Segment Of Left Lung Research Articles

Intermittent sigh breaths during high-frequency oscillatory ventilation in preterm infants: a randomised crossover study

ObjectiveTo determine if combining high-frequency oscillatory ventilation (HFOV) with additional sigh breaths would improve end-expiratory lung volume (EELV) and oxygenation in preterm infants.DesignProspective interventional crossover study.SettingNeonatal intensive care unit.PatientsVentilated preterm...

Electrical impedance segmentography: A promising tool for respiratory monitoring?

Non-invasive, radiation free bedside monitoring methods have gained increased popularity in the respiratory field. The aim of our study was to report the experience with electrical impedance segmentography (EIS), a rather new technique, which allows continuous visual and quantitative monitoring of regional lung ventilation. Prospective, pilot trial in spontaneously breathing, healthy, non-sedated term neonates between 24 and 72 hours post-delivery using a commercially available EIS-device. Systematic review of the literature. A total of 12 neonates were eligible for complete data analysis in our study. EIS was found to be a safe and easy to perform method. The median duration of the study time was 25 minutes (16-40). Individual total and regional impedance values, given in arbitrary units and it's percentage of distribution in the upper and lower right and left lung segments (UR, UL, LR, LL), were variable (median total impedance 207 arbitrary units (AU), UR% 17, LR 27%,UL 28%, LL 23%). A number of influencing factors such as body movements, sucking, jawing, and electrode issues have to be considered for correct data interpretation. The literature search revealed two small experimental studies in neonatal piglets and two human studies (one study in preschool children with bronchopulmonary dysplasia and one case report in a neonate with respiratory distress). EIS is an innovative technique and a potentially useful tool in studying regional lung ventilation in research and clinical care.

Dexamethasone inhibits endotoxin‐induced coagulopathy in human lungs

Essentials Glucocorticoids are associated with an increased risk of thrombosis.Healthy volunteers received dexamethasone or placebo in an endotoxin lung instillation model.Dexamethasone suppressed thrombin generation in bronchoalveolar lavage.Glucocorticoids inhibit endotoxin induced pulmonary coagulopathy. SummaryBackgroundActivation of local and systemic coagulation is a common finding in patients with pneumonia. There is evidence that glucocorticoids have procoagulant activity in the circulation, particularly in the context of inflammation. The effects of glucocorticoids on local pulmonary coagulation have not yet been investigated.ObjectiveTo use a human model of lung inflammation based on the local instillation of endotoxin in order to investigate whether glucocorticoids alter pulmonary coagulation.MethodsTwenty‐four healthy volunteers were randomized to receive either dexamethasone or placebo in a double‐blind trial. Endotoxin was instilled via bronchoscope into right or left lung segments, followed by saline into the contralateral site. Six hours later, a bilateral bronchoalveolar lavage (BAL) was performed and coagulation parameters were measured.ResultsEndotoxin induced activation of coagulation in the bronchoalveolar compartment: the level of prothrombin fragment 1 + 2 (F1 + 2) was increased three‐fold (248 pmol L−1, 95% confidence interval [CI] 43–454 versus 743 pmol L−1, 95% CI 437–1050) and the level of thrombin–antithrombin complex (TATc) was increased by ~ 50% (31 μg L−1, 95% CI 18–45 versus 49 μg L−1, 95% CI 36–61) as compared with saline‐challenged segments. Dexamethasone reduced F1 + 2 (284 pmol L−1, 95% CI 34–534) and TATc (9 μg L−1, 95% CI 0.7–17) levels almost to those measured in BAL fluid from the saline‐instilled segments in the placebo group. Dexamethasone even profoundly reduced F1 + 2 levels (80%) in saline‐instilled lung segments (50 pmol L−1, 95% CI 12–87). In contrast, dexamethasone had no effect on systemic F1 + 2 levels.ConclusionsDexamethasone inhibits endotoxin‐induced coagulopathy in lungs. This trial is the first to provide insights into the effects of glucocorticoids on pulmonary coagulation in response to endotoxin.

VATS left upper lobe posterior segmentectomy.

A 56-year-old male patient was admitted due to one small pulmonary nodule in the posterior segment of left upper lobe. Preoperative examinations showed no distant metastasis, pulmonary ventilation function and small airway function were highly damaged and could not tolerate lobectomy. Chest computed tomography (CT) showed one small pulmonary nodules on the posterior segment of left lung, which was considered to be early malignant lesions. In addition, no remarkably swollen lymph node was visible in the mediastinum. Therefore, video-assisted thoracic surgery (VATS) left upper lobe posterior segmentectomy was performed, and intraoperative frozen section confirmed the diagnosis of adenomatous hyperplasia of alveolar epithelial. Sequential dissection (or, single-direction approach) was applied in this surgery to avoid frequent turn-over of the lung lobes and shift of visual angle during the procedures. The Electric hook used in this surgery enables careful dissection and dissociation, with clear visual field and small blood loss.

Methodology For Delivery and Kinetics of Clearance of Insoluble Particles from Sublobar Lung Segments

Anesthetized, mixed breed dogs were studied in a supine position, mechanically ventilated and imaged from the ventral aspect by γ-camera. Five dogs were evaluated; four of these were restudied to determine repeatability of the methods. A ventilation scan (133 Xe gas) was used to characterize the homogeneity of ventilation and to outline regions of analysis. An aqueous, insoluble radiolabeled aerosol (99m Tc-sulfur colloid) was generated by ultrasonic nebulization and delivered directly through a channel of a bronchoscope scope into sublobar bronchi. Lung retention of particles was measured continuously for ~ 1 h, followed by recovery; and dogs were reimaged at 6- and 24-h time points postdeposition. After the initial hour of clearance, mean particle retention tended to be lower in left lung segments as compared to the right lung segments, that is, 57.3% (±5.0% SE) and 75.4% (±6.7%), respectively; however, these differences were not significant. At the 6-h time postdeposition, clearance was more comparable between lung segments, that is, mean retention of 43.3% for the left versus 50.4% for the right lung segments. A small, additional amount of particle clearance occurred by the 24-h endpoint; the final mean retention levels were 34.8% and 47.1 % for respective left and right lung segments. This technique assesses mucociliary clearance of aqueous aerosols delivered directly to the epithelial surfaces of sublobar bronchi.