Unilateral Lung Disease Research Articles

Unilateral interstitial lung disease: A unique manifestation of asymptomatic pulmonary artery atresia

Interstitial pulmonary fibrosis is idiopathic, bilateral, or secondary to exposure to organic antigens, or collagen disorders. Unilateral pulmonary fibrosis is uncommon and intriguing as it has different pathogenetic mechanisms. We present a case of a patient with a short 5-day history of dyspnea with no ailment in childhood. His radiograph revealed increased reticular markings in the right lung with a small right hilum. Contrast-enhanced computed tomography showed unilateral pulmonary fibrosis and confirmed the presence of an atretic right pulmonary artery contributing to the small hilum, with collateral supply from the right internal mammary artery. This asymptomatic patient had unilateral pulmonary fibrosis which had developed as a consequence of impaired blood supply to the right lung due to atresia of the right pulmonary artery with collateral from systemic circulation unable to keep abreast with normal pulmonary development.

Unilateral pulmonary artery agenesis with unilateral interstitial lung disease in an allergic bronchopulmonary aspergillosis patient

Unilateral pulmonary artery agenesis with unilateral interstitial lung disease in an allergic bronchopulmonary aspergillosis patient

The characteristics and clinical value of chest CT images of novel corona virus pneumonia: An update

Aim: To investigate the characteristics of chest Computed Tomography (CT) images of corona virus pneumonia in India. Materials and methods: Clinical data and CT images of 1000 cases of NCP were collected. Lesions were scored and characterized. The clinical manifestations and laboratory test results of the patients were analysed. Results: The main clinical manifestations were fever, dry cough, and fatigue. A total of 15000 scored lesions were found in the first chest CT images of patients. The lesions were located mainly in the subpleural area of the lungs (90%). Most of the lesions were ground-glass opacity. Pulmonary consolidation accounted for 40% of all of the lesions. Of the 1000 cases, 900 patients (90%) had bilateral lung disease, 100 (1%) patients had unilateral lung disease Conclusion: The chest CT of NCP patients is characterized by bilateral ground-glass lesions located in the subpleural area of the lung, and progressive consolidation with no migratory lesions. Pleural effusions and mediastinal lymphadenopathy are rare. As patients can have a negative early nucleic acid test, chest CT, in combination with epidemiological and laboratory tests, is a useful examination to evaluate the disease and curative effect.

Anaesthetic management for excision of rare right pulmonary glial heterotopia in a post COVID-19 survival paediatric patient.

Sir, Pulmonary glial heterotopia is a rare condition in which lung cyst is lined with glial tissue. The affected children usually present with difficulty in breathing at a young age without any other congenital anomalies.[1] Herein we describe the case of a 1-year-old boy weighing 10 kg who presented with shortness of breath (SOB) and dry cough since last one month to the paediatric surgery department. The SOB was gradual in onset and progressive in nature. The child had similar type of symptoms five months back for which a local practitioner had been consulted. The child was put on anti-tubercular treatment. On non-relief of symptoms, he was referred to us. The chest radiogram and computed tomography scan showed an 8.5 × 5.6 × 7.2 cm cyst in the lower lobe of the right lung [Figure 1 and 2]. In the meantime patient developed productive cough and fever. Reverse transcription -polymerase chain reaction (RT-PCR)test for coronavirus disease (COVID)-19 was advised and it was positive. The patient was medically managed and discharged home.Figure 1: Chest x-ray showing large cyst in right lungFigure 2: CT chest showing right lung cystThoracotomy and excision of right lung cyst was planned after patient fully recovered from COVID-19 pneumonitis and became RT-PCR negative. On preoperative examination all vital parameters were within normal ranges. The patient was wheeled into operation theatre and connected to routine monitoring. Premedication was done with intravenous [IV] midazolam 0.5 mg and intravenous fentanyl 15 mg. Induction was done with IV thiopentone sodium 50 mg and IV atracurium 5 mg bolus followed by intubation with a cuffed 4.5-mm endotracheal tube. A single lumen tube was used due to unavailability of an appropriately sized double lumen tube or bronchial blockers. Moreover, there is still a lack of consensus on lung isolation techniques in infants. The patient was put on mechanical ventilation with tidal volume [TV] 100 mL, frequency 10 and peak airway pressure 10 cm H2O. Surgery was performed in left lateral position. Intraoperatively transient electrocardiography changes were observed during manipulation, which resolved without any intervention. Maintenance was achieved via a 40:60 ratio of oxygen and nitrous oxide, sevoflurane and intermittent aliquots of atracurium. After 30 minutes there was drop in oxygen saturation (SpO2) to 85%, the patient was switched to manual ventilation. A large cyst was removed via right posterolateral thoracotomy, and an intercostal drain [ICD] was placed. On completion of the procedure, the patient was moved into the supine position. Extubation was performed successfully on the operating theatre table. After observing the patient for 15 minutes he was shifted to the paediatric intensive care unit. On the fifth postoperative day ICD was removed and he was discharged from the hospital. Histopathology revealed rare lung cyst glial heterotopia. In unilateral lung disease, an optimal ventilation-perfusion match can be achieved with the lateral decubitus position. In this position, during surgery the healthy lung occupies a dependent position and therefore it receives maximum perfusion and ventilation.[2] Various lung isolation methods have been described in the literature, such as the use of bronchial blockers, double-lumen tubes, and uniblocker tubes. The advantage of using a single lumen tube is that it is easy to insert, but there may be inadequate collapse of the diseased lung.[3] Children have smaller airways and the smallest double lumen tube is size 26 Fr, which is suitable for children aged >8 years. For smaller children, placement of a single lumen tube into the desired bronchus or the use of bronchial blockers is recommended.[4] With endobronchial tube placement, switching from one-lung ventilation to two-lung ventilation is difficult, and the tube may get blocked frequently by blood or secretions. A bigger-sized tube may cause bronchial injury.[56] Manual ventilation improved SpO2 because the anaesthesiologists were able to regulate tidal volume and peak airway pressure by constantly adjusting the adjustable pressure limiting valve in synchronisation with surgical steps. It is common in post-COVID-19 patients to have residual shortness of breath and deranged pulmonary function tests suggestive of restrictive lung disease.[7] The COVID-19 survival child presenting with a history of increasing breathlessness had a rare lung cyst. Double lung ventilation was planned and minute ventilation was maintained by dynamically adjusting TV and respiratory rate with manual ventilation. In conclusion, we want to emphasise the fact that paediatric thoracotomy should not be avoided due to a lack of ideal resources like double lumen tubes, bronchial blockers, paediatric ventilators. Notably, however, clinicians must remain vigilant and should take all necessary precautions. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

The Effect of Lateral Position with Head Up 45° on Oxygenation in Pleural Effusion Patients

The accumulation of fluid in the pleural cavity will interfere with the restriction process, namely disruption of lung expansion so that the air entering the lungs is less than normal. One of the effects is shortness of breath and a decrease in oxygen saturation. In this case, nursing actions play an important role in inadequate ventilation, namely positioning. The lateral position is one of the recommended positions for patients with unilateral lung disease, one of which is unilateral pleural effusion. Position selection is very important to facilitate adequate breathing, namely one with a head-up of 45°. According to some literature, the 45° head-up position can reduce consumption and maximize lung expansion which will result in greater ventilation. To determine the effect of the lateral position with a head-up 45°on oxygen saturation and respiratory rate in a patient with unilateral pleural effusion at the Dr. H. A. Rotinsulu Lung Hospital Bandung. The research design was a quasi-experimental design with one group pre and post-test design with a sample of 44 people. The sampling technique used consecutive sampling. The results showed that there were differences in median oxygen saturation and respiratory rate before and after the intervention. The results of a comparative study using the Wilcoxon test obtained a p value of 0.0001 (p value<0.05). There is an effect of giving a lateral position with a head-up 45° on increasing oxygen saturation and decreasing respiratory rate. Thus, it is expected for the service unit to establish a lateral position in the direction of the effusion with a head-up of 45°as the operational standard for the management of unilateral pleural effusion impaired oxygenation patients.

Chest computed tomography imaging features in patients with coronavirus disease 2019 (COVID-19).

ObjectiveTo analyze computed tomography (CT) features of symptomatic patients with coronavirus disease 2019 (COVID-19).MethodsNinety-five symptomatic patients with COVID-19 confirmed by reverse-transcription polymerase chain reaction from 1 May to 14 July 2020 were retrospectively enrolled. Follow-up CT findings and their distributions were analyzed and compared from symptom onset to late-stage disease.ResultsAmong all patients, 15.8% had unilateral lung disease and 84.2% had bilateral disease with slight right lower lobe predilection (47.4%). Regarding lesion density, 49.4% of patients had pure ground glass opacity (GGO) and 50.5% had GGO with consolidation. Typical early-stage patterns were bilateral lesions in 73.6% of patients, diffuse lesions (41.0%), and GGO (65.2%). Pleural effusion occurred in 13.6% and mediastinal lymphadenopathy in 11.5%. During intermediate-stage disease, 47.4% of patients showed GGO as the disease progressed; however, consolidation was the predominant finding (52.6%).ConclusionCOVID-19 pneumonia manifested on lung CT scans with bilateral, peripheral, and right lower lobe predominance and was characterized by diffuse bilateral GGO progressing to or coexisting with consolidation within 1 to 3 weeks. The most frequent CT lesion in the early, intermediate, and late phases was GGO. Consolidation appeared in the intermediate phase and gradually increased, ending with reticular and lung fibrosis-like patterns.

COVID-19 Viral Pneumonia Complicated with Acute Pulmonary Embolism: A Descriptive Study.

Objective To evaluate acute pulmonary embolism in patients with 2019 novel coronavirus (COVID-19) pneumonia using pulmonary CT angiography. Subjects and Methods. From 95 symptomatic patients confirmed with COVID-19 by RT-PCR from 1 May to 14 July 2020 in Dallah Hospital, Riyadh, Saudi Arabia, CT angiography was done for 25 patients suspected to have pulmonary embolism and have no contraindication for contrast study. 11 cases of them showed CT evidence of acute pulmonary embolism (PE). Retrospectively, CT angiography was analyzed and detailed findings were recorded. This study was approved by the Institutional Review Board of our hospital, and the patient consent was waived. Results The mean age of the included patients was 49 ± 11 years; the youngest was 22 years, and the oldest was 64 years. Common symptoms in the 25 cases that underwent CT angiography were fever that was noted in 21/25 cases (84%), shortness of breath in 18/25 cases (72%), cough in 16/25 cases (64%), and severe myalgia/body fatigue in 13/25 cases (52%). The less common symptoms were sore throat in 11/25 cases (44%) and headache in 10/25 cases (40%). Regarding CT findings, 4/25 cases (16%) had unilateral lung disease and 21/25 cases (84%) had bilateral disease, with slight predilection for the right lower lobe (10/25 cases, 40%). Pure ground-glass opacity (GGO) was seen in 13/25 cases (52%), and GGO with consolidation was seen in 12/25 cases (48%). Common accompanying CT signs included crazy paving stone sign in 15/25 cases (60%) and air bronchogram in 12/25 cases (48%). From the 25 patients that showed respiratory deterioration and elevated serum D-dimer level, 11 cases confirmed to have acute pulmonary embolism, while 14 cases showed negative result for pulmonary embolism. 6/11 were male and 5/11 were female. Pulmonary embolism was diagnosed at a mean of 21 days from symptom onset. Unilateral acute pulmonary embolism was seen in 3/11 cases, while 8/11 cases showed bilateral distribution. Among 11 cases with acute pulmonary embolism, no emboli at the central level could be seen, but 3 cases showed pulmonary embolism at the lobar level, 3 cases at the segmental level, and 5 cases at lobar, segmental, and subsegmental levels. Conclusion In patients with confirmed COVID-19, we should maintain a high suspicion for its thromboembolic complications such as acute pulmonary embolism that was mainly diagnosed at the end of 3rd week from symptom onset. We suggest that whenever a CT evaluation of the parenchymal involvement of COVID-19 pneumonia is performed, a simultaneous evaluation of the pulmonary arteries is also essential in order to identify early signs of associated pulmonary embolism.

COMPARISON OF THE EFFECTIVENESS OF LATERAL POSITION AND SUPINE POSITION ON PHYSIOLOGICAL PARAMETERS AND COMFORT AMONG PATIENTS WITH RESPIRATORY TRACT INFECTION

Background:Standard nursing care for critically ill patients includes lateral positioning. A therapeutic regimen of lateral positioning may reduce the adverse effects of prolonged bed rest and to improve oxygenation in patients with unilateral lung disease and decrease the length of stay in the intensive care unit. Physiological adaptations mainly due to the effect of gravity occurs during changes of position and can influence the symptoms of various diseases involving not only the circulatory system but also other systems like respiratory system and digestive system. Objectives:1) To assess the effectiveness of lateral position on physiological parameters and comfort among clients with respiratory tract infection.2).To assess the effectiveness of supine position on physiological parameters and comfort among clients with respiratory tract infection.3) To compare the effectiveness of lateral position and supine position on physiological parameters and comfort among clients with respiratory tract infection. Methods:The research approach adopted for the study was quantitative comparative experimental approach study, the research design used was Repeated Measure design. By using non probability purposive sampling 40 respiratory patients admitted in ICUs of Wanless Hospital .The content validity and reliability of the tool was done , which was suggested that the tool was reliable(r=0.70). Result:The major findings revealed that, Effectiveness of lateral position followed by supine position to see the physiological parameter is done by observational checklist (heart rate, respiratory rate, spo2, tidal volume)was significant but BP was not significant. Comfort by Likert scale was highly significant (p<0.0001). Statistical analysis is done by (paired and unpaired t test) Result showed that lateral position had significantly higher mean Pao2 than the supine position (p<0.0001) Thus findings reveals that H1 is accepted and null hypothesis is rejected. Conclusion:Lateral position was found to be effective in respiratory tract infection patients which gave a significant change in physiological parameters and comfort compared to supine position.

Chest X-rays findings in COVID 19 patients at a University Teaching Hospital - A descriptive study.

Objective:To analyze Chest X-ray findings in COVID 19 positive patients, presented at corona filtration center, Benazir Bhutto Hospital Rawalpindi, based on CXR classification of British Society of Thoracic Imaging (BSTI).Methods:In this study, all RT-PCR COVID-19 positive patients screened at corona filtration center, Benazir Bhutto hospital Rawalpindi from 20th March 2020 to 10th April 2020 were included. Mean age of the cohort with age range was calculated. Presenting complaints & Co-morbid were analyzed and tabulated in frequencies and percentages. Portable CXR findings were classified according to BSTI classification and documented in frequencies and percentages.Results:Mean age of the patients was 44 years. Presenting complaints were cough 20 (67%), fever 18 (60%), shortness of breath 11 (37%), sore throat six (20%), loss of sense of taste and smell four(13%). Main co-morbid was hypertension six (20%). Two (7%) patients had normal and seven (23%) had classical COVID CXRs. 21 (70%) patients were in indeterminate group with only one (3%) having unilateral lung disease. Three (10%) patients had diffuse lung involvement and 18(60%) had peripheral lung involvement. Majority of patients 19 (63%), had bilateral middle and lower zonal involvement.Conclusions:In this study, COVID-19 CXRs generally manifested a spectrum of pure ground glass, mixed ground glass opacities to consolidation in bilateral peripheral middle and lower lung zones. BSTI CXR reporting classification of COVID-19 is valid in our patients with addition of middle zonal involvement in classical COVID-19 criteria as opposed to just lower zone involvement.

The characteristics and clinical value of chest CT images of novel coronavirus pneumonia

AIMTo investigate the characteristics and clinical value of chest computed tomography (CT) images of novel coronavirus pneumonia (NCP).MATERIALS AND METHODSClinical data and CT images of 80 cases of NCP were collected. The clinical manifestations and laboratory test results of the patients were analysed. The lesions in each lung segment of the patient's chest CT images were characterised. Lesions were scored according to length and diffusivity.RESULTSThe main clinical manifestations were fever, dry cough, fatigue, a little white sputum, or diarrhoea. A total of 1,702 scored lesions were found in the first chest CT images of 80 patients. The lesions were located mainly in the subpleural area of the lungs (92.4%). Most of the lesions were ground-glass opacity, and subsequent fusions could increase in range and spread mainly in the subpleural area. Pulmonary consolidation accounted for 44.1% of all of the lesions. Of the 80 cases, 76 patients (95%) had bilateral lung disease, four (5%) patients had unilateral lung disease, and eight (10%) patients had cord shadow.CONCLUSIONThe chest CT of NCP patients is characterised by the onset of bilateral ground-glass lesions located in the subpleural area of the lung, and progressive lesions that result in consolidation with no migratory lesions. Pleural effusions and mediastinal lymphadenopathy are rare. As patients can have inflammatory changes in the lungs alongside a negative early nucleic acid test, chest CT, in combination with epidemiological and laboratory tests, is a useful examination to evaluate the disease and curative effect.

Salvage treatment of NSCLC recurrence after first-line chemotherapy failure: Iodine-125 seed brachytherapy or microwave ablation?

BackgroundSalvage treatments for recurrent NSCLC after first‐line chemotherapy remain challenging. This study was conducted to evaluate the clinical value of microwave ablation (MWA) and iodine‐125 brachytherapy, including overall survival (OS), disease free survival (DFS), local control, hospital stay, and health economics.MethodsThe data of 51 and 32 patients who were treated with MWA and brachytherapy was retrospectively analyzed. The number of lesions was limited up to two, with a diameter <4 cm and patients diagnosed with unilateral lung disease. Peripheral tumors were treated with MWA, while lesions close to the hilum were treated with brachytherapy. Contrast‐enhanced CT, blood cell count, coagulation function, liver & kidney function and tumor markers were performed for two years, with complications calculated. OS, DFS, local control rate, toxicity, hospital stay and expense were recorded.ResultsThe one and two‐year OS rates were 96.08% and 92.16% versus 96.88% and 90.62% in the MWA and brachytherapy groups, respectively. The one and two‐year DFS rates were 92.16% and 76.47% versus 93.75% and 78.13%, respectively. No significant differences were observed in log‐rank analysis between the groups. Local control rates at six and 12 months were 100% and 96.08% versus 100% and 96.88%, while incidences of pleural effusion were 3.92% and 3.13%, respectively (P < 0.05). Medical cost was 3356.73 ± 206.87 and 6714.28 ± 35.43 U.S. dollars (P = 0.014).ConclusionMWA and brachytherapy are effective and safe options for the treatment of NSCLC recurrence after first‐line chemotherapy. Which modality should be considered is dependent upon tumor location, tumor size and experience of specialists.

The effects of different positions on saturation and vital signs in patients.

Patient positioning is an independent nursing intervention and may increase peripheral oxygenation for patients with lung disease. Few studies have been conducted on the effect of body positions on oxygenation in patients with lung disease. To investigate the effects of five different positions on peripheral oxygen saturation (SpO2 ) and vital signs in patients with lung disease. A semi-experimental study was conducted. Consecutive samples were recorded from critical care patients followed in the chest clinic of a university hospital. A total of 109 patients with lung disease were recruited. Patients who were able to lie in all positions, and who had unilateral or bilateral lung disease documented by a medical diagnosis by a physician were included in this study. The SpO2 and vital signs were measured at each position three times. For patients with right, left, and bilateral lung disease, lying on the right side of the body at 45 in bed, the SpO2 was higher, but this difference was not statistically significant. There was a significant difference at 40 minutes between the pulse rate in patients with left and bilateral lung disease, but not in patients with right lung disease. No significant differences were found between respiratory rates and body temperature in patients in any of the three groups at 10, 25, and 40 minutes. Although this difference was not statistically significant, lying on the right side of the body at 45 in bed can be an effective position for improving oxygenation in all patients with lung disease. As there is insufficient evidence to suggest a specific position, further studies are needed. This study provides evidence that the best oxygenation in patients with unilateral and bilateral lung disease can be obtained by determining the appropriate position for critical care nurses.

Computerised decision support for differential lung ventilation.

Differential lung ventilation treatment is a mechanical ventilation strategy used for unilateral lung disease or injury. This treatment can be provided to patients who fail to respond to conventional mechanical ventilation to both lungs and is technically challenging to medical personnel. An effective computerised decision support system (CDSS) can be used as a support system to intensivists in providing this treatment to their patients. In this study, a CDSS for differential lung ventilation is presented. By using this system, the mode of ventilation to each lung can be pressure controlled or volume controlled and all ventilation parameters including the peak inspiratory pressure (P insp), tidal volume (V t), positive end-expiratory pressure, fraction of inspired oxygen (n}{}F_{{rm I}{rm O}_2}), and the respiratory rate (f) can be assigned individually to each lung. The proposed CDSS has the potential to be used as a support system to clinicians in providing differential lung ventilation treatments to patients.

Unilateral Lung Involvement of Nodular Bronchiectatic Mycobacterium Avium Complex Pulmonary Diseases: Proportion and Evolution on Serial CT Studies.

OBJECTIVE. We aimed to explore proportion, involved organisms, and serial CT features of nodular bronchiectatic (NB) Mycobacterium avium complex (MAC) pulmonary diseases that manifested as unilateral lung disease. MATERIALS AND METHODS. We retrospectively identified 674 patients with NB MAC pulmonary disease (PD) who underwent serial CT studies from January 2005 through December 2012. We selected patients with unilateral lung involvement as its initial manifestation. Retrospective analyses on serial CT findings in terms of presence and extent of lung abnormalities were performed. The organism identified (M. avium vs M. intracellulare) and treatment status were reviewed. To find the factors related to progression to involve both lungs, Cox regression analysis was performed. RESULTS. Unilateral MAC PD on initial CT was found in 47 patients (7%). Among them, 10 (21%) showed disease progression on follow-up CT to involve both lungs (mean evolving time, 1536 days). All 10 of these cases initially involved the right lung. Of these 10 patients, eight needed antibiotic treatment because of deteriorating imaging findings (4/8, 50%) or worsening symptoms (4/8, 50%). Initial total CT score (hazard ratio [HR], 1.414; 95% CI, 1.092-1.831; p < 0.01) and age (HR, 1.076; 95% CI, 1.004-1.154; p < 0.05) were related factors for disease progression in simple Cox regression test. CONCLUSION. Unilateral lung involvement of NB MAC PD is an occasional (7%) manifestation, and disease progressed in approximately 20% of patients in our study to involve both lungs. The imaging factor most related to disease progression appears to disease extent on initial CT.

Postpneumonectomy-like syndrome due to bronchial carcinoid: a unique case report

BackgroundPostpneumonectomy-like syndrome is a rare condition resulting from unilateral lung disease with severe lung volume loss leading to excessive mediastinal shift and herniation of the healthy lung into the contralateral hemithorax, mimicking the mediastinal shift observed in postpneumonectomy syndrome after pneumonectomy. We report a unique case of postpneumonectomy-like syndrome caused by an atypical bronchial carcinoid completely occluding the left main bronchus.Case presentationA 25-year-old woman presented with symptoms of chronic exertional dyspnea and productive cough. Imaging studies showed complete left lung atelectasis due to a mass occluding the left main bronchus, as well as extreme mediastinal deviation and substantial herniation of the right lung into the left hemithorax. Bronchoscopic biopsy of the tumor and subsequent left pneumonectomy with concurrent lymph node dissection revealed an atypical carcinoid. Sixteen months after surgery the patient has been asymptomatic with repeat imaging studies showing no change in mediastinal shifting.ConclusionBronchial carcinoids are notorious for causing bronchial obstruction. The present case represents an extreme complication of centrally located bronchial carcinoid, resulting in postpneumonectomy-like syndrome with severe mediastinal shift and herniation of the healthy lung into the diseased hemithorax.

Neonatal bronchoscopy: Role in respiratory disease of the newborn-A 7 year experience.

Bronchoalveolar lavage (BAL) is a standardized method to obtain specimen samples from the airway lumen of the respiratory system. BAL is used to diagnose lung infection and infection markers in neonates. The aim was to evaluate the utility of flexible fiberoptic bronchoscopy in term and preterm neonates and to evaluate the use of BAL obtained by bronchoscopy in neonatal lung disease. A retrospective analysis of Neonatal Intensive Care Unit (NICU) babies, during a 7-year period was conducted on 599 neonates who underwent the BAL procedure. Characteristics of the patients, indications, complications, and results of the procedure were recorded. The main indications were nosocomial pneumonia (140) and unilateral lung disease (74). A normal finding was most prevalent (201), followed by tracheitis (65). Microbiology on BAL fluid was positive in 33% of bronchoscopies (195/599); most common organisms isolated were Acinetobacter, Klebsiella, and Pseudomonas. Neonatal bronchoscopy can serve as an important diagnostic and therapeutic tool in the management of neonatal lung disease, BAL specimen microbiology from bronchoscopy directs clinical decision making in the management of neonatal lung infection. Individual common markers of infection have poor correlation to BAL. A combination of the markers, however, improves correlation with BAL but their utility in clinical management of lung infection is subject to caution. A negative BAL may shift management emphasis on minimizing lung injury especially in neonates who are ventilator dependent; BAL has the potential to critically affect the management of babies with significant lung disease especially when ventilator dependent.

Swyer-James-MacLeod Syndrome: A case report in an adult and review of the literature

Swyer-James-MacLeod Syndrome (SJMS) is a rare, unilateral lung disease represented by radiographic translucency of the lung parenchyma secondary to the diminution of the pulmonary vasculature and to the overdistention of the alveoli. It is an uncommon sequela of post-infectious bronchiolitis obliterans (BO) in childhood. Patients with SJMS are often diagnosed in childhood and typically present with recurrent respiratory tract infections. Symptoms during childhood can be mild or absent, leading to a delayed diagnosis in adulthood. SJMS is characterized by the destruction of the small bronchioles and agenesis or hypoplasia of the pulmonary arteries leading to hypoperfusion of the pulmonary parenchyma, resulting in characteristic chest imaging findings of unilateral hyperlucency or translucence.Swyer and James first described this syndrome in 1953. It is a rare disease that can be can be caused by an infection with adenoviruses (types 3, 7, or 21) or Bordetella pertussis, a foreign body in the airway and hydrocarbon inhalation. We present a case of SJMS in whom the adult patient had been misdiagnosed with chronic obstructive pulmonary disease (COPD). She was eventually diagnosed with SJMS based on chest x-ray and chest CT findings of unilateral lung hyperlucency, as well as with scintigraphic findings showing virtually absent perfusion to the left lower lobe of the lung.

Detection of Respiration Movement Asymmetry Between the Left and Right Lungs Using Mutual Information and Transfer Entropy

Using diagnostic imaging, asymmetry in the mechanic of the left and right lungs has been discovered in unilateral lung disease. Unilateral lung disease might affect information interaction between two lungs, which is often neglected in the study of lung function. In this paper, twenty-one subjects were recruited to collect bio-impedance respiratory signals of the left and right lungs. The differences of correlation and amplitude between the two respiratory signals were combined to verify three types of respiration movement: respiration symmetry (RS), respiration asymmetry type I (T1RA), and respiration asymmetry type II (T2RA). We extracted the correlation coefficient, mutual information (MI), and transfer entropy (TE) to evaluate lung function in these three types of lung respiration. Results showed that MI was significantly larger in RS than in T1RA and T2RA. TE in both directions (TE( $\text{L}\to \text{R}$ ) and TE( $\text{R}\to \text{L}$ )) were significantly different in RS, T1RA, and T2RA. TE( $\text{R}\to \text{L}$ ) increased progressively when shifting RS to T1RA and then to T2RA. The prominent direction of transferred information in two lungs was significantly different for T1RA and T2RA. The results indicate that MI is suitable parameters for detecting respiration symmetry and asymmetry. TE is a useful tool for detecting two respiration movement asymmetry. The results provide a better understanding of the mechanisms underlying responsible for pulmonary ventilation redistribution and could provide novel clinical markers to evaluate asymmetry of two lungs effectively.

Paediatric lung isolation

### Key points Lung isolation is required for a wide variety of pathology in paediatric patients. The varying size of the paediatric airway and size limitations of each lung isolation device poses a challenge to paediatric anaesthesiologists. The need for lung isolation includes: the prevention of contamination of one lung from the other due to haemorrhage or infection, the need to control the distribution of ventilation secondary to a bronchopulmonary fistula, a lung cyst or bullae, or severe hypoxaemia from unilateral lung disease. Extensive bronchopulmonary lavage may also necessitate lung isolation. Although lung isolation can assist in surgical exposure, in the paediatric population, surgical exposure for lung resections, mediastinal exposure, and thorascopy can often be accomplished by the CO2 pneumothorax and retraction of the operative lung without the need for lung isolation. This is most common in the young patient (<2 yr of age). Slinger1 teaches that there are the ‘ABCs’ of adult lung isolation: anatomy, bronchoscopy, and chest imaging. In paediatric lung isolation, there are still all the same ‘ABC’ considerations, with the addition of ‘D’—the varying diameter of the paediatric airway with age. ### Anatomy It has been long established that there are differences between the paediatric …

Lateral positioning for critically ill adult patients.

Critically ill patients require regular body position changes to minimize the adverse effects of bed rest, inactivity and immobilization. However, uncertainty surrounds the effectiveness of lateral positioning for improving pulmonary gas exchange, aiding drainage of tracheobronchial secretions and preventing morbidity. In addition, it is unclear whether the perceived risk levied by respiratory and haemodynamic instability upon turning critically ill patients outweighs the respiratory benefits of side-to-side rotation. Thus, lack of certainty may contribute to variation in positioning practice and equivocal patient outcomes. To evaluate effects of the lateral position compared with other body positions on patient outcomes (mortality, morbidity and clinical adverse events) in critically ill adult patients. (Clinical adverse events include hypoxaemia, hypotension, low oxygen delivery and global indicators of impaired tissue oxygenation.) We examined single use of the lateral position (i.e. on the right or left side) and repeat use of the lateral position (i.e. lateral positioning) within a positioning schedule. We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 5), MEDLINE (1950 to 23 May 2015), the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (1937 to 23 May 2015), the Allied and Complementary Medicine Database (AMED) (1984 to 23 May 2015), Latin American Caribbean Health Sciences Literature (LILACS) (1901 to 23 May 2015), Web of Science (1945 to 23 May 2015), Index to Theses in Great Britain and Ireland (1950 to 23 May 2015), Trove (2009 to 23 May 2015; previously Australasian Digital Theses Program (1997 to December 2008)) and Proquest Dissertations and Theses (2009 to 23 May 2015; previously Proquest Digital Dissertations (1980 to 23 May 2015)). We handsearched the reference lists of potentially relevant reports and two nursing journals. We included randomized and quasi-randomized trials examining effects of lateral positioning in critically ill adults. We included manual or automated turns but limited eligibility to studies that included duration of body position of 10 minutes or longer. We examined each lateral position versus at least one comparator (opposite lateral position and/or another body position) for single therapy effects, and the lateral positioning schedule (repeated lateral turning) versus other positioning schedules for repetitive therapy effects. We pre-specified methods to be used for data collection, risk of bias assessment and analysis. Two independent review authors carried out each stage of selection and data extraction and settled differences in opinion by consensus, or by third party adjudication when disagreements remained unresolved. We planned analysis of pair-wise comparisons under composite time intervals with the aim of considering recommendations based on meta-analyses of studies with low risk of bias. We included 24 studies of critically ill adults. No study reported mortality as an outcome of interest. Two randomized controlled trials (RCTs) examined lateral positioning for pulmonary morbidity outcomes but provided insufficient information for meta-analysis. A total of 22 randomized trials examined effects of lateral positioning (four parallel-group and 18 cross-over designs) by measuring various continuous data outcomes commonly used to detect adverse cardiopulmonary events within critical care areas. However, parallel-group studies were not comparable, and cross-over studies provided limited data as the result of unit of analysis errors. Eight studies provided some data; most of these were single studies with small effects that were imprecise. We pooled partial pressure of arterial oxygen (PaO2) as a measure to detect hypoxaemia from two small studies of participants with unilateral lung disease (n = 19). The mean difference (MD) between lateral positions (bad lung down versus good lung down) was approximately 50 mmHg (MD -49.26 mmHg, 95% confidence interval (CI) -67.33 to -31.18; P value < 0.00001). Despite a lower mean PaO2 for bad lung down, hypoxaemia (mean PaO2 < 60 mmHg) was not consistently reported. Furthermore, pooled data had methodological shortcomings with unclear risk of bias. We had similar doubts regarding internal validity for other studies included in the review. Review authors could provide no clinical practice recommendations based on the findings of included studies. Available research could not eliminate the uncertainty surrounding benefits and/or risks associated with lateral positioning of critically ill adult patients. Research gaps include the effectiveness of lateral positioning compared with semi recumbent positioning for mechanically ventilated patients, lateral positioning compared with prone positioning for acute respiratory distress syndrome (ARDS) and less frequent changes in body position. We recommend that future research be undertaken to address whether the routine practice of repositioning patients on their side benefits all, some or few critically ill patients.