Ventilatory Impairment Research Articles

Non-invasive ventilation during surgery under neuraxial anaesthesia: apathophysiological perspective on application and benefits and asystematic literature review.

Unlike general anaesthesia, neuraxial anaesthesia (NA) reduces the burden and risk of respiratory adverse events in the post-operative period. However, both patients affected by chronic obstructive pulmonary disease (COPD) and chest wall disorders and/or neuromuscular diseases may experience the development or the worsening of respiratory failure, even during surgery performed under NA; this latter negatively affects the function of accessory respiratory muscles, resulting in a blunted central response to hypercapnia and possibly in an exacerbation of cardiac dysfunction (NA-induced relative hypovolemia). According to European Respiratory Society (ERS) and American Thoracic Society (ATS) guidelines, non-invasive ventilation (NIV) is effective in the post-operative period for the treatment of both impaired pulmonary gas exchange and ventilation, while the intra-operative use of NIV in association with NA is just anecdotally reported in the literature. Whilst NIV does not assure a protected patent airway and requires the patient's cooperation, it is a handy tool during surgery under NA: NIV is reported to be successful for treatment of acute respiratory failure; it may be delivered through the patient's home ventilator, may reverse hypoventilation induced by sedatives or inadvertent spread of anaesthetic up to cervical dermatomes, and allow the avoidance of intubation in patients affected by chronic respiratory failure, prolonging the time of non-invasiveness of respiratory support (i.e., neuromuscular patients needing surgery). All these advantages could make NIV preferable to oxygen in carefully selected patients.

Prognostic factors and outcome of Post-Neonatal Tetanus in an intensive care unit of a Tertiary Care Hospital.

Objective:To determine the prognostic factors and outcome of tetanus in children of post-neonatal age admitted in the intensive care unit (ICU) of a tertiary care hospital.Methods:This prospective cross sectional study, carried out in the Pediatric ICU of The Children’s Hospital Lahore from Jan 2013 to March 2017. Children of both genders with age range of two months to 16 years diagnosed clinically as tetanus were included. All 132 patients were scrutinized for all possible risk factors, need for mechanical ventilation and outcome. Data was analyzed by SPSS version 20.Results:Mean age of children was 7.5±3.4 years with male predominance (70.5%). Only (38.6%) received three doses of vaccination but none had booster dose. Trauma (43.2%) encompassed maximum predisposing factor followed by ear or nose prick and ear discharge. Mean duration of ICU stay was 20±13.3 days. Mortality rate was (17.4%). Ventilator support was given to (78.8%). Neurological outcome was normal in (82.6%). Trauma, ear or nose prick in girls and ear discharge were significantly associated with poor outcome and death with p-value of <0.001, 0.011 and <0.001 respectively. Other factors associated with poor outcome were need for mechanical ventilation and neurological impairment with p-value of 0.001 and <0.001 respectively.Conclusion:Tetanus is causing our children to suffer from devastating disease. Vaccination status is not satisfactory and along with trauma, ear discharge and ear or nose prick are identifiable risk factors. To combat these issues large scale vaccination and booster doses remains promising option.

Prevalência dos diagnósticos de enfermagem respiratórios em Unidades de Terapia Intensiva Neonatal

Identificar a prevalência dos diagnósticos de enfermagem: Padrão respiratório ineficaz (PRI), Troca de gases prejudicada (TGP) e Ventilação espontânea prejudicada (VEP) e de seus indicadores clínicos em recém-nascidos internados em Unidades de Terapia Intensiva Neonatal. Estudo de abordagem quantitativa, transversal, com 154 recém-nascidos. Os dados foram coletados pela inspeção e avaliação da gasometria. Para análise, foram utilizados: Teste Qui-quadrado de Pearson e teste exato de Fisher. Os diagnósticos apresentaram prevalência elevada: VEP 94,2%; TGP 88,3% e PRI 87,7%. Dispneia e Uso aumentado de musculatura acessória foram os indicadores clínicos mais prevalentes de VEP e PRI. Para TGP, Dispneia e Cor da pele anormal. A associação evidenciou correlação significante para alguns indicadores prevalentes: dispneia, pressão parcial de oxigênio diminuída/hipoxemia, uso aumentado de musculatura acessória, padrão respiratório anormal, taquipneia, bradpneia, dióxido de carbono diminuído e gases sanguíneos arteriais.VEP, TGP e PRI apresentaram alta prevalência em recém-nascidos das Unidades de Terapia Intensiva.

Respiratory adjuncts to NIV in neuromuscular disease.

Muscle weakness is an intrinsic feature of neuromuscular diseases (NMD). When the respiratory muscles are involved, the ability to take a deep breath is compromised, leading to reduced lung volumes and a restrictive ventilatory impairment. Inspiratory, expiratory and bulbar muscle weakness can also impair cough, which may impede secretion clearance. Non-invasive ventilation (NIV) is an established and indispensable therapy to manage hypoventilation and respiratory failure. The role of other therapies that support respiratory health is less clearly defined, and the evidence of efficacy is also harder to summarize as the underlying data are of a lesser quality. This narrative review appraises the evidence for respiratory therapies in adults with NMD and respiratory system involvement. Techniques that assist lung inflation and augment cough, such as lung volume recruitment (LVR) and mechanical insufflation-exsufflation (MI-E), are a particular focus of this review. The evidence suggests that LVR, MI-E and various combinations thereof have clinical utility generally, but important methodological limitations limit the strength of clinical recommendations and hamper the integration of evidence into practice. Future trials should prospectively assess the long-term impact of LVR and cough augmentation on clinical outcomes and burden of care in addition to lung mechanics, as well as determine clear predictors of benefit from these techniques.

Ventilation and perfusion assessed by functional MRI in children with CF: reproducibility in comparison to lung function

BackgroundChronic lung diseases such as cystic fibrosis (CF) can be monitored by imaging and lung function modalities. Magnetic resonance imaging (MRI) techniques such as matrix pencil (MP) decomposition allows for evaluation of regional impairment of fractional ventilation (RFV) and relative perfusion (RQ). However, reproducibility of MP MRI outcomes in children with CF is unknown. We examined short-term variability of ventilation and perfusion impairment from MP MRI and compared this to lung function outcomes. MethodTwenty-threeCF and 12 healthy school-aged children underwent MRI and lung function tests on the same day on two occasions 24 h apart. Global ventilation inhomogeneity was assessed by the lung clearance index (LCI) from nitrogen-multiple breath washout (N2-MBW) technique. Intra-class-coefficient (ICC), percentage change, and Bland-Altman limits of agreement were evaluated to assess reproducibility. ResultsSixty-nine measurements from MP MRI and N2-MBW were performed. The ICC between two visits for RFV, RQ and LCI ranged between 0.60 and 0.90 in individuals with CF and healthy controls. In individuals with CF, percentage of change between the visits was 0.02% for RFV, −1.11% for RQ and 2.91% for LCI and limits of agreement between visits were − 4.3% and 3.9% for RFV, −4.4% and 3.7% for RQ, and −2.6 and 3.0 for LCI. ConclusionsFunctional imaging is reproducible and short-term changes in RFV and RQ greater than ±4.4% can be considered clinical meaningful. Very good short-term reproducibility, and easy application without the need for breathing maneuvers or contrast agent, makes MP MRI a promising surveillance method for CF.

Anesthetic management and associated complications of peroral endoscopic myotomy: A case series.

AIMTo investigate the anesthetic management of peroral endoscopic myotomy (POEM) and its associated complications.METHODSThis study was a single-center, retrospective, observational study comprising a case series of all patients who underwent POEM in our hospital from April 2015 to November 2016. We collected data regarding patient characteristics, anesthetic methods, surgical factors, and complications using an electronic chart.RESULTSThere were 86 patients who underwent POEM in our hospital during the study period. Preoperatively, patients were maintained on a low residue diet for 48 h prior to the procedure. They were fasted of solids for 24 h before surgery. There was one case of aspiration (1.2%). During POEM, patients were positioned supine with the upper abdomen covered by a clear drape so that pneumoperitoneum could be timeously identified. In three cases, the peak airway pressure exceeded 35 cmH2O during volume controlled ventilation with tidal volumes of 6-8 mL/kg and subsequent impairment of ventilation. These cases had been diagnosed with spastic esophageal disorders (SEDs) and the length of the muscular incision on the esophageal side was longer than normal.CONCLUSIONIn the anesthetic management of POEM, it is important to prevent aspiration during induction of anesthesia and to identify and treat complications associated with CO2 insufflation.

IMPACT OF DUST EXPOSURE AMONG STONE QUARRY WORKERS ON VENTILATORY FUNCTIONS AND SERUM LEVEL OF TUMOUR NECROSIS FACTOR- ALPHA (TNF-α)

Introduction: The health impacts of working in stone quarrying industry have been well documented. Inhalable dust is produced when the stone is cut and by the breaking of the stones on the quarry floor during the transit of the vehicles. A particular concern in some quarries is the inhalation of dust containing silica which can lead to silicosis. Workers exposed to high intensity of dust would have increased Tumour Necrosis Factor-Alpha (TNF-α) in serum which is a strong indicator in predicting the prognosis of pneumoconiosis. Aim of work: To find out the relation between serum levels of TNF-α and some spirometric parameters in workers exposed to stone dust during quarrying. Materials and Methods: Fifty five workers who were exposed to stone dust in quarrying industry participated in the study. A control group of 55 individuals were randomly selected to be matched with the exposed group as regards age, gender, and special habits of medical importance and not exposed to dust. Full medical history and clinical examination were carried out to all participants. Ventilatory function tests (FVC%, FEV1%, FEV1/FVC%, PEF%, FEF25%, FEF50% and FEF75%) and serum level of TNF-α were measured for both groups. Results: There were mild to moderate restrictive ventilatory impairment and mild obstructive impairment among the exposed group (statistically highly significant (p<0.001) when compared to the control . Serum levels of TNF-α were significantly higher among the exposed than the control group. Duration of exposure to dust negatively correlated with spirometric parameters and positively correlated with the serum level of TNF-α among the exposed group. Also the latter negatively correlated with spirometric parameters. Conclusion: Serum TNF-α can be used as a biomarker for detection and follow up of pneumoconiosis in workers exposed to stone dust in quarrying industry.

Extended Abstract: Lung Injury after Allogeneic Hematopoietic Cell Transplantation

Allogeneic hematopoietic cell transplantation (allo-HCT) is increasingly utilized in the treatment of hematologic malignant and non-malignant diseases. Therapy-related toxicity and graft versus host disease (GVHD) remain major challenges as they significantly contribute to treatment related morbidity and mortality. The pathophysiology of noninfectious lung injury is not completely understood and relates to airway disease, interstitial disease, and vessel disease. Bronchiolitis obliterans (BO) and bronchiolitis obliterans syndrome (BOS) are the only accepted diagnostic or distinctive forms of chronic GVHD of the lung in the most recent National Institutes of Health Consensus Development Project. Raised attention to noninfectious lung injury has led to the development of clinical recommendations to include pulmonary function testing in the standard of care follow-up after transplant (1). Earlier studies from our group demonstrate a correlation between the development of clinical GVHD, pulmonary GVHD, and impaired ventilation after allo-HCT, emphasizing that respiratory dysfunction after transplant is partially due to alloreactive tissue injury to the lung (2-7). While acute lung injury potentially sets the stage for chronic lung injury after HCT, additional second hits and involvement of other compartments of the adaptive immune system are probably needed for the progression to BOS/BO as well as to restrictive lung injury and fibrosis. As recently shown, B cells, macrophages as well as profibrotic pathways /BOS, all together likely are involved with each presenting potential therapeutic targets. (8-14).

SEQUÊNCIA DE ROBIN ISOLADA: DIAGNÓSTICOS DE ENFERMAGEM

RESUMO Objetivo: identificar os diagnósticos de enfermagem em lactentes com Sequência de Robin isolada. Método: estudo descritivo desenvolvido em um hospital especializado em anomalias craniofaciais e síndromes relacionadas, no período de novembro de 2015 a março de 2016. Participaram 20 lactentes com Sequência de Robin isolada. Para a coleta de dados utilizou-se o histórico de enfermagem. Os diagnósticos de enfermagem foram elencados segundo a Nanda-Internacional. Para confecção dos resultados utilizou-se a análise estatística descritiva. Resultados: foram identificados oito diagnósticos, sendo cinco com foco no problema e três de risco, incluindo: risco de aspiração (n=20, 100%); risco de infecção (n=20, 100%); amamentação ineficaz (n=19, 95%); nutrição desequilibrada: menor do que as necessidades corporais (n=19, 95%); padrão ineficaz de alimentação do lactente (n=19, 95%); risco de integridade da pele prejudicada (n=18, 90%); desobstrução ineficaz das vias aéreas (n=11, 55%) e ventilação espontânea prejudicada (n=11, 55%). Conclusão: lactentes com Sequência de Robin isolada apresentaram diagnósticos de enfermagem que se relacionaram a problemas respiratórios, alimentares, de segurança e conforto e favoreceram o planejamento e implementação dos cuidados de enfermagem ao traçarem um perfil assistencial.

COPD assessment test as a possible tool for evaluating health-related quality of life in lymphangioleiomyomatosis.

Lymphangioleiomyomatosis (LAM) is a progressive, cystic lung disease that causes an obstructive ventilatory impairment similar to chronic obstructive pulmonary disease (COPD) and impairs the health-related quality of life (HRQoL). Here, we extended the use of the COPD assessment test (CAT) to patients with chronic respiratory diseases other than COPD. Specifically, the CAT was administered to patients with LAM for the first time. Using data from 25 patients with LAM at Juntendo University who participated in the Multicenter Lymphangioleiomyomatosis Sirolimus Trial for Safety (MLSTS), we evaluated changes in pulmonary function, responses to HRQoL questionnaires (the CAT, St. George׳s Respiratory Questionnaire [SGRQ], EuroQOL Visual Analogue Scale [EuroQOL-VAS], and Functional Performance Inventory [FPI]), and the association between pulmonary function and HRQoL during a 24-month period of sirolimus treatment. Forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and CAT total scores improved over the 24 months of sirolimus treatment (5.33 ± 1.20 ml/month, 2.61 ± 1.16 ml/month, and -0.127 ± 0.022 score/month, respectively), whereas SGRQ total score, EuroQOL-VAS score, and FPI score did not. Most pulmonary functions at baseline were associated with the CAT breathlessness score during the first year. Longitudinal changes in FEV1, FEV1%predicted, or FEV1/FVC correlated significantly with the scores of CAT total, CAT breathlessness, and SGRQ activity. When analyzed by stepwise multivariate regression within a linear mixed-effects model, CAT breathlessness and confidence scores were significantly associated with a change in FEV1 from the baseline value (P = 0.0011, and P = 0.0441). Our results suggest that the CAT is a useful instrument for assessing HRQoL in sirolimus-treated patients with LAM.

Optimal PEEP during one-lung ventilation with capnothorax: An experimental study.

One-lung ventilation (OLV) with induced capnothorax carries the risk of severely impaired ventilation and circulation. Optimal PEEP may mitigate the physiological perturbations during these conditions. Right-sided OLV with capnothorax (16 cm H2 O) on the left side was initiated in eight anesthetized, muscle-relaxed piglets. A recruitment maneuver and a decremental PEEP titration from PEEP 20 cm H2 O to zero end-expiratory pressure (ZEEP) was performed. Regional ventilation and perfusion were studied with electrical impedance tomography and computer tomography of the chest was used. End-expiratory lung volume and hemodynamics were recorded and. PaO2 peaked at PEEP 12 cm H2 O (49 ± 14 kPa) and decreased to 11 ± 5 kPa at ZEEP (P < 0.001). PaCO2 was 9.5 ± 1.3 kPa at 20 cm H2 O PEEP and did not change when PEEP step-wise was reduced to 12 cm H2 O PaCO2. At lower PEEP, PaCO2 increased markedly. The ventilatory driving pressure was lowest at PEEP 14 cm H2 O (19.6 ± 5.8 cm H2 O) and increased to 38.3 ± 6.1 cm H2 O at ZEEP (P < 0.001). When reducing PEEP below 12-14 cm H2 O ventilation shifted from the dependent to the nondependent regions of the ventilated lung (P = 0.003), and perfusion shifted from the ventilated to the nonventilated lung (P = 0.02). Optimal PEEP was 12-18 cm H2 O and probably relates to capnothorax insufflation pressure. With suboptimal PEEP, ventilation/perfusion mismatch in the ventilated lung and redistribution of blood flow to the nonventilated lung occurred.

Time Course of Respiratory Dysfunction and Motor Paralysis for 12 Weeks in Cervical Spinal Cord Injury without Bone Injury.

Introduction Cervical spinal cord injury without bone injury (SCIWOBI) is a common cervical injury in the elderly population and is most likely to occur at the C3/C4 level. Respiratory dysfunction (RD) related to the damage of the spinal respiratory center, which is close to the C4 segment, is one of the greatest obstacles in improving the activities of daily living of patients with severe paralysis. We evaluated the time course of RD and motor function in cervical SCIWOBI to identify effective medical strategies. Methods We followed 54 patients (49 men, 5 women; mean age: 65 years old) who were treated for SCIWOBI at our medical center from 2011 to 2014. The patients were evaluated within 72 hours of injury and were monitored for at least 12 weeks. All patients began respiratory-muscle training the day after admission regardless of whether they were treated conservatively or surgically. The percent vital capacity (%VC), forced expiratory volume (FEV) in one second/forced vital capacity ratio (FEV 1.0%), and American Spinal Injury Association motor score (MS) were recorded at admission and again at weeks 4 and 12. We calculated the %VC rate of change and the MS improvement rate over the entire period. Results Fifty patients (92.6%) had restrictive ventilatory impairment at admission. The %VC correlated with the upper- and lower-limb MSs at admission, and the %VC and upper- and lower-limb MSs had improved by weeks 4 and 12 after the injury. The %VC rate of change was significantly correlated with the rate of improvement in lower-limb MS throughout the entire period. Conclusions Lung capacity decreased in SCIWOBI owing to respiratory-muscle paralysis and upper- and lower-limb motor paralyses. Lung capacity improved as the lower limbs recovered their motor function. Respiratory rehabilitation should be continued for at least 12 weeks after SCIWOBI.

A risk score to predict postoperative complications after lobectomy in elderly lung cancer patients.

In elderly patients with lung cancer, the presumed fear of postoperative complications has resulted in the delivery of limited resection. Surgical decision-making for such patients would become easier if clinicians could predict who is at high risk of postoperative complications. The purpose of this study is to propose a scoring system to predict the risk of postoperative complications for elderly patients with lung cancer. We reviewed patients aged 75years or older who underwent lobectomy for lung cancer at a single hospital (n = 199). A multivariable logistic regression model was utilized to determine risk factors for postoperative complications. Six risk factors for postoperative complications were identified, and we derived a risk score by assigning weights to these factors based on their odds ratios, as follows: Risk score = 7×(performance status of 2) + 6×(coronary artery disease) + 3×(a history of cerebrovascular accident) + 2×(restrictive ventilatory impairment) + 1×(male sex) + 1×(interstitial pneumonia). The postoperative complication rates in patients with risk scores of 0, 1-2, 3-5, 6-8, and 9-14 were 19, 29, 56, 68, and 90%, respectively. The proposed risk score was able to predict the incidence of postoperative complications. The risk score can be used to identify high-risk patients and to select proper treatment strategies.

Drug-Induced Sleep-Disordered Breathing and Ventilatory Impairment.

This article describes current knowledge about drug entities that have the potential to induce, aggravate, or modify sleep-disordered breathing. The drug effects on sleep-disordered breathing may vary by patient age, gender, and comorbidity. In general, the clinical relevance of drug-induced sleep-disordered breathing is increasing in sleep medicine and the evidence in the field is growing in parallel.

Review of lung sealant technologies for lung volume reduction in pulmonary disease.

Emphysema is an incurable and underdiagnosed disease with obstructive ventilatory impairment of lung function. Despite decades of research, medical treatments available so far did not significantly improve the survival benefits. Different bronchoscopic methods for lung volume reduction (LVR) in emphysema were used in the past 2 decades aiming to close the airways serving the hyperinflated lung regions and to allow the gas in the more distal bullas to be absorbed. Sealants and adhesives can be natural/biological, synthetic and semisynthetic. In lung surgery, lung sealants are used to treat prolonged air leak, which is the most common complication. Sealants can also be applied in bronchoscopic lung volume reduction (BLVR) as they administer into the peripheral airways where they polymerize and act as tissue glue on the surface of the lung to seal the target area to cause durable permanent absorption atelectasis. Initial studies analyzed the efficacy of bronchoscopic instillation of a fibrinogen–thrombin complex solution in advanced emphysema. Future studies will analyze the effects of adding chondroitin sulfate and poly-L-lysine to thrombin–fibrinogen complex thus promoting fibroblast attachment, proliferation and scarring, causing bronchial fibrostenosis and preventing ventilation of the affected part of the lung. Modifications of these methods were later developed, and the efficacy of BLVR with other sealants was analyzed in clinical studies. Results from current studies using this treatment method are promising showing that it is effective in improving exercise tolerance and quality of life in patients with advanced emphysema. It seems that subjective benefits in dyspnea scores and quality of life are more marked than improvements in lung function tests. The safety profile of sealant techniques in BLVR was mostly acceptable in clinical studies. The definite conclusions about the effectiveness of sealant in BLVR could be difficult because only a small population was involved in the current studies. More randomized large controlled studies are needed in establishing the definite role of biological BLVR in the bronchoscopic treatment of emphysema.

Haemodynamics, dyspnoea, and pulmonary reserve in heart failure with preserved ejection fraction.

Increases in left ventricular filling pressure are a fundamental haemodynamic abnormality in heart failure with preserved ejection fraction (HFpEF). However, very little is known regarding how elevated filling pressures cause pulmonary abnormalities or symptoms of dyspnoea. We sought to determine the relationships between simultaneously measured central haemodynamics, symptoms, and lung ventilatory and gas exchange abnormalities during exercise in HFpEF. Subjects with invasively-proven HFpEF (n = 50) and non-cardiac causes of dyspnoea (controls, n = 24) underwent cardiac catheterization at rest and during exercise with simultaneous expired gas analysis. During submaximal (20 W) exercise, subjects with HFpEF displayed higher pulmonary capillary wedge pressures (PCWP) and pulmonary artery pressures, higher Borg perceived dyspnoea scores, and increased ventilatory drive and respiratory rate. At peak exercise, ventilation reserve was reduced in HFpEF compared with controls, with greater dead space ventilation (higher VD/VT). Increasing exercise PCWP was directly correlated with higher perceived dyspnoea scores, lower peak exercise capacity, greater ventilatory drive, worse New York Heart Association (NYHA) functional class, and impaired pulmonary ventilation reserve. This study provides the first evidence linking altered exercise haemodynamics to pulmonary abnormalities and symptoms of dyspnoea in patients with HFpEF. Further study is required to identify the mechanisms by which haemodynamic derangements affect lung function and symptoms and to test novel therapies targeting exercise haemodynamics in HFpEF.

THE INFLUENCE OF CLIMATE ON THE RESPIRATORY FUNCTION OF THE HEALTHY POPULATION OF VLADIVOSTOK AND PATIENTS WITH BRONCHOPULMONARY PATHOLOGY

Introduction. The climatic factors affect the mucous membrane of the respiratory tract contacting with the environment. The investigation of pulmonary ventilation plays a leading role in the diagnosis of bronchial obstruction in response to an external stimulus. Material and methods. The study included a healthy population of the city and patients with chronic catarrhal nonobstructive bronchitis (CCNB), controlled and uncontrolled asthma (131 people). The respiratory function (RF) was estimated by spirography and body plethysmography. Meteorological conditions were evaluated from the point of view of contrasting weather changes (on the survey day, on 1st and 2nd days before the survey). The degree of the climatic impact on RF was determined by the statistical module “Discriminant analysis”, used to a group of RF indices relatively adverse levels of impact of the monsoon climate. Results. The low level of the responsiveness in a healthy urban population was identified. The negative impact of climatic indices on the respiratory system in CCNB patients was observed mainly in extreme weather conditions. The influence of climatic conditions on patients with asthma depends on the level of the disease control. Discussion. The influence of climatic conditions was found to be within the adaptive and compensatory responses in a group of healthy people and CCNB patients. We assumed the use of basic drugs in patients with asthma without signs of bronchial obstruction to reduce the susceptibility of the receptors of the bronchi to the negative climatic impact. The greatest negative RF response to the impact of monsoon climate manifested both in static and in dynamic weather conditions, was observed in patients with uncontrolled asthma. It was associated with the impaired pulmonary ventilation. Conclusion. The results indicate the Far East monsoon climate to be an important risk factor for the exacerbation in patients with respiratory diseases.

Airway-centered interstitial fibrosis - an under-recognized subtype of diffuse parenchymal lung diseases.

Airway centered interstitial fibrosis (ACIF) has been recently suggesed as a rare histological pattern of interstitial lung disease of variable etiology and outcome. It is characterized by fibrosis of the respiratory bronchioles and the peribronchiolar interstitium. We describe the clinical features of 13 patients (7 female, mean age 55 years) with histologically proven ACIF in 12 cases and long-term follow up. In ten patients, exogenous agents could be detected (mould n=5, wood n=2, leather exposure n=1, occupational exposure n=2). Two patients had rheumatoid arthritis and 1 patient suffered from recurrent aspiration. In three patients no associated exposure could be detected. Eight patients were never-smokers, while five were ex- smokers. At time of diagnosis patients presented with a moderate restrictive ventilation impairment and sever reduction in diffusion capacity (VC 61%, TLC 66%, DLCOc-SB 38% pred.). All patients were started on immunosuppressive therapy with steroids which were combined with azathioprine in seven and with mycophenolate mofetil in one patient. Median time of follow up was 52 months (2-127 months). Patients with ACIF due to exogenous agents or associated with RA were stable with immunosuppressive therapy. One patient with idiopathic ACIF showed a progressive deterioration within 29 months despite immunosuppression and died while on a waiting-list for lung transplantation. In our experience ACIF is a rare finding, which is relatively frequently observed in the context of hypersensitivity pneumonitis, aspiration and rheumatoid arthritis, while idiopathic ACIF was a minority. In the majority of patients, ACIF showed a favorable long-term outcome with immunosuppressive therapy. (Sarcoidosis Vasc Diffuse Lung Dis 2018; 35: 218-229).

Perioperative Complications in Posterior Spinal Fusion Surgery for Neuromuscular Scoliosis.

Introduction Patients with neuromuscular disorders sometimes show progressive spinal scoliosis. The surgery for neuromuscular scoliosis (NMS) has high rates of complications. In this study, we elucidated the perioperative complications in patients with NMS. Methods We included 83 patients with NMS (58 boys and 25 girls; 61 with muscular dystrophy, 18 with spinal muscular atrophy, and 4 others) who had undergone posterior fusion surgery for scoliosis. We evaluated the perioperative complications (within 3 months), age at time of surgery, operative time, blood loss, preoperative %VC and FEV1.0 (%) for pulmonary function, and preoperative ejection fraction (EF) for cardiac function. Results There were 5 (6%) major complications, including pneumonia and a cardiovascular complication requiring intensive care unit (ICU) care, and 15 (18%) minor complications including viral enteritis and a urinary tract infection. Overall, there were 20 (24%) complications. Three of the 5 major complications were pulmonary. The mean age at the time of surgery was 13.7 y, operative time was 304 min, and blood loss was 1530 ml. The mean preoperative %VC was 41%, FEV1.0 was 91%, and EF was 60%. When we separated the patients into a group with major complications (n = 5) and a group without major complications (n = 78), the preoperative %VC in the group with major complications (23%) was significantly lower than that in the group without (42%) (p < 0.05). However, operative time, blood loss, preoperative FEV1.0 (%) and EF between the two groups were not significantly different (p > 0.05). Conclusions Compared with the previous findings of the perioperative complication rate (45%-74%) for NMS, the complication rate was remarkably low in this case series. Because of advances in medical skills, including anesthesia and surgical instruments, surgery for NMS appears to be safe. However, patients with NMS with complications demonstrated severe restrictive ventilatory impairment preoperatively. Therefore, we should be vigilant for perioperative pulmonary complications especially in patients with NMS and preoperative severe restrictive ventilatory impairment.

Time course of alterations in chemical control of breathing in conscious spontaneously breathing 6‐OHDA SN‐lesioned Parkinson's Disease rat model

Respiratory dysfunction in Parkinson's Disease (PD) patients manifests as a variety of altered breathing patterns and chemical control of breathing deficits that are suggested to result from impairment of central respiratory control. Ongoing work in our laboratory has identified time‐dependent alterations in both basal inspiratory motor output and chemical control of breathing in the 6‐hydroxydopamine (6‐OHDA) neurotoxin‐induced unilateral substantia nigra (SN) lesion rat model. With reference to alterations in chemical control of breathing, our studies have been limited to examination of breathing behaviors at specified time points in acute terminal experiments; thus, the time course underlying the progressive nature of the changes observed is not known. Here, we begin to address this issue by examining the hypoxic (HVR; 12% O2, 3 min) and hypercapnic (HCVR; 7% CO2, 5 min) ventilatory responses using whole body plethysmography before and weekly for 4‐weeks after administration of 6‐OHDA into the SN of adult female Sprague‐Dawley rats; vehicle injected rats served as a control. For the HVR, we found that before injection into the SN, minute ventilation (MV) was increased by ~50% increase, which was mediated predominantly by an increase in breathing frequency (fb) but increases in tidal volume (VT) were noted in some rats; similar observations were noted in vehicle injected rats at the time points examined although some variability in magnitude of the responses were noted at various time points (but not in any specific pattern). In contrast, in 6‐OHDA injected rats, a markedly blunted HVR (~0–10% MV increase), in which fb and VT were minimally altered from pre‐hypoxic levels, was noted; this HVR alteration in behavior was stable over the time course examined albeit in a subset of rats, an HVR began to re‐emerge at the 4‐week post‐lesion time point. For the HCVR, we found that before injection into the SN, MV more than doubled due to similar magnitude increases in both fb and VT. In vehicle injected rats, there was a progressive increase in the magnitude of the HCVR ventilatory behaviors (MV, fb, VT) that stabilized over the 3–4 week post injection time point. In contrast in 6‐OHDA injected rats, the peak of the HCVR MV increase was similar at 5‐min of CO2 exposure, but the response during the initial 4‐min of CO2 exposure was blunted, especially at the 2–3 week post‐lesion time point. This deficit appeared to be mediated by attenuated fb and VT responses. These observations suggest that in conscious 6‐OHDA SN‐lesioned rats, chemical control of breathing undergoes progressive alterations albeit ventilatory behaviors associated with the HVR and HCVR appear to be differentially affected. It remains to be determined whether the ventilatory impairments noted in this PD rat model persist beyond the 4‐week time point studied here.Support or Funding InformationNIH NS101737; Thomas Hartman Center for Parkinson's Disease Research at Stony Brook UniversityThis abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.