Underlying Lung Pathology Research Articles

A Tenacious Trio of Retropharyngeal Emphysema, Pneumomediastinum and Subcutaneous Emphysema Secondary to Pulmonary Tuberculosis: A Case Report

Retropharyngeal emphysema (RPE) is the presence of air in the retropharyngeal area. It may occur due to various etiologies or sometimes spontaneously due to an underlying lung pathology. This report describes a case of a 26-year-old gentleman with pulmonary tuberculosis on treatment who presented with acute breathlessness and dysphagia. His neck and chest radiograph showed retropharyngeal emphysema with pneumomediastinum and subcutaneous emphysema. This was further confirmed by a CT neck and thorax. The patient was managed conservatively with analgesia, antibiotics, IV corticosteroids and oxygen supplementation. Repeat chest radiograph after 17 days showed resolution of retropharyngeal emphysema. Clinicians should have a high index of suspicion for RPE in patients who present with unexplained acute breathlessness and dysphagia of a diseased lung.

Does lung ultrasound-guided ultrafiltration lead to better outcomes in acute kidney injury requiring intermittent hemodialysis: A randomized control trial.

Optimization of ultrafiltration during hemodialysis is a critical parameter in achieving therapeutic efficacy and ensuring hemodynamic stability. While various modalities such as blood volume monitoring, inferior vena cava diameter assessment, natriuretic peptide levels, bioimpedance assay, and lung ultrasound have been widely explored in the context of maintenance hemodialysis, the concept of volume-guided ultrafiltration in dialysis patients with acute kidney injury remains unexplored. Adult patients with acute kidney injury requiring dialysis, who were hemodynamically stable and not on ventilator support, without underlying lung pathology or cardiac failure, were randomized into two groups. All patients underwent 28-zone lung ultrasound before dialysis. The ultrafiltration was decided based on the treating physician's clinical judgment in controls. In the intervention group, the ultrafiltration orders prescribed by the treating physician were modified, based on the Kerley B line scores obtained by lung ultrasound. The rest of the dialysis prescriptions were similar. A postdialysis lung ultrasound was done in both groups to assess the postdialysis volume status 30 min after the dialysis session. A total of 74 patients undergoing hemodialysis for acute kidney injury were randomized. The baseline characteristics were comparable except for higher baseline B line score scores in the intervention arm. All patients received similar dialysis prescriptions. The lung ultrasound-guided ultrafiltration arm had a higher change in B line scores (BLS) from baseline (4 [0-9.5] vs. 0 [0-4]; p value 0.004) during the first dialysis session. The predialysis BLS indexed to ultrafiltration (mL/kbw/h) were significantly lower in controls, reflecting a relatively higher rate of ultrafiltration in controls compared with intervention (p = 0.006). The total number of dialysis sessions done in the control and intervention arm were 61 and 59, respectively. Among controls, 23/61 sessions (37.7%) had intradialytic adverse events, whereas, in the intervention arm, only 4/59 sessions (6.7) had any adverse intradialytic events (p < 0.01). Lung ultrasound-guided ultrafiltration was associated with a better safety profile, as demonstrated by reduced intradialytic events.

A Tenacious Trio of Retropharyngeal Emphysema, Pneumomediastinum and Subcutaneous Emphysema Secondary to Pulmonary Tuberculosis: A Case Report

Retropharyngeal emphysema (RPE) is the presence of air in the retropharyngeal area. It may occur due to various etiologies or sometimes spontaneously due to an underlying lung pathology. This report describes a case of a 26-year-old gentleman with pulmonary tuberculosis on treatment who presented with acute breathlessness and dysphagia. His neck and chest radiograph showed retropharyngeal emphysema with pneumomediastinum and subcutaneous emphysema. This was further confirmed by a CT neck and thorax. The patient was managed conservatively with analgesia, antibiotics, IV corticosteroids and oxygen supplementation. Repeat chest radiograph after 17 days showed resolution of retropharyngeal emphysema. Clinicians should have a high index of suspicion for RPE in patients who present with unexplained acute breathlessness and dysphagia of a diseased lung.

A Novel Fetal Magnetic Resonance Imaging Lung Volume Nomogram Stratified by Estimated Fetal Weight

Introduction: Fetal magnetic resonance imaging (MRI) lung volume nomograms are increasingly used to prognosticate neonatal outcomes in fetuses with suspected pulmonary hypoplasia. However, pregnancies complicated by fetal anomalies associated with pulmonary hypoplasia may also be complicated by fetal growth restriction (FGR). If a small lung volume is suspected in such cases, it is often unclear whether the lungs are “small” because of underlying lung pathology, or small fetal size. Existing MRI lung volume nomograms have mostly been stratified by gestational age (GA), rather than estimated fetal weight (EFW). Therefore, we aimed to develop a novel fetal lung volume nomogram stratified by EFW. Methods: Consecutive fetal MRIs performed at a quaternary medical center from 2019 to 2021 were analyzed. MRIs performed due to fetal lung anomalies and cases with FGR were excluded. All MRIs were performed without IV contrast on GE 3 or 1.5 Tesla scanners (GE Healthcare). Images were reviewed by three experienced fetal radiologists. Freehand ROI in square centimeter was drawn around the contours of the lungs on consecutive slices from the apex to the base. The volume of the right, left and total lungs were calculated in mL. Lung volumes were plotted by both EFW and GA. Results: Among 301 MRI studies performed during the study period, 170 cases met inclusion criteria and were analyzed. MRIs were performed between 19- and 38-week gestation, and a sonographic EFW was obtained within a mean of 2.9 days (SD ± 5.5 days, range 0–14 days) of each MRI. Nomograms stratified by both EFW and GA were created using 200 g. and weekly intervals respectively. A formula using EFW to predict total lung volume was calculated: LV = 0.07497804 EFW0.88276 (R2 = 0.87). Conclusions: We developed a novel fetal lung volume nomogram stratified by EFW. If validated, this nomogram may assist clinicians predict outcomes in cases of fetal pulmonary hypoplasia with concomitant FGR.

The Impact of Medical Comorbidities on Cough Improvement Following Superior Laryngeal Block.

Chronic refractory cough is defined as cough lasting greater than 8 weeks and with an unclear etiology. Blockade of the internal branch superior laryngeal nerve (iSLN) has been shown to be safe and effective in the treatment of chronic cough. It remains unknown, however, if underlying comorbidities impact patient response to iSLN blockade. A total of 44 patients aged 18 years and older were seen at our institution's Laryngology clinics between 2019 and 2022 and treated with iSLN blockade. Patient demographics, comorbidities, and pre- and post-treatment cough severity index (CSI) scores were collected from electronic medical records. Two-tailed independent T tests were used to compare CSI scores between groups with and without 4 underlying comorbidities: GERD, pulmonary history, smoking history, and evidence of vocal fold paresis or asymmetry on stroboscopy. Patients with a history of GERD or smoking and those with evidence of glottic insufficiency had similar improvements in CSI compared to those who did not (22.5 ± 26.4 vs 45.0 ± 47.1, P = .36; 32.7 ± 27.8 vs 29.0 ± 38, P = .85; 41.3 ± 18.8 vs 27.2 ± 37.7, P = .195). Patients with underlying pulmonary conditions had a significantly reduced response to iSLN blockade than did patients without underlying disease (9.85 ± 15.0 vs 47.4 ± 38.1, P = .028). Underlying lung pathology may contribute to decreased iSLN blockade efficacy in the treatment of chronic refractory cough from laryngeal hypersensitivity and its treatment is likely necessary for optimal symptom reduction. Characterizing patient comorbidity profiles can help guide patient counseling on expected treatment efficacy.

A Case Report of Pneumoretroperitoneum from Blunt Trauma in a Patient with Chronic Obstructive Pulmonary Disease.

Pneumomediastinum is a rare complication of blunt traumatic injury and is thought to be due to the Macklin effect, a pathophysiologic process comprised of three steps: alveolar rupture secondary to blunt injury; air dissecting along bronchovascular sheaths; and spread of pulmonary interstitial edema into the mediastinal space. Pneumomediastinum is rarely associated with pneumoretroperitoneum. We present a case of a patient who suffered a cardiac arrest after a fall during a chronic obstructive pulmonary disease exacerbation, leading to pneumoretroperitoneum. This case highlights the complications that can arise from blunt trauma and how underlying lung pathology can worsen these complications.

Long-term clinical outcomes after initial secondary pneumothorax surgery.

Given the heterogeneity of underlying lung disease and the higher morbidity and mortality associated with surgery for secondary pneumothorax (SP), treatment standardization and evidence-based early surgical management are challenging pursuits. Our aim was to document the clinical course of SP after initial surgical intervention and analyse related recurrence risk. We conducted a retrospective review of 160 patients, each with SP, using clinical records housed in an institutional database. Clinical, imaging, and operative data were retrieved, and Cox proportional hazards (PH) analysis was undertaken to identify risk factors for recurrence. During a mean follow-up of 58.7 months, the overall recurrence rate in this cohort was 18.75% (ipsilateral, 14; contralateral, 16). A total of 24 patients had ≥3 ipsilateral episodes <6 months prior to surgery, marked by initial index episodes. In multivariate Cox PH analysis, the strongest risk factor for recurrence was underlying lung pathology other than chronic obstructive pulmonary disease [COPD: hazard ratio (HR) =5.3; P<0.001]. In this setting, underlying lung disease of a non-COPD nature is a proven risk factor for postsurgical recurrence. There is also a tendency in some patients for multiple episodes of pneumothorax within short periods of time, especially in the absence of COPD. Underlying disease processes may thus merit consideration in treatment planning.

A STUDY ON INTERCOSTAL CHEST TUBE IN PATIENTS WITH PNEUMOTHORAX IN A TERTIARY CARE CENTRE: A RETROSPECTIVE STUDY

Background : Pneumothorax is the accumulation of air within the pleural space, i.e within two layers of the pleura. It may occur spontaneously due to underlying lung pathology or due to trauma in various forms. Spontaneous pneumothorax is further classied into primary and secondary depending on the etiological ndings. Intercostals water sealed drainage system, commonly known as chest tube, are designed to remove air or uid from the pleural cavity which accumulates due to various etiologies and has been used for the management of pneumothorax for a long time. This is a retrospective observational study made on 50 p Methods : atients who presented with pneumothorax due to various causes and were managed by chest tube drainage in a tertiary care hospital. Results and observations : Of 50 patients, 46 patients (92%) had successful outcome. However the p-value came out to be 0.64 (&gt; 0.05), hence the role of chest tube in primary management of pneumothorax is ruled out. The initial management of pneumothorax is conservative with observatio Conclusion : n and needle aspiration. Chest tube drainage should be considered only when conservative measures fail and clinical and radiological parameters suggest deterioration, since the more invasive method as primary treatment causes more complications

Patient Self-Inflicted Lung Injury-A Narrative Review of Pathophysiology, Early Recognition, and Management Options.

Patient self-inflicted lung injury (P-SILI) is a life-threatening condition arising from excessive respiratory effort and work of breathing in patients with lung injury. The pathophysiology of P-SILI involves factors related to the underlying lung pathology and vigorous respiratory effort. P-SILI might develop both during spontaneous breathing and mechanical ventilation with preserved spontaneous respiratory activity. In spontaneously breathing patients, clinical signs of increased work of breathing and scales developed for early detection of potentially harmful effort might help clinicians prevent unnecessary intubation, while, on the contrary, identifying patients who would benefit from early intubation. In mechanically ventilated patients, several simple non-invasive methods for assessing the inspiratory effort exerted by the respiratory muscles were correlated with respiratory muscle pressure. In patients with signs of injurious respiratory effort, therapy aimed to minimize this problem has been demonstrated to prevent aggravation of lung injury and, therefore, improve the outcome of such patients. In this narrative review, we accumulated the current information on pathophysiology and early detection of vigorous respiratory effort. In addition, we proposed a simple algorithm for prevention and treatment of P-SILI that is easily applicable in clinical practice.

Surgical management of pulmonary aspergilloma

: Pulmonary aspergillomas occur due to the aspergillus fungus colonising pre-existing cavities within the lungs of patients with underlying lung pathology or in those who are immunosuppressed. Their clinical presentation can be variable and they often present to the surgical clinic after patients develop haemoptysis. This haemoptysis can vary from mild bleeds to catastrophic life-threatening haemorrhage. Surgery for patients with aspergillomas historically carried a high morbidity and mortality impact and so the role of surgery was usually saved for patients presenting with severe haemoptysis. In recent years further research has demonstrated a reduction in the morbidity and mortality impact of surgery and therefore the question has been raised whether surgical intervention should be offered at an earlier stage. Surgery for pulmonary aspergilloma is technically challenging and does still carry a marked morbidity and mortality risk. Although these risks have reduced in recent years, surgery should still be reserved for symptomatic patients with a significant risk of further bleeding. A multi-disciplinary framework is crucial to offer best risk; benefit assessment and discussion for this high-risk patient group. This article will describe the natural history and presentations of aspergillomas, the indications and types of surgery as well as a multi-disciplinary approach to patient assessment.

Morbidity, mortality, and surgical treatment of secondary spontaneous pneumothorax.

Pneumothorax in patients with underlying lung pathology is called secondary spontaneous pneumothorax (SSP). It is an important health problem worldwide, with significant morbidity, high health-care expenses, and possibility of mortality. This study aimed to evaluate the epidemiological characteristics, risk factors for mortality and morbidity, and treatment options of SSP. Outcomes of 133 patients with SSP were evaluated retrospectively. Patients with SP with evidence of underlying lung disease or a smoking history over 50 years of age were considered SSP. The patients were analyzed in terms of epidemiological fea-tures, underlying diseases, treatment methods, complications, and mortality. The treatment options included thoracotomy (T), video-assisted thoracoscopic surgery (VATS), tube thoracostomy, and conservative treatment. The mean age was 50.50±20.374 years, and the age range was 16-95. Ninety-three (69.9%) of the patients were smokers. The most common clinical finding was dyspnea in 77 (57.9%) patients. The most common underlying disease was chronic obstructive pulmonary disease in 62 patients (46.6%). Six (4.5%) patients received conservative treatment, a chest tube was placed in 89 (66.9%) patients, and 38 (28.6%) patients were treated with surgery. As an operative procedure, lung wedge resection was performed in 24 (18.0%) patients and bulla resection was performed in 6 (4.5%) patients. Parietal pleurectomy was performed in 27 (20.3%) patients. Axillary mini-T or T was performed more frequently in large pneumothorax, smokers, and in obstructive pulmonary disease. Tube thoracostomy was used more frequently in poor physical performance, comorbidities, and infectious diseases. Complications were ob-served in 55 patients (41.4%). The most common complication was persistent air leakage in 18 (13.5%) patients. Complications were associated with large pneumothorax (P=0.003), poor physical performance (P=0.009), infectious diseases (P= 0.030), and occupational risk factors (P=0.032). Recurrence was developed in 12 (9.0%) patients. Postoperative recurrence was observed in 1 patient. Four (3%) patients died. Mortality was higher in patients with poor physical performance (P=0.027), comorbidities (P=0.008), and patients with complications (P=0.027). The length of stay in the hospital was high in mini-axillary T (AT)/T (P<0.001) and VATS (P<0.001). There was no significant relationship between the mini-AT/T and VATS in terms of length of hospital stay. Large pneumothorax, poor physical performance, and comorbidity are associated with morbidity and mortality. Conservative treatment for small pneumothorax and chest tube for large pneumothorax is the most appropriate initial treatment. Resection of the bullous region through VATS or mini-AT/T is the most appropriate surgical technique.

Respiratory Complications and Weaning Considerations for Patients with Spinal Cord Injuries: A Narrative Review.

Respiratory complications following traumatic spinal cord injury are common and are associated with high morbidity and mortality. The inability to cough and clear secretions coupled with weakened respiratory and abdominal muscles commonly leads to respiratory failure, pulmonary edema, and pneumonia. Higher level and severity of the spinal cord injury, history of underlying lung pathology, history of smoking, and poor baseline health status are potential predictors for patients that will experience respiratory complications. For patients who may require prolonged intubation, early tracheostomy has been shown to lead to improved outcomes. Prediction models to aid clinicians with the decision and timing of tracheostomy have been shown to be successful but require larger validation studies in the future. Mechanical ventilation weaning strategies also require further investigation but should focus on a combination of optimizing ventilator setting, pulmonary toilet techniques, psychosocial well-being, and an aggressive bowel regimen.

S2743 Mesalamine-Induced Interstitial Lung Disease in a Crohn’s Patient With COVID-19

Introduction: Extraintestinal manifestations of Crohn’s disease (CD) generally correlate to the disease activity and may be seen in 1 of 4 patients with CD. Though the prevalence of bronchopulmonary manifestations in CD is 0.4%, subclinical pulmonary changes may be seen in up to half of adults with CD, with involvement of the tracheobronchial tree, lung parenchyma or the pleura. Case Description/Methods: A 61-year-old man, with a history of CD diagnosed 2 years ago, currently in remission with mesalamine, was admitted to the ICU with acute hypoxic respiratory failure due to COVID-19. Inflammatory markers were elevated and he needed high-flow nasal cannula. He was started on a 5-day course of dexamethasone. By HOD-9 O2 requirement and inflammatory markers had trended down. However, around HOD-10 his O2 requirement increased to 6-10 L at rest. CT-chest showed peripherally distributed ground-glass opacities and superimposed early diffuse fibrotic lung changes. Superadded bacterial infection was ruled out. Mesalamine was discontinued and the patient was started on a course of iv methylprednisolone, after which oxygen requirements dramatically declined. He was discharged on HOD 24 with 2L O2 at rest and 4L on ambulation and a prednisone taper. Chest x-ray in 8 weeks showed improving infiltrates. On follow-up 5 months later, he was not on O2 anymore and was doing well. Discussion: Latent interstitial pulmonary involvement is seen in around 20%-55% of patients with IBD, with the most common manifestation being drug-induced lung disease, due to sulfasalazine, mesalamine, methotrexate, or anti-TNF agents. Pulmonary function tests can help in early identification of lung injury since respiratory involvement is latent many times. Onset of drug reaction can occur from 5 days to 44 months after initiation of mesalamine therapy and has been reported in the form of eosinophilic pneumonia, organizing pneumonia, nonspecific interstitial pneumonia and hypersensitivity pneumonitis. The absence of other extra-intestinal manifestations, and the remission of CD itself, can be helpful in excluding other pulmonary manifestations of CD from drug-induced lung disease. Discontinuation of the causative drug, along with a course of steroids, can help in reversing the symptoms. Though the differential of mesalamine-induced lung injury, cannot be confirmed nor excluded here, this patient probably had underlying lung pathology from his CD or its treatment, making his recovery from COVID-19 more complicated (Figure).Figure 1.: A: Portable Chest X-ray showing multifocal pneumonia, low lung volumes with bilateral patchy airspace disease; B, C: CT-Chest showing peripherally distributed ground-glass opacities, distributed in upper and lower lobes. There were superimposed early diffuse lung fibrotic changes, without any evidence of pulmonary thromboembolism; D: CT Chest, 5 months post-discharge, showing improvement in opacities.

A prospective observational study to determine the predictors of failure of non-invasive ventilation in patients with type 2 respiratory failure

Background: This study aims to evaluate clinical and biochemical parameters likely to predict the failure of non-invasive ventilation (NIV) in patients with type 2 respiratory failure. Methods: The study was conducted from September 2016 to August 2018. Clinical and biochemical parameters of 151 patients were analysed after the application of NIV and divided into two groups, success group if they remained on NIV after 48 h and failure group if intubated. Results: Among 151 patients, 65 patients (43%) were intubated and included in the failure group. The remaining 86 patients (57%) were included in the success group. Of the 65 patients who got intubated, 16 patients died while 49 recovered. Out of the 151 patients enrolled the gender distribution was 65 males and 86 females. There was no statistically significant association of the outcome of NIV usage with the comorbidity of the patient and with the underlying lung pathology of the patient. Seventy-two per cent (47 patients) of the NIV failures were in the first 6 h. Lower pH, higher partial pressure of carbon dioxide, higher heart rate and respiratory rate (RR) at baseline showed a statistically significant association with the failure of NIV usage in patients with type 2 respiratory failure. Failure of clinical and biochemical parameters to improve at various time points was also associated with increased chances of failure of NIV usage. Conclusions: Linear regression analysis showed that pH and RR at baseline and presence of severe pulmonary artery hypertension were found to be predictors of failure of NIV.

The role of routine pulmonary imaging before hyperbaric oxygen treatment.

Respiratory injury during or following hyperbaric oxygen treatment (HBOT) is rare, but associated pressure changes can cause iatrogenic pulmonary barotrauma with potentially severe sequelae such as pneumothoraces. Pulmonary blebs, bullae, and other emphysematous airspace abnormalities increase the risk of respiratory complications and are prevalent in otherwise healthy adults. HBOT providers may elect to use chest X-ray routinely as a pre-treatment screening tool to identify these anomalies, particularly if a history of preceding pulmonary disease is identified, but this approach has a low sensitivity and frequently provides false negative results. Computed tomography scans offer greater sensitivity for airspace lesions, but given the high prevalence of incidental and insignificant pulmonary findings among healthy individuals, would lead to a high false positive rate because most lesions are unlikely to pose a hazard during HBOT. Post-mortem and imaging studies of airspace lesion prevalence show that a significant proportion of patients who undergo HBOT likely have pulmonary abnormalities such as blebs and bullae. Nevertheless, pulmonary barotrauma is rare, and occurs mainly in those with known underlying lung pathology. Consequently, routinely using chest X-ray or computed tomography scans as screening tools prior to HBOT for low-risk patients without a pertinent medical history or lack of clinical symptoms of cardiorespiratory disease is of low value. This review outlines published cases of patients experiencing pulmonary barotrauma while undergoing pressurised treatment/testing in a hyperbaric chamber and analyses the relationship between barotrauma and pulmonary findings on imaging prior to or following exposure. A checklist and clinical decision-making tool based on suggested low-risk and high-risk features are offered to guide the use of targeted baseline thoracic imaging prior to HBOT.

Risk Factors and Outcome of Pneumothorax in Neonates at Benghazi Children Hospital during Three Years Review

Background: Pneumothorax occurs more frequently in the neonatal period than in any other period of life and it is associated with the increased mortality and morbidity. Aims: This study was conducted to evaluate the frequency of pneumothorax and to assess risk factors, management as well as the outcome of newborn infants with pneumothorax. Subjects and Methods: A case series study of 112 newborns infants with pneumothorax (PTX) who were admitted and treated at NICU in Benghazi children hospital in Libya for three years period, from January 2018 to December 2020 are included in this descriptive study. Medical records were evaluated for baseline characteristics of neonates, predisposing factors of neonatal PTX, management and mortality. Results: During the observed three-year period, 5166 neonates were admitted to hospital and 112 of neonates were diagnosed with pneumothorax (CXR confirmed), so the frequency of pneumothorax was 2.2% from neonatal admission. Males outnumbered females by a ratio of 1.9:1. Full term delivery was recorded in 60.7% of patients and 39.3% were pre term. Mean birth weight was 2.5±0.67 kg, with medium weight 2.8kg and minimum weight was 1.08kg and maximum weight was 4.5kg. More than half (68.7%) of patients had birth weight ≥2.5kg. Administration of corticosteroid during pregnancy was recorded in 13.4% of mothers. Concerning mode of delivery, C/S constitute 75%, elective C/S was recorded in 64.3% and 35.7% was emergency, while normal delivery recorded 25%. Spontaneous pneumothorax was found in 32.1%, and secondary pneumothorax was recorded in 67.9% of patients. Age of baby when had PTX was ≤ 48 hours of age in 63.4% of them and &gt;48 hours of age in 36.6%. Side of PTX was at right side in 54.5%, at left side in 22.3% and bilateral in 23.2%. Underlying lung pathology was recorded in 60.7% of patients, 41% had hyaline membrane disease, 8.9% had transient tachypnea of newborn, 6.3% had Congenital Pneumonia, 2.7% had Meconium aspiration ............

A Case of Secondary Spontaneous Pneumothorax in a Patient with Interstitial Lung Disease

Secondary Spontaneous Pneumothorax occurs in people with wide variety of parenchymal lung disease. These individuals have underlying pulmonary pathology that alters normal lung structure. Patients presenting with acute respiratory distress with underlying lung pathology should always be evaluated radiologically for any complications such as secondary spontaneous pneumothorax and managed accordingly. My case report of secondary spontaneous pneumothorax in a female patient with interstitial lung disease illustrates the importance of computed tomography (CT scan of Chest), insertion of intercostal drain tube and course of antibiotics for infection control and prevention. Keywords: Secondary spontaneous pneumothorax, Interstitial lung disease, Intercostal drainage tube

Comparison of Assist/Control Ventilation with and without Volume Guarantee in Term or Near-Term Infants.

This study aimed to compare the effects of volume guarantee (VG) combined with assist/control (AC) ventilation to AC alone on hypocarbia episodes and extubation success in infants born at or near term. In this prospective cohort study, infants >34 weeks of gestation at birth, who were born in our hospital supported by synchronized, time-cycled, pressure limited, assist/control ventilation (AC) or assist-controlled VG mechanical ventilation (AC + VG) were included. After admission, infants received either AC or VG + AC using by Leoni Plus ventilator. The ventilation mode was left to the clinician. In the AC group, peak airway pressure was set clinically. In the VG + AC group, desired tidal volume was set at 5 mL/kg, with the ventilator adjusting peak inspiratory pressure to deliver this volume. The study was completed once the patient extubated. There were 35 patients in each group. Incidence of hypocarbia was lower in the VG + AC compared with AC (%17.1 and 22.8%, respectively) but statistically not significant. Out-of-range partial pressure of carbon dioxide (PCO2) levels were lower in the VG + AC group and it reached borderline statistical significance (p = 0.06). The median extubation time was 70 (42-110) hours in the VG + AC group, 89.5 (48.5-115.5) hours in the AC group, and it did not differ between groups (p = 0.47). We found combining AC and VG ventilation compared with AC ventilation alone yielded similar hypocarbia episodes and extubation time for infants of >34 gestational weeks with borderline significance lower out-of-range PCO2 incidence. · Underlying lung pathology requiring mechanical ventilation support in term infant is heterogeneous.. · VG ventilation compared with conventional modes yielded similar hypocarbia episodes in term infants.. · Combining VG ventilation lead to borderline significance lower out-of-range PCO2 incidence..

The Objective and Subjective Outcome of Bullectomy in Patients of Bullous Lung Disease: A Prospective Study

Background: This study aimed to evaluate the outcome of bullectomy in patients with bullous lung by comparative analysis of their preoperative and postoperative pulmonary function parameters and subjective dyspnea score.&#x0D; Materials and Methods: The study included 42 cases of bullous lung disease, who underwent open or video-assisted thoracoscopic surgery (VATS) bullectomy at our hospital from November 2019 till January 2022. All patients were subjected to set protocol which included preoperative comprehensive history and physical examination, chest X-ray, lung CT, and pulmonary function tests. Postoperative evaluation included 3 monthly follow-up for three visits, with clinical assessment for subjective dyspnea score and pulmonary function tests (PFTs). Preoperative and postoperative comparisons of parameters were made using the student’s paired t-test to calculate the statistical significance.&#x0D; Results: Primary bullous lung disease was the most common underlying lung pathology in our population, followed by COPD. Spontaneous pneumothorax was the most common presenting feature, and the most patients presented in their fourth decade of life with a history of smoking.&#x0D; All cases underwent VATS/open bullectomy. Most patients were discharged on the 4th postoperative day. Statistically, significant improvement was seen in mean FEV1 (forced expiratory volume in 1st second), FVC (forced vital capacity), and FEV1/FVC. FEV1 appeared to be the most reliable indicator of postoperative progress. The subjective dyspnea score improved in a statistically meaningful way. Diffuse parenchymal disease patients had a higher rate of complications. Our research found no evidence of mortality.&#x0D; Conclusion: We conclude that surgery remains the standard treatment for bullous lung disease. Most of the patients who got benefitted are those having localized disease with remaining normal parenchyma. Statistically significant improvement in subjective and objective parameters is seen in all cases. Those with the diffuse emphysematous disease need careful selection given their high complication rate.

Abstract No.: ABS1737: Relationship of Lung Ultra-sound Score with oxygenation and pulmonary mechanics in mechanically ventilated patients in the intensive care unit

Background and Aims:Lung ultra-sonography is a technique to recognise impaired alveolar air content and increased interstitial and alveolar fluid. The ultra-sound waves reflect lung aeration beyond parietal pleura, indicating underlying lung pathology. This study ascertains the relationship of Lung Ultra-sound Score (LUSS) with oxygenation and dynamic compliance.Methods:One hundred and one lung ultra-sounds were performed in 50 patients aged 18–60 years, requiring mechanical ventilation in the intensive care unit for at least 24 hours to study the relationship between LUSS and PaO2/FiO2 and pulmonary mechanics. The twelve-region method was used; the number of B lines was counted in each inter-costal space, and the score was awarded. At the same time, ventilator parameters and arterial blood gases were noted. The correlation between variables was evaluated using the Spearman coefficient.Table 1Ventilatory charactersticsParametersNo. of scansMedian (range)SIMV/PS91ASV5PC5FiO21010.5 (0.3-1)PEEP (cm H2O)8 (5-14)PIP (cm H2O)20 (12-32)COMPLIANCE (ml/cm H2O)22 (7.4-42)RESISTANCE (cm H2O/l/sec)2.2 (1-4.5)Pplat (cm H2O)13 (6-20)Pressure support (cm H2O)12 (8-14)Table 2Compliance, resistance, and LUSS by PaO2/FiO2Ratio <200 Mean±SD median (range)Ratio ≥200 Mean±SD median (range) P No. of USG3863Compliance (ml/cm H2O) (7.4-42)18.01±5.0726.24±6.140.000Resistance (cm H2O/l/sec) (1-4.5)2.94±0.911.95±0.740.000LUSS24.5 (12-36)7 (0-11)0.000Results:LUSS showed a negative correlation with PaO2/FiO2 ratio (R2 = 0.607, p < 0.0001) and lung compliance (R2 = 0.354, p < 0.0001) but a positive linear correlation with lung resistance (R2 = 0.406, p < 0.0001).Conclusion:LUSS is an easy and effective bedside tool to measure lung parameters in mechanically ventilated patients, and LUSS correlates significantly with oxygenation, lung compliance, and resistance.