrical, Gynecological and Neonatal Hematology (JSOGNH), Kitakyushu, Japan
- Department of Obstetrics and Gynecology, Hamamatsu Medical Center, Hamamatsu, Japan
| | - Atsuo Itakura
- The Japan Society of Obstetrical, Gynecological and Neonatal Hematology (JSOGNH), Kitakyushu, Japan
- Department of Obstetrics and Gynecology, Juntendo University Graduate School of Medicine, Tokyo, Japan
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Kaya B, Dilli D, Sarikaya Y, Akduman H, Citli R, Orun UA, Tasar M, Zenciroglu A. Lung ultrasound in the evaluation of pulmonary edema in newborns with critical congenital heart disease. Pediatr Neonatol 2024:S1875-9572(24)00039-1. [PMID: 38514358 DOI: 10.1016/j.pedneo.2024.02.006] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/26/2024] [Accepted: 02/16/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Newborns with critical congenital heart disease (CCHD) with increased pulmonary blood flow (PBF) are at high risk for congestive heart failure. In this study, we aimed to evaluate the presence and degree of pulmonary edema in newborns with CCHD using lung ultrasound (LUS) during the perioperative period. METHODS Prospective clinical trial, 44 newborn patients with CCHD were evaluated in this prospective clinical trial. LUS was repeatedly performed to determine the course of pulmonary edema during the perioperative period. LUS was performed simultaneously with chest radiography (CXR), which was the main part of patient management. The primary outcome of this study was to identify whether a correlation existed between LUS and CXR findings. The secondary outcomes were to determine the relationship between LUS and the need for respiratory support, diuretic use, vasoactive inotropic score (VIS), and pro-B-type natriuretic peptide (pro-BNP) levels during the perioperative period. RESULTS The mean gestational age of the patients was 38.3 ± 1.7 weeks, with a mean birth weight of 3026 ± 432 g. In the preoperative period, both LUS and CXR images were consistent with clinical signs of pulmonary edema. On the first postoperative day, pulmonary edema increased compared to the preoperative period but gradually decreased by the 6th day of surgery (p < 0.05). Positive correlations were observed between the LUS and CXR findings at all study points (p < 0.05). The LUS findings exhibited trends parallel to those of VIS, serum pro-BNP levels, need for respiratory support, and diuretic requirements. As expected, these trends were more pronounced in CCHDs where PBF increased. CONCLUSION In CCHD, serial lung ultrasound (LUS) assessments, particularly in cases with increased PBF, can provide valuable guidance for managing patients during the perioperative period.
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Affiliation(s)
- Basak Kaya
- Dr. Sami Ulus Maternity and Child Research and Training Hospital, Department of Neonatology, Ankara, Turkey.
| | - Dilek Dilli
- Dr. Sami Ulus Maternity and Child Research and Training Hospital, Department of Neonatology, Ankara, Turkey
| | - Yasin Sarikaya
- Dr. Sami Ulus Maternity and Child Research and Training Hospital Department of Radiology, Ankara, Turkey
| | - Hasan Akduman
- Dr. Sami Ulus Maternity and Child Research and Training Hospital, Department of Neonatology, Ankara, Turkey
| | - Rumeysa Citli
- Dr. Sami Ulus Maternity and Child Research and Training Hospital, Department of Neonatology, Ankara, Turkey
| | - Utku A Orun
- Dr. Sami Ulus Maternity and Child Research and Training Hospital, Department of Pediatric Cardiology, Ankara, Turkey
| | - Mehmet Tasar
- Dr. Sami Ulus Maternity and Child Research and Training Hospital, Department of Pediatric Cardiovascular Surgery, Ankara, Turkey
| | - Aysegul Zenciroglu
- Dr. Sami Ulus Maternity and Child Research and Training Hospital, Department of Neonatology, Ankara, Turkey
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Underner M, Perriot J, Peiffer G, Jaafari N, Urban T. [Synthetic cannabinoid overdose: Watch out for acute respiratory complications]. Rev Mal Respir 2024; 41:262-263. [PMID: 38461091 DOI: 10.1016/j.rmr.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 02/13/2024] [Indexed: 03/11/2024]
Affiliation(s)
- M Underner
- Consultation de tabacologie, unité de recherche clinique, université de Poitiers, centre hospitalier Henri-Laborit, 370, avenue Jacques-Cœur, CS 10587, 86021 Poitiers cedex, France.
| | - J Perriot
- Dispensaire Émile-Roux, centre d'addictologie, 63100 Clermont-Ferrand, France
| | - G Peiffer
- Service de pneumologie, CHR de Metz-Thionville, 57038 Metz, France
| | - N Jaafari
- Consultation de tabacologie, unité de recherche clinique, université de Poitiers, centre hospitalier Henri-Laborit, 370, avenue Jacques-Cœur, CS 10587, 86021 Poitiers cedex, France
| | - T Urban
- Service de pneumologie, CHU d'Angers, 49000 Angers, France
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Rottmann FA, Staudacher DL, Sternheim D, Müller-Peltzer K. [Pulmonary infiltrates following accidental immobilzation]. Med Klin Intensivmed Notfmed 2024; 119:154-155. [PMID: 37932537 DOI: 10.1007/s00063-023-01076-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 09/22/2023] [Accepted: 09/26/2023] [Indexed: 11/08/2023]
Affiliation(s)
- Felix Arne Rottmann
- Klinik für Innere Medizin IV - Nephrologie und Allgemeinmedizin, Universitätsklinikum Freiburg im Breisgau, Hugstetter Str. 55, 79106, Freiburg, Deutschland.
| | - Dawid Leander Staudacher
- Interdisziplinäre Medizinische Intensivtherapie, Universitätsklinikum Freiburg im Breisgau, Freiburg, Deutschland
| | - Doreen Sternheim
- Universitäts-Notfallzentrum, Universitätsklinikum Freiburg im Breisgau, Freiburg, Deutschland
| | - Katharina Müller-Peltzer
- Klinik für diagnostische und interventionelle Radiologie, Universitätsklinikum Freiburg im Breisgau, Freiburg, Deutschland
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Nivatpumin P, Lertkovit S. Case report: Maternal cardiac arrest at 12 hours postpartum. Heliyon 2024; 10:e23337. [PMID: 38148823 PMCID: PMC10750056 DOI: 10.1016/j.heliyon.2023.e23337] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 11/08/2023] [Accepted: 12/01/2023] [Indexed: 12/28/2023] Open
Abstract
Maternal cardiac arrest is a rare occurrence. In this case report, we present a detailed account of a 37-year-old pregnant woman with preeclampsia with severe features who underwent cesarean delivery. The patient experienced dyspnea and hypoxia at 12 hours postpartum, leading to cardiac arrest in the maternity ward. Advanced cardiac life support measures, including 15 minutes of chest compressions, were performed until spontaneous circulation was restored. This study explores the underlying factors contributing to maternal cardiac arrest during the postpartum period. Additionally, it highlights the effective strategies employed by our multidisciplinary team in managing and resolving this critical medical event.
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Affiliation(s)
- Patchareya Nivatpumin
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Saranya Lertkovit
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Zhang SJ, He SZ, Wu JJ, Chen YJ, Lyu GR. Evaluation of extravascular lung water and cardiac function in normal vaginal delivery by intrapartum bedside ultrasound. BMC Pregnancy Childbirth 2024; 24:13. [PMID: 38166871 PMCID: PMC10759567 DOI: 10.1186/s12884-023-06201-4] [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: 08/22/2023] [Accepted: 12/13/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Healthy parturients may experience pulmonary edema and disturbed cardiac function during labor. We aimed to evaluate the extravascular lung water (EVLW), intravascular volume, and cardiac function of normal parturients during spontaneous vaginal delivery by bedside ultrasound. And to explore the correlation between EVLW and intravascular volume, cardiac function. METHODS This was a prospective observational study including 30 singleton-term pregnant women undergoing spontaneous vaginal delivery. Bedside ultrasound was performed at the early labor, the end of the second stage of labor, 2 and 24 h postpartum, and 120 scanning results were recorded. EVLW was evaluated by the echo comet score (ECS) obtained by the 28-rib interspaces technique. Inferior vena cava collapsibility index (IVC-CI), left ventricle ejection fraction, right ventricle fractional area change, left and right ventricular E/A ratio, and left and right ventricular index of myocardial performance (LIMP and RIMP) were measured. Measurements among different time points were compared, and the correlations between ECS and other measurements were analyzed. RESULTS During the spontaneous vaginal delivery of healthy pregnant women, 2 had a mild EVLW increase at the early labor, 8 at the end of the second stage of labor, 13 at 2 h postpartum, and 4 at 24 h postpartum (P < 0.001). From the early labor to 24 h postpartum, ECS first increased and then decreased, reaching its peak at 2 h postpartum (P < 0.001). IVC-CI first decreased and then increased, reaching its minimum at the end of the second stage of labor (P < 0.001). RIMP exceeded the cut-off value of 0.43 at the end of the second stage of labor. ECS was weakly correlated with IVC-CI (r=-0.373, P < 0.001), LIMP (r = 0.298, P = 0.022) and RIMP (r = 0.211, P = 0.021). CONCLUSIONS During spontaneous vaginal delivery, the most vital period of perinatal care is between the end of the second stage of labor and 2 h postpartum, because the risk of pulmonary edema is higher and the right ventricle function may decline. IVC-CI can be used to evaluate maternal intravascular volume. The increase in EVLW may be related to the increase in intravascular volume and the decrease in ventricular function.
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Affiliation(s)
- Shi-Jie Zhang
- Department of Ultrasound, Second Affiliated Hospital of Fujian Medical University, No. 34 North Zhongshan Road, Quanzhou, 362000, Fujian Province, China
| | - Shao-Zheng He
- Department of Ultrasound, Second Affiliated Hospital of Fujian Medical University, No. 34 North Zhongshan Road, Quanzhou, 362000, Fujian Province, China
| | - Jing-Jing Wu
- Department of Obstetrics and Gynecology, Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, China
| | - Yong-Jian Chen
- Department of Ultrasound, Second Affiliated Hospital of Fujian Medical University, No. 34 North Zhongshan Road, Quanzhou, 362000, Fujian Province, China
| | - Guo-Rong Lyu
- Department of Ultrasound, Second Affiliated Hospital of Fujian Medical University, No. 34 North Zhongshan Road, Quanzhou, 362000, Fujian Province, China.
- Department of Clinical Medicine, Quanzhou Medical College, Quanzhou, Fujian Province, China.
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Uehara H, Taguchi D, Osanai T, Oe Y, Yoshimura T, Yashiro S, Gunji T, Okuyama M. Naphazoline intoxication with transient QT prolongation and acute myocardial injury. J Cardiol Cases 2024; 29:11-14. [PMID: 38188313 PMCID: PMC10770086 DOI: 10.1016/j.jccase.2023.09.004] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/28/2023] [Accepted: 08/23/2023] [Indexed: 01/09/2024] Open
Abstract
A 27-year-old Japanese woman with a history of depression and an eating disorder presented to our emergency department with a chief complaint of generalized weakness. Electrocardiography showed prominent QT prolongation with multiple ventricular contractions. Chest X-ray plain computed tomography revealed pulmonary edema. Echocardiography showed decreased left ventricular systolic function. Suspecting acute myocarditis, we performed a myocardial biopsy from the right ventricular septum. The biopsy histology revealed extensive myocardial fibrosis and a very mild inflammatory cell infiltrate. In an additional detailed medical interview, the patient admitted that she had consumed three bottles of a first-aid liquid containing naphazoline approximately ~12 h before her presentation, in a suicide attempt. Her QTc and left ventricular ejection fraction improved during hospitalization. Learning objective Acute drug intoxication can cause QT prolongation and ventricular arrhythmias, cardiomyopathy, and pulmonary edema. When acute QT prolongation, myocardial damage, and pulmonary edema are seen (suggesting acute myocarditis), naphazoline intoxication should be investigated in the differential diagnosis.
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Affiliation(s)
- Hiroki Uehara
- Department of Cardiovascular Medicine, Kin-ikyo Chuo Hospital, Sapporo, Japan
| | - Dai Taguchi
- Department of Emergency, Kin-ikyo Chuo Hospital, Sapporo, Japan
| | - Toshiaki Osanai
- Department of Cardiovascular Medicine, Kin-ikyo Chuo Hospital, Sapporo, Japan
| | - Yutaro Oe
- Department of Cardiovascular Medicine, Kin-ikyo Chuo Hospital, Sapporo, Japan
| | - Takaki Yoshimura
- Department of Cardiovascular Medicine, Kin-ikyo Chuo Hospital, Sapporo, Japan
| | | | - Takahiro Gunji
- Department of Cardiovascular Medicine, Kin-ikyo Chuo Hospital, Sapporo, Japan
| | - Masaki Okuyama
- Department of Cardiovascular Medicine, Kin-ikyo Chuo Hospital, Sapporo, Japan
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Aljonaieh KI, Aldakhil S. Pulmonary edema: A complication of post-complete ingrown toenail excision. A case report. Saudi J Anaesth 2024; 18:131-133. [PMID: 38313710 PMCID: PMC10833009 DOI: 10.4103/sja.sja_536_23] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 06/18/2023] [Accepted: 06/19/2023] [Indexed: 02/06/2024] Open
Abstract
A sympathetic crashing pulmonary edema (SCAPE) is an emergency medical situation necessitating early recognition and treatment. We present a case of a 15-years old male who underwent a toenail excision of his left big toe and who developed SCAPE postoperatively. The low incidence of SCAPE intraoperatively makes it challenging for anesthesiologists to diagnose it. It occurs unexpectedly and precipitously, and it may increase the risks of morbidity and mortality if it is not treated promptly. Our aim is to raise awareness of how to abruptly manage such cases.
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Affiliation(s)
- Khalid Ibrahim Aljonaieh
- Department of Anaesthesiology, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
| | - Sadal Aldakhil
- Department of Anaesthesiology, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
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10
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Motes A, Nugent K. Periodic generalized edema following COVID-19 infection. Am J Med Sci 2024; 367:61-66. [PMID: 37816456 DOI: 10.1016/j.amjms.2023.10.002] [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: 02/27/2023] [Revised: 10/03/2023] [Accepted: 10/04/2023] [Indexed: 10/12/2023]
Abstract
The unprecedented impact and sequelae of COVID-19 infection are not yet fully understood, and better understanding of the pathophysiology of these infections is needed. Endothelial dysfunction might be common sequelae associated with COVID-19, and increased inflammatory responses, oxidative stress, proinflammatory cytokines, and impaired mitochondrial function also contribute to the pathophysiology of post COVID-19 medical disorders. Systemic capillary leak syndrome following COVID-19 infection, both new onset and exacerbation of a prior disorder, has been reported. The pathophysiology of SCLS is uncertain; it likely develops during transient vascular endothelial dysfunction or endotheliopathy and inflammation resulting from circulating humoral factors. Here, we report a case of adult patient with 2 episodes of systemic capillary leak syndrome following prior COVID-19 infection. This patient had a transient response to intravenous IgG.
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Affiliation(s)
- Arunee Motes
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX United States
| | - Kenneth Nugent
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX United States.
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Ward JL, DeFrancesco TC. The Role of Point-of-Care Ultrasound in Managing Cardiac Emergencies. Vet Clin North Am Small Anim Pract 2023; 53:1429-1443. [PMID: 37423842 DOI: 10.1016/j.cvsm.2023.05.017] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Point-of-care ultrasound (POCUS) is a useful imaging tool for the diagnosis and monitoring of cardiac emergencies. Unlike complete echocardiography, POCUS is a time-sensitive examination involving a subset of targeted thoracic ultrasound views to identify abnormalities of the heart, lungs, pleural space, and caudal vena cava. When integrated with other clinical information, POCUS can be helpful in the diagnosis of left-sided and right-sided congestive heart failure, pericardial effusion and tamponade, and severe pulmonary hypertension and can help clinicians monitor resolution or recurrence of these conditions.
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Affiliation(s)
- Jessica L Ward
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, 1809 South Riverside Drive, Ames, IA 50010, USA.
| | - Teresa C DeFrancesco
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, 1052 William Moore Drive, Raleigh, NC 27607, USA
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Mao Y, Alarfaj AA, Hussein-Al-Ali SH, Ma H. Diterpene Coronarin Attenuates Lipopolysaccharide-Induced Acute Lung Injury in Both In Vivo and In Vitro Models. Appl Biochem Biotechnol 2023:10.1007/s12010-023-04711-7. [PMID: 37906408 DOI: 10.1007/s12010-023-04711-7] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Acute lung injury (ALI) is a clinical condition occurs due to severe systemic inflammatory response for clinical stimulus like pneumonia, sepsis, trauma, aspiration, inhalation of toxic gases, and pancreatitis. Disruption of alveolar barriers, activation of macrophages, infiltration of neutrophils, and proinflammatory cytokines are the vital events occurs during ALI. The drugs which inhibit these inflammatory response can protect lungs from inflammatory insults. In this study, we examined the potency of phytochemical coronarin, a diterpene which have been proven to possess anti-inflammatory, antioxidant, antiangiogenic, and antitumor activities. Healthy BALB/c mice were induced to acute lung injury with intra-tracheal administration of LPS and then treated with 5 and 10 mg/kg concentration of coronarin. The wet/dry lung weight of mice were estimated to assess the induction of pulmonary edema. BALF fluid was analyzed for protein concentrations and immune cells count. Myeloperoxidase activity and levels of chemokines MCP-2 and MIP-2, iNOS, COX-2, and PGE-2 were quantified to assess the immunomodulatory effect of coronarin against LPS-induced ALI. The levels of proinflammatory cytokines was measured to examine the anti-inflammatory property of coronarin, and it was confirmed with histopathological analysis of the lung tissue. Murine RAW 264.7 cells were utilized for the in vitro analysis. Cell cytoxicity and cytoprotective property of coronarin was assessed with MTT assay in LPS-treated Murine RAW 264.7. The anti-inflammatory property of coronarin was further confirmed in in vitro condition by estimating the levels of pro-inflammatory cytokines in coronarin-treated and untreated LPS-induced cells. Overall, our in vivo and in vitro results confirm coronarin significantly inhibited the infiltration of neutrophils prevented immunodulatory activity and synthesis of proinflammatory cytokines and alleviated the acute lung injury induced by LPS. Coronarin is a potent anti-inflammatory drug which can be subjected to further research to be prescribed as drug for ALI.
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Affiliation(s)
- Ya Mao
- Department of Cardiothoracic Surgery, Yantai Mountain Hospital, Yantai, 264001, China
| | - Abdullah A Alarfaj
- Department of Respiratory II, Yantai Mountain Hospital, Yantai, 264001, China
| | - Samer Hasan Hussein-Al-Ali
- Faculty of Pharmacy, PO Box 33 and 22 Isra University Office 11622 by Queen Alia International Airport south of the capital, Amman, Jordan
| | - Hongxia Ma
- Department of thoracic surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250000, China.
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Atmowihardjo LN, Schippers JR, Haaksma ME, Smit MR, Bogaard HJ, Heunks L, Juffermans NP, Schultz MJ, Endeman H, van Velzen P, Tuinman PR, Aman J, Bos LDJ. The diagnostic accuracy of lung ultrasound to determine PiCCO-derived extravascular lung water in invasively ventilated patients with COVID-19 ARDS. Ultrasound J 2023; 15:40. [PMID: 37782370 PMCID: PMC10545605 DOI: 10.1186/s13089-023-00340-7] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 09/14/2023] [Indexed: 10/03/2023] Open
Abstract
BACKGROUND Lung ultrasound (LUS) can detect pulmonary edema and it is under consideration to be added to updated acute respiratory distress syndrome (ARDS) criteria. However, it remains uncertain whether different LUS scores can be used to quantify pulmonary edema in patient with ARDS. OBJECTIVES This study examined the diagnostic accuracy of four LUS scores with the extravascular lung water index (EVLWi) assessed by transpulmonary thermodilution in patients with moderate-to-severe COVID-19 ARDS. METHODS In this predefined secondary analysis of a multicenter randomized-controlled trial (InventCOVID), patients were enrolled within 48 hours after intubation and underwent LUS and EVLWi measurement on the first and fourth day after enrolment. EVLWi and ∆EVLWi were used as reference standards. Two 12-region scores (global LUS and LUS-ARDS), an 8-region anterior-lateral score and a 4-region B-line score were used as index tests. Pearson correlation was performed and the area under the receiver operating characteristics curve (AUROCC) for severe pulmonary edema (EVLWi > 15 mL/kg) was calculated. RESULTS 26 out of 30 patients (87%) had complete LUS and EVLWi measurements at time point 1 and 24 out of 29 patients (83%) at time point 2. The global LUS (r = 0.54), LUS-ARDS (r = 0.58) and anterior-lateral score (r = 0.54) correlated significantly with EVLWi, while the B-line score did not (r = 0.32). ∆global LUS (r = 0.49) and ∆anterior-lateral LUS (r = 0.52) correlated significantly with ∆EVLWi. AUROCC for EVLWi > 15 ml/kg was 0.73 for the global LUS, 0.79 for the anterior-lateral and 0.85 for the LUS-ARDS score. CONCLUSIONS Overall, LUS demonstrated an acceptable diagnostic accuracy for detection of pulmonary edema in moderate-to-severe COVID-19 ARDS when compared with PICCO. For identifying patients at risk of severe pulmonary edema, an extended score considering pleural morphology may be of added value. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT04794088, registered on 11 March 2021. European Clinical Trials Database number 2020-005447-23.
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Affiliation(s)
- Leila N Atmowihardjo
- Intensive Care, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
- Department of Intensive Care Medicine, Amsterdam University Medical Center, Location AMC, Meibergdreef 9, Room G3-228, 1105 AZ, Amsterdam, The Netherlands.
| | - Job R Schippers
- Department of Pulmonology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
| | - Mark E Haaksma
- Intensive Care, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
| | - Marry R Smit
- Intensive Care, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Harm J Bogaard
- Department of Pulmonology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
| | - Leo Heunks
- Department of Intensive Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nicole P Juffermans
- Intensive Care, Erasmus University Medical Center, Doctor Molewaterplein 40, Rotterdam, The Netherlands
- Laboratory of Translational Intensive Care, Erasmus University, Rotterdam, the Netherlands
| | - Marcus J Schultz
- Intensive Care, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Mahidol Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Henrik Endeman
- Intensive Care, Erasmus University Medical Center, Doctor Molewaterplein 40, Rotterdam, The Netherlands
| | - Patricia van Velzen
- Dijklander Hospital Location Purmerend, Intensive Care, Waterlandlaan 250, Purmerend, The Netherlands
| | - Pieter R Tuinman
- Intensive Care, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Leiden IC Focused Echography, Amsterdam, The Netherlands
| | - Jurjan Aman
- Department of Pulmonology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
| | - Lieuwe D J Bos
- Intensive Care, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
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Choi HY, Kang HK, Heo MH, Lee SI, Kim JY, Kim KT, Park JS, Choe WJ, Kim KW, Kim JH. Severe pulmonary edema occurred during endobronchial ultrasound under monitored anesthesia care - A case report. Anesth Pain Med (Seoul) 2023; 18:439-444. [PMID: 37919928 PMCID: PMC10635853 DOI: 10.17085/apm.23085] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/11/2023] [Accepted: 10/06/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Endobronchial ultrasound (EBUS) is widely used to diagnose lung cancer. Monitored anesthesia care (MAC) can enhance patient comfort and procedural conditions during EBUS. EBUS under MAC is usually safe but can lead to various complications. CASE A 34-year-old male who had increased sputum for two months showed an enlarged paratracheal lymph node and planned for lymph node biopsy by EBUS. During EBUS under MAC, an unexpected oxygen saturation decline required intervention. After intubation, copious frothy fluid was suctioned from the bronchi, and oxygenation was recovered. A narrowed trachea and the EBUS bronchoscope might have resulted in upper airway obstruction, and suction performed under these conditions might have caused pulmonary edema. The patient received non-invasive ventilation and high-flow nasal cannula and recovered without complications. CONCLUSIONS When there is an expected risk of upper airway obstruction during EBUS, careful preoperative evaluation and preparation are essential to prevent negative pressure pulmonary edema.
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Affiliation(s)
- Hwan Yong Choi
- Department of Anesthesiology and Pain Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Hyung Koo Kang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Min Hee Heo
- Department of Anesthesiology and Pain Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Sang Il Lee
- Department of Anesthesiology and Pain Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Ji Yeon Kim
- Department of Anesthesiology and Pain Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Kyung-Tae Kim
- Department of Anesthesiology and Pain Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Jang Su Park
- Department of Anesthesiology and Pain Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Won Joo Choe
- Department of Anesthesiology and Pain Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Kyung Woo Kim
- Department of Anesthesiology and Pain Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Jun Hyun Kim
- Department of Anesthesiology and Pain Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
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15
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Mi Y, Huang L, Liu J, Chao H, Hu W, Shan G. High-altitude resident pulmonary edema induced by SARS-CoV-2 infection in children - A case series. Int J Infect Dis 2023; 135:118-122. [PMID: 37611798 DOI: 10.1016/j.ijid.2023.08.015] [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: 05/25/2023] [Revised: 07/25/2023] [Accepted: 08/15/2023] [Indexed: 08/25/2023] Open
Abstract
From December 2022 to January 2023, seven children aged ≤14 years and residing in an area at 2999 m without altitude change in the past month developed severe cough, dyspnea, cyanosis, and severe pulmonary lesions within 2-3 days after SARS-CoV-2 infection. They were diagnosed to have high-altitude resident pulmonary edema. They completely recovered following 4-7 days of treatment with oxygen inhalation, vasodilation, diuretics, and glucocorticoids.
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Affiliation(s)
- Yumei Mi
- Department of Infectious Disease, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, People's Republic of China; Pediatric Department, People's Hospital of Haixi Autonomous Prefecture of Qinghai Province, Delingha, People's Republic of China
| | - Lisu Huang
- Department of Infectious Disease, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, People's Republic of China
| | - Jieming Liu
- Department of Critical Care Medicine, Zhejiang Cancer Hospital, Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, People's Republic of China; Department of Critical Care Medicine, People's Hospital of Haixi Autonomous Prefecture of Qinghai Province, Delingha, People's Republic of China
| | - Huamao Chao
- Pediatric Department, People's Hospital of Haixi Autonomous Prefecture of Qinghai Province, Delingha, People's Republic of China
| | - Weilin Hu
- Department of Infectious Disease, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, People's Republic of China
| | - Guodong Shan
- Department of Gastroenterology, The First Affiliated Hospital of Zhejiang University, Hangzhou, People's Republic of China; Department of Gastroenterology, People's Hospital of Haixi Prefecture of Qinghai Province, Delingha, People's Republic of China.
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16
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Zeng J, Li Y, Liu J, Li L. Severe noncardiogenic pulmonary edema after cardiopulmonary bypass: Case report. Heliyon 2023; 9:e20846. [PMID: 37867906 PMCID: PMC10589860 DOI: 10.1016/j.heliyon.2023.e20846] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 10/09/2023] [Accepted: 10/09/2023] [Indexed: 10/24/2023] Open
Abstract
Lung injury is a common complication after cardiopulmonary bypass (CPB). However, cases of noncardiogenic pulmonary edema in which the patient ultimately requires extracorporeal membrane oxygenation (ECMO) support are uncommon. A 54-year-old man was admitted to the hospital with shortness of breath after activity and paroxysmal dyspnoea at night for 3 months. Infective endocarditis and acute heart failure were diagnosed. The patient underwent emergency surgery including aortic valve replacement, mitral valve replacement, tricuspid valve repair, and ventricular septal defect correction. It's noteworthy that the patient experienced significant pulmonary edema during the surgery and within 8 hours postoperatively, with over 3000 mL of yellow-clear fluid aspirated from the trachea and bronchi. The patient eventually recovered through ECMO V-V mode treatment. Inflammatory markers were markedly elevated during the perioperative period, and blood smear revealed Gram-positive bacterial infection. Blood NGS testing detected Streptococcus pneumoniae infection. Despite various factors contributing to the patient's pulmonary edema, it is hypothesized that the edema is related to uncontrolled inflammatory response and cytokine storm. Therefore, when significant pulmonary edema occurs during surgery, swift and decisive actions are necessary to avoid missing the optimal rescue window. If required, the use of ECMO is an effective final treatment option.
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Affiliation(s)
- Jianfeng Zeng
- Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yongxing Li
- Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jing Liu
- Department of Anesthesiology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Li Li
- Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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Abstract
How to cite this article: Havaldar AA, Krishna B. Wean to Win. Indian J Crit Care Med 2023;27(10):695-696.
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Affiliation(s)
- Amarja Ashok Havaldar
- Department of Critical Care, St. John's Medical College Hospital, Bengaluru, Karnataka, India
| | - Bhuvana Krishna
- Department of Critical Care, St. John's Medical College Hospital, Bengaluru, Karnataka, India
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18
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Imamura T, Narang N, Izumida T, Onoda H, Tanaka S, Ushijima R, Kinugawa K. Association of remote dielectric sensing and six-minute walk distance among those with severe aortic stenosis. J Cardiol 2023; 82:257-260. [PMID: 37209905 DOI: 10.1016/j.jjcc.2023.05.004] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 04/19/2023] [Accepted: 05/02/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND Remote dielectric sensing (ReDS) is a novel non-invasive electromagnetic energy-incorporated technology to quantify lung fluid levels. The six-minute walk test is an established method to assess exercise capacity among those with a variety of chronic conditions related to heart and pulmonary diseases. We aimed to understand the association between ReDS value and six-minute walk distance (6MWD) in patients with severe aortic stenosis being evaluated for valve replacement. METHODS Patients who were hospitalized to receive trans-catheter aortic valve replacement were prospectively included and simultaneous ReDS and 6MWD measurements were performed on admission. We attempted to correlate 6MWD with ReDS value. RESULTS A total of 25 patients (median 85 years, 11 men) were included. Median 6MWD was 168 (133, 244) meters and median ReDS value was 26 % (23 %, 30 %). 6MWD displayed a moderate inverse correlation with ReDS value (r = -0.516, p = 0.008) and significantly distinguished ReDS value ≥30 %, representing mild or greater pulmonary congestion, at a cut-off of 170 m (sensitivity 0.67 and specificity 1.00). CONCLUSIONS 6MWD had a moderate inverse correlation with ReDS values among candidates for trans-catheter aortic valve replacement, indicating that patients with shorter 6MWD had increased pulmonary congestion as assessed by ReDS system.
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Affiliation(s)
- Teruhiko Imamura
- Second Department of Internal Medicine, University of Toyama, Toyama, Japan.
| | | | - Toshihide Izumida
- Second Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Hiroshi Onoda
- Second Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Shuhei Tanaka
- Second Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Ryuichi Ushijima
- Second Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Koichiro Kinugawa
- Second Department of Internal Medicine, University of Toyama, Toyama, Japan
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19
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Wang Y, Wang Y, Ma J, Li Y, Cao L, Zhu T, Hu H, Liu H. YuPingFengSan ameliorates LPS-induced acute lung injury and gut barrier dysfunction in mice. J Ethnopharmacol 2023; 312:116452. [PMID: 37019161 DOI: 10.1016/j.jep.2023.116452] [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] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 03/24/2023] [Accepted: 03/31/2023] [Indexed: 05/08/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Yupingfengsan (YPFS) is a traditional Chinese medicine decoction. YPFS comprises Astragalus mongholicus Bunge (Huangqi), Atractylodes rubra Dekker (Baizhu), and Saposhnikovia divaricata (Turcz.ex Ledeb.) Schischk (Fangfeng). YPFS is commonly used to treat chronic obstructive pulmonary disease, asthma, respiratory infections, and pneumonia, but the mechanism of action remains unclear. AIM OF THE STUDY Acute lung injury (ALI) and its severe form of acute respiratory distress syndrome (ARDS) cause morbidity and mortality in critical patients. YPFS is a commonly used herbal soup to treat respiratory and immune system diseases. Nevertheless, the effect of YPFS on ALI remains unclear. This study aimed to investigate the effect of YPFS on lipopolysaccharide (LPS)-induced ALI in mice and elucidate its potential molecular mechanisms. MATERIALS AND METHODS The major components of YPFS were detected by High-performance liquid chromatography (HPLC). C57BL/6J mice were given YPFS for seven days and then treated with LPS. IL-1β, IL-6, TNF-α, IL-8, iNOS, NLRP3, PPARγ, HO-1, ZO-1, Occludin, Claudin-1, AQP3, AQP4, AQP5, ENaCα, ENaCβ, EnaCγ mRNA in lung and ZO-1, Occludin, Claudin-1, AQP3, AQP4, AQP5, ENaCα, ENaCβ, and EnaCγ mRNA in colon tissues were measured by Real-Time Quantitative PCR (RT-qPCR). The expressions of TLR4, MyD88, NOD-like receptor thermal protein domain associated protein 3 (NLRP3), ASC, MAPK signaling pathway, Nrf2, and HO-1 in the lung were detected by Western blot. Plasma inflammatory factors Interleukin (IL)-1β, IL-6, and Tumor Necrosis Factor-α (TNF-α) were determined by Enzyme-linked Immunosorbent Assay (ELISA). Lung tissues were processed for H & E staining, and colon tissues for HE, WGA-FITC, and Alcian Blue staining. RESULTS The results showed that YPFS administration alleviated lung injury and suppressed the production of inflammatory factors, including IL-1β, IL-6, and TNF-α. Additionally, YPFS reduced pulmonary edema by promoting the expressions of aquaporin and sodium channel-related genes (AQP3, AQP4, AQP5, ENaCα, ENaCβ, and EnaCγ). Further, YPFS intervention exhibited a therapeutic effect on ALI by inhibiting the activation of the NLRP3 inflammasome and MAPK signaling pathways. Finally, YPFS improved gut barrier integrity and suppressed intestinal inflammation in LPS-challenged mice. CONCLUSIONS YPFS protected mice against LPS-induced ALI by attenuating lung and intestinal tissue damage. This study sheds light on the potential application of YPFS to treat ALI/ARDS.
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Affiliation(s)
- Yao Wang
- College of Basic Medical Sciences, Hubei University of Chinese Medicine, Huangjiahu West Road 16, Wuhan, 430065, PR China; College of Acupuncture and Orthopedics, Hubei University of Chinese Medicine, Huangjiahu West Road 16, Wuhan, 430065, PR China
| | - Yanchun Wang
- Clinical College of Traditional Chinese Medicine, Hubei University of Chinese Medicine, Huangjiahu West Road 16, Wuhan, 430065, PR China
| | - Jun Ma
- College of Acupuncture and Orthopedics, Hubei University of Chinese Medicine, Huangjiahu West Road 16, Wuhan, 430065, PR China
| | - Yanan Li
- College of Acupuncture and Orthopedics, Hubei University of Chinese Medicine, Huangjiahu West Road 16, Wuhan, 430065, PR China
| | - Lu Cao
- College of Basic Medical Sciences, Hubei University of Chinese Medicine, Huangjiahu West Road 16, Wuhan, 430065, PR China
| | - Tianxiang Zhu
- College of Basic Medical Sciences, Hubei University of Chinese Medicine, Huangjiahu West Road 16, Wuhan, 430065, PR China
| | - Haiming Hu
- College of Basic Medical Sciences, Hubei University of Chinese Medicine, Huangjiahu West Road 16, Wuhan, 430065, PR China.
| | - Hongtao Liu
- College of Basic Medical Sciences, Hubei University of Chinese Medicine, Huangjiahu West Road 16, Wuhan, 430065, PR China.
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Vergouwen MDI, Rinkel GJE. Emergency Medical Management of Aneurysmal Subarachnoid Hemorrhage. Neurocrit Care 2023; 39:51-58. [PMID: 37344653 PMCID: PMC10499704 DOI: 10.1007/s12028-023-01757-7] [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: 03/27/2023] [Accepted: 05/08/2023] [Indexed: 06/23/2023]
Abstract
Aneurysmal subarachnoid hemorrhage is a medical emergency that necessitates direct transfer to a tertiary referral center specialized in the diagnosis and treatment of this condition. The initial hours after aneurysmal rupture are critical for patients with aneurysmal subarachnoid hemorrhage, both in terms of rebleeding and combating the effect of early brain injury. No good treatment options are available to reduce the risk of rebleeding before aneurysm occlusion. Lowering the blood pressure may reduce the risk of rebleeding but carries a risk of inducing delayed cerebral ischemia or aggravating the consequences of early brain injury. Early brain injury after aneurysmal rupture has an important effect on final clinical outcome. Proper cerebral perfusion is pivotal in these initial hours after aneurysmal rupture but threatened by complications such as neurogenic pulmonary edema and cardiac stunning, or by acute hydrocephalus, which may necessitate early drainage of cerebrospinal fluid.
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Affiliation(s)
- Mervyn D I Vergouwen
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
| | - Gabriel J E Rinkel
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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21
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Tian L, Zhao C, Yan Y, Jia Q, Cui S, Chen H, Li X, Jiang H, Yao Y, He K, Zhao X. Ceramide-1-phosphate alleviates high-altitude pulmonary edema by stabilizing circadian ARNTL-mediated mitochondrial dynamics. J Adv Res 2023:S2090-1232(23)00200-X. [PMID: 37479181 DOI: 10.1016/j.jare.2023.07.008] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/25/2023] [Accepted: 07/18/2023] [Indexed: 07/23/2023] Open
Abstract
INTRODUCTION High-altitude pulmonary edema (HAPE) is a severe and potentially fatal condition with limited treatment options. Although ceramide kinase (CERK)-derived ceramide-1-phosphate (C1P) has been demonstrated to offer protection against various pulmonary diseases, its effects on HAPE remain unclear. OBJECTIVES Our study aimed to investigate the potential role of CERK-derived C1P in the development of HAPE and to reveal the molecular mechanisms underlying its protective effects. We hypothesized that CERK-derived C1P could protect against HAPE by stabilizing circadian rhythms and maintaining mitochondrial dynamics. METHODS To test our hypothesis, we used CERK-knockout mice and established HAPE mouse models using a FLYDWC50-1C hypobaric hypoxic cabin. We utilized a range of methods, including lipidomics, transcriptomics, immunofluorescence, Western blotting, and transmission electron microscopy, to identify the mechanisms of regulation. RESULTS Our findings demonstrated that CERK-derived C1P played a protective role against HAPE. Inhibition of CERK exacerbated HAPE induced by the hypobaric hypoxic environment. Specifically, we identified a novel mechanism in which CERK inhibition induced aryl hydrocarbon receptor nuclear translocator-like (ARNTL) autophagic degradation, inducing the circadian rhythm and triggering mitochondrial damage by controlling the expression of proteins required for mitochondrial fission and fusion. The decreased ARNTL caused by CERK inhibition impaired mitochondrial dynamics, induced oxidative stress damage, and resulted in defects in mitophagy, particularly under hypoxia. Exogenous C1P prevented ARNTL degradation, alleviated mitochondrial damage, neutralized oxidative stress induced by CERK inhibition, and ultimately relieved HAPE. CONCLUSIONS This study provides evidence for the protective effect of C1P against HAPE, specifically, through stabilizing circadian rhythms and maintaining mitochondrial dynamics. Exogenous C1P therapy may be a promising strategy for treating HAPE. Our findings also highlight the importance of the circadian rhythm and mitochondrial dynamics in the pathogenesis of HAPE, suggesting that targeting these pathways may be a potential therapeutic approach for this condition.
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Affiliation(s)
- Liuyang Tian
- School of Medicine, Nankai University, Tianjin, 300071, China; Medical Big Data Research Center, Medical Innovation Research Division of the Chinese PLA General Hospital, Beijing, 100853, China; National Engineering Research Center for Medical Big Data Application Technology, the Chinese PLA General Hospital, Beijing, 100853, China
| | - Chenghui Zhao
- National Engineering Research Center for Medical Big Data Application Technology, the Chinese PLA General Hospital, Beijing, 100853, China; Research Center for Biomedical Engineering, Medical Innovation Research Division of the Chinese PLA General Hospital, Beijing, 100853, China
| | - Yan Yan
- Research Center for Translational Medicine, Medical Innovation Research Division of the Chinese PLA General Hospital, Beijing, 100853, China
| | - Qian Jia
- National Engineering Research Center for Medical Big Data Application Technology, the Chinese PLA General Hospital, Beijing, 100853, China; Research Center for Translational Medicine, Medical Innovation Research Division of the Chinese PLA General Hospital, Beijing, 100853, China
| | - Saijia Cui
- Research Center for Translational Medicine, Medical Innovation Research Division of the Chinese PLA General Hospital, Beijing, 100853, China
| | - Huining Chen
- Research Center for Translational Medicine, Medical Innovation Research Division of the Chinese PLA General Hospital, Beijing, 100853, China
| | - Xiaolu Li
- Experimental Research Center, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University Beijing Anzhen Hospital, Beijing, 100029, China
| | - Hongfeng Jiang
- Experimental Research Center, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University Beijing Anzhen Hospital, Beijing, 100029, China
| | - Yongming Yao
- Experimental Research Center, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University Beijing Anzhen Hospital, Beijing, 100029, China.
| | - Kunlun He
- Medical Big Data Research Center, Medical Innovation Research Division of the Chinese PLA General Hospital, Beijing, 100853, China; National Engineering Research Center for Medical Big Data Application Technology, the Chinese PLA General Hospital, Beijing, 100853, China; School of Medicine, Nankai University, Tianjin, 300071, China.
| | - Xiaojing Zhao
- National Engineering Research Center for Medical Big Data Application Technology, the Chinese PLA General Hospital, Beijing, 100853, China; Research Center for Translational Medicine, Medical Innovation Research Division of the Chinese PLA General Hospital, Beijing, 100853, China.
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De Pinho A, Mota De Sousa A, Melo A, Ferreira A. Unknown rheumatic cardiac disease as cause of acute onset post-partum dyspnea: a case report. BMC Pregnancy Childbirth 2023; 23:489. [PMID: 37400772 PMCID: PMC10316575 DOI: 10.1186/s12884-023-05809-w] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 06/23/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND Acute post-partum dyspnea configures an obstetric challenge with multiple differential diagnosis. CASE PRESENTATION We present a case of a previous healthy woman with preeclampsia who developed severe dyspnea 30 h after delivery. She complained of cough, orthopnea, and bilateral lower extremities oedema. She denied headaches, blurry vision, nausea, vomiting, fever or chills. Auscultation revealed a diastolic murmur, and was compatible with pulmonary oedema. A timely bedside echocardiogram showed moderate dilated left atrium with severe mitral insufficiency suggestive of an unknown rheumatic disease. She was managed with noninvasive ventilation, loop diuretics, vasodilators, thromboprophylaxis, head-end elevation, and fluid restriction with progressive improving. CONCLUSIONS Hemodynamic changes in pregnant patients with previously silent cardiac disease may pose a challenge and cause post-partum dyspnea. This scenario requires a timely and multidisciplinary approach.
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Affiliation(s)
- António De Pinho
- Obstetrics and Gynecology Department - Tâmega E Sousa Hospital Center, Penafiel - Porto, Avenida do Hospital Padre Américo 210, Penafiel, 4564-007, Portugal.
- Biomedicine Department - Faculty of Medicine, University of Porto, Porto, Portugal.
- Pediatrics and Gynecology/Obstetrics Department - Faculty of Medicine, University of Porto, Porto, Portugal.
| | - Andreia Mota De Sousa
- Obstetrics and Gynecology Department - Tâmega E Sousa Hospital Center, Penafiel - Porto, Avenida do Hospital Padre Américo 210, Penafiel, 4564-007, Portugal
| | - Anabela Melo
- Obstetrics and Gynecology Department - Tâmega E Sousa Hospital Center, Penafiel - Porto, Avenida do Hospital Padre Américo 210, Penafiel, 4564-007, Portugal
| | - Anabela Ferreira
- Obstetrics and Gynecology Department - Tâmega E Sousa Hospital Center, Penafiel - Porto, Avenida do Hospital Padre Américo 210, Penafiel, 4564-007, Portugal
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23
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Atmowihardjo LN, Schippers JR, Duijvelaar E, Bartelink IH, Bet PM, Swart NEL, van Rein N, Purdy K, Cavalla D, McElroy A, Fritchley S, Vonk Noordegraaf A, Endeman H, van Velzen P, Koopmans M, Bogaard HJ, Heunks L, Juffermans N, Schultz MJ, Tuinman PR, Bos LDJ, Aman J. Efficacy and safety of intravenous imatinib in COVID-19 ARDS: a randomized, double-blind, placebo-controlled clinical trial. Crit Care 2023; 27:226. [PMID: 37291677 DOI: 10.1186/s13054-023-04516-4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 05/31/2023] [Indexed: 06/10/2023] Open
Abstract
PURPOSE A hallmark of acute respiratory distress syndrome (ARDS) is hypoxaemic respiratory failure due to pulmonary vascular hyperpermeability. The tyrosine kinase inhibitor imatinib reversed pulmonary capillary leak in preclinical studies and improved clinical outcomes in hospitalized COVID-19 patients. We investigated the effect of intravenous (IV) imatinib on pulmonary edema in COVID-19 ARDS. METHODS This was a multicenter, randomized, double-blind, placebo-controlled trial. Invasively ventilated patients with moderate-to-severe COVID-19 ARDS were randomized to 200 mg IV imatinib or placebo twice daily for a maximum of seven days. The primary outcome was the change in extravascular lung water index (∆EVLWi) between days 1 and 4. Secondary outcomes included safety, duration of invasive ventilation, ventilator-free days (VFD) and 28-day mortality. Posthoc analyses were performed in previously identified biological subphenotypes. RESULTS 66 patients were randomized to imatinib (n = 33) or placebo (n = 33). There was no difference in ∆EVLWi between the groups (0.19 ml/kg, 95% CI - 3.16 to 2.77, p = 0.89). Imatinib treatment did not affect duration of invasive ventilation (p = 0.29), VFD (p = 0.29) or 28-day mortality (p = 0.79). IV imatinib was well-tolerated and appeared safe. In a subgroup of patients characterized by high IL-6, TNFR1 and SP-D levels (n = 20), imatinib significantly decreased EVLWi per treatment day (- 1.17 ml/kg, 95% CI - 1.87 to - 0.44). CONCLUSIONS IV imatinib did not reduce pulmonary edema or improve clinical outcomes in invasively ventilated COVID-19 patients. While this trial does not support the use of imatinib in the general COVID-19 ARDS population, imatinib reduced pulmonary edema in a subgroup of patients, underscoring the potential value of predictive enrichment in ARDS trials. Trial registration NCT04794088 , registered 11 March 2021. European Clinical Trials Database (EudraCT number: 2020-005447-23).
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Affiliation(s)
- Leila N Atmowihardjo
- Intensive Care, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Job R Schippers
- Department of Pulmonary Medicine, Amsterdam University Medical Centers, Location VUmc, Room number 5A-074, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Erik Duijvelaar
- Department of Pulmonary Medicine, Amsterdam University Medical Centers, Location VUmc, Room number 5A-074, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Imke H Bartelink
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
| | - Pierre M Bet
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
| | - Noortje E L Swart
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Nienke van Rein
- Department of Clinical Pharmacology and Pharmacy, Leiden UMC, Albinusdreef 2, Leiden, The Netherlands
| | | | | | | | | | - Anton Vonk Noordegraaf
- Department of Pulmonary Medicine, Amsterdam University Medical Centers, Location VUmc, Room number 5A-074, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Henrik Endeman
- Intensive Care, Erasmus University Medical Centre, Doctor Molewaterplein 40, Rotterdam, The Netherlands
| | - Patricia van Velzen
- Intensive Care, Dijklander Hospital, Location Purmerend, Waterlandlaan 250, Purmerend, The Netherlands
| | - Matty Koopmans
- Intensive Care, OLVG Hospital Location Oost, Oosterpark 9, Amsterdam, The Netherlands
| | - Harm Jan Bogaard
- Department of Pulmonary Medicine, Amsterdam University Medical Centers, Location VUmc, Room number 5A-074, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Leo Heunks
- Intensive Care, Erasmus University Medical Centre, Doctor Molewaterplein 40, Rotterdam, The Netherlands
| | - Nicole Juffermans
- Intensive Care, OLVG Hospital Location Oost, Oosterpark 9, Amsterdam, The Netherlands
- Laboratory of Translational Intensive Care, Erasmus University, Rotterdam, The Netherlands
| | - Marcus J Schultz
- Intensive Care, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Mahidol Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Department of Research and Development, Hamilton Medical AG, Chur, Switzerland
| | - Pieter R Tuinman
- Intensive Care, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
| | - Lieuwe D J Bos
- Intensive Care, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Department of Pulmonary Medicine, Amsterdam University Medical Centers, Location VUmc, Room number 5A-074, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Jurjan Aman
- Department of Pulmonary Medicine, Amsterdam University Medical Centers, Location VUmc, Room number 5A-074, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
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24
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Gottlieb M, Patel D, Viars M, Tsintolas J, Peksa GD, Bailitz J. Comparison of artificial intelligence versus real-time physician assessment of pulmonary edema with lung ultrasound. Am J Emerg Med 2023; 70:109-112. [PMID: 37269797 DOI: 10.1016/j.ajem.2023.05.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 04/13/2023] [Revised: 05/13/2023] [Accepted: 05/20/2023] [Indexed: 06/05/2023] Open
Abstract
BACKGROUND Lung ultrasound can evaluate for pulmonary edema, but data suggest moderate inter-rater reliability among users. Artificial intelligence (AI) has been proposed as a model to increase the accuracy of B line interpretation. Early data suggest a benefit among more novice users, but data are limited among average residency-trained physicians. The objective of this study was to compare the accuracy of AI versus real-time physician assessment for B lines. METHODS This was a prospective, observational study of adult Emergency Department patients presenting with suspected pulmonary edema. We excluded patients with active COVID-19 or interstitial lung disease. A physician performed thoracic ultrasound using the 12-zone technique. The physician recorded a video clip in each zone and provided an interpretation of positive (≥3 B lines or a wide, dense B line) or negative (<3 B lines and the absence of a wide, dense B line) for pulmonary edema based upon the real-time assessment. A research assistant then utilized the AI program to analyze the same saved clip to determine if it was positive versus negative for pulmonary edema. The physician sonographer was blinded to this assessment. The video clips were then reviewed independently by two expert physician sonographers (ultrasound leaders with >10,000 prior ultrasound image reviews) who were blinded to the AI and initial determinations. The experts reviewed all discordant values and reached consensus on whether the field (i.e., the area of lung between two adjacent ribs) was positive or negative using the same criteria as defined above, which served as the gold standard. RESULTS 71 patients were included in the study (56.3% female; mean BMI: 33.4 [95% CI 30.6-36.2]), with 88.3% (752/852) of lung fields being of adequate quality for assessment. Overall, 36.1% of lung fields were positive for pulmonary edema. The physician was 96.7% (95% CI 93.8%-98.5%) sensitive and 79.1% (95% CI 75.1%-82.6%) specific. The AI software was 95.6% (95% CI 92.4%-97.7%) sensitive and 64.1% (95% CI 59.8%-68.5%) specific. CONCLUSION Both the physician and AI software were highly sensitive, though the physician was more specific. Future research should identify which factors are associated with increased diagnostic accuracy.
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Affiliation(s)
- Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, United States of America.
| | - Daven Patel
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, United States of America.
| | - Miranda Viars
- Rush Medical College, Chicago, IL, United States of America.
| | - Jack Tsintolas
- Rush Medical College, Chicago, IL, United States of America.
| | - Gary D Peksa
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, United States of America.
| | - John Bailitz
- Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America.
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25
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Schulz D, Rasch S, Heilmaier M, Abbassi R, Poszler A, Ulrich J, Steinhardt M, Kaissis GA, Schmid RM, Braren R, Lahmer T. A deep learning model enables accurate prediction and quantification of pulmonary edema from chest X-rays. Crit Care 2023; 27:201. [PMID: 37237287 DOI: 10.1186/s13054-023-04426-5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 04/02/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND A quantitative assessment of pulmonary edema is important because the clinical severity can range from mild impairment to life threatening. A quantitative surrogate measure, although invasive, for pulmonary edema is the extravascular lung water index (EVLWI) extracted from the transpulmonary thermodilution (TPTD). Severity of edema from chest X-rays, to date is based on the subjective classification of radiologists. In this work, we use machine learning to quantitatively predict the severity of pulmonary edema from chest radiography. METHODS We retrospectively included 471 X-rays from 431 patients who underwent chest radiography and TPTD measurement within 24 h at our intensive care unit. The EVLWI extracted from the TPTD was used as a quantitative measure for pulmonary edema. We used a deep learning approach and binned the data into two, three, four and five classes increasing the resolution of the EVLWI prediction from the X-rays. RESULTS The accuracy, area under the receiver operating characteristic curve (AUROC) and Mathews correlation coefficient (MCC) in the binary classification models (EVLWI < 15, ≥ 15) were 0.93 (accuracy), 0.98 (AUROC) and 0.86(MCC). In the three multiclass models, the accuracy ranged between 0.90 and 0.95, the AUROC between 0.97 and 0.99 and the MCC between 0.86 and 0.92. CONCLUSION Deep learning can quantify pulmonary edema as measured by EVLWI with high accuracy.
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Affiliation(s)
- Dominik Schulz
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar, Munich, Germany.
- III. Medizinische Klinik, Universitätsklinikum Augsburg, Augsburg, Germany.
| | - Sebastian Rasch
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar, Munich, Germany
| | - Markus Heilmaier
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar, Munich, Germany
| | - Rami Abbassi
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar, Munich, Germany
| | - Alexander Poszler
- Innere Medizin - Gastroenterologie, Krankenhaus Agatharied, Hausham, Germany
| | - Jörg Ulrich
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar, Munich, Germany
| | - Manuel Steinhardt
- Institute for Diagnostic and Interventional Radiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Georgios A Kaissis
- Institute for Diagnostic and Interventional Radiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Roland M Schmid
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar, Munich, Germany
| | - Rickmer Braren
- Institute for Diagnostic and Interventional Radiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Tobias Lahmer
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar, Munich, Germany
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26
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Zhang H, Lian H, Wang X, Zhang Q, Liu D. Tricuspid annular plane systolic excursion/mitral annular plane systolic excursion ratio in critically ill patients: an index of right- and left-ventricular function mismatch and a risk factor for cardiogenic pulmonary edema. BMC Anesthesiol 2023; 23:175. [PMID: 37217863 DOI: 10.1186/s12871-023-02142-9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 05/16/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND This study aimed to explore whether the tricuspid annular systolic excursion (TAPSE)/mitral annular systolic excursion (MAPSE) ratio was associated with the occurrence of cardiogenic pulmonary edema (CPE) in critically ill patients. MATERIALS AND METHODS This was a prospective observational study conducted in a tertiary hospital. Adult patients admitted to the intensive care unit who were on mechanical ventilation or in need of oxygen therapy were prospectively screened for enrolment. The diagnosis of CPE was determined based on lung ultrasound and echocardiography findings. TAPSE ≥ 17 mm and MAPSE ≥ 11 mm were used as normal references. RESULTS Among the 290 patients enrolled in this study, 86 had CPE. In the logistic regression analysis, the TASPE/MAPSE ratio was independently associated with the occurrence of CPE (odds ratio 4.855, 95% CI: 2.215-10.641, p < 0.001). The patients' heart function could be categorized into four types: normal TAPSE in combination with normal MAPSE (TAPSE↑/MAPSE↑) (n = 157), abnormal TAPSE in combination with abnormal MAPSE (TAPSE↓/MAPSE↓) (n = 40), abnormal TAPSE in combination with normal MAPSE (TAPSE↓/MAPSE↑) (n = 50) and normal TAPSE in combination with abnormal MAPSE (TAPSE↑/MAPSE↓) (n = 43). The prevalence of CPE in patients with TAPSE↑/MAPSE↓ (86.0%) was significantly higher than that in patients with TAPSE↑/MAPSE↑ (15.3%), TAPSE↓/MAPSE↓ (37.5%), or TAPSE↓/MAPSE↑ (20.0%) (p < 0.001). The ROC analysis showed that the area under the curve for the TAPSE/MAPSE ratio was 0.761 (95% CI: 0.698-0.824, p < 0.001). A TAPSE/MAPSE ratio of 1.7 allowed the identification of patients at risk of CPE with a sensitivity of 62.8%, a specificity of 77.9%, a positive predictive value of 54.7% and a negative predictive value of 83.3%. CONCLUSIONS The TAPSE/MAPSE ratio can be used to identify critically ill patients at higher risk of CPE.
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Affiliation(s)
- Hongmin Zhang
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1# Shuai Fu Yuan, Dong Cheng District, Beijing, 100730, China.
| | - Hui Lian
- Department of Health Care, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaoting Wang
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1# Shuai Fu Yuan, Dong Cheng District, Beijing, 100730, China.
| | - Qing Zhang
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1# Shuai Fu Yuan, Dong Cheng District, Beijing, 100730, China
| | - Dawei Liu
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1# Shuai Fu Yuan, Dong Cheng District, Beijing, 100730, China
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27
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Liang TY, Lu LH, Tang SY, Zheng ZH, Shi K, Liu JQ. Current status and prospects of basic research and clinical application of mesenchymal stem cells in acute respiratory distress syndrome. World J Stem Cells 2023; 15:150-164. [PMID: 37180997 PMCID: PMC10173811 DOI: 10.4252/wjsc.v15.i4.150] [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: 12/20/2022] [Revised: 01/20/2023] [Accepted: 03/20/2023] [Indexed: 04/26/2023] Open
Abstract
Acute respiratory distress syndrome (ARDS) is a common and clinically devastating disease that causes respiratory failure. Morbidity and mortality of patients in intensive care units are stubbornly high, and various complications severely affect the quality of life of survivors. The pathophysiology of ARDS includes increased alveolar-capillary membrane permeability, an influx of protein-rich pulmonary edema fluid, and surfactant dysfunction leading to severe hypoxemia. At present, the main treatment for ARDS is mechanical treatment combined with diuretics to reduce pulmonary edema, which primarily improves symptoms, but the prognosis of patients with ARDS is still very poor. Mesenchymal stem cells (MSCs) are stromal cells that possess the capacity to self-renew and also exhibit multilineage differentiation. MSCs can be isolated from a variety of tissues, such as the umbilical cord, endometrial polyps, menstrual blood, bone marrow, and adipose tissues. Studies have confirmed the critical healing and immunomodulatory properties of MSCs in the treatment of a variety of diseases. Recently, the potential of stem cells in treating ARDS has been explored via basic research and clinical trials. The efficacy of MSCs has been shown in a variety of in vivo models of ARDS, reducing bacterial pneumonia and ischemia-reperfusion injury while promoting the repair of ventilator-induced lung injury. This article reviews the current basic research findings and clinical applications of MSCs in the treatment of ARDS in order to emphasize the clinical prospects of MSCs.
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Affiliation(s)
- Tian-Yu Liang
- Emergency and Critical Care Center, Intensive Care Unit, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou 310014, Zhejiang Province, China
| | - Li-Hai Lu
- Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
| | - Si-Yu Tang
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
| | - Zi-Hao Zheng
- Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
| | - Kai Shi
- Department of Respiratory Medicine, The Affiliated Hospital of Hangzhou Normal University, Hangzhou 310015, Zhejiang Province, China
| | - Jing-Quan Liu
- Emergency and Critical Care Center, Intensive Care Unit, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou 310014, Zhejiang Province, China.
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28
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Saeed O, Nunez JI, Jorde UP. Pulmonary Protection from Left Ventricular Distension During Venoarterial Extracorporeal Membrane Oxygenation: Review and Management Algorithm. Lung 2023; 201:119-134. [PMID: 37043003 DOI: 10.1007/s00408-023-00616-8] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 03/22/2023] [Indexed: 04/13/2023]
Abstract
The use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) in adults for refractory cardiogenic shock has risen exponentially during the prior decade. Although VA-ECMO provides cardiopulmonary support, it can alter left ventricular (LV) loading conditions leading to LV distension, which makes the lungs susceptible to congestion and promotes intracardiac thrombosis. These conditions can be alleviated by pharmacologic and mechanical unloading, but gaps in knowledge remain on optimal timing and methods of this approach. This review provides an overview of the epidemiology of VA-ECMO, describes pathophysiology and methods for monitoring and reducing LV loading and summarizes contemporary studies examining the association between LV unloading and adverse events. We offer a simple protocol for implementing LV unloading during VA-ECMO to provide pulmonary protection and improve outcomes.
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Affiliation(s)
- Omar Saeed
- Department of Medicine, Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, 3400 Bainbridge Avenue, Bronx, NY, 10023, USA.
| | - Jose I Nunez
- Department of Medicine, Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, 3400 Bainbridge Avenue, Bronx, NY, 10023, USA
| | - Ulrich P Jorde
- Department of Medicine, Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, 3400 Bainbridge Avenue, Bronx, NY, 10023, USA
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29
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Abstract
We investigated the agreement between remote dielectric sensing (ReDS) system, which is a recently introduced non-invasive technology to quantify the degree of pulmonary congestion, and lung ultrasound (LUS), which is a gold standard to assess the existence of severe pulmonary congestion. Consecutive patients who were hospitalized to examine the cause of heart failure and treat their heart failure in our institute were prospectively included. They received LUS and simultaneous ReDS measurements. Three or more B-lines at each LUS zone was assigned to B-profile positive, indicating the existence of significant pulmonary congestion. ReDS values ≥ 35% were defined as significant pulmonary congestion. A total of 19 heart failure patients were included (77 years, 13 men). Plasma B-type natriuretic peptide level was 131 (36, 416) pg/ml. Three patients had B-profile, indicating significant pulmonary congestion, and two of them had ≥ 35% of ReDS (sensitivity 66.7%, specificity 87.5%, and negative predictive value 93.3%). Most of the patients (79%) had lower B-lines below 3 and did not satisfy the criteria of B-profile, irrespective of wide ranges of ReDS values. ReDS system had as acceptable predictability as LUS in assessing the existence of significant pulmonary congestion. ReDS would be recommended to rule out significant pulmonary congestion or quantify the degree of less significant pulmonary congestion.
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Affiliation(s)
- Toshihide Izumida
- Second Department of Internal Medicine, University of Toyama, 2630 Sugitani Toyama, Toyama, 930-0194, Japan
| | - Teruhiko Imamura
- Second Department of Internal Medicine, University of Toyama, 2630 Sugitani Toyama, Toyama, 930-0194, Japan.
| | - Koichiro Kinugawa
- Second Department of Internal Medicine, University of Toyama, 2630 Sugitani Toyama, Toyama, 930-0194, Japan
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30
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Kelly GS, Branstetter LA, Moran TP, Hanzelka N, Cooper CD. Low- versus high-dose nitroglycerin infusion in the management of acute pulmonary edema. Am J Emerg Med 2023; 65:71-75. [PMID: 36587564 DOI: 10.1016/j.ajem.2022.12.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 11/12/2022] [Revised: 12/15/2022] [Accepted: 12/18/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Nitroglycerin (NTG) is commonly used for the management of pulmonary edema in acute heart failure presentations. Although commonly initiated at low infusion rates, higher infusion rates have favorable pharmacodynamic properties and may improve outcomes in the management of acute pulmonary edema. OBJECTIVES To characterize the clinical outcomes including the time to resolution of severe hypertension when using an initial low dose (<100 μg/min) versus high-dose (≥100 μg/min) strategy. METHODS This was a retrospective study performed at a single, tertiary academic emergency department in Atlanta, GA. We describe the blood pressure effects and key safety outcomes (intubation, hypotension, intensive care unit admissions) during the first hour of treatment of acute pulmonary edema. RESULTS 41 patients were included in the final sample. 27 (66%) received low dose NTG and 14 (34%) received high dose NTG. The high dose group reached their blood pressure faster on average (hazard ratio = 3.5, 95% CI: 1.2-10.1). 8/14 (57%) of patients in the high dose group reached their BP target within the first hour of treatment, compared to 6/27 (22%) in the low dose group. Observed incidence of safety outcomes were similar between the two groups. CONCLUSIONS Higher initial NTG doses may be an effective way to decrease times to achieve blood pressure targets and should be the focus of future trials.
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Affiliation(s)
- Geoffrey S Kelly
- Emory University School of Medicine, Department of Emergency Medicine, 550 W Peachtree St NW, Atlanta, GA 30308, United States of America..
| | - Lindsey A Branstetter
- Emory University, Emergency Medicine Clinical Pharmacy Specialist, Department of Pharmacy, 550 W Peachtree St NW, Atlanta, GA 30308, United States of America
| | - Tim P Moran
- Emory University School of Medicine, Department of Emergency Medicine, 550 W Peachtree St NW, Atlanta, GA 30308, United States of America
| | - Nathan Hanzelka
- University of Georgia College of Pharmacy, 550 W Peachtree St NW, Atlanta, GA 30308, United States of America
| | - Claudia D Cooper
- Emory University, Emergency Medicine Clinical Pharmacy Specialist, Department of Pharmacy, 550 W Peachtree St NW, Atlanta, GA 30308, United States of America
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Phillip R, Howard J, Hawamdeh H, Tribble T, Gurley J, Saha S. Left Atrial Veno-Arterial Extracorporeal Membrane Oxygenation Case Series: A Single-Center Experience. J Surg Res 2023; 281:238-244. [PMID: 36209682 DOI: 10.1016/j.jss.2022.08.020] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 08/01/2022] [Accepted: 08/20/2022] [Indexed: 11/21/2022]
Abstract
INTRODUCTION We aimed to review the characteristics and outcomes of left atrial veno-arterial extra corporeal membrane oxygenation (LAVA ECMO) at our institution over a 4-y period from 2017 to 2020. METHODS Among 227 adult patients who received VA ECMO support from January 2017 to December 2020, we reviewed 33 of these who underwent transseptal cannulation and were converted to LAVA ECMO. The timing of transseptal cannulation, either at initiation of VA ECMO (n = 25) or with a later transseptal cannulation to treat complications of left ventricular (LV) distention while on VA ECMO (n = 8), was reviewed. The clinical characteristics, indications, echocardiography data, and outcomes were assessed. RESULTS Duration of LAVA ECMO support ranged from 1 to 13 d, with a median of 5 d. Successful weaning from the LAVA ECMO circuit was achieved for 15 patients (45%). The in-hospital mortality rate was 66%. There were 11 patients (33%) who survived to be discharged from the hospital. CONCLUSIONS LV distention is a known complication of VA ECMO and impedes the recovery of the heart. LAVA ECMO provides a novel approach to treating LV distention. Additionally, our review shows that this modality may be used as a bridge to durable mechanical circulatory support, cardiac transplantation, or recovery.
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Affiliation(s)
- Rebecca Phillip
- Department of Surgery, University of Kentucky, Lexington, Kentucky; Division of Cardiothoracic Surgery, University of Kentucky, Lexington, Kentucky.
| | - Jordan Howard
- UK College of Medicine - 3(rd) Year, University of Kentucky, Lexington, Kentucky
| | - Hussam Hawamdeh
- Division of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky
| | - Thomas Tribble
- UK HealthCare Extracorporeal Life Support (ECLS), University of Kentucky, Lexington, Kentucky
| | - John Gurley
- Division of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky
| | - Sibu Saha
- Department of Surgery, University of Kentucky, Lexington, Kentucky; Division of Cardiothoracic Surgery, University of Kentucky, Lexington, Kentucky
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Kimura BJ, Nayak KR. Point-of-care ultrasound in acute coronary syndrome-it's about time. Intern Emerg Med 2023; 18:15-17. [PMID: 36334186 DOI: 10.1007/s11739-022-03145-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 10/21/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Bruce J Kimura
- Departments of Cardiology and Medicine, Scripps Mercy Hospital, 501 Washington St, #512, San Diego, CA, 92103, USA.
| | - Keshav R Nayak
- Departments of Cardiology and Medicine, Scripps Mercy Hospital, 501 Washington St, #512, San Diego, CA, 92103, USA
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Izumida T, Imamura T, Nakagaito M, Onoda H, Tanaka S, Ushijima R, Fujioka H, Kakeshita K, Kinugawa K. Association Between Remote Dielectric Sensing and Body Mass Index. Int Heart J 2023; 64:865-869. [PMID: 37778989 DOI: 10.1536/ihj.23-191] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
Remote dielectric sensing (ReDS) is a non-invasive, electromagnetic energy-based technology to quantify pulmonary congestion. However, the accuracy of ReDS values in patients with a variety of physiques has not been fully validated.Prospective successive measurements of ReDS values and body mass index (BMI) were performed on admission in consecutive hospitalized patients with cardiovascular diseases. Patients were stratified into 4 groups according to the WHO classification: underweight (BMI < 18.5), normal weight (18.5 ≤ BMI < 24.9), pre-obese (25.0 ≤ BMI < 29.9), and obese (30.0 ≤ BMI). The indexed ReDS value was defined as a ReDS value divided by the modified congestion score index (the severity of pulmonary congestion on chest X-ray). The indexed ReDS values were compared among the 4 stratified groups.A total of 436 patients (76 [69, 82] years old and 254 men) were included. The median indexed ReDS values were 21.3 (19.1, 23.8), 25.7 (21.0, 29.5), 25.7 (20.3, 31.0), and 28.0 (21.1, 34.0) in underweight, normal weight, pre-obese, and obese patients, respectively, highlighting the underweight group had the lowest values (P < 0.001).ReDS values may be underestimated and specific caution should be paid in its interpretation in underweight patients.
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Affiliation(s)
| | | | | | - Hiroshi Onoda
- Second Department of Internal Medicine, University of Toyama
| | - Shuhei Tanaka
- Second Department of Internal Medicine, University of Toyama
| | | | - Hayato Fujioka
- Second Department of Internal Medicine, University of Toyama
| | - Kota Kakeshita
- Second Department of Internal Medicine, University of Toyama
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Ayata R, Fujita M, Harada K, Esaki Y, Koga Y, Hisamoto Y, Asami-Noyama M, Takeda S, Harada K, Tsuruta R. A case of pulmonary edema due to guanfacine intoxication with measurement of serum guanfacine concentrations. J Toxicol Sci 2023; 48:641-644. [PMID: 38044125 DOI: 10.2131/jts.48.641] [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] [Indexed: 12/05/2023]
Abstract
Guanfacine hydrochloride extended-release (GXR) is used to treat attention deficit hyperactivity disorder. It is a selective α2A-adrenorecepor agonist that was reported to cause QT prolongation and hypotension in the event of overdosing. We report the case of a 17-year-old man who took 226 tablets of GXR 3 mg for attempted suicide. He was found complaining of dyspnea, and emergency medical services were called. When the patient was transferred to our hospital, his Glasgow coma scale was 12 (E4V3M5). He was agitated and hypoxemic. He was intubated for invasive mechanical ventilation under sedation. His chest X-ray and computed tomography scan showed pulmonary edema. Transthoracic echocardiography showed markedly reduced cardiac function. His serum guanfacine concentration peaked on day 3 after admission. His pulmonary edema improved quickly after a decrease in serum guanfacine concentration, but cardiac decompensation persisted for about 1 month. This case reveals that the decline in cardiac function after guanfacine intoxication is prolonged even after its serum concentration has decreased.
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Affiliation(s)
- Ryo Ayata
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital
| | - Motoki Fujita
- Acute and General Medicine, Yamaguchi University Graduate School of Medicine
| | - Kayoko Harada
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital
| | - Yusuke Esaki
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital
| | - Yasutaka Koga
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital
| | - Yukari Hisamoto
- Department of Respiratory Medicine and Infectious Disease, Yamaguchi University Hospital
| | - Maki Asami-Noyama
- Department of Respiratory Medicine and Infectious Disease, Yamaguchi University Hospital
| | - Saki Takeda
- Department of Forensic Medicine, Fukushima Medical University School of Medicine
| | - Kazuki Harada
- Department of Forensic Medicine, Fukushima Medical University School of Medicine
| | - Ryosuke Tsuruta
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital
- Acute and General Medicine, Yamaguchi University Graduate School of Medicine
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Mavromatidis K, Athanasios Bakaloudis A, Skandalos I, Kalogiannidou I, Georgoulidou A. A case report on the placement of a temporal dialysis catheter in the femoral artery for emergency dialysis. Caspian J Intern Med 2023; 14:755-759. [PMID: 38024169 PMCID: PMC10646364 DOI: 10.22088/cjim.14.4.755] [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] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 04/20/2022] [Accepted: 04/27/2022] [Indexed: 12/01/2023]
Abstract
Background Ensuring vascular access is essential for dialysis patients. This can be achieved through an arteriovenous anastomosis (fistulae), a central venous catheter, or an arteriovenous graft. However, in some cases vascular access to the patient's blood is not possible. Case Presentation A multi-vascular male patient, who had been undergoing dialysis for 17 years, was presented to our renal department. There was no possibility of vascular access to the patient's venous network for dialysis. A peritoneal dialysis catheter was inserted, but it was malfunctioning. An attempt was made to place a HeRO AV Graft, but it did not succeed due to contraindications from the patient's venous network, as shown by the computed tomography. While trying to solve the problem in order to dialyze the patient during his hospitalization, he experienced severe shortness of breath with tachypnea (pulmonary edema), along with acidosis and hyperkalemia. A temporal dialysis catheter was urgently inserted into the left femoral artery and isolated ultrafiltration was performed, and by removing 1500 ml of ultrafiltration, the patient improved significantly. During the subsequent days, he underwent another 11 dialysis sessions using the femoral artery catheter. While he was hospitalized and being dialyzed via the femoral artery, a successful effort was made to catheterize the right external jugular vein, from which he continues to be dialyzed today. Conclusion The patient's treatment through the placement of a temporal dialysis catheter in the femoral artery enabled him to survive. It is our belief that such a solution could be helpful in similar cases.
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Affiliation(s)
| | | | - Ioannis Skandalos
- Department of Surgery, Gen . Hosp. “St. Pavlos”, Thessaloniki, Greece
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Houseman BS, Martinelli AN, Oliver WD, Devabhakthuni S, Mattu A. High-dose nitroglycerin infusion description of safety and efficacy in sympathetic crashing acute pulmonary edema: The HI-DOSE SCAPE study. Am J Emerg Med 2023; 63:74-78. [PMID: 36327753 DOI: 10.1016/j.ajem.2022.10.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 05/27/2022] [Revised: 10/07/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Sympathetic crashing acute pulmonary edema (SCAPE) is a medical emergency in which severe, acute elevation in blood pressure results in acute heart failure and fluid accumulation in the lungs. Without prompt recognition and treatment, the condition often progresses rapidly to respiratory failure necessitating intubation and intensive care unit (ICU) admission. In addition to non-invasive positive pressure ventilation (NIPPV), high-dose nitroglycerin (HDN) has become a mainstay of treatment; however, an optimal dosing strategy has not been established. OBJECTIVE The purpose of this study was to describe the characteristics and outcomes of patients who received an HDN infusion (≥ 100 μg/min) for the management of SCAPE in the Emergency Department (ED) of a large urban academic medical center. Outcomes were also analyzed to determine predictors of safety and efficacy including use of adjunct medication therapies. RESULTS There were 67 adult patients who received HDN infusion for SCAPE from January 1, 2018 to December 31, 2018. The median (IQR) systolic blood pressure (SBP) on initiation of HDN infusion was 211 (192-233) mmHg. Patients were 63% male, 84% black, 51% had a history of heart failure (HF), and 36% had end-stage renal disease (ESRD). IV nitroglycerin (NTG) was initiated at a median (IQR) dose of 100 (100-200) mcg/min with median (IQR) peak rate in the first hour of 200 (127.5-200) mcg/min and an absolute maximum observed rate of 400 μg/min overall. 73% of patients received NIPPV, 48% sublingual (SL) or IV bolus nitroglycerin before HDN infusion, 58% loop diuretic, and 34% angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB). Rates of ICU admission, intubation, acute kidney injury (AKI) at 48 h, and hypotension were 37%, 21%, 13%, and 4% respectively. CONCLUSION This is the largest to date study describing the use of an HDN infusion (≥100 μg/min) strategy for the management of SCAPE. HDN infusion may be a safe alternative strategy to intermittent bolus HDN.
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Affiliation(s)
- Brandon S Houseman
- Department of Pharmacy, The University of Maryland Medical Center, Baltimore, MD, United States of America
| | - Ashley N Martinelli
- Department of Pharmacy, The University of Maryland Medical Center, Baltimore, MD, United States of America.
| | - Wesley D Oliver
- Department of Pharmacy, The University of Maryland Medical Center, Baltimore, MD, United States of America
| | - Sandeep Devabhakthuni
- Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, MD, United States of America
| | - Amal Mattu
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, United States of America
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Nishikawa T, Fukuhara K. Betamethasone use and risk factors for pulmonary edema during the perinatal period: a single-center retrospective cohort study in Japan. BMC Pregnancy Childbirth 2022; 22:636. [PMID: 35962336 PMCID: PMC9373293 DOI: 10.1186/s12884-022-04918-2] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 07/12/2022] [Indexed: 11/17/2022] Open
Abstract
Background A few studies have reported that maternal administration of antenatal corticosteroids increased the risk of pulmonary edema (PE). However, despite the increasing usage rate of betamethasone as antenatal corticosteroid, maternal administration of betamethasone as a risk factor for PE has not been well studied. This study aimed to evaluate how maternal backgrounds and complications, tocolytic agents, and betamethasone affect the incidence of PE during the perinatal period and determine the risk factor for PE. Methods This was a single-center retrospective cohort study in Kurashiki, Japan. The study subjects were patients who had been admitted to our hospital for perinatal management including pregnancy, delivery and puerperium between 2017 and 2020. The primary outcome measure was defined as the incidence of PE during hospitalization. First, in all study subjects, Cox proportional hazards model was used to determine the risk factor for PE during the perinatal period. Next, using propensity score matching, we divided the patients into the betamethasone and betamethasone-free groups and examined the association between betamethasone use and the incidence of PE with Cox proportional hazards model. Results During the study period, 4919 cases were hospitalized, and there were 16 PE cases (0.3%). In all analyzed subjects, the occurrence of PE was significantly associated with preeclampsia (hazard ratio 16.8, 95% confidence intervals (CI) 5.39–52.7, P < 0.001) and the combined use of the tocolytic agents such as ritodrine hydrochloride and magnesium sulfate, and betamethasone (hazard ratio 11.3, 95% CI 2.66–48.1, P = 0.001). In contrast, after propensity score matching, no statistically significant difference was found between the betamethasone and betamethasone-free groups in the incidence of PE (hazard ratio 3.19, 95% CI 0.67–15.3, P = 0.145). Conclusions A combined use of tocolytic agents and antenatal corticosteroids such as betamethasone may be an independent risk factor for PE during the perinatal period. On the other hand, betamethasone use alone may not be associated with the incidence of PE. When tocolytic agents and betamethasone are administrated to pregnant women, it is important to pay attention to the appearance of maternal respiratory symptoms.
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Affiliation(s)
- Takashi Nishikawa
- Department of Obstetrics and Gynecology, Kurashiki Central Hospital, Ohara Health Care Foundation, 1-1-1 Miwa, Kurashiki, Okayama, 7108602, Japan.
| | - Ken Fukuhara
- Department of Obstetrics and Gynecology, Kurashiki Central Hospital, Ohara Health Care Foundation, 1-1-1 Miwa, Kurashiki, Okayama, 7108602, Japan
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Jiang YX, Huang ZW. Ulinastatin alleviates pulmonary edema by reducing pulmonary permeability and stimulating alveolar fluid clearance in a rat model of acute lung injury. Iran J Basic Med Sci 2022; 25:1002-1008. [PMID: 36159332 PMCID: PMC9464339 DOI: 10.22038/ijbms.2022.64655.14230] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 07/30/2022] [Indexed: 11/04/2022]
Abstract
Objectives Previous studies have shown that ulinastatin (UTI) alleviates pulmonary edema in acute lung injury (ALI) caused by lipopolysaccharide (LPS), although the mechanism behind this action is uncertain. This research aimed to identify the fundamental mechanism by which UTI alleviates pulmonary edema. Materials and Methods We established a model of acute lung injury (ALI) in rats by using LPS as the inciting agent.The control, LPS, and LPS+UTI groups were each comprised of a specific number of randomly selected Wistar rats. We evaluated lung injury and determined pulmonary edema. The concentrations of TNF-α, IL-1β and IL-6 in BALF and the expression levels of α1Na, k-ATPase, β1Na, K-AtPase, α-ENaC, β-ENaC, γ-ENaC, Zonula occludens (ZO)-1, Occludin, Caludin-5, PI3K, Akt, TLR4, MyD88 and NF-ƘBwere identified in lung tissues. Results The presence of UTI was associated with a reduction in lung pathological alterations, lung injury scores, the lung W/D ratio, and MPO activity, in addition to the improved gas exchange (P<0.01). Furthermore, UTI alleviated EB leakage and stimulated AFC (P<0.01). Importantly, UTI increased the expression of ZO-1, Occludin, Caludin-5, α1Na, K-ATPase, β1Na, K-AtPase, α-ENaC, β-ENaC, and γ-ENaC (P<0.01). Furthermore, UTI inhibited the inflammatory response, enhanced the expression of PI3K and Akt and hindered TLR4, MyD88, and NF-ƘB expression (P<0.01) in lung tissues. Conclusion Our results demonstrated that UTI attenuated pulmonary edema by reducing pulmonary permeability and promoting AFC through inhibiting the inflammatory response, and the mechanism is related to promoting PI3K/Akt signaling pathways and suppressing TLR4/MyD88/NF-ƘB signaling pathways.
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Affiliation(s)
- Yuan-xu Jiang
- Department of Anesthesiology, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University, The Fist Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong Province, 518020, P.R. China,Corresponding author: Yuan-xu Jiang. Shenzhen People’s Hospital , no.1017 Dongmen North Road. Shenzhen,Guangdong Province ,518020, P.R China.Tel: 13613051840;
| | - Ze-wei Huang
- Department of Critical Care Medicine, Shenzhen People’s Hospital, Shenzhen, Guangdong Province, 518020, P.R. China
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Voigt I, Mighali M, Manda D, Aurich P, Bruder O. Radiographic assessment of lung edema (RALE) score is associated with clinical outcomes in patients with refractory cardiogenic shock and refractory cardiac arrest after percutaneous implantation of extracorporeal life support. Intern Emerg Med 2022; 17:1463-1470. [PMID: 35169942 DOI: 10.1007/s11739-022-02937-7] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 01/19/2022] [Indexed: 01/27/2023]
Abstract
VA-ECMO is a promising therapeutic option in refractory cardiogenic shock (RCS) and refractory cardiac arrest (RCA). However, increase in left ventricular afterload enhances further reduction of LV contractility and pulmonary edema. The aim of this study was to evaluate pulmonary edema based on the RALE score and the prognostic value of the score on ECLS weaning and mortality. In this retrospective study, data from 40 patients (16 RCAs and 24 RCSs) were analyzed. Demographic, clinical data and the RALE score for evaluating pulmonary edema were assessed. Descriptive statistics, intraclass correlation, and receiver operating characteristic (ROC) curves were computed. Weaning from ECLS was successful in 30 (75%) patients, 16 patients (40%) were discharged alive. Overall, the survivors were younger, presenting with a higher left ventricular ejection fraction (30 ± 2% vs.23 ± 9%;p < 0.01) and a lower initial serum lactate concentration 7.7 ± 4.5 mmol/l vs. 11.5 ± 4.9 mmol/l; p = 0.017). Survivors had lower RALE scores than non-survivors (16.3 ± 9.4 vs. 26.4 ± 10.4; p = 0.0034). The interobserver variability of the RALE score was good (0.832). The AUC predicting mortality and weaning from ECLS presented comparable results to the established parameters (SAVE, serum lactate). Implementation of the RALE score could support prediction of outcome parameters during VA-ECMO therapy.
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Affiliation(s)
- Ingo Voigt
- Department of Acute and Emergency Medicine, Elisabeth-Hospital Essen, Essen, Germany.
- Ruhr-University, Bochum, Germany.
| | - Marco Mighali
- Department of Acute and Emergency Medicine, Elisabeth-Hospital Essen, Essen, Germany
| | - Daniela Manda
- Department of Acute and Emergency Medicine, Elisabeth-Hospital Essen, Essen, Germany
| | - Phillip Aurich
- Department of Acute and Emergency Medicine, Elisabeth-Hospital Essen, Essen, Germany
- Department of Cardiology and Angiology, Elisabeth-Hospital Essen, Essen, Germany
| | - Oliver Bruder
- Department of Cardiology and Angiology, Elisabeth-Hospital Essen, Essen, Germany
- Ruhr-University, Bochum, Germany
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Zamani Rarani F, Zamani Rarani M, Hamblin MR, Rashidi B, Hashemian SMR, Mirzaei H. Comprehensive overview of COVID-19-related respiratory failure: focus on cellular interactions. Cell Mol Biol Lett 2022; 27:63. [PMID: 35907817 PMCID: PMC9338538 DOI: 10.1186/s11658-022-00363-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 03/14/2022] [Accepted: 07/06/2022] [Indexed: 01/08/2023] Open
Abstract
The pandemic outbreak of coronavirus disease 2019 (COVID-19) has created health challenges in all parts of the world. Understanding the entry mechanism of this virus into host cells is essential for effective treatment of COVID-19 disease. This virus can bind to various cell surface molecules or receptors, such as angiotensin-converting enzyme 2 (ACE2), to gain cell entry. Respiratory failure and pulmonary edema are the most important causes of mortality from COVID-19 infections. Cytokines, especially proinflammatory cytokines, are the main mediators of these complications. For normal respiratory function, a healthy air-blood barrier and sufficient blood flow to the lungs are required. In this review, we first discuss airway epithelial cells, airway stem cells, and the expression of COVID-19 receptors in the airway epithelium. Then, we discuss the suggested molecular mechanisms of endothelial dysfunction and blood vessel damage in COVID-19. Coagulopathy can be caused by platelet activation leading to clots, which restrict blood flow to the lungs and lead to respiratory failure. Finally, we present an overview of the effects of immune and non-immune cells and cytokines in COVID-19-related respiratory failure.
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Affiliation(s)
- Fahimeh Zamani Rarani
- Department of Anatomical Sciences, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Zamani Rarani
- Department of Anatomical Sciences, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Michael R. Hamblin
- Laser Research Centre, Faculty of Health Science, University of Johannesburg, Doornfontein, 2028 South Africa
| | - Bahman Rashidi
- Department of Anatomical Sciences, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Seyed Mohammad Reza Hashemian
- Chronic Respiratory Diseases Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamed Mirzaei
- Student Research Committee, Kashan University of Medical Sciences, Kashan, Iran
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Institute for Basic Sciences, Kashan University of Medical Sciences, Kashan, IR Iran
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Kowalleck U, Ahmed MAA, Koedel J, Schierle K, Salameh A, Rassler B. Relaxin does not prevent development of hypoxia-induced pulmonary edema in rats. Pflugers Arch 2022. [PMID: 35778581 DOI: 10.1007/s00424-022-02720-9] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 06/06/2022] [Accepted: 06/15/2022] [Indexed: 11/29/2022]
Abstract
Acute hypoxia impairs left ventricular (LV) inotropic function and induces development of pulmonary edema (PE). Enhanced and uneven hypoxic pulmonary vasoconstriction is an important pathogenic factor of hypoxic PE. We hypothesized that the potent vasodilator relaxin might reduce hypoxic pulmonary vasoconstriction and prevent PE formation. Furthermore, as relaxin has shown beneficial effects in acute heart failure, we expected that relaxin might also improve LV inotropic function in hypoxia. Forty-two rats were exposed over 24 h to normoxia or hypoxia (10% N2 in O2). They were infused with either 0.9% NaCl solution (normoxic/hypoxic controls) or relaxin at two doses (15 and 75 μg kg−1 day−1). After 24 h, hemodynamic measurements and bronchoalveolar lavage were performed. Lung tissue was obtained for histological and immunohistochemical analyses. Hypoxic control rats presented significant depression of LV systolic pressure by 19% and of left and right ventricular contractility by about 40%. Relaxin did not prevent the hypoxic decrease in LV inotropic function, but re-increased right ventricular contractility. Moreover, hypoxia induced moderate interstitial PE and inflammation in the lung. Contrasting to our hypothesis, relaxin did not prevent hypoxia-induced pulmonary edema and inflammation. In hypoxic control rats, PE was similarly distributed in the apical and basal lung lobes. In relaxin-treated rats, PE index was 35–40% higher in the apical than in the basal lobe, which is probably due to gravity effects. We suggest that relaxin induced exaggerated vasodilation, and hence pulmonary overperfusion. In conclusion, the results show that relaxin does not prevent but rather may aggravate PE formation.
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Imamura T. How to utilize remote dielectric sensing in the emergent department? Am J Emerg Med 2022; 60:195. [PMID: 35760740 DOI: 10.1016/j.ajem.2022.06.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 06/17/2022] [Indexed: 10/17/2022] Open
Affiliation(s)
- Teruhiko Imamura
- Second Department of Internal Medicine, University of Toyama, Toyama, Japan.
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Mochida Y, Nishizawa R, Ochiai K, Inoue Y, Kaita Y, Yamaguchi Y. Delayed tension gastrothorax caused necrosis of stomach and re-expansion pulmonary edema: a case report. Surg Case Rep 2022; 8:100. [PMID: 35585466 PMCID: PMC9117577 DOI: 10.1186/s40792-022-01454-1] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 05/14/2022] [Indexed: 11/10/2022] Open
Abstract
Background Traumatic tension gastrothorax is a rare and potentially fatal condition occurring in patients with congenital or acquired diaphragmatic defects. Traumatic tension gastrothorax leads to acute and severe respiratory distress. Delayed tension gastrothorax that develops late during injury can be more severe. Case presentation An 84-year-old woman was brought to our facility with cardiac arrest and returned to spontaneous circulation after 2 min of cardiopulmonary resuscitation. Computed tomography showed diaphragmatic injury and tension gastrothorax due to trauma because of a fall episode few days earlier. Emergency thoracotomy and laparotomy was performed, because nasogastric tube insertion failed. There was a partially necrotic stomach in the chest cavity. The stomach was retracted from the thoracic cavity into the abdominal cavity and placed in its proper position. There was a 5 cm tear of the diaphragm. The tear was sutured and closed and then the necrotic area of the stomach was resected. Although the surgery relieved the intrathoracic compression, it resulted in re-expansion pulmonary edema immediately after surgery and hypoxemia. The patient was unable to overcome the hypoxemic state and eventually died. Conclusions Delayed tension gastrothorax can lead not only to obstructive shock due to intrathoracic compression but also to more severe organ ischemia and re-expansion pulmonary edema due to insufflation.
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Affiliation(s)
- Yuki Mochida
- Department of Trauma and Critical Care Medicine, Kyorin University School of Medicine, 6-20-2, Shinkawa, Mitaka-shi, Tokyo, 181-8611, Japan.
| | - Ryohei Nishizawa
- Department of Trauma and Critical Care Medicine, Kyorin University School of Medicine, 6-20-2, Shinkawa, Mitaka-shi, Tokyo, 181-8611, Japan
| | - Koji Ochiai
- Department of Trauma and Critical Care Medicine, Kyorin University School of Medicine, 6-20-2, Shinkawa, Mitaka-shi, Tokyo, 181-8611, Japan
| | - Yoshitaka Inoue
- Department of Trauma and Critical Care Medicine, Kyorin University School of Medicine, 6-20-2, Shinkawa, Mitaka-shi, Tokyo, 181-8611, Japan
| | - Yasuhiko Kaita
- Department of Trauma and Critical Care Medicine, Kyorin University School of Medicine, 6-20-2, Shinkawa, Mitaka-shi, Tokyo, 181-8611, Japan
| | - Yoshihiro Yamaguchi
- Department of Trauma and Critical Care Medicine, Kyorin University School of Medicine, 6-20-2, Shinkawa, Mitaka-shi, Tokyo, 181-8611, Japan
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Hsieh SJ, Chung SD, Chang CY. Cystic pheochromocytoma leading to multisystem crisis: A silent and hazardous neoplasm. Asian J Surg 2022; 45:2054-2055. [PMID: 35525694 DOI: 10.1016/j.asjsur.2022.04.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 04/21/2022] [Indexed: 11/02/2022] Open
Affiliation(s)
- Shang-Ju Hsieh
- Division of Urology, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Shiu-Dong Chung
- Division of Urology, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Chao-Yuan Chang
- Division of Urology, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
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Huang Q, Lei Y, Xing W, He C, Wei G, Miao Z, Hao Y, Li G, Wang Y, Li Q, Li X, Li W, Chen J. Evaluation of Pulmonary Edema Using Ultrasound Imaging in Patients With COVID-19 Pneumonia Based on a Non-local Channel Attention ResNet. Ultrasound Med Biol 2022; 48:945-953. [PMID: 35277285 PMCID: PMC8818339 DOI: 10.1016/j.ultrasmedbio.2022.01.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 01/10/2022] [Accepted: 01/27/2022] [Indexed: 05/16/2023]
Abstract
Recent research has revealed that COVID-19 pneumonia is often accompanied by pulmonary edema. Pulmonary edema is a manifestation of acute lung injury (ALI), and may progress to hypoxemia and potentially acute respiratory distress syndrome (ARDS), which have higher mortality. Precise classification of the degree of pulmonary edema in patients is of great significance in choosing a treatment plan and improving the chance of survival. Here we propose a deep learning neural network named Non-local Channel Attention ResNet to analyze the lung ultrasound images and automatically score the degree of pulmonary edema of patients with COVID-19 pneumonia. The proposed method was designed by combining the ResNet with the non-local module and the channel attention mechanism. The non-local module was used to extract the information on characteristics of A-lines and B-lines, on the basis of which the degree of pulmonary edema could be defined. The channel attention mechanism was used to assign weights to decisive channels. The data set contains 2220 lung ultrasound images provided by Huoshenshan Hospital, Wuhan, China, of which 2062 effective images with accurate scores assigned by two experienced clinicians were used in the experiment. The experimental results indicated that our method achieved high accuracy in classifying the degree of pulmonary edema in patients with COVID-19 pneumonia by comparison with previous deep learning methods, indicating its potential to monitor patients with COVID-19 pneumonia.
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Affiliation(s)
- Qinghua Huang
- School of Computer Science, Northwestern Polytechnical University, Xi'an, China; School of Artificial Intelligence, Optics and Electronics, Northwestern Polytechnical University, Xi'an, China
| | - Ye Lei
- School of Computer Science, Northwestern Polytechnical University, Xi'an, China; School of Artificial Intelligence, Optics and Electronics, Northwestern Polytechnical University, Xi'an, China
| | - Wenyu Xing
- Center for Biomedical Engineering, School of Information Science and Technology, Fudan University, Shanghai, China
| | - Chao He
- Department of Emergency and Critical Care, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Gaofeng Wei
- Naval Medical Department, Naval Medical University, Shanghai, China
| | - Zhaoji Miao
- School of Computer Science, Northwestern Polytechnical University, Xi'an, China; School of Artificial Intelligence, Optics and Electronics, Northwestern Polytechnical University, Xi'an, China
| | - Yifan Hao
- School of Computer Science, Northwestern Polytechnical University, Xi'an, China; School of Artificial Intelligence, Optics and Electronics, Northwestern Polytechnical University, Xi'an, China
| | - Guannan Li
- Shanghai Key Laboratory of Multidimensional Information Processing, School of Communication & Electronic Engineering, East China Normal University, Shanghai, China
| | - Yan Wang
- Shanghai Key Laboratory of Multidimensional Information Processing, School of Communication & Electronic Engineering, East China Normal University, Shanghai, China
| | - Qingli Li
- Shanghai Key Laboratory of Multidimensional Information Processing, School of Communication & Electronic Engineering, East China Normal University, Shanghai, China
| | - Xuelong Li
- School of Computer Science, Northwestern Polytechnical University, Xi'an, China; School of Artificial Intelligence, Optics and Electronics, Northwestern Polytechnical University, Xi'an, China
| | - Wenfang Li
- Department of Emergency and Critical Care, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Jiangang Chen
- Shanghai Key Laboratory of Multidimensional Information Processing, School of Communication & Electronic Engineering, East China Normal University, Shanghai, China; Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, Shanghai, China.
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Williams PT. Quantile-specific heritability of 8-isoprostane and the modulating effects of smoking, alcohol, cardiovascular disease and diabetes on 8-isoprostane-gene interactions. Free Radic Biol Med 2022; 178:262-270. [PMID: 34883250 PMCID: PMC10101173 DOI: 10.1016/j.freeradbiomed.2021.11.022] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Urinary 8-isoprostane provides a significantly heritable measure of oxidative stress. Prior reports suggest that genetic variants may modulate oxidative stress due to smoking, other environmental factors, and disease. Alternatively, these apparent modulations may reflect a dependence of genetic effects on 8-isoprostane concentrations. METHOD To test whether genetic effects on 8-isoprostane concentrations are quantile-dependent, quantile-specific offspring-parent (βOP) and full-sib regression slopes (βFS) were estimated by applying quantile regression to the age- and sex-adjusted creatinine-standardized urinary 8-isoprostane concentrations of Framingham Heart Study families. Quantile-specific heritabilities were calculated as h2 = 2βOP/(1+rspouse) and h2 = {(1+8rspouseβFS)0.5-1}/(2rspouse)). RESULTS Spouse 8-isoprostane concentrations were weakly concordant (rspouse = 0.06). 8-isoprostane heritability (h2±SE) increased significantly with increasing percentiles of its distribution (Plinear trend = 0.0009, Pquadratic trend = 0.0007, Pcubic trend = 0.003) when estimated from βOP, and when estimated from βFS (Plinear trend = 0.005, Pquadratic trend = 0.09, Pcubic trend = 0.06). Compared to the 10th percentile, βOP-estimated h2 was over 22-fold greater at the 90th percentile (Pdifference = 9.2 × 10-5), and 5.3-fold greater when estimated from βFS (Pdifference = 0.004). Significantly higher 8-isoprostane heritability in smokers than nonsmokers (0.352 ± 0.147 vs. 0.061 ± 0.036, Pdifference = 0.01), and heavier than lighter drinkers (0.449 ± 0.216 vs. 0.078 ± 0.037, Pdifference = 0.01) were eliminated when corrected for the higher 8-isoprostane concentrations of the smokers and heavier drinkers. CONCLUSION Heritability of oxidative stress as measured by 8-isoprostane is quantile-dependent, which may contribute to the larger reported effects on oxidative stress by UCP2 -866G > A, IL6 -572C > G and LTA 252A > G polymorphisms in smokers than nonsmokers, by the UCP2 -866G > A polymorphism in coronary heart disease patients, by the ESRRG rs1890552 A > G polymorphism in type 2 diabetics, by the CYBA 242C > T polymorphism after exercise training, by the PLIN 11482G > A/14995A > T haplotype before weight loss, and by the CYBA -930A > G and GSTP1 I105V haplotypes in patients with pulmonary edema.
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Affiliation(s)
- Paul T Williams
- Lawrence Berkeley National Laboratory, Molecular Biophysics & Integrated Bioimaging Division, 1 Cyclotron Road, Berkeley, CA, 94720, USA.
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Abstract
The alveolo-capillary barrier is relatively impermeable, and facilitates gas exchange via the large alveolar surface in the lung. Disruption of alveolo-capillary barrier leads to accumulation of edema fluid in lung injury. Studies in animal models of various forms of lung injury provide evidence that TRPV4 channels play a critical role in disruption of the alveolo-capillary barrier and pathogenesis of lung injury. TRPV4 channels from capillary endothelial cells, alveolar epithelial cells, and immune cells have been implicated in the pathogenesis of lung injury. Recent studies in endothelium-specific TRPV4 knockout mice point to a central role for endothelial TRPV4 channels in lung injury. In this chapter, we review the findings on the pathological roles of endothelial TRPV4 channels in different forms of lung injury and future directions for further investigation.
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Melzig C, Rengier F. [Increased pulmonary arterial and venous pressure]. Radiologe 2021; 62:120-129. [PMID: 34967911 DOI: 10.1007/s00117-021-00951-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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Increases in pressure in the pulmonary arteries or pulmonary veins may be the result of a variety of underlying diseases. Noninvasive imaging plays a crucial role not only for identification, but also for differential diagnosis. OBJECTIVES This article provides a comparative review of the signs of increased pulmonary arterial and pulmonary venous pressure in chest X‑ray and computed tomography (CT). RADIOLOGICAL PROCEDURES Typical signs of a pulmonary arterial or pulmonary venous pressure increase in chest X‑ray and CT facilitate diagnosis of pulmonary hypertension (e.g., enlargement of central pulmonary arteries) and interstitial or alveolar pulmonary edema (e.g., Kerley lines/thickened interlobular septae or butterfly edema). A basic understanding of imaging findings and underlying pathophysiology helps in establishing the differential diagnosis. CONCLUSIONS Chest X‑ray and CT are essential for diagnosis of patients with suspected increased pulmonary arterial or pulmonary venous pressure.
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Affiliation(s)
- Claudius Melzig
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Deutschland
- Translational Lung Research Center (TLRC), Member of the German Center for Lung Research (DZL), University of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Deutschland
| | - Fabian Rengier
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Deutschland.
- Translational Lung Research Center (TLRC), Member of the German Center for Lung Research (DZL), University of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Deutschland.
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Velichko E, Shariaty F, Orooji M, Pavlov V, Pervunina T, Zavjalov S, Khazaei R, Radmard AR. Development of computer-aided model to differentiate COVID-19 from pulmonary edema in lung CT scan: EDECOVID-net. Comput Biol Med 2021; 141:105172. [PMID: 34973585 DOI: 10.1016/j.compbiomed.2021.105172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 08/05/2021] [Revised: 12/21/2021] [Accepted: 12/21/2021] [Indexed: 01/08/2023]
Abstract
The efforts made to prevent the spread of COVID-19 face specific challenges in diagnosing COVID-19 patients and differentiating them from patients with pulmonary edema. Although systemically administered pulmonary vasodilators and acetazolamide are of great benefit for treating pulmonary edema, they should not be used to treat COVID-19 as they carry the risk of several adverse consequences, including worsening the matching of ventilation and perfusion, impaired carbon dioxide transport, systemic hypotension, and increased work of breathing. This study proposes a machine learning-based method (EDECOVID-net) that automatically differentiates the COVID-19 symptoms from pulmonary edema in lung CT scans using radiomic features. To the best of our knowledge, EDECOVID-net is the first method to differentiate COVID-19 from pulmonary edema and a helpful tool for diagnosing COVID-19 at early stages. The EDECOVID-net has been proposed as a new machine learning-based method with some advantages, such as having simple structure and few mathematical calculations. In total, 13 717 imaging patches, including 5759 COVID-19 and 7958 edema images, were extracted using a CT incision by a specialist radiologist. The EDECOVID-net can distinguish the patients with COVID-19 from those with pulmonary edema with an accuracy of 0.98. In addition, the accuracy of the EDECOVID-net algorithm is compared with other machine learning methods, such as VGG-16 (Acc = 0.94), VGG-19 (Acc = 0.96), Xception (Acc = 0.95), ResNet101 (Acc = 0.97), and DenseNet20l (Acc = 0.97).
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Kummer RL, Kempainen RR, Olives TD, Leatherman JW, Prekker ME. Naloxone-associated pulmonary edema following recreational opioid overdose: A case series. Am J Emerg Med 2021; 53:41-43. [PMID: 34973491 DOI: 10.1016/j.ajem.2021.12.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 10/29/2021] [Revised: 12/03/2021] [Accepted: 12/13/2021] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE Describe a series of patients who developed naloxone-associated pulmonary edema after recreational opioid use. DESIGN Single center retrospective case series of patients who developed pulmonary edema following the prehospital administration of naloxone. SETTING Academic, urban safety-net hospital. PATIENTS Adults with recreational opioid overdose who developed naloxone-associated pulmonary edema, defined as the acute onset of respiratory distress, hypoxemia, and radiographic pulmonary edema after naloxone administration for opioid intoxication, provided that gas exchange and chest imaging rapidly improved and pulmonary aspiration of gastric contents was not clinically suspected. MEASUREMENTS AND MAIN RESULTS Ten adults (median age 23 years, 90% male) met our case definition for naloxone-associated pulmonary edema. Implicated opioids were heroin in 8 patients and methadone and oxycodone in 1 patient each. The median total dose of naloxone was 4.25 mg (interquartile range [IQR] 3.3-9.8) prior to the onset of clinically-apparent pulmonary edema. Seven patients received invasive mechanical ventilation for a median of two days (IQR 0.8-5), one of whom received veno-venous extracorporeal membrane oxygenation support, and all survived to hospital discharge. CONCLUSIONS Severe acute pulmonary edema may follow naloxone administration after recreational opioid overdose. Acute care clinicians should be aware of this potentially life-threatening adverse effect of naloxone.
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Affiliation(s)
- Rebecca L Kummer
- Department of Medicine, Hennepin County Medical Center, Minneapolis, MN, United States of America.
| | - Robert R Kempainen
- Division of Pulmonary and Critical Care Medicine, Hennepin County Medical Center, Minneapolis, MN, United States of America
| | - Travis D Olives
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, United States of America; Minnesota Poison Control System, Minneapolis, MN, United States of America
| | - James W Leatherman
- Division of Pulmonary and Critical Care Medicine, Hennepin County Medical Center, Minneapolis, MN, United States of America
| | - Matthew E Prekker
- Division of Pulmonary and Critical Care Medicine, Hennepin County Medical Center, Minneapolis, MN, United States of America; Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, United States of America
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