Cases Of Bronchiectasis Research Articles

Necrotizing pneumonia-a rare but complex complication in bronchiectasis patients.

Pneumonia occurs commonly in bronchiectasis patients with exacerbation, though necrotizing pneumonia remains rare. This report presents two cases of bronchiectasis complicated by necrotizing pneumonia. The first case involves a 39-year-old female with bronchiectasis due to primary ciliary dyskinesia. She presented with severe chest pain and persistent fever unresponsive to oral antibiotics. Chest computed tomography (CT) revealed necrotizing pneumonia with associated empyema, necessitating prolonged antibiotic therapy, pleural drainage and ultimately surgical decortication. The second case is a 39-year-old male with bronchiectasis following ammonia inhalation injury, presenting with pleuritic chest pain and productive cough, with a CT scan showing consolidation with low attenuation areas. Intensive antibiotic treatment was required, alongside corticosteroids and inhaled antibiotics afterward. These cases demonstrate the importance of identifying risk factors for necrotizing pneumonia in bronchiectasis patients. Tailoring treatment strategies, including extending antibiotic regimens, using inhaled antibiotics, and administering corticosteroids, is essential to mitigate poor outcomes.

Effect of BAL Lipoxin A4 Level in Children with Bronchiectasis on Disease Severity

Abstract Background A central feature of most cases of bronchiectasis is airway inflammation. The elevated neutrophil count has been strongly correlated with impaired lung function, bronchiectasis severity, and disease duration. There is a failure of resolution of inflammation in bronchiectasis, leading to irreversible damage and dilatation of the bronchial airways with loss of mucociliary function. Lipoxins were the first agents to be identified as anti-inflammatory endogenous lipid mediators involved in the resolution of inflammation. Aim of the Work This study aimed to measure Lipoxin A4 level in bronchoalveolar lavage (BAL) of children with Cystic Fibrosis bronchiectasis (CF) and Non-CF bronchiectasis as a prognostic marker for clinical and radiological severity in these children as regard Bronchiectasis severity score. Methods A cross-sectional study was conducted at Children’s Hospital, Ain Shams University from December 2020 to December 2021, on children following up at the Pediatric Pulmonology Clinic. The study included 15patients with cystic fibrosis (CF) bronchiectasis, 15 patients with non-CF bronchiectasis, and 30 control cases,without breathing difficulty or signs of RDS. Human Lipoxin A4 was measured in BAL by ELISA. Results There was a significant difference between patients and controls as regards Lipoxin A4 level (p = 0.002),being higher in control group, but no significant difference in its level between CF and non-CF bronchiectasischildren(p = 0.663). Conclusion Severe bronchiectasis is associated with decreased airway Lipoxin A4 levels as lowest level of lipoxinA4 was found in severe cases by bronchiectasis severity score.

Efficacy of Inhaled Corticosteroids in Patients with Bronchiectasis without Airway Hyperresponsiveness: A Pilot Study

ABSTRACT Background: The effect of inhaled corticosteroids (ICS) in stable cases of bronchiectasis without hyperresponsiveness has not been studied. The objective of the study was to assess the effect of inhaled fluticasone 500 μg twice daily on health-related quality of life (HRQoL), pulmonary function, and frequency of exacerbations in stable patients of bronchiectasis without bronchial hyperresponsiveness (BHR) diagnosed by indirect bronchoprovocation test. Materials and Methods: It was a pilot study with an open-label randomized control design conducted in a Tertiary Care Chest Hospital, with 40 patients in each arm. Bronchiectasis was diagnosed by high-resolution computed tomography chest. Patients with BHR were excluded by performing an indirect bronchoprovocation test using inhaled adenosine monophosphate. Eighty patients meeting the inclusion criteria were randomized into intervention group (IG) receiving 500 μg fluticasone propionate twice a day and control group (CG) receiving standard care without ICS. Both groups were assessed monthly till 6 months. Clinical data (mainly forced expiratory volume in 1st s [FEV1], number of exacerbations, HRQoL by St. George respiratory questionnaire (SGRQ) was collected at baseline and end of 6 months. Results: Eighty (IG - 40, CG - 40) patients of stable state noncystic fibrosis bronchiectasis completed the study. The mean age in our study was IG 49.7 ± 17.6 vs. CG 49.9 ± 16.6, males IG 62.5% vs. CG 60%, most common etiology was tuberculosis IG 40% (16/40) vs CG 37.5% (15/40). Difference in SGRQ score (baseline end of treatment) IG 5.47 vs. CG 1.65 (p = 0.00). Difference in FEV1 IG 0.054L vs. CG 0.004L (P = 0.00), mean number of exacerbations at end of treatment IG – 1 ± 0.9 vs. CG 1.2 ± 1.1. Conclusion: Patients with stable bronchiectasis without BHR, treated with inhaled fluticasone 500 μg twice daily for 6 months showed a clinically significant improvement in HRQoL. No statistically significant difference was seen in pulmonary function and frequency of exacerbations.

Levels of Galectin-7 in serum and sputum in children with asthma

Objective: To observe the expression of Galectin-7 in the serum and sputum of asthmatic children and to explore its significance in asthmatic children. Methods: The study prospectively case-control selected 183 children diagnosed with bronchial asthma at Department Ⅱ of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Beijing Children's Hospital of Capital Medical University. The control group consisted of 41 children with other bronchial diseases and 43 healthy children. Children in the asthma group were divided into acute and non-acute exacerbation groups. Acute exacerbation group was divided as mild acute, moderate acute and severe acute groups; non-acute exacerbation group was divided as mild persistent, moderate persistent and severe persistent groups. Children without acute exacerbation asthma in the asthma group were divided into high and low Galectin-7 groups based on median serum Galectin-7 levels. Serum and sputum were collected, Galectin-7 levels were measured using enzyme-linked immunosorbent assay. The study compared and analyzed the differences in Galectin-7 levels between children with asthma and the control groups using Mann-Whitney U test or the Kruskal-Wallis or the Chi-square test for inter-group comparisons. Results: Among 183 children, 61 cases had acute asthma exacerbation, and 122 cases had persistent asthma without acute exacerbation. The asthma group comprised 110 males and 73 females. The control group consisted of 41 children with other bronchial diseases, including 24 cases of bronchiectasis and 17 cases of obliterans bronchitis. The control group comprised 26 males and 15 females. Forty-three healthy children who underwent physical examination, including 22 males and 21 females. The levels of Galectin-7 in serum were significantly higher in children with an acute asthma exacerbation than that of healthy children (0.1 (0, 0.7) vs. 0 (0, 0.2) μg/L, Z=2.09, P=0.001). Galectin-7 levels in sputum were higher in children with an acute asthma exacerbation than that in children with other bronchial diseases (1.2 (0.1,3.7) vs. 0.4 (0.1, 1.5) μg/L, Z=2.20, P<0.001). Serum Galectin-7 levels were significantly higher in children with persistent asthma compared to children with other bronchial diseases and healthy children (0.6 (0.3, 1.2) vs. 0.1 (0, 0.5) and 0 (0, 0.2) μg/L, Z=-6.12,-7.63, both P<0.001), and the levels were significantly and positively correlated with asthma severity (r=0.77, P<0.001), disease duration (r=0.34, P=0.001), and number of previous attacks (r=0.51, P<0.001). There were 61 children in the high-Galectin-7 group and 61 children in the low-Galectin-7 group. Children with high Galectin-7 had more asthma triggers, a greater proportion with a positive family history, more previous asthma attacks, longer duration of asthma, and higher serum total IgE levels compared to those with low Galectin-7 (χ2=9.30, 22.46, Z=5.06, 3.57, 2.31, all P<0.05). Conclusion: The expression of Galectin-7 is found to be elevated in the serum and sputum of asthmatic children and correlated with asthma conditions.

Cystic Fibrosis Carrier States Are Associated With More Severe Cases of Bronchiectasis.

People with cystic fibrosis (CF) are at increased risk for bronchiectasis, and several reports suggest that CF carriers may also be at higher risk for developing bronchiectasis. The purpose of this study was to determine if CF carriers are at risk for more severe courses or complications of bronchiectasis. Using MarketScan data (2001-2021), we built a cohort consisting of 105 CF carriers with bronchiectasis and 300 083 controls with bronchiectasis but without a CF carrier diagnosis. We evaluated if CF carriers were more likely to be hospitalized for bronchiectasis. In addition, we examined if CF carriers were more likely to be infected with Pseudomonas aeruginosa or nontuberculous mycobacteria (NTM) or to have filled more antibiotic prescriptions. We considered regression models for incident and rate outcomes that controlled for age, sex, smoking status, and comorbidities. The odds of hospitalization were almost 2.4 times higher (95% CI, 1.116-5.255) for CF carriers with bronchiectasis when compared with non-CF carriers with bronchiectasis. The estimated odds of being diagnosed with a Pseudomonas infection for CF carriers vs noncarriers was about 4.2 times higher (95% CI, 2.417-7.551) and 5.4 times higher (95% CI, 3.398-8.804) for being diagnosed with NTM. The rate of distinct antibiotic fill dates was estimated to be 2 times higher for carriers as compared with controls (95% CI, 1.735-2.333), and the rate ratio for the total number of days of antibiotics supplied was estimated as 2.8 (95% CI, 2.290-3.442). CF carriers with bronchiectasis required more hospitalizations and more frequent administration of antibiotics as compared with noncarriers. Given that CF carriers were also more likely to be diagnosed with Pseudomonas and NTM infections, CF carriers with bronchiectasis may have a phenotype more resembling CF-related bronchiectasis than non-CF bronchiectasis.

Diagnostic value of nasal nitric oxide for children with primary ciliary dyskinesia

Objective: To evaluate the value of nasal nitric oxide (nNO) measurement as a diagnostic tool for Chinese patients with primary ciliary dyskinesia (PCD). Methods: This study is a retrospective study. The patients were recruited from those who were admitted to the respiratory Department of Respiratory Medicine, Children's Hospital of Fudan University from March 2018 to September 2022. Children with PCD were included as the PCD group, and children with situs inversus or ambiguus, cystic fibrosis (CF), bronchiectasis, chronic suppurative lung disease and asthma were included as the PCD symptom-similar group. Children who visited the Department of Child health Care and urology in the same hospital from December 2022 to January 2023 were selected as nNO normal control group. nNO was measured during plateau exhalation against resistance in three groups. Mann-Whitney U test was used to analyze the nNO data. The receiver operating characteristic of nNO value for the diagnosis of PCD was plotted and, the area under the curve and Youden index was calculated to find the best cut-off value. Results: nNO was measured in 40 patients with PCD group, 75 PCD symptom-similar group (including 23 cases of situs inversus or ambiguus, 8 cases of CF, 26 cases of bronchiectasis or chronic suppurative lung disease, 18 cases of asthma), and 55 nNO normal controls group. The age of the three groups was respectively 9.7 (6.7,13.4), 9.3 (7.0,13.0) and 9.9 (7.3,13.0) years old. nNO values were significantly lower in children with PCD than in PCD symptom-similar group and nNO normal controls (12 (9,19) vs. 182 (121,222), 209 (165,261) nl/min, U=143.00, 2.00, both P<0.001). In the PCD symptom-similar group, situs inversus or ambiguus, CF, bronchiectasis or chronic suppurative lung disease and asthma were significantly higher than children with PCD (185 (123,218), 97 (52, 132), 154 (31, 202), 266 (202,414) vs. 12 (9,19) nl/min,U=1.00, 9.00, 133.00, 0, all P<0.001). A cut-off value of 84 nl/min could provide the best sensitivity (0.98) and specificity (0.92) with an area under the curve of 0.97 (95%CI 0.95-1.00, P<0.001). Conclusions: nNO value can draw a distinction between patients with PCD and others. A cut-off value of 84 nl/min is recommended for children with PCD.

ROLE OF LOW-DOSE AZITHROMYCIN IN THE MANAGEMENT OF CYSTIC BRONCHIECTASIS: A CASE SERIES

Bronchiectasis is an abnormal chronic and persistent dilatation of the bronchi that is accompanied by destruction of the bronchial walls due to congenital or acquired disorders such as chronic respiratory tract infections. Recurrent respiratory tract infections are characteristic of bronchiectasis. Radiological examination plays a role in diagnosis, a thin section CT to confirm a diagnosis of bronchiectasis when clinically suspected, and provides clearer information on lung morphology. The goals of treating bronchiectasis are to prevent exacerbations, reduce complaints, improve the patient's quality of life, and stop the disease from worsening. Therapy is expected to address the proven underlying cause, cutting off the vicious cycle of bronchiectasis Long-term antibiotics are considered in patients with bronchiectasis with frequent exacerbations three or more times per year to relieve symptoms and reduce the frequency of exacerbations. Macrolides are a plausible alternative antibiotic and anti-inflammatory agent with a lower burden of treatment for bronchiectasis patients. We present three cases of Bronchiectasis that were admitted to Mataram University Hospital. The three cases were given Long-term antibiotics with low-dose Azithromycin for 2 and 3 months. This report demonstrates clinical improvement in a reduction of exacerbation frequency, improvement in quality of life, decreased sputum production, and increased ability to carry out activities in patients treated with low-dose azithromycin. The most common side effect that appears in three cases is gastrointestinal disturbances.

Bronchiectasis as co morbidity with COPD or ILD: complex interactions and severe consequences

BackgroundBronchiectasis is a chronic pulmonary disease characterized by widened, malformed bronchi, with profuse expectoration and impaired quality of life. COPD and ILD are common co-morbidities with bronchiectasis.MethodsThe present study evaluated the clinical, laboratory& radiological characteristics of COPD and ILD with/without bronchiectasis. A hospital-based, retrospective study was conducted for 1 year.ResultsA total of 101 patients were analyzed, 60 patients had COPD, 34 had ILD and 7 patients had bronchiectasis without COPD or ILD. It was noticed that, out of the analyzed 60 COPD patients, 10 patients developed bronchiectasis (16.7%) versus10 patients of 34 ILD patients (29.4%). In COPD and ILD accompanied by bronchiectasis, the incidence of hemoptysis was significantly higher in comparison to those without bronchiectasis. Moreover, they showed a significant increase in partial pressure of carbon dioxide (PCO2) in comparison to those without bronchiectasis, as well as in comparison to bronchiectasis only. Sputum culture revealed that COPD with bronchiectasis were significantly associated with Staphlococcus aureus (77.8%), more than ILD with Bronchiectasis (33.3%). While S. pneumoniae were more evident in cases of ILD with bronchiectasis (22.2%). The bilateral, peripheral bronchiectasis was more common than the unilateral, central bronchiectasis among cases of COPD with bronchiectasis followed by ILD with bronchiectasis more than bronchiectasis only.ConclusionPatients with COPD /ILD with bronchiectasis can be associated with serious clinical manifestations as hemoptysis. Their sputum cultures detected more positive organisms than negative in comparison to cases of bronchiectasis only. Screening of COPD and ILD patients using HRCT Scanning is a recommended preventive measure for early detection of bronchiectasis.

A Rare Case of Bronchiectasis with Mucoid Impaction Caused by Schizophyllum commune in an Immunocompetent Woman in South Korea

Sookin Moon, M.D., Ka Yeon Jung, M.D., Hyunjoo Lee, M.D., Soo-Youn Ham, M.D., Seong Jun Park, M.D., Eun Hye Cho, M.D., Hee-Yeon Woo, M.D., Hyosoon Park, M.D., Seong Yong Lim, M.D., Min-Jung Kwon, M.D.. Lab Med Online 2023;13:27-30. https://doi.org/10.47429/lmo.2023.13.1.27

Diagnostic Efficacy of CT Radiomic Features in Pulmonary Invasive Mucinous Adenocarcinoma.

In order to solve the problem of the effect of CT images on the diagnosis of lungs, the authors proposed a method for the diagnosis of invasive mucinous adenocarcinoma of the lungs based on CT radiomic features, and the modified method is found by reviewing past cases: among the 34 cases of primary pulmonary lymphoma, 12 cases were nodular mass type, 19 cases were nonnodular mass type, and 3 cases were mixed type; 13 cases involved bilateral lung lobes, 7 cases involved right lung, and 4 cases involved left lung example. There were 17 cases of tumor consolidation density shadow, 17 cases of mixed density shadow, the average CT value was about 32HU, 15 cases of cavitation sign, 6 cases of cavity, 9 cases of angiography sign, 30 cases of air bronchus sign, 22 cases of bronchiectasis, bronchial stenosis or amputation in 8 cases, pleural effusion in 12 cases, lymph node enlargement in 15 cases, and pleural metastasis in 2 cases. The final pathological results included 24 cases of membrane-associated lymphoid tissue (MALT) lymphoma, 9 cases of diffuse large B-cell lymphoma (DLBCL), and 1 case of T-cell lymphoma. The CT manifestations of primary pulmonary lymphoma (PPL) are diverse and do not have obvious specificity, the imaging manifestations are correlated with pathological types, and air bronchial signs, bronchiectasis, angiography signs, and other signs are used for the diagnosis of PPL. This is of great significance for the diagnosis of PPL.

AN UNUSUAL CASE OF BRONCHIECTASIS IN A PATIENT WITH DERMATOMYOSITIS

TYPE: Case Report TOPIC: Diffuse Lung Disease INTRODUCTION: Bronchiectasis is a progressive lung disease defined by dilatation of the bronchi in the setting of chronic airway infection and/or inflammation. It is common pulmonary manifestation in certain rhumatologic disorders, however, it has never been reported in association with inflammatory myopathies. Here we present a case of bronchiectasis in a patient with dermatomyositis. CASE PRESENTATION: A 71 year old African American woman with history of dermatomyositis presented with productive cough for two years. She was diagnosed with dermatomyositis 20 years prior, treated with immunosuppressives and no current active disease. She had no history of smoking, recurrent respiratory infection or occupational exposure. Her Chest CT demonstrated bibasilar and upper lobes cylindrical bronchiectasis (figure). Labratory tests indicated normal CBC, CMP, Muscle enzyms, Serum IgE levels to Aspergillus, Alpha-1antitrypsin and negative ANA, RF, Anti-CCP and TB tests. Patient was started on acapella therapy and albuterol as needed with improvement in her symptoms. DISCUSSION: Bronchiectasis often develops in the setting of infections, ciliary clearance impairment, immunodeficiencies, allergic bronchopulmonary aspergillosis and Alpha1-antitrypsin deficiency. It is an unusual manifestation in inflammatory myopathies where Interstitial Lung Diseases (ILDs) are the most common pattern of lung involvement. ILDs often present with dyspnea, dry cough and CT findings of basal reticular abnormalities or honeycombing, as oppose to our patient's presentation and CT findings of diffuse cylindrical bronchiectasis without reticular abnormalities. With all other etiologies ruled out, it was suspected her dermatomyositis to be the underlying etiology of bronchiectasis. CONCLUSIONS: It is important to recognize and suspect atypical lung presentations in patients with inflammatory myopathies. DISCLOSURE: Nothing to declare. KEYWORD: Bronchiectasis

Bronchiectasis in severe asthma and asthmatic components in bronchiectasis.

Asthma and bronchiectasis are different diseases; however, differentiating them can be difficult because they share several symptomatic and physiological similarities. Approximately 20% of patients with bronchiectasis have eosinophilic inflammation, 34% show wheezing, and 7-46% have comorbid asthma, although comorbidity with severe asthma may be limited as shown in 3.3% of cases of bronchiectasis. Meanwhile, 25-68% of patients with severe asthma have comorbid bronchiectasis, and at least two phenotypes are present in the accompanying bronchiectasis: eosinophilic bronchiectasis and chronic infectious bronchiolitis/bronchiectasis. Recent studies show that type-2-targeted biologics are effective for eosinophilic bronchiectasis and theoretically effective for some of the remaining cases when used before oral corticosteroids. Further studies are needed to identify treatment strategies for severe asthma with comorbid bronchiectasis and vice versa.

The role of syphilis in the etiology of oronchiectasis in children. Pr. Med. 1932. P. 56, Mikulovski

A. describes 2 cases of bronchiectasis in children with syphilitic manifestations. The first child (1 year old) developed "bronchiectasis after whooping cough."

“A STUDY OF CORRELATION BETWEEN CLINICAL FEATURES, RADIOLOGICAL FINDINGS AND SPIROMETRY PARAMETERS IN PATIENTS OF BRONCHIECTASIS”

INTRODUCTION: Bronchiectasis is dened as an irreversible dilation and destruction of one or more bronchi with a reduction in clearance of secretions and in the expiratory airow. Etiologies include prior lung infection, systemic inammatory disorders, and genetic disorders of host defense. METHODOLOGY: This is an Observational study of 160 patients patient who were diagnosed with Bronchiectasis in tertiary health care centre over a period of 15 months. Data was collected and analyzed for correlation between clinical features, radiological ndings and spirometry parameters. RESULT: Mean age of presentation was 21-30 years. Most important etiology was post-infections, pulmonary tuberculosis followed by pneumonia. The cardinal symptoms of bronchiectasis were productive cough followed by dyspnoea on exertion. The most common bacteria isolated from sputum culture was Haemophilus Inuenzae. The commonest radiological pattern of bronchiectasis was cylindrical followed by cystic and varicose. Most of the patients had obstructive pattern in spirometry tests. CONCLUSION: Radiological ndings and spirometry test are more valuable for early and accurate diagnosis of bronchiectasis which help in early and prompt management. Cases of bronchiectasis have repeated history of admissions in the hospital thus all options of treatment including surgical intervention must be taken into consideration for good quality life and healthy.

Whole genome sequencing in the diagnosis of primary ciliary dyskinesia

BackgroundIt is estimated that 1–13% of cases of bronchiectasis in adults globally are attributable to primary ciliary dyskinesia (PCD) but many adult patients with bronchiectasis have not been investigated for PCD. PCD is a disorder caused by mutations in genes required for motile cilium structure or function, resulting in impaired mucociliary clearance. Symptoms appear in infancy but diagnosis is often late or missed, often due to the lack of a “gold standard” diagnostic tool and non-specific symptoms. Mutations in > 50 genes account for around 70% of cases, with additional genes, and non-coding, synonymous, missense changes or structural variants (SVs) in known genes presumed to account for the missing heritability.MethodsUK patients with no identified genetic confirmation for the cause of their PCD or bronchiectasis were eligible for whole genome sequencing (WGS) in the Genomics England Ltd 100,000 Genomes Project. 21 PCD probands and 52 non-cystic fibrosis (CF) bronchiectasis probands were recruited in Wessex Genome Medicine Centre (GMC). We carried out analysis of single nucleotide variants (SNVs) and SVs in all families recruited in Wessex GMC.Results16/21 probands in the PCD cohort received confirmed (n = 9), probable (n = 4) or possible (n = 3) diagnosis from WGS, although 13/16 of these could have been picked up by current standard of care gene panel testing. In the other cases, SVs were identified which were missed by panel testing. We identified variants in novel PCD candidate genes (IFT140 and PLK4) in 2 probands in the PCD cohort. 3/52 probands in the non-CF bronchiectasis cohort received a confirmed (n = 2) or possible (n = 1) diagnosis of PCD. We identified variants in novel PCD candidate genes (CFAP53 and CEP164) in 2 further probands in the non-CF bronchiectasis cohort.ConclusionsGenetic testing is an important component of diagnosing PCD, especially in cases of atypical disease history. WGS is effective in cases where prior gene panel testing has found no variants or only heterozygous variants. In these cases it may detect SVs and is a powerful tool for novel gene discovery.

Application of extracorporeal membrane oxygenation in the perioperative period of lung transplantation

Objective: To investigate the application of extracorporeal membrane oxygenation (ECMO) in the perioperative period of lung transplantation, and summarize the experience. Methods: The clinical data of 19 patients receiving lung transplantation operation in Renmin Hospital of Wuhan University from December 2016 to December 2020 were retrospectively analyzed. Patients were divided into groups according to whether ECMO support was used, and their clinical data were compared. Results: Among the 19 patients, there were 5 cases of chronic obstructive pulmonary disease, 3 cases of bronchiectasis, 4 cases of pneumoconiosis, 4 cases of idiopathic pulmonary fibrosis, 1 case of connective tissue disease interstitial pulmonary fibrosis, 1 case of Kartagener syndrome, and 1 case of COVID-19 with advanced pulmonary fibrosis. Among the 10 patients in the non-ECMO group, 1 died during the operation, 1 died after abandoning treatment, and 1 was discharged after abandoning treatment. There were 9 patients in the ECMO group, 2 patients received ECMO bridged treatment before surgery, and the remaining 7 patients received ECMO adjuvant treatment after anesthesia. In the ECMO group, 1 patient died, 1 patient was discharged after abandoning treatment, and the rest patients were all improved and discharged after successful weaning of ECMO. The two groups only differed in the way of preoperative respiratory support (P=0.033). There were no significant differences in gender, age, preoperative assessment, surgical process, length of hospital stay, ICU stay, postoperative multi-drug resistant organism infection, and outcome. Conclusion: ECMO is an important auxiliary tool during the perioperative period of lung transplantation. The use of ECMO did not increase the risk of postoperative infection with multidrug-resistant bacteria, nor did it lead to an increase in mortality. In the other hand, the choice of preoperative respiratory support method has reference for perioperative patients whether to use ECMO. © 2021, Editorial Board of Medical Journal of Wuhan University. All right reserved.

Summary of perioperative hemodynamic management of 19 lung transplant recipients

Objective: To summarize and discuss the experience of perioperative hemodynamic management of lung transplant recipients. Methods: A total of 19 lung transplant recipients from December 2016 to December 2020 were investigated in Renmin Hospital of Wuhan University, all of which were transferred to the intensive care unit for further monitoring and treatment, and their clinical data were retrospectively analyzed. Results: The 19 lung transplant recipients included 5 cases of chronic obstructive pulmonary disease (COPD), 5 cases of idiopathic pulmonary fibrosis (IPF), 4 cases of pneumoconiosis, 2 cases of bronchiectasis, 1 case of later lung fibrosis associated with COVID-19, 1 case of connective tissue disease-related pulmonary fibrosis, and 1 case of Kartagener syndrome. Twelve cases adopted double lung transplantation, while seven cases reveived unilateral lung transplantation (4 cases of left single lung transplantation and 3 cases of right single lung transplantation). There were 6 deaths during the perioperative period. One case died of multi-drug resistant bacteria infection, one case died of circulatory failure caused by active thoracic hemorrhage post-operation, the third case died of intraoperative cardiac arrest, and the other 3 cases were given up because of multiple organs failure. The remaining 13 cases were cured and discharged. Of the 19 recipients, 14 received vasopressors. The total and daily fluid output of the recipients in 3 postoperation days were greater than the input volume (P<0.05). Conclusion: Lung transplantation is an effective method for the treatment of end-stage lung disease. The hemodynamic management is a keypoint during perioperative period. It is import to maintain the blood volume as low as possible under the premise of systemic perfusion, limit the amount of fluid, choose albumin or plasma to increase the colloidal osmotic pressure, and strengthen the maintenance of right heart function. These abobe measures may improve the prognosis of lung transplant recipients. © 2021, Editorial Board of Medical Journal of Wuhan University. All right reserved.

P0190POINT-OF-CARE ULTRASONOGRAPHY FOR VOLUME ASSESSMENT IS EASY TO LEARN AND HAS GOOD REPRODUCIBILITY IN NEW USERS

Abstract Background and Aims In recent years, point-of-care ultrasonography (POCUS) with lung ultrasonography (LUS) and inferior vena cava diameter (IVCD) measurements have attracted growing attention due to their capacity to estimate volume status in end-stage kidney disease (ESKD). There have been concerns about inter-operator reproducibility in POCUS, particularly the new user’s ability to distinguish varying lung pathologies on LUS accurately. For instance, lung diseases with thickening of subpleural structures, such as pulmonary fibrosis, can mimic LUS B-lines. B-lines are artefacts produced by extravascular lung water, which is summated into a B-line score (BLS). This study aims to investigate the ease of learning, and the inter-operator reproducibility of LUS and IVCD in an Asian haemodialysis (HD) cohort, in users with no prior ultrasound experience. Method A subgroup of 14 HD patients from the observational study by Teng et al comparing LUS and IVCD with other fluid assessment methods in a HD cohort, underwent LUS and IVCD pre- and post-HD with 2 operators in separate settings. LUS was performed via a 28-point protocol, while IVCD was measured in both inspiration (IVCDmin) and expiration (IVCDmax). IVCDi was calculated by indexing IVCD to body surface area. Study details are available elsewhere. One operator was a Nephrologist experienced in ultrasonography who had done 150 previous studies, whilst the second operator was a Resident who had no prior exposure to POCUS. The Resident underwent 4 hours of instructional teaching including theory sessions, simulation and image interpretation. Images acquired by the Resident during the study were audited for interpretative accuracy, such as the ability to diagnose lung pathology accurately. The Resident was required to review the clinical presentations of all patients before making ultrasound diagnoses. Results 392 lung images and 56 IVC images were acquired for 14 HD patients. 100% of patients’ clinical notes were reviewed prior to making ultrasound diagnosis. &amp;gt;98% of the diagnoses were correctly made, and only in 1 patient (7 lung images; case of bronchiectasis), was the ultrasonographic diagnosis incorrectly made of B-lines, although B-lines were seen in other lung fields in the same patient. There was excellent inter-operator variability for BLS (r = 0.983, p &amp;lt; 0.001). There was moderate agreement between both operators in terms of BLS and by BLS categories (k = 0.586, p = 0.015 and k = 0.521, p = 0.010). In 14 independent LUS studies, only 1 reading demonstrated interobserver difference exceeding 1.96 standard deviation (SD). There was also excellent inter-operator variability for IVCDimax (r = 0.994, p &amp;lt; 0.001) and IVCDimin. In 14 independent IVCDimax readings, 2 readings demonstrated interobserver difference exceeding 1.96 SD. Conclusion Point-of-care ultrasonography for volume assessment is able to demonstrate good inter-operator reproducibility and is easy for new users to learn. There is hence potential for more widespread incorporation of these volume assessment tools into community dialysis centres. POCUS has traditionally been performed by medical professionals, but in light of the relative ease of learning curve, it may be possible for allied healthcare professionals to acquire skills in POCUS.

A case of bronchiectasis with right middle lobe resection after embolization of bronchial artery, inferior phrenic artery, and internal thoracic artery with severe shunt with middle lobe pulmonary artery

A case of bronchiectasis with right middle lobe resection after embolization of bronchial artery, inferior phrenic artery, and internal thoracic artery with severe shunt with middle lobe pulmonary artery

Pediculated Intercostal Muscle Flaps in Bronchiactasis Resectional Surgery for Bronchial Stump Reinforcement.

To determine the outcome of muscle flap to cover the bronchial stump in the resectional surgery for bronchiectasis for prevention of bronchopleural fistula. Case series. Combined Military Hospitals of Quetta, Lahore, and Rawalpindi from January 2006 to August 2017. Patients with localised bronchiectatic changes were included. Patients with carcinoma and without flap resection were excluded. Resectional surgery was performed through posterolateral thoracotomy approach, under general anesthesia with one lung ventilation. Pediculated or bipediculated intercostal muscle flap (ICM) was used to reinforce the bronchial stump. Pediculated ICM flaps were utilised for reinforcement of bronchial stump and bipediculated flaps were used over lesser. Three hundred and ninety-eight cases of bronchiectasis with average age of patients 38.5 ±19.8 years and male to female ratio of 2:1 were included. Bronchiectasis was unilateral in 377 cases. Tuberculous was found in 278 of the cases. Thirty-five had poor lung function tests (FEV1 <1.5%). Eighty-two patients underwent pneumonectomy, 228 patients had lobectomy and 88 patients underwent segmentectomy. Posterior-based pediculated ICM flap was used in 365 patients, and bipediculated ICM flaps in 30 cases. The most common complication was post-thoracotomy neuralgia 53. Bronchopleural fistula, despite transposition of intercostal muscle flap on bronchial stump, was present in 4 patients. Application of muscle flap over bronchial stump after resection surgery for bronchiectasis, is simple, safe and effective surgical option to avoid complication of bronchopleural fistula.