Loss Of Lung Volume Research Articles

EVALUATION OF LUNG FUNCTION AFTER SARS-COV-2 PNEUMONIA

TOPIC: Pulmonary Physiology TYPE: Original Investigations PURPOSE: To investigate the patients' lung function at 3 and 6 months after hospital discharge for Coronavirus Disease 2019 (COVID-19) pneumonia. METHODS: A prospective lung function assessment has been conducted with spirometry measurements, including lung volumes, lung diffusion capacity for carbon monoxide (DLCO) with alveolar volume (VA), and transfer coefficient (KCO) determination. Patients with a restrictive ventilatory defect or impaired DLCO were re-evaluated at 6 months with global spirometry and chest HRCT scan. RESULTS: 40 patients have been enrolled in the study. Among them, 19 (48%) had normal pulmonary function tests (group A), and 21 (52%) showed residual lung function abnormalities at 3 months after hospital discharge (group B). In group B, 4 patients (19%) had an isolated loss of lung volume (Subgroup B1), 13 patients (62%) had both lung volume, and DLCO decreased (Subgroup B2), and 4 patients (19%) had isolated reduction in DLCO (Subgroup B3). At the 6-month follow-up visit, in Subgroup B1, although all patients improved, only one normalized the total lung capacity (TLC). In Subgroup B2, TLC and DLCO increased significantly (p<0.01), but only 3 patients reached normal values. In Subgroup B3, DLCO improved for most patients, normalizing in 50% of them. Always at the 6-months follow-up visit, significant correlations between an internal chest HRCT scan severity score and TLC (r2=0.33;p<0.01) and DLCO (r2=0.32;p<0.01) has been found. CONCLUSIONS: Nearly 50% of patients recovered in the post-critical phase. Most of those with abnormal pulmonary function tests at the 3-months follow-up visit had an improvement at the 6-month evaluation, but only 29% reached normal values. CLINICAL IMPLICATIONS: In patients with previous COVID-19 pneumonia, lung function spontaneous recovery is faster at first. However, at 6-months after hospital discharge, this recovery process goes more slowly, leaving more than one-third of patients with abnormal lung function tests. DISCLOSURES: No relevant relationships by Francesca Cettolo, source=Web Response No relevant relationships by Manuela Ciarfaglia, source=Web Response No relevant relationships by Jordan Franz Giordani, source=Web Response No relevant relationships by Michele Guerini, source=Web Response No relevant relationships by Guido Levi, source=Web Response No relevant relationships by Nicla Orzes, source=Web Response No relevant relationships by Laura Pini, source=Web Response No relevant relationships by Alessandro Pini, source=Web Response No relevant relationships by Claudio Tantucci, source=Web Response No relevant relationships by Silvia Uccelli, source=Web Response

Pathophysiology of pulmonary function anomalies in COVID-19 survivors.

Coronavirus disease 2019 (COVID-19) is a disease caused by a new coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-​2), and the predisposing and protecting factors have not been fully elucidated. COVID-19 primarily impacts the respiratory system, and can result in mild illness or serious disease leading to critical illness requiring admission to the intensive care unit due to respiratory failure. After hospital discharge, the more commonly described pulmonary function anomalies are alterations in diffusing capacity and the loss of lung volume. Reduction of inspiratory muscle contraction may also be underestimated. This article will focus on the pathophysiology of pulmonary function anomalies in COVID-19 survivors. We will discuss current advances and provide future directions and also present our perspective on this field.

Thoracic Morphology and Bronchial Narrowing Are Related to Pulmonary Function in Adolescent Idiopathic Scoliosis.

In adolescent idiopathic scoliosis (AIS), lung function impairment is not necessarily related to the coronal spinal deformity. Recently, right-sided bronchial narrowing has been reported in thoracic AIS. The aim of this study was to describe the relation of chest and spinal deformity parameters, bronchial narrowing, and lung volumes with pulmonary function in preoperative AIS. Spinal radiographs, low-dose computed tomographic (CT) scans of the spine including the chest, and pulmonary function tests were retrospectively collected for 85 preoperative patients with thoracic AIS in 2 centers and were compared with 14 matched controls. Three-dimensional lung and airway reconstructions were acquired. Correlation analysis was performed in which radiographic spinal parameters, CT-based thoracic deformity parameters (rib-hump index [RHi], spinal penetration index, endothoracic hump ratio, hemithoracic-width ratio), lung volume asymmetry, and bronchial cross-sectional area were compared with percent-of-predicted spirometry results. Forty-one patients (48%) had a percent-of-predicted forced expiratory volume in 1 second (FEV1%) or percent-of-predicted forced vital capacity (FVC%) of <65%, and 17 patients (20%) had obstructive lung disease. All thoracic deformity parameters correlated significantly with FEV1% and FVC%; RHi was found to be the best correlate (rs = -0.52 for FEV1% and -0.54 for FVC%). Patients with AIS with impaired pulmonary function had hypokyphosis, a larger rib hump, increased spinal and thoracic rotation, a narrower right hemithorax, and increased intrusion of the spine into the chest. Spinal intrusion correlated with right-sided bronchial narrowing, relative right lung volume loss, and decreased FEV1% and FVC%. Multivariate regression including spinal and thoracic deformity parameters, lung volume asymmetry, and airway parameters could explain 57% of the variance in FEV1% and 54% of the variance in FVC%. Chest intrusion by the endothoracic hump is related to right-sided bronchial narrowing and lung function loss in preoperative AIS. The findings support the theory that ventilatory dysfunction in thoracic AIS is not only restrictive but frequently has an obstructive component, especially in patients with hypokyphosis. RHi is the most predictive chest parameter for lung function loss. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

A prospective evaluation of lung function at three and six months in patients with previous SARS-COV-2 pneumonia

ObjectiveThis study investigated the consequences of Coronavirus Disease 2019 (COVID-19) pneumonia on lung function in the first 6 months after hospital discharge. MethodsA prospective lung function assessment in SARS-CoV2 patients with COVID-19 pneumonia, hospitalized between March and April 2020, was conducted with spirometry measurements including lung volumes, mainly total lung capacity (TLC), lung diffusion capacity for carbon monoxide (DLCO) collected at 3 months after hospital discharge. Patients with restrictive ventilatory defect or impaired DLCO or both were re-evaluated at 6 months with global spirometry and chest HRCT scan. ResultsAmong 40 consecutive patients, 19 (48%) had normal pulmonary functional tests (group A), and 21 (52%) showed residual lung function abnormalities at 3 months after hospital discharge (group B). In group B, 4 patients (19%) had only loss of lung volume as shown by TLC reduction (group 1), 13 patients (62%) had decreased both TLC and DLCO (group 2), and 4 patients (19%) had isolated reduction in DLCO (group 3). At 6-month follow-up in group 1, although all patients improved, only one normalized total lung capacity (TLC). In group 2, TLC and DLCO increased significantly (p < 0.01), but only 3 patients reached normal values. In group 3, DLCO improved for most patients, normalizing in 50% of them. At 6-months significant correlations between an internal-built chest HRCT scan severity score and TLC (r2 = 0.33; p < 0.01) and DLCO (r2 = 0.32; p < 0.01) were found. ConclusionsNearly 50% of patients recovered in the post-critical phase. Most of those with abnormal pulmonary function tests at 3 months improved subsequently, but only another 29% (6 out of 21) reached normal values at 6 months. These results indicate that lung function spontaneous recovery is faster at first and occurs more slowly thereafter, leaving more than one third (15 out of 40) of patients with abnormal lung function tests at 6 months.

Extubation generates lung volume inhomogeneity in preterm infants

ObjectiveTo evaluate the feasibility of electrical impedance tomography (EIT) to describe the regional tidal ventilation (VT) and change in end-expiratory lung volume (EELV) patterns in preterm infants during the process...

Diaphragm neurostimulation during mechanical ventilation reduces atelectasis and transpulmonary plateau pressure, preserving lung homogeneity and [Formula: see text]/[Formula: see text

Tidal volume delivered by mechanical ventilation to a sedated patient is distributed in a nonphysiological pattern, causing atelectasis (underinflation) and overdistension (overinflation). Activation of the diaphragm during controlled mechanical ventilation in these sedated patients may provide a method to reduce atelectasis and alveolar inhomogeneity, protecting the lungs from ventilator-induced lung injury while also protecting the diaphragm by preventing ventilator-induced diaphragm dysfunction. We studied the hypothesis that diaphragm contractions elicited by transvenous phrenic nerve stimulation, delivered in synchrony with volume-control ventilation, would reduce atelectasis and lung inhomogeneity in a healthy, normal lung pig model. Twenty-five large pigs were ventilated for 50 h with lung-protective volume-control ventilation combined with synchronous transvenous phrenic-nerve neurostimulation on every breath, or every second breath. This was compared to lung-protective ventilation alone. Lung mechanics and ventilation pressures were measured using esophageal pressure manometry and electrical impedance tomography. Alveolar homogeneity was measured using alveolar chord length of preserved lung tissue. Lung injury was measured using inflammatory cytokine concentration in bronchoalveolar lavage fluid and serum. We found that diaphragm neurostimulation on every breath preserved [Formula: see text]/[Formula: see text] and significantly reduced the loss of end-expiratory lung volume after 50 h of mechanical ventilation. Neurostimulation on every breath reduced plateau and driving pressures, improved both static and dynamic compliance and resulted in less alveolar inhomogeneity. These findings support that temporary transvenous diaphragm neurostimulation during volume-controlled, lung-protective ventilation may offer a potential method to provide both lung- and diaphragm-protective ventilation.NEW & NOTEWORTHY Temporary transvenous diaphragm neurostimulation has been shown to mitigate diaphragm atrophy in a preclinical model. This study contributes to this work by demonstrating that diaphragm neurostimulation can also offer lung protection from ventilator injury, providing a potential solution to the dilemma of lung- versus diaphragm-protective ventilation. Our findings show that neurostimulation on every breath preserved [Formula: see text]/[Formula: see text], end-expiratory lung volume, alveolar homogeneity, and required lower pressures than lung-protective ventilation over 50 h in healthy pigs.

Effect of High-Flow Nasal Cannula for Hypoxemia Following Sun's Procedure in Acute Aortic Dissection Type a Patients.

Background: Patients with acute aortic dissection type A (AADA) often have hypoxemia (partial pressure of oxygen [PaO2]/fraction of inspired oxygen [FiO2] <300 mmHg) before weaning in the intensive care unit (ICU). This study compared the efficacy of high-flow nasal cannula (HFNC) with that of conventional oxygen therapy (COT) in patients with AADA following Sun's procedure.Methods: The medical records of 87 adult patients with AADA who underwent Sun's procedure and met the inclusion criteria (PaO2/FiO2 <300 mmHg before weaning) were retrospectively analyzed. After surgery, 41 patients were treated with HFNC and 46 were treated with COT. The oxygenation level, FiO2, partial pressure of carbon dioxide, heart rate, respiratory rate, subjective discomfort, and reintubation rate were recorded. The difference in lung volume loss between the HFNC and COT groups was assessed using the radiological atelectasis score (chest radiograph) or calculated from three-dimensional (3D) reconstructed computed tomography (CT) images.Results: From day 1 to day 5 after weaning, there was no significant difference in PaO2/FiO2 between the HFNC and COT groups, although the FiO2 was significantly lower in the HFNC group than in the COT group (P < 0.05). Further studies indicated that the percentage of lung volume loss (pleural effusion and/or pulmonary atelectasis) by 3D reconstruction of CT images at 4–8 days post-operation was significantly lower in the HFNC group (P < 0.05). The subjective experience of breathing discomfort, reintubation rate, and length of stay in the ICU were significantly reduced in the HFNC group (P < 0.05). There was no significant difference in readmission to the ICU and in-hospital mortality between the two groups.Conclusions: HFNC can be used as an effective oxygen therapy for AADA patients with hypoxemia after Sun's procedure.

Systemic sclerosis with associated interstitial lung disease: management considerations and future directions.

Systemic sclerosis (SSc), also referred to as scleroderma, is a rare autoimmune disease associated with vasculopathy, inflammation, andfibrosis of the skin and/or internal organs. Interstitial lung disease (ILD) is a frequent complication and is the leading cause of death in patients with SSc. Although economic data are limited, available data suggest that SSc-ILD is associated with significant cost implications. Treatment of SSc-ILD has historically been with immunosuppressive agents. In2019, however, the treatment landscape expanded with the FDA approval of the tyrosine kinase inhibitor nintedanib. A lack of codified treatment guidelines for patients with SSc-ILD creates significant challenges in improving outcomes at the patient level and, more generally, in reducing disease burden to the health care system. As the treatment landscape continues to evolve, it is likely that to reduce lung volume loss in patients, acombination of immunosuppressive and antifibrotic approaches will need to be used. Additionally, a greater emphasis on risk-stratification strategies may allow for more efficient follow-up, monitoring, andassessment of treatment response.

High-flow nasal cannula oxygen therapy for outpatients undergoing flexible bronchoscopy: a randomised controlled trial

IntroductionHigh-flow nasal cannula (HFNC) provides benefits to patients undergoing flexible bronchoscopy (FOB). We compared the effects of HFNC versus standard therapy (ST) on gas exchange, lung volume and diaphragm function...

Pericardial calcification with plain radiographic features of tuberculosis in a child: incidental finding and a case report

Tuberculous pericarditis is frequently reported as the primary cause of pericardial calcification and occurs in about 1-2% of individuals with pulmonary tuberculosis, this however is a rare finding in the Western world. This is a 12-year-old male child that was referred from a peripheral health care center for plain radiograph of the chest on account of cough, easy fatiguability, night sweats, loss of weight, loss of appetite and dyspnea most times on excersion for more than a month duration. The plain chest radiograph demonstrated normal cardiac size with a cardiothoracic ratio of about 55/120, there is circumferential radio-opacity of calcic density around the peripheral walls of the heart; the pericardial calcification. The vascular pedicle appears slightly widened. The lung fields show extensive streaky opacities with cystic lung changes bilaterally more marked on the left lung field where consolidation, loss of lung volume and pleural effusion are also demonstrated. A two-dimensional echocardiography showed mild-moderate pericardial effusion, thickening of both visceral and parietal pericardium, and echogenic fond-like structures protruding in to the pericardial cavity. A diagnosis of pulmonary tuberculosis with features of tuberculous pericarditis in a 12-year-old male child was established. The patient has been placed on anti-tuberculous drugs, hematinic, and parents advised on good and adequate diet with adequate rehydration and strict drug compliance. Screening of the siblings and members of the family with close contact have also been emphasized. We report the radiographic features of pulmonary tuberculosis and pericardial calcification in a 12-year-old male child due to its peculiar presentation.

Quantification of dual-energy CT-derived functional parameters as potential imaging markers for progression of idiopathic pulmonary fibrosis

ObjectivesThe individual course of disease in idiopathic pulmonary fibrosis (IPF) is highly variable. Assessment of disease activity and prospective estimation of disease progression might have the potential to improve therapy management and indicate the onset of treatment at an earlier stage. The aim of this study was to evaluate whether regional ventilation, lung perfusion, and late enhancement can serve as early imaging markers for disease progression in patients with IPF.MethodsIn this retrospective study, contrast-enhanced dual-energy CT scans of 32 patients in inspiration and delayed expiration were performed at two time points with a mean interval of 15.4 months. The pulmonary blood volume (PBV) images obtained in the arterial and delayed perfusion phase served as a surrogate for arterial lung perfusion and parenchymal late enhancement. The virtual non-contrast (VNC) images in inspiration and expiration were non-linearly registered to provide regional ventilation images. Image-derived parameters were correlated with longitudinal changes of lung function (FVC%, DLCO%), mean lung density in CT, and CT-derived lung volume.ResultsRegional ventilation and late enhancement at baseline preceded future change in lung volume (R - 0.474, p 0.006/R - 0.422, p 0.016, respectively) and mean lung density (R - 0.469, p 0.007/R - 0.402, p 0.022, respectively). Regional ventilation also correlated with a future change in FVC% (R - 0.398, p 0.024).ConclusionCT-derived functional parameters of regional ventilation and parenchymal late enhancement are potential early imaging markers for idiopathic pulmonary fibrosis progression.Key Points• Functional CT parameters at baseline (regional ventilation and late enhancement) correlate with future structural changes of the lung as measured with loss of lung volume and increase in lung density in serial CT scans of patients with idiopathic pulmonary fibrosis.• Functional CT parameter measurements in high-attenuation areas (- 600 to - 250 HU) are significantly different from normal-attenuation areas (- 950 to - 600 HU) of the lung.• Mean regional ventilation in functional CT correlates with a future change in forced vital capacity (FVC) in pulmonary function tests.

A postoperative comparison of high-flow nasal cannula therapy and conventional oxygen therapy for esophageal cancer patients.

Hypoxaemia in post-surgical patients of esophageal cancer (EC) is common in thoracic departments. However, few studies have investigated the role of high-flow nasal cannula (HFNC) compared with conventional oxygen therapy (COT). A retrospective study was implemented to enroll hypoxemic patients after esophagectomy who were treated by HFNC or COT immediately after extubation between January 2019 and December 2019. We compared the effect of HFNC or COT in patients regarding the vital signs and arterial blood gases, the incidence of anastomotic leakage, postoperative pulmonary complications (PPCs), sore throat/nose, and reintubation, length of stay, and sputum production. We also 3D reconstructed the postoperative chest CT, and compared the amount of lung volume loss caused by PPCs (pneumothorax, atelectasis, pulmonary consolidation and pleural effusion) between the two groups. Compared to patients in COT group, sore throat/nose in HFNC group was lower, the sputum production was higher, and the total hospital stay was shorter. Compared to COT, HFNC treatment decreased systolic blood pressure (SBP) at day 1, diastolic blood pressure (DBP) at day 1-4, and heart rate (HR) at day 2-4, increased arterial partial pressure of oxygen (PaO2) at day 1-4, and arterial oxygen saturation (SaO2%) at day 1-2. In addition, the rate of PPCs and anastomotic leakage in HFNC group were lower than those in COT group. Compared to COT, HFNC treatment significantly decreased the amount of lung volume loss caused by PPCs. HFNC can improve the hypoxemia of patients after esophagectomy, increase the flow of sputum, reduce the incidence of PPC and anastomotic leakage.

Evaluation of lung volume loss with 3D CT volumetry in COVID-19 patients.

Evaluation of lung volume loss with 3D CT volumetry in COVID-19 patients.

Assessment of mustard vesicant lung injury and anti-TNF-α efficacy in rodents using live-animal imaging.

Nitrogen mustard (NM) causes acute lung injury, which progresses to fibrosis. This is associated with a macrophage-dominant inflammatory response and the production of proinflammatory/profibrotic mediators, including tumor necrosis factor alpha (TNF-α). Herein, we refined magnetic resonance imaging (MRI) and computed tomography (CT) imaging methodologies to track the progression of NM-induced lung injury in rodents and assess the efficacy of anti-TNF-α antibody in mitigating toxicity. Anti-TNF-α antibody was administered to rats (15 mg/kg, every 8 days, intravenously) beginning 30 min after treatment with phosphate-buffered saline control or NM (0.125 mg/kg, intratracheally). Animals were imaged by MRI and CT prior to exposure and 1-28 days postexposure. Using MRI, we characterized acute lung injury and fibrosis by quantifying high-signal lung volume, which represents edema, inflammation, and tissue consolidation; these pathologies were found to persist for 28 days following NM exposure. CT scans were used to assess structural components of the lung and to register changes in tissue radiodensities. CT scans showed that in control animals, total lung volume increased with time. Treatment of rats with NM caused loss of lung volume; anti-TNF-α antibody mitigated this decrease. These studies demonstrate that MRI and CT can be used to monitor lung disease and the impact of therapeutic intervention.

Effects of 0 PEEP and &lt; 1.0 FIO2 on SpO2 and PETCO2 During Open Endotracheal Suctioning

Hyperoxygenation and hyperinflation, preferably with a mechanical ventilator, is the most commonly used technique to prevent the adverse effects of open endotracheal suctioning on arterial oxygenation and pulmonary volume. However, limited data are available on the effects of oxygen concentrations < 100% and PEEP with zero end-expiratory pressure (0 PEEP) to improve oxygenation and to maintain adequate ventilation during open endotracheal suctioning. The aim of this study was to analyze the behavior of [Formula: see text] and end-tidal CO2 pressure ([Formula: see text]) in open endotracheal suctioning using the 0 PEEP technique with baseline [Formula: see text] (0 PEEP baseline [Formula: see text]) and 0 PEEP + hyperoxygenation of 20% above the baseline value (0 PEEP [Formula: see text] + 0.20) in critically ill subjects receiving mechanical ventilation. This was a prospective, randomized, single-blind crossover study, for which 48 subjects with various clinical and surgical conditions were selected; of these, 38 subjects completed the study. The subjects were randomized for 2 interventions: 0 PEEP baseline [Formula: see text] and 0 PEEP [Formula: see text] + 0.20 during the open endotracheal suctioning procedure. Oxygenation was assessed via oxygen saturation as measured with pulse oximetry ([Formula: see text]), and changes in lung were monitored via [Formula: see text] using volumetric capnography. In the intragroup analysis with 0 PEEP baseline [Formula: see text], there was no significant increase after open endotracheal suctioning in either [Formula: see text] (P = .63) or [Formula: see text] (P = .11). With 0 PEEP [Formula: see text] + 0.20, there was a significant increase in [Formula: see text] (P < .001), with no significant changes in [Formula: see text] (P = .55). In the intergroup comparisons, there was a significant increase compared to the basal values only with the 0 PEEP + 0.20 method at 1 min after hyperoxygenation (P < .001), post-immediately (P < .001), at 1 min after (P < .001), and at 2 min after open endotracheal suctioning (P < .001). The appropriate indication of the hyperinflation strategy via mechanical ventilation using 0 PEEP with or without hyperoxygenation proved to be efficient to maintain [Formula: see text] and [Formula: see text] levels. These results suggest that the technique can minimize the loss of lung volume due to open endotracheal suctioning. (ClinicalTrials.gov registration NCT02440919).

End-expiratory lung volume assessment using helium and carbon dioxide in an experimental model of pediatric capnoperitoneum.

Capnoperitoneum during laparoscopy leads to cranial shift of the diaphragm, loss in lung volume, and risk of impaired gas exchange. Infants are susceptible to these changes and bedside assessment of lung volume during laparoscopy might assist with optimizing the ventilation. Thus, the primary aim was to investigate the monitoring value of a continuous end-expiratory lung volume (EELV) assessment method based on CO2 dynamics ( ) in a pediatric capnoperitoneum model by evaluating the correlation and trending ability against helium washout (EELVHe ). Intra-abdominal pressure (IAP) was randomly varied between 0, 6, and 12mmHg with CO2 insufflation, while positive end-expiratory pressure (PEEP) levels of 3, 6, and 9cm H2 O were randomly applied in eight anesthetized and mechanically ventilated chinchilla rabbits. Concomitant and EELVHe and lung clearance index (LCI) were obtained under each experimental condition. Significant correlations were found between and EELVHe before capnoperitoneum (r=.85, P<.001), although increased IAP distorted this relationship. The negative influence of IAP was counteracted by the application of PEEP 9, which restored the correlation between and EELVHe and resulted in 100% concordance rate between the methods regarding changes in lung volume. EELVHe and LCI showed a curvilinear relationship, and an EELVHe of approximately 20mLkg-1 , determined with a receiver operating characteristic curve, was associated with near-normal LCI values. In this animal model of pediatric capnoperitoneum, reliable assessment of changes in EELV based on requires an open lung strategy, defined as EELV above approximately 20mLkg-1 .

Attenuation of Aortic Remodeling with Low Doses of Neprilysin/Angiotensin II Receptor Blockers Sacubitril/Valsartan in a Fibrillin‐1‐Deficient Model of Marfan Syndrome

IntroductionSacubitril is a neprilysin inhibitor indicated for heart failure patients with reduced ejection fraction (HFReF), which causes protective natriuretic peptide accumulation. To maximize efficacy and minimize side effects, sacubitril is administered in combination with valsartan, a blood pressure‐lowering angiotensin II receptor blocker (ARB). We and others have shown that ARBs are capable of blood pressure lowering‐independent effects on vascular and lung remodeling, but whether the sacubitril/ARB combination shows greater anti‐vascular and lung remodeling effects is unknown.ObjectiveSince ARBs are routinely prescribed to patients with Marfan syndrome, which is a fibrillin‐1 mutation‐induced connective tissue disease that causes aortic widening, dissection and lung emphysema, we sought to test the anti‐remodeling effects of low‐doses sacubitril/valsartan combination on the vascular and pulmonary complications associated with Marfan syndrome in mice.ResultsTreatment with low dose valsartan and sacubitril/valsartan (pure forms in drinking water) did not significantly lower blood pressure when compared with vehicle group in the C1039G fibrillin‐1 model of Marfan syndrome. There was a non‐significant inhibitory trend of Marfan‐associated aortic root widening with valsartan and especially sacubitril/valsartan, whereas only the latter induced a significant and near‐complete (74%) inhibition of Marfan‐associated ascending aorta widening (P&lt;0.008). None of the treatment groups significantly reduced emphysema, loss of lung volume, change in hysteresis, tissue damping and resistance associated with Marfan syndrome.ConclusionSacubitril/valsartan combination may be more clinically relevant than valsartan alone in settings of aortic dilation, even at low doses.Support or Funding InformationSupported by Novartis Canada

Ultra-high-resolution computed tomography can demonstrate alveolar collapse in novel coronavirus (COVID-19) pneumonia.

PurposeTo review the chest computed tomography (CT) findings on the ultra-high-resolution CT (U-HRCT) in patients with the Novel coronavirus disease 2019 (COVID-19).Materials and MethodsIn February 2020, six consecutive patients with COVID-19 pneumonia (median age, 69 years) underwent U-HR CT imaging. U-HR-CT has a larger matrix size of 1024 × 1024 thinner slice thickness of 0.25 mm and can demonstrate terminal bronchioles in the normal lungs; as a result, Reid’s secondary lobules and their abnormalities can be identified. The distribution and hallmarks (ground-glass opacity, consolidation with or without architectural distortion, linear opacity, crazy paving) of the lung opacities on U-HRCT were visually evaluated on a 1 K monitor by two experienced reviewers. The CT lung volume was measured, and the ratio of the measured lung volume to the predicted total lung capacity (predTLC) based on sex, age and height was calculated.ResultsAll cases showed crazy paving pattern in U-HRCT. In these lesions, the secondary lobules were smaller than those in the un-affected lungs. CT lung volume decreased in two cases comparing predTLC.ConclusionU-HRCT can evaluate not only the distribution and hallmarks of COVID-19 pneumonia but also visualize local lung volume loss.

Physiologic Effects of Nasal Aspiration and Nasopharyngeal Suctioning on Infants With Viral Bronchiolitis.

There is limited evidence supporting an optimum method for removing mucus from the airways of hospitalized infants with bronchiolitis. This study was designed to evaluate short-term physiologic effects between nasal aspiration and nasopharyngeal suctioning in infants. Sixteen infants requiring hospitalization for supportive management of bronchiolitis were instrumented with transcutaneously measured partial pressure of carbon dioxide ([Formula: see text]) and [Formula: see text] monitoring. Electrical impedance tomography (EIT) was used to estimate changes in inspiratory and end-expiratory lung volume loss and recovery. Subjects were suctioned with both nasal aspiration and nasopharyngeal suctioning methods in a randomized order (8 received nasal aspiration followed by nasopharyngeal suctioning, and 8 received nasophayrgeal suctioning followed by nasal aspiration). Noninvasive gas exchange and EIT measurements were obtained at baseline (pre-suction) and at 10, 20, and 30 min following each suctioning intervention. Sputum mass was obtained following suctioning, and clinical respiratory severity scores, before and after suctioning, were computed. There were no differences in inspiratory EIT (P = .93), change in end-expiratory lung impedance (ΔEELI; P = .53), [Formula: see text] (P = .41), [Formula: see text] (P = .88), heart rate (P = .31), or breathing frequency (P = .15) over the course of suctioning between nasal aspiration and nasopharyngeal suctioning. Sputum mass (P = .14) and clinical respiratory score differences before and after suctioning (P = .59) were not different between the 2 suctioning interventions. Sputum mass was not associated with ΔEELI at 30 min for nasal aspiration (ρ = 0.11, P = .69), but there was a moderate positive association for nasopharyngeal suctioning (ρ = 0.50, P = .048). Infants with viral bronchiolitis appeared to tolerate both suctioning techniques without adverse short-term physiologic effects, as indicated by the unchanged gas exchange and estimated lung volumes (EIT). Nasopharyngeal suctioning recovered 36% more sputum than did nasal aspiration and there was moderate correlation between sputum mass and end-expiratory lung impedance change at 30 minutes post-suction with nasopharyngeal that was not present with nasal aspiration. It is possible that a subset of patients may benefit from one type of suctioning over another. Future research focusing on important outcomes for suctioning patients with bronchiolitis with varying degrees of lung disease severity is needed.

Challenges in multidisciplinary medical rehabilitation - Swyer-James-MacLeod Syndrome: case presentation and short literature review

Introduction. Swyer-James-MacLeod syndrome (SJMS) or unilateral hyperlucent lung syndrome is a rare disorder caused by infectious bronchiolitis obliterans and pneumonitis occurring in childhood. It is characterized by hypoplasia and/or agenesis of the pulmonary arteries resulting in pulmonary parenchyma hypoperfusion. Materials and methods. We report the case of a 27 years-old female patient who presented with progressive dyspnea, productive cough, fever and chills. Results and discussion. Chest radiography showed unilateral loss of left lung volume with hyperlucency. Unilateral reduction in vascularity with reduced caliber of the left pulmonary artery was revealed on CT scan of the chest, final diagnosis of SJMS being confirmed by angiography. Conclusions. This case strongly supports the recommendation of considering SJMS within the differential diagnosis workup of bronchiectasis, the syndrome being usually underdiagnosed.