Pulmonary Dysfunction In Patients Research Articles

Pulmonary Dysfunction in Patients with Cirrhosis of the Liver: A Study of Pulmonary Function Tests and Arterial Blood Gases.

Respiratory complications in liver cirrhosis can occur due to various mechanisms, such as ascites causing restricted lung expansion and opening of intrapulmonary vascular shunts due to high portal pressures. We aimed to study the effects of the liver dysfunction on the lungs by evaluating arterial blood gas (ABG) and pulmonary function test (PFT) of all study subjects. A cross-sectional study was done between August 2020 and September 2022. Diagnosed cases of the liver cirrhosis were enrolled in the study after informed consent and were subjected to the following investigations: chest X-ray, oximetry, spirometry, diffusing capacity of the lung for carbon monoxide (DLCO), two-dimensional echocardiography, and ABG analysis (ABGA). The cases were divided into three groups based on their Child-Pugh staging, and statistical analysis was done on the collected data. A total of 64 (53 males and 11 females) patients with an average age of 49.82 ± 9.89 years were studied. Alcoholism was the most common cause of cirrhosis in males. Breathlessness (65.6%) and pleural effusion (26.6%) were the most common respiratory symptoms and signs, respectively. Seventeen patients had hepatic hydrothorax, eight patients had hepatopulmonary syndrome (HPS), and six patients had portopulmonary hypertension. Low pH (17.2%) and oxygen partial pressure (PaO2) (20.3%) were the most common ABGA findings. The pH, PaO2, forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC), and DLCO were significantly low in Child Pugh Stage C (P < 0.05). The pH, pO2, HCO3, FEV1, FVC, FEV1/FVC, and DLCO were significantly lower in patients with HPS (P < 0.05). Metabolic acidosis and low FEV1/FVC and DLCO were the common findings in study subjects. Pulmonary dysfunction was common in advanced liver cirrhosis. Patients with HPS had worse ABG and PFT parameters than those without HPS.

Cardiac dysfunction mediators CXCL-9 and chemotaxis of phagocytes characterized patients with long-term pulmonary dysfunction after COVID-19.

Abstract Severe COVID-19 is characterized by marked cytokine release and pulmonary dysfunction; however, it is still unknown which mediators support post-COVID-19 pulmonary dysfunction. Our aim was to determine the signaling pathways associated with long-term pulmonary dysfunction in patients with COVID-19. Our cohort of 60 patients with COVID-19 were followed up at 4- and 12-months post infection. Pulmonary sequelae were analyzed by computed tomography (CT), diffusing capacity of carbon monoxide (DLCO), spirometry, 6-minute walk test (6MWT) and handgrip test. Cytokines, chemokines and blood tests parameters were also analyzed. Furthermore, signaling pathways associated with pulmonary dysfunction were identified by serum proteomics analysis using TimsTOF-Pro and ingenuity pathway analysis. Fourteen patients with CT and abnormal DLCO were classified as patients with long-term pulmonary dysfunction (LTPD), who also presented impaired spirometry tests, 6MWT and handgrip strength than patients without sequelae or patients with CT only. We observed that only CXCL-9 was significantly increased in LTPD patients in comparison with other groups. In addition, the main signaling pathways identified by proteomics in LTPD patients were associated with an immunothrombotic state related to cardiac dysfunction, migration of dysfunctional monocytes and reduced IFN-signaling. In summary, patients with LTPD presented a restrictive lung condition, with greater fatigue, lower aerobic capacity and muscle strength 4-months post-COVID-19. Our data suggest that patients with previous cardiac dysfunction who had severe o moderate COVID-19 are more susceptible to develop LTPD. PROYECTO COVID1005, ACT210085 y Fondecyt Regular 1211480.

Diaphragmatic ultrasound can help evaluate pulmonary dysfunction in patients with stroke.

Pulmonary dysfunction after stroke is increasingly gaining attention from clinical and rehabilitation specialists. However, owing to cognitive and motor dysfunction in patients with stroke, determining the pulmonary function of these patients remains challenging. The present study aimed to devise a simple method for an early evaluation of pulmonary dysfunction in patients with stroke. Overall, 41 patients with stroke in the recovery period (stroke group) and 22 matched healthy controls (control group) were included in the study. We first collected data regarding baseline characteristics for all participants. Furthermore, the participants with stroke were examined using additional scales, such as the National Institutes of Health Stroke Scale (NIHSS), Fugl-Meyer assessment scale (FMA), and modified Barthel Index (MBI). Subsequently, we examined the participants with simple pulmonary function detection and diaphragm ultrasound (B-mode). Ultrasound indices calculated were as follows: the thickness of the diaphragm under the position of functional residual capacity (TdiFRC), the thickness of the diaphragm under the position of forced vital capacity (TdiFVC), thickness fraction, and diaphragmatic mobility. Finally, we compared and analyzed all data to identify group differences, the correlation between pulmonary function and diaphragmatic ultrasound indices, and the correlation between pulmonary function and assessment scale scores in patients with stroke, respectively. Compared with the control group, patients in the stroke group exhibited lower values for indices of pulmonary and diaphragmatic function (p < 0.001), except for TdiFRC (p > 0.05). The majority of the patients with stroke had restrictive ventilatory dysfunction, as indicated by a significantly higher incidence ratio (36 in 41 patients) than that in the control group (0 in 22 patients) (p < 0.001). Moreover, significant correlations were found between pulmonary function and diaphragmatic ultrasound indices (p < 0.05), with the strongest correlation between TdiFVC and pulmonary indices. In the stroke group, pulmonary function indices were negatively correlated with the NIHSS scores (p < 0.001) and positively correlated with the FMA scores (p < 0.001). No (p > 0.05) or weak (p < 0.05) correlation was found between pulmonary function indices and the MBI scores. We found that patients with stroke had pulmonary dysfunction even in the recovery period. Diaphragmatic ultrasound can be used as a simple and effective tool for detecting pulmonary dysfunction in patients with stroke, with TdiFVC being the most effective index.

Rozchynni fibryn-monomerni kompleksy i D-dymery yak pokaznyky tiazhkosty hostroho pankreatytu

Introduction. Local and systemic inflammation, disorders in the hemostatic system are among the key components of acute pancreatitis (AP) pathogenesis already in its early stages, and in future development of thrombohemorrhagic complications. The degree of systemic hemostatic disorders in AP varies from subclinical activation of coagulation, which can only be detected using sensitive markers of activation of coagulation factors, to fulminant disseminated intravascular coagulation syndrome, characterized by multiple systemic microvascular thrombosis and profuse bleeding from different sites. It has been proven that D-dimers and soluble fibrin-monomeric complexes (SFMK) are valuable markers of coagulation and fibrinolysis activation. The aim of the study. To study the dynamics of D-dimers, soluble fibrin-monomeric complexes in the blood of patients with acute pancreatitis, depending on the severity of the disease. Materials and methods. A prospective examination of 206 patients with AP was carried out. According to the criteria of the International Classification, mild pancreatitis was verified in 51 patients, moderate – in 98, severe – in 57. The concentration of SFMK, D-dimers was determined in 66 patients with AP on the first, third, seventh and fourteenth days of conservative treatment. The reference values were estimated in 11 healthy individuals. Results. The enhansed concentration of SFMK and D-dimers were detected in the blood of all patients under examination. Their content directly correlated with the severity of AP course as determined by the Ranson and BISAP score, the severity of the patient’s condition by the APACHE II score and organ dysfunction by the SOFA score, and the degree of damage to the pancreas by the Balthazar criteria. The concentration of SFMK and D-dimers significantly increased with the occurrence of respiratory, cardiovascular, renal, and metabolic dysfunction. A reliable direct correlation was determined between the amount of SFMK and the concentration of creatinine and glucose in the blood of patients with AP. The increase in the level of D-dimers significantly directly correlated with the concentration of creatinine in the blood serum. The sensitivity of SFMK determination (cut-of value 137.50 ng/L) for predicting pulmonary dysfunction was 86.20 %, and the specificity was 83.80 %, with positive and negative predictive values of 80.65 and 88.57 % respectively. Conclusions. The course of acute pancreatitis is accompanied by local or systemic inflammation, changes in the hemostatic system, severity of which correlating with the severity of the disease. Characteristic feature for patients with severe acute pancreatitis is the combination of systemic inflammation with procoagulant changes. The severity of acute pancreatitis, the severity of patient’s condition and organ dysfunction, the severity of pancreatic lesions are associated with an increase of fibrin degradation products. The concentration of soluble fibrin-monomeric complexes can be used to predict pulmonary dysfunction in patients with acute pancreatitis.

Diabetic Neuropathy, a Cause of Pulmonary Dysfunction in Patients of Type 2 Diabetes Mellitus

Introduction: Diabetic neuropathy (DN) is most commonly associated with diabetic peripheral neuropathy (DPN). About 66% of diabetic patients have either clinical or subclinical neuropathy. Materials and Methods: One hundred and twenty patients were enrolled in our study, 60 patients are of Type 2 diabetes mellitus (T2DM) with neuropathy (DPN), and 60 were of T2DM without neuropathy. They were assessed for neuropathy. Serum fasting blood glucose, postprandial blood glucose, glycosylated hemoglobin A1C (HbA1C), and duration of disease were obtained from the patients. Forced expiratory volume at the 1st s (FEV1) and forced vital capacity were recorded and % FEV1 was calculated. Results: The mean age of T2DM with neuropathy was 49.17 ± 7.1 and in patients of T2DM without neuropathy was 46.63 ± 8.028. The mean value of % FEV1 in T2DM with neuropathy is 95.45 ± 7.16, while in T2DM without neuropathy, it is 83.53 ± 6.22, and the difference was statistically significant. Linear correlation of % FEV1 with fasting plasma glucose (FPG) (r = 0.474, P = 0.008) and HbA1C (r = 0.588, P = 0.001) shows a statistically significant association in diabetic peripheral neuropathy. The standardized β weights of FPG, postprandial plasma glucose, and HbA1C show significant values in patients of DPN. Conclusion: Diabetic peripheral neuropathy (DPN) is associated with decreased pulmonary function as compared to patients of diabetes without neuropathy, the glycemic status of patients may also adversely affect % FEV1. Thus, proper control of hyperglycemia will decrease the further progression of the disease. We also suggest performing pulmonary function test in patients of diabetes mellitus with DN in the preoperative period so as to optimize the perioperative care.

Pulmonary function in patient with ulcerative colitis

Aim: To determine the type and frequency of pulmonary involvement in patients with UC and to determine the distribution of pulmonary dysfunction in patients with UC. Methods: A total of 39 cases of UC, were enrolled consecutively in this study from the Department of Gastroenterology. The age, sex, family history, duration of disease, biochemical parameters (CRP, ESR, blood routine test, etc.), lung function, chest X-ray, diagnoses, and treatments were collected. Patients and controls underwent standard pulmonary function testing. Comparisons of rates among multiple groups were done with Fisher exact test, continuous variables were compared with one-way ANOVA. Results: According to the true love index, the severity of active UC was moderate and severe among 36.7% and 63.3% of subjects respectively. The pulmonary function test “FCV” showed reduced mean FCV among subjects with active UC (2.86±0.77 litres) and inactive UC (3.91±0.62 litres) as compared to controls (4.04±1.14 litres). Among the patients with deranged PFT, 1 (7.6%) had obstructive, 7 (53.8%) had small airway disease and 5 (38.6%) had a restrictive pattern of lung involvement. Conclusion: Subclinical pulmonary dysfunction is frequent in UC and dependent on disease activity. Some alterations were sub-clinical and some of the patients showed troublesome pulmonary symptoms.

The Levels of Serum Serotonin Can Be Related to Skin and Pulmonary Manifestations of Systemic Sclerosis.

Background and Objective: The most prominent feature of systemic sclerosis (SSc), besides vasculopathy and autoimmune disorders, is excessive fibrosis. Serotonin affects hemostasis and can induce vasoconstriction, which is presumed to be one of the pathophysiological patterns in SSc that leads to fibrosis. Our aim was to explore the possible association of serotonin with some of the clinical features of SSc in our cohort of patients. Materials and Methods: We measured serotonin levels in sera of 29 female SSc patients. Patients were 41–79 years old, their average disease duration was 9 years. Serotonin values were analyzed in correlation with clinical and laboratory parameters, such as modified Rodnan skin score (mRSS), digital ulcers (DU), and spirometry parameters-forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), and lung diffusion capacity of carbon monoxide (DLCO). Statistical analyses were performed using statistical software Statistica. Results: We found correlation of serotonin level with mRSS (r = 0.388, p = 0.038). The highest values of serotonin were documented in patients with refractory DU, but this was not statistically significant. We also found a negative correlation between serotonin and FVC (r = −0.397), although it did not reach the level of significance (p = 0.114). Conclusions: Our study suggests that levels of serum serotonin could affect the course of skin fibrosis and partially restrictive pulmonary dysfunction in patients with SSc. We assume that serotonin might have influence on several features of SSc, but more studies are needed to reveal those relations.

Prevalence of pulmonary dysfunction in patients with beta thalassemia major: a systematic review and meta-analysis

Background Many studies have been conducted on heart, liver, and endocrine abnormalities in thalassemia; however, studies on pulmonary dysfunction (PD) have been limited. Previous studies on the prevalence of restrictive lung disease (RLD) and obstructive lung disease (OLD) in β-thalassemia major patients have lacked agreement. Objective To assess the prevalence of PD in β-thalassemia major patients by systematic review of the literature and meta-analysis. Methods We searched Cochrane library, PubMed, Web of Science, MEDLINE, Scopus, and Embase for relevant articles. Articles were selected according to the inclusion criteria and data were extracted. The primary outcome was prevalence of pulmonary dysfunction in β-thalassemia major with 95% confidence interval (95%CI). Subgroup analyses were applied to explore the prevalence in different age groups, regions, and serum ferritin levels. Sensitivity analysis and publication bias assessment were also conducted. Results A total of 37 studies comprising 1,467 cases were included in this analysis. Pulmonary dysfunction was present in 64.7% (95%CI 57.6 to 71.1) of cases. The pooled prevalence of RLD (44.9%) was higher than that of OLD (7.6%) and diffusion impairment (DI) (35.6%). Subgroup analysis revealed that the region with the highest pooled prevalence of PD was the Americas (75.2%). The highest prevalence of RLD and DI was found in Asia (48.2% and 44.6%, respectively) and that of OLD in Europe (9.7%). Sensitivity analysis showed that the pooled results were robust. Conclusion A high prevalence of pulmonary dysfunction, mainly RLD rather than OLD, was detected in β-thalassemia major patients.

Respiratory Dysfunctions in Parkinson's Disease Patients.

Respiratory dysfunctions have been associated with Parkinson’s disease since the first observations of the disease in 1817. Patients with Parkinson’s disease frequently present respiratory disorders with obstructive ventilatory patterns and restrictive modifications, as well as limitations in respiratory volumes. In addition, respiratory impairments are observed due to the rigidity and kyphosis that Parkinson’s disease patients experience. Subsidiary pulmonary complications can also appear as side effects of medication. Silent aspiration can be the cause of pneumonia in Parkinson’s disease. Pulmonary dysfunction is one of the main factors that leads to the morbidity and mortality of patients with Parkinson’s disease. Here, we performed a narrative review of the literature and reviewed studies on dyspnea, lung volumes, respiratory muscle function, sleep breathing disorders, and subsidiary speech and swallow impairments related to pulmonary dysfunction in patients with Parkinson’s disease.

Improved detection of air trapping on expiratory computed tomography using deep learning.

BackgroundRadiologic evidence of air trapping (AT) on expiratory computed tomography (CT) scans is associated with early pulmonary dysfunction in patients with cystic fibrosis (CF). However, standard techniques for quantitative assessment of AT are highly variable, resulting in limited efficacy for monitoring disease progression.ObjectiveTo investigate the effectiveness of a convolutional neural network (CNN) model for quantifying and monitoring AT, and to compare it with other quantitative AT measures obtained from threshold-based techniques.Materials and methodsPaired volumetric whole lung inspiratory and expiratory CT scans were obtained at four time points (0, 3, 12 and 24 months) on 36 subjects with mild CF lung disease. A densely connected CNN (DN) was trained using AT segmentation maps generated from a personalized threshold-based method (PTM). Quantitative AT (QAT) values, presented as the relative volume of AT over the lungs, from the DN approach were compared to QAT values from the PTM method. Radiographic assessment, spirometric measures, and clinical scores were correlated to the DN QAT values using a linear mixed effects model.ResultsQAT values from the DN were found to increase from 8.65% ± 1.38% to 21.38% ± 1.82%, respectively, over a two-year period. Comparison of CNN model results to intensity-based measures demonstrated a systematic drop in the Dice coefficient over time (decreased from 0.86 ± 0.03 to 0.45 ± 0.04). The trends observed in DN QAT values were consistent with clinical scores for AT, bronchiectasis, and mucus plugging. In addition, the DN approach was found to be less susceptible to variations in expiratory deflation levels than the threshold-based approach.ConclusionThe CNN model effectively delineated AT on expiratory CT scans, which provides an automated and objective approach for assessing and monitoring AT in CF patients.

P0663RELATIONSHIP BETWEEN ENDOTHELIAL LESION AND PULMONARY DYSFUNCTION AMONG HEMODIALYTIC CHRONIC KIDNEY DISEASE PATIENTS WITH AND WITHOUT DIABETES MELLITUS

Abstract Background and Aims Patients with Chronic Kidney Disease (CKD) on dialysis and Diabetes Mellitus type 2 (DM2) may develop dysfunction in several systems, including the respiratory system. The aim of this study is to investigate if there is a relationship between endothelial lesion and pulmonary dysfunction in patients with CKD in hemodialysis with and without DM2. Method This is a cross-sectional study, from October 2017 to August 2018, including 60 patients divided into three groups: patients on hemodialysis (HD) without DM2 (HD in NDM = 30); HD with DM2 (HD in DM = 15); Non-hemodialysis with DM2 (DM without HD = 15) aged 40 to 60 years, regardless of gender. Analyzed pulmonary function were: maximal inspiratory and expiratory pressures (MIP and MEP) and measures of lung capacities and volumes: Forced Vital Capacity (FVC) and Forced Expiratory Volume in one second (FEV1). Results In the DM group in HD: MIP, MEP, FVC and FEV1 showed significant differences (p = 0.008; and p = 0.000; p = 0.000; p = 0.000), respectively. In the HD without NDM group: only the MIP parameter showed no significant difference (p = 0.256), MEP, FVC and FEV1 showed a statistically significant difference (p = 0.001; p = 0.000; p = 0.000), respectively. In the DM group without HD: only MIP showed no statistically significant difference (p = 0.491), MEP, FVC and FEV1 showed a statistically significant difference (p = 0.000; p = 0.008; p = 0.000), respectively when compared to their predicted value. Significant difference was detected between the groups regarding VCAM-1 only between DM in HD and DM without HD (p = 0.040). Syndecan-1 and Angiopoietin-2 plasma levels were statistically different when compared between the groups (p = 0.000) for the two biomarkers, this difference was observed only between the dialysis groups and the diabetic group without dialysis. In the multivariate regression analysis, when the fact that the individual had DM was also added, there was a greater association of VCAM-1 with the fact that the patient did not reach the predicted MEP, this value increased to OR = 8.762 (CI = 2.317 - 33.136) times of chance of not achieving the expected (p = 0.001). However, no statistically significant difference was found when the fact that the patient underwent hemodialysis was included (p = 0.885). Regarding Spearman correlation between MIP and VCAM-1 / Syndecan-1 / angiopoietin-2 there was no significant difference. However, in the correlation between MEP and endothelial lesion biomarkers, there was a significant difference only when compared with VCAM-1 (r = -0.287, p = 0.036). The FEV1 and FVC parameters obtained statistically significant results when correlated only with angiopoietin-2 (r = -0.309; -0.361), respectively. Conclusion Inspiratory muscle strength is reduced only when DM and HD are present when compared to their predicted. Expiratory muscle strength is reduced in all three groups and this parameter is most affected in diabetic individuals undergoing hemodialysis. Pulmonary function is compromised in all three groups equally. Endothelial glycocalyx lesion biomarkers (Angiopoietin-2 and Syndecan-1) are increased mainly in subjects on hemodialysis. Endothelial dysfunction is evidenced in HD group DM by increased VCAM-1 levels. There is a relationship between the lack of expected expiratory muscle strength with high values of VCAM-1 and when added the fact of having DM this relationship increases, however when added the fact of being dialytic there is no significant relationship. There is an inversely proportional correlation between expiratory muscle strength with the adhesion molecule marker (VCAM-1) and between pulmonary function with the endothelial lesion marker (Angiopoietin-2).

Assessment of Occult Pulmonary Involvement in Ulcerative Colitis

Introduction: Nearly 50% of patients with inflammatory bowel disease (IBD) experience at least one extraintestinal manifestation. Bronchopulmonary involvement is rare in IBD. Pulmonary function test (PFT) abnormality in cases of ulcerative colitis (UC) has been reported to be 17–55%. Occult pulmonary disease may be diagnosed using variables of the PFT. Hence, we aim to evaluate the frequency and type of pulmonary dysfunction in patients with UC in remission. Methods: Eighty-three patients of UC in remission and 48 controls underwent the PFT including forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), Tiffeneau value (FEV1/FVC), and midexpiratory flow (MEF 25–75%) rate with a spirometer. The patients were divided based on the age of onset of UC into A1 (<16 years), A2 (16–40 years), and A3 (>40 years) and based on the extent of disease into E1 (proctitis), E2 (left-sided colitis), and E3 (extensive colitis). Results: Patients with UC had significantly abnormal PFT compared with controls (51 [61.5%] vss. 8 [16.67%]; p = 0.000). Patients with UC commonly had a restrictive pattern (33 [64.47%]) of PFT followed by small airway disease (11 [21.56%]) and obstructive pattern (7 [13.72%]). Pulmonary involvement in cases of UC was more in E3 followed by E2 and E1. Pulmonary involvement was more in the late age of onset of disease. BMI was positively and significantly correlated with FEV1 and FVC. Hemoglobin had a positive and significant correlation with FEV1 while a negative correlation with FEV1/FVC and MEF 25–75%. All predictors except for age were found to contribute in higher risk (OR > 1) for PFT abnormality. Conclusion: Patients with UC have chronic pulmonary inflammation leading to different patterns of lung involvement in the form of restrictive, obstructive airway, and small airway disease. Patients with UC commonly have a restrictive pattern of pulmonary involvement. Impairment of the PFT is related to the disease extent and the age of onset of disease. Assessment of the PFT using a spirometer is a noninvasive, simple, cost-effective, and reliable method for early detection of occult pulmonary involvement in patients of UC.

Left ventricular diastolic and pulmonary dysfunction in patients with sub-clinical hypothyroidism; A case- control study

Left ventricular diastolic and pulmonary dysfunction in patients with sub-clinical hypothyroidism; A case- control study - IJIRM- Print ISSN No: - 2581-4214 Online ISSN No:- 2581-4222 Article DOI No:- 10.18231/j.ijirm.2019.057, IP Indian Journal of Immunology and Respiratory Medicine-IP Indian J Immunol Respir Med

Correlation between diaphragmatic sagittal rotation and pulmonary dysfunction in patients with ankylosing spondylitis accompanied by kyphosis.

ObjectiveThis study was performed to investigate the correlation between pulmonary dysfunction patterns and diaphragmatic sagittal rotation in patients with ankylosing spondylitis accompanied by kyphosis.MethodsThirty patients (27 male, 3 female) with kyphotic deformity secondary to ankylosing spondylitis underwent pedicle subtraction osteotomy and were retrospectively reviewed. All patients had undergone preoperative computed tomography with three-dimensional reconstruction, full-length spine radiographs, and pulmonary function tests. The diaphragmatic angle in the median sagittal plane (DA), pulmonary function test results, and radiological parameters were studied.ResultsCorrelation coefficients were used to present the correlation between the DA and pulmonary function and the global kyphosis (GK), respectively. The data analysis presented positive correlations between the DA value and vital capacity (VC), forced vital capacity (FVC), expiratory reserve volume (ERV), inspiratory reserve volume (IRV) and peak expiratory flow (PEF). There was likewise a negative correlation between DA value and the global kyphosis (GK). Additionally, there were further significantly statistical improvements for DA, ERV, IRV, FVC, and VC, PEF, postoperatively.ConclusionsExcept for the restriction of the chest wall motion and the abnormalities of lung parenchyma, the diaphragmatic sagittal rotation is also an influencing factor of pulmonary dysfunction in patients with ankylosing spondylitis accompanied by kyphosis.

Improvement of pulmonary dysfunction in patients with severe adult spinal deformity after corrective spinal fusion surgery

In some cases of adolescent idiopathic scoliosis, corrective surgery can improve pulmonary function. However, the effectiveness of corrective surgery in improving pulmonary function in adult spinal deformity (ASD) has not been reported. Therefore, the purpose of our study was to investigate the recovery of pulmonary function after corrective fusion surgery in 4 patients with severe ASD and associated pulmonary dysfunction. The first patient was a 42-year-old woman with spondylo-epiphyseal dysplasia, whose main presenting complaint was dyspnea. As a result of her respiratory dysfunction, associated with her severe spinal deformity, she required Home Oxygen Therapy (HOT). Prior to surgery, her %vital capacity (VC) was 25%, with a kyphosis angle of 170°. The second patient was a 55-year-old woman with a history of acromegaly, who presented with low back pain. Prior to surgery, she had a %VC of 48% and a Cobb angle of 85°. The third patient was a 59-year-old woman with adolescent idiopathic scoliosis, which had been previously treated, and who was now experiencing increasing low back pain. Prior to surgery, she had a %VC of 58% and a Cobb angle of 87°. The fourth patient was a 60-year-old man, with a history of tuberculous spine, who presented with low back pain. Prior to surgery, his %VC of 75% and Cobb angle of 100°. Pulmonary function improved after corrective fusion surgery in all cases. Halo traction with respiratory rehabilitation should be recommended before corrective spinal fusion surgery for patients with severe ASD and pulmonary dysfunction.

Bone mineral density and vertebral fractures and their relationship with pulmonary dysfunction in patients with chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is associated with osteoporosis and vertebral fractures. It is still unclear whether the presence of fractures and changes in bone mineral density (BMD) are associated with disease severity and prognosis. The aim of this study was to evaluate BMD and morphometric vertebral fractures (MVF) in COPD patients in comparison with two control groups and to correlate these parameters with indices of COPD severity (VEF1 and GOLD) and prognosis (BODE). This was a cross-sectional study in COPD patients (disease group, DG) who underwent BMD and vertebral fracture assessment (VFA). Two control groups were used: smokers without COPD (smoker group, SG) and healthy never-smoker individuals (never-smoker group, NSG). The DG comprised 121 patients (65 women, mean age 67.9 ± 8.6years). Altered BMD was observed in 88.4% of the patients in the DG, which was more prevalent when compared with the control groups (p < 0.001). The BMD values were lower in the DG than in the control groups (p < 0.05). BMD was associated with the worst disease severity and prognosis (p < 0.05). The prevalence of MVF was high (57.8%) and greater than that in the SG (23.8%) and the NSG (14.8%; p < 0.001). The prevalence of fractures was not associated with disease severity and prognosis. COPD patients have a higher prevalence of MVF and low BMD, and the latter was associated with the severity and poor prognosis of the disease.

Simvastatin to reduce pulmonary dysfunction in patients with acute respiratory distress syndrome: the HARP-2 RCT

Background Acute lung injury is a common devastating clinical syndrome characterised by life-threatening respiratory failure requiring mechanical ventilation and multiple organ failure, and is a major cause of morbidity and mortality. Objective This study tested the hypothesis that treatment with simvastatin would improve clinical outcomes in patients with acute respiratory distress syndrome (ARDS). Design This was a multicentre, allocation-concealed, randomised, double-blind, parallel-group trial. Setting/participants Patients in intensive care units were eligible if they were intubated and mechanically ventilated and had ARDS as defined by a partial pressure of arterial oxygen to fraction of inspired oxygen concentration (PaO2 : FiO2) ratio of ≤ 300 mmHg, bilateral pulmonary infiltrates consistent with pulmonary oedema and no evidence of left atrial hypertension. Intervention Patients were randomised in a 1 : 1 ratio to receive enteral simvastatin 80 mg or identical placebo tablets once daily for up to 28 days. Main outcome measures The primary outcome was the number of ventilator-free days (VFDs) to day 28. Secondary outcomes included the number of non-pulmonary organ failure-free days to day 28, mortality and safety. The biological effect by which simvastatin may modify mechanisms implicated in the development of ARDS was also investigated. A cost-effectiveness analysis was also planned. Results The study was completed when 540 patients were recruited with 259 patients allocated to simvastatin and 281 patients to placebo, with 258 patients in the simvastatin group and 279 patients in the placebo group included in the analysis of the primary outcome. There was no significant difference between study groups in mean [standard deviation (SD)] VFDs [12.6 days (SD 9.9 days) with simvastatin and 11.5 days (SD 10.4 days) with placebo; mean difference 1.1, 95% confidence interval –0.6 to 2.8; p = 0.21], non-pulmonary organ failure-free days [19.4 days (SD 11.1 days) with simvastatin and 17.8 days (SD 11.7 days) with placebo; p = 0.11] or in 28-day mortality (22.0% with simvastatin and 26.8% with placebo; p = 0.23). There was no difference in the incidence of severe adverse events between the groups. Simvastatin did not significantly modulate any of the biological mechanisms investigated. Simvastatin was cost-effective at 1 year compared with placebo for the treatment of ARDS, being associated with both a small quality-adjusted life-year (QALY) gain and cost saving. Limitations One possibility for the lack of efficacy relates to the statin and dosage used. It is possible that adverse effects at the simvastatin dosage used outweighed a beneficial effect, although our data suggest that this is unlikely. The heterogenous cohort of patients with ARDS was an attempt to ensure that our findings would be generalisable; however, it may be more appropriate to target potential therapies based on their proposed biological mechanism for a specific population of patients. The assumptions underpinning the economic benefit are based on the analysis of a subgroup of responders. Conclusions High-dose enteral simvastatin, while safe and with minimal adverse effects, is not effective at improving clinical outcomes in patients with ARDS. There was a small gain in QALYs and a cost saving associated with simvastatin. Future work There is a need to confirm if ARDS endotypes that are more likely to benefit from targeted treatment with simvastatin exist. The potential role of simvastatin in the prevention of ARDS in patients at a high risk of developing ARDS has not yet been evaluated. Trial registration Current Controlled Trials ISRCTN88244364. Funding This project was funded by the Efficacy and Mechanism Evaluation programme, a Medical Research Council and National Institute for Health Research (NIHR) partnership. This study was also funded in the Republic of Ireland by the Health Research Board (HRA_POR-2010-131). In addition, the Health and Social Care Research and Development division of the Public Health Agency in Northern Ireland, the Intensive Care Society of Ireland and REVIVE provided additional funding.

Factors associated with pulmonary dysfunction in patients undergoing coronary artery bypass graft surgery with use of intra-aortic balloon pump

Abstract Objective The aim of this study was to identify pulmonary dysfunction and factors associated with prolonged mechanical ventilation, hospital stay, weaning failure and mortality in patients undergoing coronary artery bypass grafting with use of intra-aortic balloon pump (IABP). Methods This observational study analyzed respiratory, surgical, clinical and demographic variables and related them to outcomes. Results We analyzed 39 patients with a mean age of 61.2 years. Pulmonary dysfunction, characterized by mildly impaired gas exchange, was present from the immediate postoperative period to the third postoperative day. Mechanical ventilation time was influenced by the use of IABP and PaO2/FiO2, female gender and smoking. Intensive care unit (ICU) stay was influenced by APACHE II score and use of IABP. Mortality was strongly influenced by APACHE II score, followed by weaning failure. Conclusion Pulmonary dysfunction was present from the first to the third postoperative day. Mechanical ventilation time was influenced by female gender, smoking, duration of IABP use and PaO2/FiO2 on the first postoperative day. ICU stay was influenced by APACHE II score and duration of IABP. Mortality was influenced by APACHE II score, followed by weaning failure.

Preoperative low muscle mass has a strong negative effect on pulmonary function in patients undergoing living donor liver transplantation.

This study investigated the effect of preoperative sarcopenia on cardiopulmonary function in patients undergoing living donor liver transplantation (LDLT). A retrospective analysis was performed of 207 patients who underwent LDLT between January 2008 and April 2015. The quantity and quality of skeletal muscle were evaluated by the psoas muscle mass index (PMI) and intramuscular adipose tissue content (IMAC), respectively, using preoperative computed tomography imaging. The correlations between preoperative cardiopulmonary function and sarcopenic factors (PMI, IMAC, and grip strength [GS]) were examined. Moreover, overall survival (OS) rates according to preoperative pulmonary function and risk factors were analyzed. No significant differences were found between ejection fraction (EF) and these sarcopenic factors. In contrast, preoperative vital capacity (VC) and forced expiratory volume (FEV) 1.0 were significantly correlated with PMI (P<0.001, P<0.001), IMAC (P=0.024, P=0.013), and GS (P=0.006, P=0.033) in males. Preoperative VC and FEV1.0 were significantly correlated with IMAC (P=0.002, P=0.001) and GS (P=0.002, P=0.001) in females. Moreover, %VC, VC, and FEV1.0 in the preoperative low muscle mass group were significantly lower than in the normal muscle mass group (P=0.004, P<0.001, P<0.001, respectively) in males. Multivariate analysis revealed that preoperative low PMI and preoperative restrictive ventilatory impairment were independent risk factors (P=0.046 and P=0.014, respectively). Preoperative low muscle mass was closely involved with pulmonary dysfunction in patients undergoing LDLT.

Pulmonary Dysfunction in Patients with Liver Cirrhosis

Pulmonary Dysfunction in Patients with Liver Cirrhosis