Severity Of Pulmonary Complications Research Articles

Expression of miR-106a-5p, miR-106b-5p, and TGFβ1I1 in Peripheral Blood Mononuclear Cells (PBMCs) of Chemical Veterans Exposed to Sulfur Mustard With Long-term Pulmonary Complications

Background: Sulfur mustard as a chemical warfare agent causes short and long-term pulmonary complications in its victims. MicroRNAs are known to act as remarkable regulators of biological pathways, monitoring, and treatment of diseases including respiratory problems. In this study, we investigated the expression of miR-106a-5p and miR-106b-5p, two regulators of TGF-β signaling, as well as their target molecule, TGFβ1I1, in peripheral blood mononuclear cells from SM-exposed individuals. Materials and Methods: A total of 70 veterans with SM-induced pulmonary complications were examined and compared to 35 gender and age-matched healthy controls. After clinical examination and pulmonary function tests, the severity of pulmonary complications was classified. Total RNA was extracted from PBMCs and the purity of extracted RNA samples was evaluated by a NanoDrop 2000. The miR-106a-5p, miR-106b-5p, and TGFβ1I1 expression levels were measured by real-time RT-PCR. Results: The miR-106a-5p expression levels were significantly increased in both mild (P=0.015) and severe groups compared with the control group. The miR-106b-5p expression levels were considerably elevated in the severe group TGFβ1I1 expression levels were notably reduced in the severe group compared with the control group. Although, a slight decrease in TGFβ1I1 expression levels was observed in the mild group compared with the control. Conclusion: Our results indicate that exposure to sulfur mustard affects the expression of miR-106a-5p, miR-106b-5p, and their target gene, TGFβ1I1, in peripheral blood mononuclear cells. Considering the role of TGFβ1I1 in the regulation of TGF-β signaling, the mentioned changes might point to a potential mechanism by which SM exposure causes chronic pulmonary complications. In a ROC analysis, miR-106a-5p and miR-106b-5p potentially turned out to be a suitable diagnostic biomarker in the mild and severe categories of patients. Although, miR-106a-5p could be considered a better biomarker than miR-106b-5p.

Investigating the incidence, impact, and severity of pulmonary complications after hepatectomy: A single institution experience

BackgroundPostoperative pulmonary complications are a common cause of postoperative morbidity in patients undergoing hepatectomy. This study aimed to identify risk factors, define severity, and evaluate the impact of postoperative pulmonary complications on postoperative morbidity after hepatectomy. MethodWe used a prospective database in identifying all hepatectomies from 2013 to 2018. The database was then augmented using extensive review of medical records. The Strasburg system was used in categorizing resections per complexity: major hepatic resection and minor hepatic resection, whereas the Clavien-Dindo system was used in defining postoperative pulmonary complications per severity. Potential confounders were controlled for on multiple regression models. ResultsA total of 702 cases were identified: major hepatic resection 413 (60%) and minor hepatic resection 289 (40%). Patients demonstrated comparable characteristics, but the postoperative pulmonary complications group was more likely to have chronic obstructive pulmonary disease (10% vs 5%; P = .02). Severe postoperative pulmonary complications among major hepatectomy was observed in 38 patients (13%). Predictors for severe postoperative pulmonary complications requiring intervention included postoperative liver failure (odds ratio = 2.8; P = .002) and biliary fistula (odds ratio = 3.5; P = .001). In addition, the occurrence of severe postoperative pulmonary complications markedly hindered recovery, increasing length of stay by 4.4-fold and readmission rates by 3-fold (P < .001). On multivariable analysis, postoperative pulmonary complications significantly increase postoperative length of stay (8 vs 5 days; P < .001) and readmission (odds ratio = 3.2; P = .001). Mortality was similar (1% vs 4%; P = .066). ConclusionPostoperative pulmonary complications are a major cause of delayed recovery and worse outcomes after hepatectomy. Further, postoperative liver failure and biliary fistula can predict the occurrence of severe postoperative pulmonary complications among major hepatic resection and the associated need for readmission with these complications.

Pulmonary complications in dogs with acute presentation of pancreatitis

BackgroundIn humans, respiratory complications in patients with acute pancreatitis (AP) are a common life-threatening comorbidity. Since possible lung impairment has not been individually evaluated in canine AP, the aims of the present study were to: (1) describe the prevalence, types and severity of pulmonary complications in dogs with acute presentation of AP, and (2) evaluate their association with mortality. AP diagnosis was based on compatible clinical and laboratory parameters, abnormal canine pancreatic-lipase test, and positive abdominal ultrasound within 48 h from admission. The canine acute pancreatitis severity score (CAPS) was calculated for each dog at admission. Arterial blood gas analysis and thoracic radiography were performed at admission. Thoracic radiography was classified on the basis of pulmonary pattern (normal, interstitial or alveolar) and a modified lung injury score (mLIS) was applied to the ventrodorsal projections for each dog. VetALI/VetARDS were diagnosed using current veterinary consensus. Dogs were divided into non-survivors or survivors (hospital discharge). Clinical, radiological and blood gas parameters collected at presentation were compared between survivors and non-survivors and associated with mortality.ResultsThis prospective cohort study included twenty-six client-owned dogs with AP. Twelve out of twenty-six dogs (46%) died or were euthanized. At admission, thirteen dogs showed respiratory distress at physical examination, which was associated with death (P < 0.001). Radiographic abnormalities were found in twenty-one dogs: alveolar (n = 11) and interstitial pattern (n = 10). Radiographic alterations and mLIS score were both associated with death (P = 0.02 and P = 0.0023). The results of the arterial blood-gas evaluation showed that non-survivors had lower PaCO2 and HCO3− levels, and higher A-a gradient than survivors (P = 0.0014, P = 0.019 and P = 0.004, respectively). Specifically, three dogs had aspiration pneumonia, and VetALI was diagnosed in nine dogs (34.6%), and no dogs met the criteria for VetARDS. The presence of VetALI was associated with mortality (P < 0.001).ConclusionsAs with humans, possible lung impairments, such as VetALI, should be investigated in dogs with acute presentation of pancreatitis.

Thoracic Complications in Behçet's Disease: Imaging Findings.

Behçet's disease (BD) causes vascular inflammation and necrosis in a wide range of organs and tissues. In the thorax, it may cause vascular complications, affecting the aorta, brachiocephalic arteries, bronchial arteries, pulmonary arteries, pulmonary veins, capillaries, and mediastinal and thoracic inlet veins. In BD, chest radiograph is commonly used for the initial assessment of pulmonary symptoms and complications and for follow-up and establishment of the response to treatment. With the advancement of helical or multislice computed tomography (CT) technologies, such noninvasive imaging techniques have been employed for the diagnosis of vascular lesions, vascular complications, and pulmonary parenchymal manifestations of BD. CT scan (especially, CT angiography) has been used to determine the presence and severity of pulmonary complications without resorting to more invasive procedures, in conjunction with gadolinium-enhanced three-dimensional (3D) gradient-echo magnetic resonance (MR) imaging with the subtraction of arterial phase images. These radiologic methods have characteristics that are complementary to each other in diagnosis of the thoracic complications in BD. 3D ultrashort echo time (UTE) MR imaging (MRI) could potentially yield superior image quality for pulmonary vessels and lung parenchyma when compared with breath-hold 3D MR angiography.

Associations between immune-suppressive and stimulating drugs and novel COVID-19-a systematic review of current evidence.

BackgroundCancer and transplant patients with COVID-19 have a higher risk of developing severe and even fatal respiratory diseases, especially as they may be treated with immune-suppressive or immune-stimulating drugs. This review focuses on the effects of these drugs on host immunity against COVID-19.MethodsUsing Ovid MEDLINE, we reviewed current evidence for immune-suppressing or -stimulating drugs: cytotoxic chemotherapy, low-dose steroids, tumour necrosis factorα (TNFα) blockers, interlukin-6 (IL-6) blockade, Janus kinase (JAK) inhibitors, IL-1 blockade, mycophenolate, tacrolimus, anti-CD20 and CTLA4-Ig.Results89 studies were included. Cytotoxic chemotherapy has been shown to be a specific inhibitor for severe acute respiratory syndrome coronavirus in in vitro studies, but no specific studies exist as of yet for COVID-19. No conclusive evidence for or against the use of non-steroidal anti-inflammatory drugs (NSAIDs) in the treatment of COVID-19 patients is available, nor is there evidence indicating that TNFα blockade is harmful to patients in the context of COVID-19. COVID-19 has been observed to induce a pro-inflammatory cytokine generation and secretion of cytokines, such as IL-6, but there is no evidence of the beneficial impact of IL-6 inhibitors on the modulation of COVID-19. Although there are potential targets in the JAK-STAT pathway that can be manipulated in treatment for coronaviruses and it is evident that IL-1 is elevated in patients with a coronavirus, there is currently no evidence for a role of these drugs in treatment of COVID-19.ConclusionThe COVID-19 pandemic has led to challenging decision-making about treatment of critically unwell patients. Low-dose prednisolone and tacrolimus may have beneficial impacts on COVID-19. The mycophenolate mofetil picture is less clear, with conflicting data from pre-clinical studies. There is no definitive evidence that specific cytotoxic drugs, low-dose methotrexate for auto-immune disease, NSAIDs, JAK kinase inhibitors or anti-TNFα agents are contraindicated. There is clear evidence that IL-6 peak levels are associated with severity of pulmonary complications.

Peripheral blood mononuclear cellular viability and its correlation with long-term pulmonary complications after sulfur mustard exposure

IntroductionSulfur mustard (SM) as a chemical warfare agent has short- and long-term complications on its victims. Complications of exposure to SM depend on the level of contamination. Long-term pulmonary complications are the most serious problems. Recent evidence has shown that absorbed SM can be conducted to other tissues by the bloodstream. In this study, we evaluated the long-term effects of SM on the vital activity of peripheral blood mononuclear cells (PBMCs) in SM-exposed patients with long-term pulmonary complications. Materials and methodsOur study samples were 110 patients with long-term pulmonary complications in the SM-exposed group and 109 unexposed individuals in the control group. After clinical examination and pulmonary function tests, the severity of pulmonary complications was classified. Also, the participants' peripheral blood was taken into EDTA-treated Vacutainer tubes. Then, the complete blood count (CBC) was calculated, and PBMCs was purified from whole blood using Ficol-Paque gradient method, finally, the vital activity was assessed by MTT assay. ResultThe vital activity of PBMCs in the SM-exposed group with the mitogen was significantly lower than that in the control group (P = 0.016). Whereas, there was no significant difference in the viability of PBMCs without the mitogen between two groups.Furthermore, hematologic findings indicated that the SM-exposed group had a significant increase in the total count of WBC, neutrophil, MCV, and HCT values but the lymphocyte count and MCHC value were significantly lower than those in the control group. ConclusionExposure to SM even after a long time, can affect hematologic parameters and vital activity of PBMCs.

Circulating mesenchymal stem cells in sulfur mustard-exposed patients with long-term pulmonary complications

Sulfur mustard (SM) is a toxic agent that causes acute and long-term pulmonary complications. Recent evidence has shown the impact of SM on mesenchymal stem cells (MSCs). These cells have a critical role in repairing the damaged tissues. In this study, we evaluated the mobilization of MSCs in SM-exposed patients with long-term pulmonary complications. Fifty-nine SM-injured patients with prolonged pulmonary complications and 20 healthy individuals were included. Patients were classified based on taking drugs, having comorbidities, and severity of respiratory consequence. MSCs with phenotype of CD45-CD44+CD29+CD105+ were evaluated in peripheral blood using flow cytometry. Circulating MSCs were lower in SM-exposed patients compared to the control group (0.93 vs. 2.72 respectively, P = 0.005). No significant difference was observed in the MSC count between patients taking corticosteroids or antibiotics and those patients not taking them. Comorbidities like liver and kidney diseases had changed the count of MSCs in SM-exposed subjects. In addition, the frequency of MSCs did not show any association with the severity of long-term pulmonary complications. In conclusion, SM-exposure causes a decline in the frequency of circulating MSCs in survivors. The lower number of the peripheral MSC population in SM-exposed patients was not affected by taking corticosteroids or antibiotics, but comorbidities are probably involved in MSC frequency. The decreases observed in the number of circulating MSCs was not associated with the severity of the pulmonary complications; however, further studies in mustard lung models are required to demonstrate the therapeutic or pathologic role of MSCs in SM injuries.

Alcohol intake and T cell aging in HIV+ humans are associated with gut bacterial burden

Sulfur mustard (SM) is a toxic agent that causes acute and long-term pulmonary complications. Recent evidence has shown the impact of SM on mesenchymal stem cells (MSCs). These cells have a critical role in repairing the damaged tissues. In this study, we evaluated the mobilization of MSCs in SM-exposed patients with long-term pulmonary complications. Fifty-nine SM-injured patients with prolonged pulmonary complications and 20 healthy individuals were included. Patients were classified based on taking drugs, having comorbidities, and severity of respiratory consequence. MSCs with phenotype of CD45-CD44+CD29+CD105+ were evaluated in peripheral blood using flow cytometry. Circulating MSCs were lower in SM-exposed patients compared to the control group (0.93 vs. 2.72 respectively, P = 0.005). No significant difference was observed in the MSC count between patients taking corticosteroids or antibiotics and those patients not taking them. Comorbidities like liver and kidney diseases had changed the count of MSCs in SM-exposed subjects. In addition, the frequency of MSCs did not show any association with the severity of long-term pulmonary complications. In conclusion, SM-exposure causes a decline in the frequency of circulating MSCs in survivors. The lower number of the peripheral MSC population in SM-exposed patients was not affected by taking corticosteroids or antibiotics, but comorbidities are probably involved in MSC frequency. The decreases observed in the number of circulating MSCs was not associated with the severity of the pulmonary complications; however, further studies in mustard lung models are required to demonstrate the therapeutic or pathologic role of MSCs in SM injuries.

Prophylactic Chest Physiotherapy in Major Abdominal Surgery among Elderly Patients

Introduction: Chest physiotherapy has long been an established mode of treatment for pulmonary complications after major abdominal surgery. This study aimed to assess the effect of prophylactic chest physiotherapy on the frequency and severity of pulmonary complications following abdominal surgery. Material and Methods: A randomized controlled study of prophylactic chest physiotherapy was conducted among fifty post-operative patients (age > 60 years) who underwent elective open major abdominal surgery and were admitted in surgical ward of a tertiary care center. The patients were randomized into two groups: treatment group (n=25) and control group (n=25). The treatment group patients were given preoperative verbal information and informed consent was taken to undergo chest physiotherapy. In group A (n=15), patients performed incentive spirometry and in group B (n=10), patient performed breathing exercises with pursed lips, deep breathing and coughing hourly. In the control group (Group C, n=25), patients were not given any preoperative chest physiotherapy. Observations: The frequency of pulmonary complications was higher in group C (Atelectasis-12%, Basal pneumonia-28%, Pleural effusion-4%) in comparison to group A (Atelectasis-6.6%, Basal pneumonia-6.6%) and group B (Atelectasis-10%, Basal pneumonia-10%). The frequency of postoperative pulmonary complications after major abdominal surgery was less with spirometry (group A- 40%) compared to other physiotherapy (group B, 50%). Complications were maximum in patients without physiotherapy (group C- 72%). Conclusion: Prophylactic chest physiotherapy significantly reduces the frequency and severity of pulmonary complications following abdominal surgery.

Analysis of risk factors for pulmonary complications in patients with limited-stage small cell lung cancer : A single-centre retrospective study.

The most effective therapy in patients with limited-stage small cell lung cancer (LSSCLC) seems to be chemotherapy (using platinum-based regimens) and thoracic radiotherapy (TRT), which is followed by prophylactic cranial irradiation. The analysed group comprised 217patients who received combined treatment for LSSCLC, i.e. chemotherapy (according to cisplatin and etoposide schedule) and TRT (concurrent in 101 and sequential in 116patients). The influence of chemoradiotherapy (ChT-RT) schedule on treatment results (frequency of complete response, survival rates, and incidence of treatment failure and complications) was evaluated, and the frequency and severity of pulmonary complications were analysed to identify risk factors. The 5‑year survival rates in concurrent vs. sequential ChT-RT schedules were 27.3 vs. 11.7% (overall) and 28 vs. 14.3% (disease-free). The frequencies of adverse events in relation to concurrent vs. sequential therapy were 85.1 vs. 9.5% (haematological complications) and 58.4 vs. 38.8% (pulmonary fibrosis), respectively. It was found that concurrent ChT-RT (hazard ratio, HR2.75), a total dose equal to or more than 54Gy (HR2.55), the presence of haematological complications (HR1.89) and a lung volume receiving a dose equal to or greater than 20Gy exceeding 31% (HR1.06) were the risk factors for pulmonary complications. Pulmonary complications after ChT-RT developed in 82% of patients treated for LSSCLC. In comparison to the sequential approach, concurrent ChT-RT had a positive effect on treatment outcome. However, this is a factor that can impair treatment tolerance, which manifests in the appearance of side effects.

Comparison the effect of incentive spirometry and conservative therapy among open heart surgery patients for the prevention of postoperative pulmonary complications

Abstractpatients under Open heart surgery, high risk for many respiratory complications post operatively, chest physiotherapy techniques are used to increase lung volumes, improve oxygenation and decrease the incidence and severity of pulmonary complications after cardiac surgery .deep breathing is a major part of the therapy. Aim ,This study amid to compare the effect of incentive spirometer, and conservative therapy among open heart surgery patients for the prevention of postoperative pulmonary complications. Design, Aquasi –experimental design. Setting, conducted in postoperative intensive care unit of Assiut university hospitals. Subject, a convenience sample of 50 adult open heart patients of both sexes.Group1 (incentive spirometry), group2 (conservative therapy).25 patients for each. Tools, Two tools were developed in this study, tool one (Patient's socio demographic characteristics and health status among open heart patients), tool two (Observation checklist for post-operative pulmonary complications among open heart surgical patients).Result of this study revealed that a statistical significant difference was found between the two groups regarding to atalectasis . As regard pulmonary secretion it was noticed that a highly percent 80%&72% of patients in group 2(conservative therapy)&1(incentive spirometer) respectively. Conclusion of this study illustrated that a positive effects of incentive spirometer compared with other physiotherapy breathing techniques on occurrence of pulmonary complications among open heart patients postoperatively, showed a significantly smaller amount of secretions and atelectasis, improved oxygenation and had less reduction in FVC(forced vital capacity) and FEV1 (forced expiratory volume in one second)on the fourth postoperative day compared to conservative therapy. Recommendations, Explain to the nurse the deference between deep breathing exercise alone and deep breathing exercise with anther maneuver.

Predictors of pulmonary complications in blunt traumatic spinal cord injury

Pulmonary complications are the most common acute systemic adverse events following spinal cord injury (SCI), and contribute to morbidity, mortality, and increased length of hospital stay (LOS). Identification of factors associated with pulmonary complications would be of value in prevention and acute care management. Predictors of pulmonary complications after SCI and their effect on neurological recovery were prospectively studied between 2005 and 2009 at the 9 hospitals in the North American Clinical Trials Network (NACTN). The authors sought to address 2 specific aims: 1) define and analyze the predictors of moderate and severe pulmonary complications following SCI; and 2) investigate whether pulmonary complications negatively affected the American Spinal Injury Association (ASIA) Impairment Scale conversion rate of patients with SCI. The NACTN registry of the demographic data, neurological findings, imaging studies, and acute hospitalization duration of patients with SCI was used to analyze the incidence and severity of pulmonary complications in 109 patients with early MR imaging and long-term follow-up (mean 9.5 months). Univariate and Bayesian logistic regression analyses were used to analyze the data. In this study, 86 patients were male, and the mean age was 43 years. The causes of injury were motor vehicle accidents and falls in 80 patients. The SCI segmental level was in the cervical, thoracic, and conus medullaris regions in 87, 14, and 8 patients, respectively. Sixty-four patients were neurologically motor complete at the time of admission. The authors encountered 87 complications in 51 patients: ventilator-dependent respiratory failure (26); pneumonia (25); pleural effusion (17); acute lung injury (6); lobar collapse (4); pneumothorax (4); pulmonary embolism (2); hemothorax (2), and mucus plug (1). Univariate analysis indicated associations between pulmonary complications and younger age, sports injuries, ASIA Impairment Scale grade, ascending neurological level, and lesion length on the MRI studies at admission. Bayesian logistic regression indicated a significant relationship between pulmonary complications and ASIA Impairment Scale Grades A (p = 0.0002) and B (p = 0.04) at admission. Pulmonary complications did not affect long-term conversion of ASIA Impairment Scale grades. The ASIA Impairment Scale grade was the fundamental clinical entity predicting pulmonary complications. Although pulmonary complications significantly increased LOS, they did not increase mortality rates and did not adversely affect the rate of conversion to a better ASIA Impairment Scale grade in patients with SCI. Maximum canal compromise, maximum spinal cord compression, and Acute Physiology and Chronic Health Evaluation-II score had no relationship to pulmonary complications.

Pulmonary Complications in Survivors of Childhood Hematological Malignancies: Single-Center Experience

Children treated for cancer face the risk of complications later in life, including pulmonary dysfunction. The objective of this study was to evaluate frequency and severity of pulmonary complications in survivors of childhood leukemia and lymphoma treated with chemotherapy alone or combined with radiotherapy. Seventy cancer survivors of hematological malignancies were evaluated for pulmonary complications through history taking, chest examination, high-resolution computed tomography (HRCT) chest, and pulmonary function testing (PFTs). Although most survivors were not clinically compromised, the spectrum of impaired PFTs included obstructive pattern (14.3%), restrictive pattern (5.7%), and mixed pattern (20%). Significant pulmonary dysfunction was seen in children older than 10 years of age (P = .003), and in patients treated with combined chemotherapy and radiotherapy (72.7%) compared with those treated with chemotherapy alone (25%) (P = .001). Cumulative dose of bleomycin was significantly associated with abnormal PFTs (P = .04). Multivariate analysis revealed methotrexate therapy as significant predictor of abnormal PFTs (P = .002). Male patients who received combined therapy showed higher frequency of restrictive, obstructive lung disease, abnormal respiratory reactance, and peripheral airway disease (P = .007, P = .04, P = .002, P = .003, P = .05, respectively). Those with abnormal CT findings (n = 14) had lower forced vital capacity (FVC%), forced expiratory volume in 1 second (FEV1%), and peak expiratory flow (PEF%) when compared to cases with normal CT (P = .001, P <0.001, P = .001, respectively). Subclinical pulmonary function abnormalities are found in survivors of childhood hematological malignancies previously treated and off therapy. Pulmonary dysfunction is more evident with combined chemotherapy and radiotherapy, bleomycin, and methotrexate are the most incriminated chemotherapeutic agents, and males are at higher risk than females; therefore a specific and extended follow-up is warranted.

Une dyspnée fébrile

Sulfur mustard (SM) is a toxic agent that causes acute and long-term pulmonary complications. Recent evidence has shown the impact of SM on mesenchymal stem cells (MSCs). These cells have a critical role in repairing the damaged tissues. In this study, we evaluated the mobilization of MSCs in SM-exposed patients with long-term pulmonary complications. Fifty-nine SM-injured patients with prolonged pulmonary complications and 20 healthy individuals were included. Patients were classified based on taking drugs, having comorbidities, and severity of respiratory consequence. MSCs with phenotype of CD45-CD44+CD29+CD105+ were evaluated in peripheral blood using flow cytometry. Circulating MSCs were lower in SM-exposed patients compared to the control group (0.93 vs. 2.72 respectively, P = 0.005). No significant difference was observed in the MSC count between patients taking corticosteroids or antibiotics and those patients not taking them. Comorbidities like liver and kidney diseases had changed the count of MSCs in SM-exposed subjects. In addition, the frequency of MSCs did not show any association with the severity of long-term pulmonary complications. In conclusion, SM-exposure causes a decline in the frequency of circulating MSCs in survivors. The lower number of the peripheral MSC population in SM-exposed patients was not affected by taking corticosteroids or antibiotics, but comorbidities are probably involved in MSC frequency. The decreases observed in the number of circulating MSCs was not associated with the severity of the pulmonary complications; however, further studies in mustard lung models are required to demonstrate the therapeutic or pathologic role of MSCs in SM injuries.

Analysis of Respiratory Complications After Minimally Invasive Esophagectomy: Preliminary Observation of Persistent Aspiration Risk

Minimally invasive (MI) esophageal resection (ER) has the theoretical advantage of reduced postoperative complications compared with standard ER. However, the impact of MIER on rates and severity of pulmonary complications is unclear. Four patients underwent laparoscopic gastroesophageal mobilization and resection followed by gastric pull-up and cervical esophageal anastomosis (MIER). Videofluoroscopic swallowing studies (VFSS) assessed pharyngolaryngeal function postoperatively. All postoperative complications were documented. Each MIER was completed successfully without intraoperative complications. Mean operative time was 4.3 +/- 2 h. Postoperatively, VFSS detected laryngeal penetration, vocal cord paralysis, and/or aspiration in three patients, two of whom experienced severe respiratory complications. MIER patients are susceptible to aspiration, likely due to transient denervation of the pharynx and laryngeal structures. Following MIER, aggressive pulmonary toilet and aspiration precautions are emphasized to reduce pulmonary complications. Furthermore, serial evaluation of deglutition is encouraged to guide the safe and appropriate resumption of oral feeding.

Ventilatory care in myasthenia gravis crisis: assessing the baseline adverse event rate.

Myasthenic patients who require mechanical ventilation often develop pneumonia or atelectasis. Although there are differences in the prevalence of these complications among various institutions, there is no evidence that aggressive treatment shortens the course of the myasthenic crisis. We have quantified the severity of lung injury and aggressiveness of respiratory intervention in myasthenic patients admitted to the neuro-critical care unit. We retrospectively identified all mechanically ventilated myasthenic patients admitted in our unit between 1990 and 1998. Neuro-critical care unit of a tertiary care center in an urban area with a large, established, regional neuromuscular disease program. Eighteen myasthenia gravis patients with 24 episodes of respiratory failure requiring mechanical ventilation. A novel respiratory intervention index, comprising the use of suction, intermittent positive-pressure breathing or bronchodilator treatments, sighs, and chest physiotherapy represented the aggressiveness of the respiratory treatment. The respiratory intervention index was correlated with the lung injury score, used as a measure of lung involvement and other respiratory variables. MEASUREMENTS AND MAIN RESULTS Our patients had less atelectasis and pneumonia than previously published series (46% vs. 91%), leading to shorter mechanical support and neuro-critical care unit stay. The mean respiratory intervention index correlated with lung injury score and inversely with forced vital capacity. This study presents an estimate for both severity of pulmonary complications and intensity of respiratory therapy in the severe myasthenic patient with mechanical ventilatory compromise. Our results suggest that aggressive respiratory treatment should be used in myasthenic patients in crisis to diminish the risk for prolonged respiratory complications. These observations should be validated in a prospective study.

PULMONARY COMPLICATIONS POST SPINE SURGERY

S119 INTRODUCTION: Scoliosis surgery may involve an anterior and posterior approach in order to achieve proper correction and stabilize the spine. The expected decrease in lung volumes occurring postoperatively coupled with pain, inability to cough, and possible preexisting lung disease from scoliosis may all predispose to pulmonary complications. We chose to assess the incidence and severity of pulmonary complications in that setting METHODS: We retrospectively reviewed a total of sixty-three charts of patients who underwent anterior-posterior thoracic lumbar spine fusion in the period of 1995 to 1997. All of these patients received general anesthesia. Sixty five percent had invasion of the pleural cavity. Radiographic findings were reviewed and correlated with patient characteristics, and outcome postoperatively. RESULTS: There were fifty females and thirteen males. The mean age was 44 +/- 16. Seventy-one percent of patients developed radiographic abnormalities which were more common in patients with invasion of their chest wall. Of the 18 with normal chest x-ray, only four had surgical intervention in their thoracic cavity. Effusions were seen in 54% of patients, infiltrates in 22%, lobar collapse in 9%, and atelectasis in 30%. There was no correlation between blood loss, blood transfused, crystalloid infusion and chest x-ray abnormalities. The FEV1 and FEV1/FVC ratio were similar in those who developed radiographic abnormalities and those who did not. There was no statistically significant difference in age, and smoking history. Two patients developed pneumonia and two required bronchoscopy for lung reexpansion. There was a statistically significant difference in the hospital stay between those with chest x-ray abnormalities and those without. CONCLUSION: Radiographic abnormalities are common after major spine surgery involving an anterior and posterior approach especially when the thoracic cavity is invaded. Effusions are the most common abnormalities seen on chest x-ray followed by atelectasis and infiltrate. In view of the morbity and longer hospital stay associated with such findings, close monitoring of pulmonary status with aggressive pulmonary toilet are indicated in those patients. (Table 1)Table 1: Patient Characteristics

Pulmonary Complications of Orthotopic Liver Transplantation

We retrospectively reviewed the pulmonary complications and associated morbidity and mortality of 44 consecutive patients who underwent 52 orthotopic liver transplantations (OLTs) at the Mayo Clinic during 1987. All survivors participated in follow-up for 1 year after OLT. Of the five deaths in the study group, three were associated with pulmonary infections. On postoperative chest roentgenograms, 24 cases of pulmonary infiltrates were noted; 12 were caused by infections. Ten opportunistic pulmonary infections developed in nine patients: four cytomegalovirus, three Pneumocystis carinii pneumonia, and one each of Cryptococcus, Aspergillus, and Candida. All except one of the opportunistic infections were diagnosed after the sixth postoperative week. Fiberoptic bronchoscopy was helpful for diagnosing opportunistic pulmonary infections in six patients. One Aspergillus pulmonary infection was diagnosed by transthoracic needle aspiration. Bacterial pneumonia occurred in five patients. Preoperative pulmonary function tests, performed in 40 patients, revealed a restrictive ventilatory defect in 28% and impaired gas transfer in 52%. Pleural effusion was present in 18% of patients preoperatively and in 77% during the first week after OLT. Preoperative severity of liver disease and results of arterial blood gas determinations, pulmonary function tests, and chest roentgenography were not associated with postoperative mortality and pulmonary infections. Infectious and noninfectious pulmonary complications are common in liver transplant recipients. Attempts to decrease the frequency and severity of pulmonary complications by early diagnosis and effective treatment may diminish the morbidity and mortality associated with OLT.

Randomized Controlled Trial of Physiotherapy for Postoperative Pulmonary Complications

This assessment of routine postoperative chest physiotherapy would indicate that such practice is beneficial in contradistinction to the findings of other investigators in which its value was not proved. The authors are to be commended for dividing pulmonary complications between atelectasis and pulmonary infection and not simply lumping them together. Fewer infections were seen in the study group, indicating that the severity of pulmonary complications is decreased by chest physiotherapy. Interestingly, the overall incidence of complications was not altered. Prospective randomization of patients adds to the validity of their findings. Practically speaking, any successful therapy depends on the respiratory therapist and how carefully the treatment is given, and sometimes this is done better during a clinical investigation.

Preoperative Pulmonary Evaluation and Therapy for Surgery Patients

Simple pulmonary function studies can be utilized successfully for diagnosis of pulmonary problems in surgery patients preoperatively. In the present study, randomly selected patients were treated preoperatively and postoperatively with cessation of smoking, bronchodilator drugs, antibiotics, inhalation of humidified gases, segmental postural drainage, and chest physiotherapy. When compared to nontreated poor risk patients, the treated patients had a marked reduction in postoperative morbidity and mortality due to pulmonary complications. Although the frequency and the severity of pulmonary complications were somewhat greater in the treated patients than in a group of good patients who were considerably younger in age, the differences were not significant. Extension of these simple therapeutic measures to large numbers of poor risk patients should reduce postoperative morbidity and mortality, allow earlier discharge, and lower the costs of patient care.