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The respiratory pump that provides pulmonary ventilation includes the respiratory center, peripheral nervous system, chest and respiratory muscles. The aim of this study was to evaluate the activity of the respiratory center and the respiratory muscles strength after COVID-19 (COronaVIrus Disease 2019). Methods. The observational retrospective cross-sectional study included 74 post-COVID-19 patients (56 (76%) men, median age - 48 years). Spirometry, body plethysmography, measurement of lung diffusing capacity (DLCO), maximal inspiratory and expiratory pressures (MIP and MEP), and airway occlusion pressure after 0.1 sec (P0.1) were performed. In addition, dyspnea was assessed in 31 patients using the mMRC scale and muscle strength was assessed in 27 of those patients using MRC Weakness scale. Results. The median time from the COVID-19 onset to pulmonary function tests (PFTs) was 120 days. The total sample was divided into 2 subgroups: 1 - P0.1 <= 0.15 kPa (norm), 2 - > 0.15 kPa. The lung volumes, airway resistance, MIP, and MEP were within normal values in most patients, whereas DLCO was reduced in 59% of cases in both the total sample and the subgroups. Mild dyspnea and a slight decrease in muscle strength were also detected. Statistically significant differences between the subgroups were found in the lung volumes (lower) and airway resistance (higher) in subgroup 2. Correlation analysis revealed moderate negative correlations between P0.1 and ventilation parameters. Conclusion. Measurement of P0.1 is a simple and non-invasive method for assessing pulmonary function. In our study, an increase in P0.1 was detected in 45% of post-COVID-19 cases, possibly due to impaired pulmonary mechanics despite the preserved pulmonary ventilation as well as normal MIP and MEP values.Copyright © Savushkina O.I. et al., 2023.
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The respiratory pump that provides pulmonary ventilation includes the respiratory center, peripheral nervous system, chest and respiratory muscles. The aim of this study was to evaluate the activity of the respiratory center and the respiratory muscles strength after COVID-19 (COronaVIrus Disease 2019). Methods. The observational retrospective cross-sectional study included 74 post-COVID-19 patients (56 (76%) men, median age - 48 years). Spirometry, body plethysmography, measurement of lung diffusing capacity (DLCO), maximal inspiratory and expiratory pressures (MIP and MEP), and airway occlusion pressure after 0.1 sec (P0.1) were performed. In addition, dyspnea was assessed in 31 patients using the mMRC scale and muscle strength was assessed in 27 of those patients using MRC Weakness scale. Results. The median time from the COVID-19 onset to pulmonary function tests (PFTs) was 120 days. The total sample was divided into 2 subgroups: 1 - P0.1 <= 0.15 kPa (norm), 2 - > 0.15 kPa. The lung volumes, airway resistance, MIP, and MEP were within normal values in most patients, whereas DLCO was reduced in 59% of cases in both the total sample and the subgroups. Mild dyspnea and a slight decrease in muscle strength were also detected. Statistically significant differences between the subgroups were found in the lung volumes (lower) and airway resistance (higher) in subgroup 2. Correlation analysis revealed moderate negative correlations between P0.1 and ventilation parameters. Conclusion. Measurement of P0.1 is a simple and non-invasive method for assessing pulmonary function. In our study, an increase in P0.1 was detected in 45% of post-COVID-19 cases, possibly due to impaired pulmonary mechanics despite the preserved pulmonary ventilation as well as normal MIP and MEP values.Copyright © Savushkina O.I. et al., 2023.
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Introduction: Patients with COVID-19-related acute respiratory distress syndrome (ARDS) require respiratory support with invasive mechanical ventilation and show varying responses to recruitment manoeuvres. In patients with ARDS not related to COVID-19, two pulmonary subphenotypes that differed in recruitability were identified using latent class analysis (LCA) of imaging and clinical respiratory parameters [1]. We aimed to validate these phenotypes and evaluate if similar subphenotypes are present in patients with COVID-19-related ARDS. Method(s): This is the retrospective analysis of mechanically ventilated patients with COVID-19-related ARDS who underwent CT scans at positive end-expiratory pressure of 10 cmH2O and after a recruitment manoeuvre at 20 cmH2O. LCA was applied to quantitative CT-derived parameters, clinical respiratory parameters, blood gas analysis and routine laboratory values before recruitment to identify subphenotypes. Result(s): 99 patients were included. Using 12 variables, a two-class LCA model was identified as best fitting. Subphenotype 2 (recruitable) was characterized by a lower PaO2/ FiO2, lower normally aerated lung volume and lower compliance as opposed to a higher nonaerated lung mass and higher mechanical power when compared to subphenotype 1 (non-recruitable) (Fig. 1). Patients with subphenotype 2 had more decrease in non-aerated lung mass in response to a standardized recruitment manoeuvre (p = 0.024) and were mechanically ventilated longer until successful extubation (adjusted SHR 0.46, 95% CI 0.23-0.91, p = 0.026), while no difference in survival was found (p = 0.814). Conclusion(s): A recruitable and non-recruitable subphenotype were identified in patients with COVID-19-related ARDS. The subphenotypes are similar to non-COVID-19-related ARDS and are promising for identification of recruitable patients in future practice as they can be classified with only few clinically available parameters before the recruitment manoeuvre.
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Introduction: Patient with chronic obstructive lung disease (COPD) have an increased risk of severe Coronavirus disease (COVID-19), which is why self-isolation was recommended. However, long periods of social isolation accompanied with limited access to health care systems might influence the outcome of patients with severe COPD negatively. Methods: Data from COPD and pneumonia patients at Charité-Universitätsmedizin, Berlin and the volume of endoscopic lung volume reduction (ELVR) from the German lung emphysema registry (Lungenemphysem Register e.V.) were analyzed from pre-pandemic (2012 to 2019) to pandemic (2020 and 2021) period. In addition, 52 patients with COPD GOLD IV status included in the lung emphysema registry received questionnaires during lockdowns from June 2020 to April 2021. Results: Admissions and ventilation therapies administered to COPD patients significantly decreased during the COVID-19 pandemic. Likewise, there was a reduction of ELVR treatments and follow-ups registered in German emphysema centers. Mortality was slightly higher among patients hospitalized with COPD during pandemic. Increasing proportions of COPD patients with GOLD III and GOLD IV status reported behavioral changes and subjective feelings of increasing COPD symptoms the longer the lockdown lasted. However, COPD symptom questionnaires revealed stable COPD symptoms over the pandemic time-period. Summary: This study reveals reduced COPD admissions and elective treatment procedures of COPD patients during pandemic, but a slight increase of mortality among patients hospitalized with COPD irrespective of COVID-19. Correspondingly, patients with severe COPD reported subjective deterioration of their health status probably caused by their very strict compliance to lockdown measures.
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Background: SARS-Co- V 2 infection has a global impact, being declared by the WHO pandemic since march 2020. The pediatric population is also affected, according to the latest data in approximately 18% of cases. Children endure the disease in milder forms compared to adults. The clinical picture is dominated by catarrhal respiratory signs, febrile syndrome, cough. Radiological investigations are designed to assess the stage of the disease, the affected lung volume and the complications present. Aim.The evaluation of radiological and clinical changes in children with COVID-19 infection correlated with age. Method(s): The study includes 64 children hospitalized in the COVID-19 department of the IMSP Mother and Child Institute. The study sample was divided into 5 groups, with the age: 0-1 month, 1-12 months, 1-3 years, 3-7 years, > 7 years. The mean age was 2.04 +/- 0.38 years. All patients were evaluated according to clinical manifestations and chest radiography. Result(s): The largest share among hospitalized children up to one year -33%. Frequent hospitalization of these children is due to immune system and anatomical features of the respiratory tract. The severe debut of the disease presented the newborns (58.3%: 95% CI 27.67-84.83) and children up to one year (52.4%: 95% CI 29,78-74,29), caused by febrile syndrome in 48.4%: 95% CI 35,75-61.27, chi2 = 3,18, p > 0.5, catarrhal respiratory signs in 50%: 95% CI 37,23-62,77, chi2 = 3.49, p > 0.4, cough in 63.5%: 95% CI 52.19-78.19, chi2 = 5.5, p > 0.05. The most common radiological change in children with COVID-19 infection is the interstitial inflammation "ground-glass". It has a frequency of about 60% in all study groups, with maximum enrollment in children up to one year 66.7%: 95% CI, 34.9-90 and in children aged 1-3 years -57.1%: 95% CI, 38.6-90.9, chi2 = 0.9, p > 0.05. Pneumonic infiltrations is detected in 40%, with the maximum enrollment in children up to one year (42.9%: 95% CI, 21.8-66) and pre-school children (57.1%: 95% CI, 21.5 -69,2) chi2 = 0.44, p > 0.05. Conclusion(s): Children up to one year of age needed more frequent hospitalization due to the severe onset of the disease. The predominant clinical manifestations is fever, catarrhal respiratory signs and cough. The most common radiological change in children with COVID-19 infection is the interstitial inflammation "ground-glass".
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Background: Even if definitive evidence is still missing, prone position in non-intubated hypoxemic patients with Covid-19 is largely used. The aim of the present study was to investigate whether the amount and distribution of lung abnormalities evaluated by CT-scan can predict the improvement of oxygenation when Covid-19 patients undergoing non-invasive ventilation (NIV) are turned prone. Method(s): Retrospective monocentric study of severe Covid-19 patients who underwent NIV and prone position, evaluated with a basal chest CT-scan. Result(s): Forty-five severe Covid-19 patients were considered. On average 50% of the overall lung volume was involved by pneumonia at CT-scan, with ground glass, and consolidation accounting for 44, and 4%, respectively. The parenchymal abnormalities were predominantly posterior, as demonstrated by a posterior/anterior ratio of ground glass and consolidation of 1.5, and 4.4, respectively. PaO2/FiO2, whose basal value under NIV in supine position was 140 [IQR 108;169] improved on average by 67% (+98) during prone position. Once supine position was resumed, improvement in oxygenation was maintained in 28 patients (62% of the overall population, categorized as "responders"). We did not find significant difference between responders and non-responders in terms of the amount and distribution of parenchymal abnormalities. No correlation emerged between the distribution of parenchymal abnormalies and changes in oxygenation in supine position before and after prone position (R2 = 0.009, p= 0.526). Conclusion(s): the amount and distribution of lung abnormalities evaluated by CT-scan do not predict the response to awake prone position in patients with severe Covid-19 pneumonia undergoing non-invasive ventilation.
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To date, millions of people worldwide have recovered from COVID19, but concern remains on long-term impairment. We aimed to determine 3-6 months respiratory outcomes in a Latin American Public Health Hospital. Method(s): COVID-19 patients referred (April-June 2021,gamma variant breakdown) were enrolled, recalling epidemiology, demographic, comorbidities, laboratory, radiology, treatment and outcomes, performing spirometry, lung volumes, diffusing capacity (DLCO), walking test (6MWT);values< 80% of predicted were considered abnormal. Logistic regression analysis were performed to evaluate covariates associated with DLCO abnormality. Result(s): 56 patients followed 6 months make up the cohort. 56,9 +/- 13,0 years, 58,9% female,46,4% ever smokers, 42,9% obesity (BMI >30), 37,5% hypertension, 23,2% diabetes, 16,1% heart disease, 16,1% asthma. 64% dyspnea (MRC>1), 50% fatigue, sit to stand Sp02% 94,7 +/- 3,9. Lymphocites103 /muL 413,3 +/- 625,7,D-dimer ng/ml 3050,9 +/-7226,1,ferritin ng/ml 641,8 +/- 1173,4, 21.4% radiology abnormality, 35.7% admitted to ICU, days stay 17,1 +/- 10,5. 3 vs 6 months: TLC 5,3 +/- 1,9 vs 5,16 +/- 2,3 p=0.05;FVC 3,10 +/- 0,9 vs 3,16 +/- 1,0 p=0.04;DLCO:17,2 +/- 6,0 vs 17,8 +/- 6,2 7 p=0.006;Sp02% in 6MWT 90,1 +/- 98,2 vs 91,1 +/- 3,6 p=0.05. 6 months: dyspnea 28.6%, fatigue 26.8%, abnormality in: FVC 12,5%,FEV1 16,1%,DLCO 58,9%,distance 6MW 28,6%. Abnormal DLCO correlations: age > 65 p=0.02,smoking p=0.04,heart disease p=0.04,dyspnea MRC>1 p=0.002, persistent fatigue p=0.05. Conclusion(s): At 6 months some COVID-19 patients maintain symptoms and impaired DLCO and are the main target for further follow up and intervention.
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The pulmonary limitations after COVID-19 are still not completely known. Lung function test (LFT) and 6-minute walk test (6MWT) are accessible and safe tests to access them. Aim(s): To evaluate the differences between non-severe and severe COVID-19 patients regarding LFT and 6MWT. Method(s): This study included patients with previous COVID-19 assessed in Pulmonology Department at 2 hospitals during 7 months who performed LFT and 6MWT. Baseline and immediately pos-6MWT heart rate (HR), SpO2, respiratory rate (RR) and perceived symptoms using a modified BORG scale were collected. We compared nonsevere and severe patients. Result(s): We included 151 patients, 69 (45.7%) with severe disease. LFT was performed 116.8+/-68.3days and the 6MWT 129.1+/-72.3days after COVID-19, without statistical difference between groups. We documented lower %FVC (94.4+/-14.7vs101.1+/-12.6%, p=0.003), %TLC (95.4+/-15.3vs107.1+/-12.3%, p=0.000) and %DLCO (68.8+/-16.5vs78.9+/-15.9%, p=0.000) in the severe group, without statistical differences in FEV1, FEV1/FVC and KCO. The 6MWT distance (m: 426.5+/-110.9vs498.2+/-93.5m, p=0.000;%:77.3+/-16.8%vs86.1+/-13.4%, p=0.001), estimated metabolic equivalents (3.03+/-0.5vs3.4+/-0.4, p=0.000) and minimal SpO2 (92.0+/-3.3vs93.8+/-3.1%, p=0.000) were lower in the severe group. The time spent below 90%SpO2 (5.6+/-19.4vs2.6+/-13.6%, p=0.039), %age-predicted maximal HR (68.5+/-10.5vs64.9+/-8.8%, p=0.023) and initial RR (19.1+/-5.1vs18.7+/-9.3 cpm, p=0.014) were higher. We did not document differences regarding the differential (maximal-initial) HR, final RR, differential (final-initial) RR and symptoms. Conclusion(s): Severe group showed higher functional limitation, mainly in lung volumes and in submaximal exercise evaluation.
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The SARS-CoV-2 virus causes pneumonia which can result in lung function (LF) impairment. Impaired LF shortly after the disease is not commonly observed, but the LF substantially fluctuates even when its value remains within the limits of the norm. The aim of the study was to determine the variability scope of LF during the first year after COVID-19 pneumonia. Material(s) and Method(s): LF measurements (spirometry, body-plethysmography, transfer factor) were conducted up to 1 month, 3, 6, and 12 months after hospitalization in a group of consecutive patients recovered from moderate to severe COVID-19 pneumonia requiring hospitalization. The coefficient of variation (CV) was calculated to assess the stability of LF. Result(s): 113 patients were included, with a lung involvement median of 40% (IQR:30-60%). Shortly after hospitalization, we detected 3.5% airway obstructions, 12.4% restrictions, and 26.5% lung transfer factor impairments. During one year significant changes were observed in lung volumes but not flow indices. The most pronounced improvements were observed in lung transfer factor (TLco) and they were associated with volume changes (VA), but not Kco improvements (figure 1). Stable LF (CV<4%) was observed only in 21% of patients. Conclusion(s): Impaired LF shortly after COVID-19 was detected in a quarter of patients with significant improvement in the next months. However, lung function remained unstable in the majority of examined patients.
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Methods: in this retrospective study, we evaluated 394 patients from march 2020 to december 2020 and we enrolled43 patients who developed fibrotic lesions after 1 year from a sars cov2 pneumoniae.These patients underwent BAL (Bronchioloalveolar lavage), respiratory functional and immunological tests.At admission, 41/43 patients had GGO on chest CT scan, while 13/43 showed parenchymal consolidation. 9/43 weretreated with oxygen therapy, 14/43 with HNFC, 10/43 with NIV, 10/43 with IOT.At 12 months CT, 23/43 had persistent GGO areas and 2/43 lung consolidations. All showed new onset interstitialthickening. Result(s): no differences in lung volumes between patients who required mechanical ventilation vs those who did not;while the Dlco values were lower in mechanical ventilated patients (p=0.047).The median negativization of the nasopharyngeal molecular swab was 30 days: we didn't show differences in eitherinflammation markers and in the respiratory function parameters in those who had negativization before or after 30days. 43/394 patients showed persistence of DLco and CT scan alterations. We submitted these patients to BAL in order to quantify whether there was inflammation of the lung. Median lymphocytes on BAL was 10%, while median serum lymphocytes was 31.4%. Only 4/43 patients had BAL lymphocytosis greater than 30%. We treated these 4 patients with systemic steroid therapy as an organizing pneumoniae. Conclusion(s): patients who were hospitalized with respiratory failure due to Covid 19, 10% had TC and respiratory functional changes after one year and 10% of these, had lymphocytic inflammation in the BAL, treated with steroid. Further studies are needed.
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Lung fibrosis quantification from CT scans is prone to large inter and intra observer variability and its correlation with PFT is essential in the definition of disease progression. There is the need for a reliable and reproducible tool for abnormalities quantification. For this reason, a deep learning abnormalities quantification model was used to explore the correlation with PFT in ILD patients. The abnormalities segmentation model is based on 2D U-Net combined with Res Next as encoder and deep supervision and was trained on axial unenhanced chest CT scans of 199 COVID-19 patients and externally validated on 50 COVID-19 patients. Whole lungs were segmented using RadiomiX toolbox. Validation of the quantification performance was explored in a cohort of 20 ILD patients. The model performed the automatic segmentation of all abnormalities and calculate the ratio on the total lung volume ((abnormalities volume/whole lungs volume) * 100). This value is then correlated with the Forced Vital Capacity (FVC) and Diffusion Lung Capacity for carbon monoxide (DLCO) for each patient with Pearson correlation coefficient (rho). The deep learning segmentation algorithm achieved good performances (mean DSC 0.6 +/- 0.1) on the external test set. The percentage volume of disease region correlated with FVC and DLCO were the rho = -0.70402, -0.58133, respectively (P <. 001 for all). The developed algorithm performed similarly to radiologists for disease-extent contouring, which correlated with pulmonary function to assess CT images from patients with ILD. This automatic quantification tool could help in the prognosis and diagnosis of ILDs, based on the lung abnormalities extent.
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An introduction to articles published within the issue is presented on topics including the effects of physiotherapy on hemodynamics, gas exchange and cerebral physiology in ventilated subjects, an evaluation of four mechanical insufflation-exsufflation (MI-E) devices, and a session of intermittent intrapulmonary deflation technique and positive expiratory pressure therapy in chronic obstructive pulmonary disease (COPD) patients.
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Background: The Computed Tomography Scan (CT scan) was widely used for SARS-CoV-2 pneumonia evaluation and its correlation with clinical and laboratory findings is useful in clinical management. Aims and objectives: This study examines the clinical and functional features of COVID-19 pneumonia in relation with the extent of ground glass (GGO) and consolidation areas defined by volumetric investigations on CT scan. Method(s): Sixty-one patients attending the emergency department were enrolled. A semi-automatic segmentation software was used to extract volumetric data that has been compared with clinical and laboratory findings. Result(s): The decrease of aerated lung volume with the increase of GGO and consolidation areas were strongly related with a decrease of P/F ratio (p<0.0001, p<0.0001 and p=0.0002 respectively). An inverse correlation was observed between GGO and consolidation areas with P/F (R= -0.62, p<0.0001 and R= -0.4 and p=0.003, respectively). No significant correlation was observed between consolidation versus ground glass opacities ratio (C/GGO) and P/F. The increase of GGO and consolidation corresponded to an increase in CRP (R=-0.68, p<0.0001) and LDH (R=-0.55, p<0.0001) and a decrease in both the absolute number and the percentage of lymphocytes (respectively: R= 0.48, p<0.0001 and R= 0.54, p<0.0001) with a similar increase of neutrophils (respectively: R= -0.33, p=0.01 and R= -0.54, p<0.0001). These parameters had a stronger correlation with GGO than with consolidation areas. Conclusion(s): The extension and the characteristics in terms of GGO and consolidation of the lung lesions have a significant correlation with P/F reduction, CRP and LDH increase and lymphocytes decrease.
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BACKGROUND: The COVID-19 pandemic has a great impact on numberless aspects of our society. In our bronchoscopic lung volume reduction interventional program, we work with severe COPD patients on a daily basis. OBJECTIVES: We were interested in the prevalence and outcome of COVID-19, impact of the pandemic on daily life, and the vaccination coverage in our severe COPD patients who have been treated with one-way endobronchial valves. METHOD: A questionnaire, which consisted of questions related to the infection rate, treatment, and outcome of COVID-19 infections; feelings of anxiety related to the pandemic; adherence to preventive measures; and willingness to be vaccinated; was sent to our patients in June 2021. RESULTS: The questionnaire was sent to 215 patients, and the response rate was 100%. The vaccination rate was 97% in our surveyed population. The majority of patients (63%) indicated that they were quite or very anxious to get infected with COVID-19. Twenty-five (11.5%) patients were diagnosed with COVID-19, with none of these patients having been vaccinated at the time of infection. The infection rate reported in this study is comparable to that of the general Dutch population. However, the hospital admission rate and mortality rates are higher. CONCLUSIONS: Our results show that the SARS-CoV-2 infection rate in severe COPD patients treated with endobronchial valves was comparable with the general population; however, the hospital admission and mortality rates were worse.
Subject(s)
COVID-19 , Pulmonary Disease, Chronic Obstructive , Humans , Pneumonectomy/methods , Prevalence , Pandemics , Bronchoscopy/methods , SARS-CoV-2 , Pulmonary Disease, Chronic Obstructive/epidemiology , Pulmonary Disease, Chronic Obstructive/surgeryABSTRACT
Background: Prone position (PP) is a recommended intervention in severe classical acute respiratory distress syndrome (ARDS). Changes in lung resting volume, respiratory mechanics and gas exchange during a 16-h cycle of PP in COVID-19 ARDS has not been yet elucidated. Methods: Patients with severe COVID-19 ARDS were enrolled between May and September 2021 in a prospective cohort study in a University Teaching Hospital. Lung resting volume was quantitatively assessed by multiple breath nitrogen wash-in/wash-out technique to measure the end-expiratory lung volume (EELV). Timepoints included the following: Baseline, Supine Position (S1); start of PP (P0), and every 4-h (P4; P8; P12) until the end of PP (P16); and Supine Position (S2). Respiratory mechanics and gas exchange were assessed at each timepoint. Measurements and main results: 40 mechanically ventilated patients were included. EELV/predicted body weight (PBW) increased significantly over time. The highest increase was observed at P4. The highest absolute EELV/PBW values were observed at the end of the PP (P16 vs S1; median 33.5 ml/kg [InterQuartileRange, 28.2-38.7] vs 23.4 ml/kg [18.5-26.4], p < 0.001). Strain decreased immediately after PP and remained stable between P4 and P16. PaO2/FiO2 increased during PP reaching the highest level at P12 (P12 vs S1; 163 [138-217] vs 81 [65-97], p < 0.001). EELV/PBW, strain and PaO2/FiO2 decreased at S2 although EELV/PBW and PaO2/FiO2 were still significantly higher as compared to S1. Both absolute values over time and changes of strain and PaO2/FiO2 at P16 and S2 versus S1 were strongly associated with EELV/PBW levels. Conclusion: In severe COVID-19 ARDS, EELV steadily increased over a 16-h cycle of PP peaking at P16. Strain gradually decreased, and oxygenation improved over time. Changes in strain and oxygenation at the end of PP and back to SP were strongly associated with changes in EELV/PBW. Whether the change in EELV and oxygenation during PP may play a role on outcomes in COVID-ARDS deserves further investigation. Clinical trial registration: [www.ClinicalTrials.gov], identifier [NCT04818164].
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SESSION TITLE: Rare Cases with Masquerading Pulmonary Symptoms SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/18/2022 01:35 pm - 02:35 pm INTRODUCTION: COVID vaccinations have been encouraged by many healthcare providers but many adverse effects have also been reported. The adverse effects of the vaccine can vary based on each individual. Common adverse effects of the vaccine included fatigue, fever, chills, sore throat, muscle pain, headache, rash at injection site. Pleurodynia, also known as Devil's Grip, is a viral myalgia which causes sharp chest pain or the sensation of a grip around one's chest. Pleurodynia treatment is mostly supportive like anti-inflammatories (NSAIDS), pain management, and antibiotics (if bacterial inflammation is suspected). CASE PRESENTATION: We present a case report of a 63-year-old female who presented with complaints of pleuritic chest pain worse with inspiration. She had a history of atrial fibrillation and HTN. Patient had received the Pfizer COVID booster vaccine a few days prior to onset of the pleuritic chest pain. She was obese and had a 40 pack year smoking history. She was on room air saturating 92% with no increased work of breathing. Lung sounds were diminished due to body habitus but clear. Chest x-ray showed low lung volumes with no evidence of acute pulmonary disease. Computed Tomography Angiography (CTA) chest showed no pulmonary embolism and small left partially loculated pleural effusion with peripheral airspace opacities abutting the pleura. Acute coronary syndrome was ruled out and other cardiac workup was negative. COVID PCR was negative. Patient was treated empirically for bacterial infection with ceftriaxone and azithromycin. She was given NSAIDS to decrease inflammation and pain. Patient's symptoms improved significantly with treatment. She was discharged on NSAIDS and advised to follow up outpatient with her primary care and pulmonology. DISCUSSION: Research studies have indicated that the COVID vaccines (like Pfizer) can cause exacerbation of inflammatory or autoimmune conditions. Multiple mechanisms may be responsible for myocarditis, pericarditis, and other inflammatory conditions post vaccines. One mechanism describes that lipid particles of SARS mRNA vaccines can induce inflammation by activating the NLR pyrin domain containing 3 inflammasome of mRNA which are recognized by toll like receptors and cytosolic inflammasome components leading to inflammation. Another mechanism explains that viral proteins can cause immune cross reactivity with self-antigens expressed in the myocardium leading to an inflammatory process. CONCLUSIONS: As per current literature review there are no case reports about pleurodynia post COVID vaccination but pericarditis and myocarditis have been described. Further research studies are indicated to assess the cause and pathophysiology of pleurodynia post COVID vaccine. Physicians should have a high index of clinical suspicion for pleurodynia when assessing a patient with pleuritic chest pain with a recent history of COVID vaccination. Reference #1: 1. Analysis of COVID 19 Vaccine Type and Adverse Effects Following Vaccination. Beatthy, A;Peyser, N;Butcher, X. AMA Netw Open. 2021;4(12):e2140364. doi:10.1001/jamanetworkopen.2021.40364 Reference #2: 1. Association of Group B Coxsackieviruses with Cases of Pericarditis Myocarditis, or Pleurodynia by Demonstration of Immunoglobulin M Antibody. Schmidt, N;Magoffin, R;& Lennette, E. Infection and Immunty Journal. 1973 Sep;8(3): 341–348. PMCID: PMC422854 Reference #3: 3. Autoimmune phenomena following SARS-CoV-2 vaccination. Ishay, Y;Kenig, A;Toren, T;Amer, R;et. al. International Journal of Immuno-pharmacology. 2021 Oct;99: 107970. DISCLOSURES: No relevant relationships by Olufunmilola Ajala No relevant relationships by Arij Azhar No relevant relationships by Louis Gerolemou No relevant relationships by Wael Kalaji No relevant relationships by Steven Miller No relevant relationships by Kunal Nangrani No relevant relationships by Gaurav Parhar No relevant relationships by iran Zaman
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SESSION TITLE: Unique Uses of Pulmonary Function Tests SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: Breathlessness, fatigue, and exertional intolerance can persist for several months in up to 50% people after recovery from SARS-CoV-2 infection. The physiological underpinning(s) of the reduced exercise capacity associated with post-acute sequelae of SARS-CoV-2 infection (PASC) requires further investigation. We characterized pulmonary function relative to normative values and determined the relationship between measures of pulmonary function and peak pulmonary O2 uptake (V̇O2peak) in people with PASC. METHODS: Pulmonary function [including lung diffusing capacity for carbon monoxide (DLCO), and maximal inspiratory pressure (MIP)] and the cardiopulmonary responses to maximal incremental treadmill exercise (CPET) were assessed in ten adults (five females;age 41 ± 11 y;BMI 21 ± 5 kg/m2) with PASC. Time from initial SARS-CoV-2 infection to study enrollment was 6 ± 4 months. At the time of study, participants (n) reported persistent fatigue (9), breathlessness (9), headache (6), chest tightness (4), cough (2), muscle pain (4), palpitations (4), dizziness (5), and nausea (1). RESULTS: There was inter-individual heterogeneity in total lung capacity (TLC;range 68 to 117% predicted), forced vital capacity (FVC;range 73 to 123% predicted), forced expiratory volume in 1 s (FEV1;92 to 109% predicted), and maximal voluntary ventilation (MVV;range 75 to 122% predicted);however, no group mean measure of spirometric function or lung volume was different relative to normative values. Conversely, group mean DLCO (21 ± 9 vs. 27 ± 5 ml/min/mmHg, P = 0.017) and MIP (75 ± 43 vs. 102 ± 18 cmH2O, P = 0.049) were reduced relative to normative values. During the CPET, peak RER and heart rate were 1.16 ± 0.12 and 174 ± 16 beats/min (97 ± 8% predicted), respectively. V̇O2peak was 27.3 ± 6.8 ml/kg/min (90 ± 20% predicted, range 49-122% predicted, V̇O2peak <85% predicted in 4 of 10 participants), and there was no clear evidence of ventilatory or gas exchange impairment to exercise (breathing reserve 49 ± 31 L;minimum SpO2 96 ± 2%;V̇E/V̇CO2 nadir 27 ± 2;∆PETCO2 7.4 ± 2.8 mmHg). There was no relationship between percent predicted V̇O2peak and percent predicted TLC (r2 = 0.061, P = 0.492), FVC (r2 = 0.196, P = 0.200), FEV1 (r2 = 0.173, P = 0.232), MVV (r2 = 0.037, P = 0.595), DLCO (r2 = 0.007, P = 0.836), and MIP (r2 = 0.007, P = 0.820). CONCLUSIONS: Impaired pulmonary function and decreased exercise capacity are present in some but not all people with PASC who report persistent fatigue and breathlessness. Presently, we find no relationship between pulmonary function and V̇O2peak in people with PASC. CLINICAL IMPLICATIONS: Some but not all people with PASC have normal exercise capacity within ~2-12 months after recovery from SARS-CoV-2 infection. CPET may be considered when evaluating the presence and mechanistic underpinning(s) of impaired exercise capacity in such individuals. DISCLOSURES: No relevant relationships by Natalie Bonvie-Hill No relevant relationships by Igor Fernandes No relevant relationships by Augustine Lee No relevant relationships by Amy Lockwood No relevant relationships by Bala Munipalli No relevant relationships by Tathagat Narula No relevant relationships by Brian Shapiro Competitive research grant recipient relationship with Gilead Sciences Inc. Please note: 1 year Added 03/30/2022 by Bryan Taylor, value=Grant/Research Support
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SESSION TITLE: Great Procedural Cases: Fire, Ice, Struts, Valves, and Glue SESSION TYPE: Case Reports PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm INTRODUCTION: Secondary spontaneous pneumothoraxes commonly occur in patients with cystic fibrosis (CF) and can be complicated by persistent air leak (PAL) due to bronchopleural or alveolopleural fistula. More recently, bronchoscopic placement of one-way endobronchial valves (EBV) for PAL have been explored. We present the first case series of patients with CF who developed secondary spontaneous pneumothoraxes and were successfully treated with EBV. CASE PRESENTATION: A 30-year-old female with CF (F508del/dupex6B-10) and history of pneumothorax, presented with acute hypoxic respiratory failure. She was found to have a right-sided pneumothorax. A chest tube was placed, with a continuous air leak for 4 days. She was a suboptimal surgical candidate given extensive apical lung disease, making localization of the air leak difficult. In addition, the increased tissue density would have made wedge resection challenging. After multidisciplinary discussion, the patient underwent placement of 5 Zephyr EBV (Pulmonx Inc., Redwood City, CA) for PAL. The lung had re-expanded, but there was still an intermittent air leak. She underwent pleurodesis with betadine. Her chest tube was removed 2 days later, and she was discharged. She was seen in the pulmonary clinic 5 days after being discharged and was noted to have recurrent right pneumothorax. She underwent chest tube placement with flutter valve. The chest tube was removed after 10 days. The patient was scheduled for removal of EBV 6 weeks after placement, but the procedure was delayed to symptomatic COVID-19 infection. EBV were eventually removed 12 weeks after placement. Pneumothorax has not recurred 6 weeks post EBV removal. A 53-year-old female with CF (394delTT/3272-26A-G) and a small right apical secondary spontaneous pneumothorax 3 months prior to hospitalization presented with progressive dyspnea. Imaging showed that the pneumothorax had enlarged. A chest tube was placed with continuous air leak. After a multidisciplinary discussion, 5 Zephyr EBV were placed 2 days later. There was immediate improvement of the pneumothorax, with almost no air leak. Her chest tube was removed 48 hours after placement of EBV, and patient was discharged on day 4. The EBV were removed 8 weeks later with no recurrence of pneumothorax 1 month after valve removal. DISCUSSION: To our knowledge this is the first case series describing the use of Zephyr EBV in CF patients with secondary spontaneous pneumothorax complicated by PAL. Although previous guidelines still recommend surgery and/or pleurodesis for PAL, this may not be the best option for patients with CF who may require lung transplantation. EBV are currently FDA approved for lung volume reduction to treat emphysema, but it is likely a viable non-surgical alternative for PAL. CONCLUSIONS: EBV is a well-tolerated treatment option for PAL due to secondary spontaneous pneumothoraxes. Reference #1: Bongers KS, De Cardenas J. Endobronchial valve treatment of persistent alveolopleural fistulae in a patient with cystic fibrosis and empyema. J Cyst Fibros. 2020 Sep;19(5):e36-e38. doi: 10.1016/j.jcf.2020.03.014. Epub 2020 Apr 18. PMID: 32312675. Reference #2: Travaline JM, McKenna RJ Jr, De Giacomo T, Venuta F, Hazelrigg SR, Boomer M, Criner GJ;Endobronchial Valve for Persistent Air Leak Group. Treatment of persistent pulmonary air leaks using endobronchial valves. Chest. 2009 Aug;136(2):355-360. doi: 10.1378/chest.08-2389. Epub 2009 Apr 6. Erratum in: Chest. 2009 Sep;136(3):950. PMID: 19349382. Reference #3: Dugan KC, Laxmanan B, Murgu S, Hogarth DK. Management of Persistent Air Leaks. Chest. 2017 Aug;152(2):417-423. doi: 10.1016/j.chest.2017.02.020. Epub 2017 Mar 4. PMID: 28267436;PMCID: PMC6026238. DISCLOSURES: No relevant relationships by Bryan Benn no disclosure on file for Julie Biller;No relevant relationships by Rose Franco Speaker/Speaker's Bureau relationship with Biodesix Please note: 2018 - present by Jonathan Kurman, value=Honoraria Consultant relationship with Level Ex Please note: 2018 - present by Jonathan Kurman, value=Consulting fee Consultant relationship with Medtronic Please note: 2020 - present by Jonathan Kurman, value=Consulting fee Consultant relationship with Pinnacle Biologics Please note: 2020 - present Added 04/01/2022 by Jonathan Kurman, value=Consulting fee Consultant relationship with Boston Scientific Please note: 2021 - present by Jonathan Kurman, value=Consulting fee Consultant relationship with Cook Medical Please note: 2021 - present by Jonathan Kurman, value=Consulting fee Speaker/Speaker's Bureau relationship with Erbe Please note: 2021 - present by Jonathan Kurman, value=Honoraria research panel relationship with Intuitive Please note: 2020 - present by Jonathan Kurman, value=Honoraria Removed 04/01/2022 by Jonathan Kurman Consultant relationship with Pulmonx Please note: 2020 - present by Jonathan Kurman, value=Consulting fee Travel relationship with Ambu Please note: 2021-present Added 04/01/2022 by Jonathan Kurman, value=Travel Removed 04/01/2022 by Jonathan Kurman Consultant relationship with Ambu Please note: 2022-present Added 04/01/2022 by Jonathan Kurman, value=Consulting fee Speaker/Speaker's Bureau relationship with Veracyte Please note: 2021-present Added 04/01/2022 by Jonathan Kurman, value=Honoraria No relevant relationships by Shreya Podder
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SESSION TITLE: Occupational and Environmental Lung Disease Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: We describe a case of acute progression of chronic hypersensitivity pneumonitis (HP) in an adult, previously misdiagnosed as COPD for 13 years due to severe emphysematous changes seen on imaging. He was also found to have acutely worsened disease as a result of Covid-19. CASE PRESENTATION: A 64-year-old male presented to the pulmonary clinic with dyspnea on minimal exertion. He reported respiratory complaints for 13 years, treated with 2 L/min of oxygen overnight, and budesonide-formoterol and tiotropium inhalers. These complaints were previously associated with brief occupational mold exposure and possible COPD. His respiratory distress worsened one year ago when he was hospitalized for Covid-19. On discharge, his oxygen requirement had increased to 6 L/min. CT chest showed air-trapping in the mid-zones bilaterally, mosaic attenuation, and peri-bronchial thickening. PFTs showed an FEV1 33% and FVC 55% of predicted, consistent with severe obstruction and reduction in lung volume. As the patient was a lifetime non-smoker, alternative diagnoses were pursued. Alpha-1 antitrypsin levels and immunologic testing, including scleroderma and myositis panels, were within normal limits. Positive findings included CCP IgG/IgA antibodies at 96 units and HP panel positive for pigeon serum antibodies. Prompted by this testing, the patient revealed that he had parakeets in his home for the past 15 years. He also reported significant symptom improvement on occasions that he took a course of steroids. Based on these findings, a diagnosis of chronic fibrotic hypersensitivity pneumonitis with bronchiolitis obliterans was considered. The patient's severe airflow obstruction and respiratory failure precluded surgical lung biopsy. Empiric management was initiated with 30 mg of prednisone daily with a slow taper and instruction to eliminate exposure to exotic birds. DISCUSSION: HP is commonly caused by inhalation of and sensitization to an aerosolized environmental antigen;a common subtype is bird fancier's lung due to repetitive exposure of avian antigen. Continuous antigen exposure increases the risk for development of fibrosis, which was also seen in our patient. The most commonly described radiologic findings in HP are ground-glass opacities, ill-defined centrilobular nodules, and focal areas of air trapping resulting in mosaic attenuation and fibrosis. More than 20% lymphocytosis on bronchoalveolar lavage is also a sensitive tool in detecting alveolitis. The relationship between Covid-19 and disease progression in HP is not well studied. CONCLUSIONS: Chronic hypersensitivity pneumonitis from avian antigens, or Bird fancier's lung, can present with severe emphysematous changes on CT imaging, along with obstructive pattern of PFTs. This should be an important differential, especially in patients who are non-smokers. Covid-19 causes disease progression in HP, this relationship needs to be further explored. Reference #1: Funke M., Fellrath J.-M. Hypersensitivity pneumonitis secondary to lovebirds: a new cause of bird fancier's disease. Eur. Respir. J. 2008;32:517–521. DOI: 10.1183/09031936.00108507 Reference #2: Pereira C., Gimenez A., Kuranishi L., Storrer K. Chronic hypersensitivity pneumonitis. J. Asthma Allergy. 2016;9:171–181. DOI: 10.2147/JAA.S81540 Reference #3: C.S. Glazer, C.S. Rose, D.A. Lynch Clinical and radiologic manifestations of hypersensitivity pneumonitis J. Thorac. Imag., 17 (4) (2002), pp. 261-272. DOI: 10.1097/00005382-200210000-00003 Morell F, Roger A, Reyes L, Cruz MJ, Murio C, Muñoz X Bird fancier's lung: a series of 86 patients. Medicine (Baltimore). 2008;87(2):110-130. DOI: 10.1097/MD.0b013e31816d1dda DISCLOSURES: No relevant relationships by Momina Amjad No relevant relationships by Amit Chopra No relevant relationships by Rafeh Safdar
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SESSION TITLE: Pneumothorax, Chylothorax, and Pleural Effusion Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: An alveolopleural fistula (APF) is a pathological communication between the pulmonary alveoli and the pleural space. If pneumothorax persists beyond five days, it is labeled as a prolonged air leak (PAL). Herein, we present a patient with respiratory failure, spontaneous pneumothorax with persistent air leak resulting in functional pneumonectomy despite CTS intervention. CASE PRESENTATION: A 60-year-old female with PMH of diabetes, hypertension was initially admitted for right lower extremity cellulitis. About ten days into the admission, patient started becoming progressively hypoxic and was noted to be saturating 82% on room air with crackles noted bilaterally. A CT angiogram showed findings suggestive of multifocal pneumonia. Covid-19 pneumonia was initially suspected despite negative testing and a course of remdesivir and steroids was administered. All other infectious workup returned negative. Patient's oxygenation requirements worsened over the next two weeks eventually requiring intubation. Bronchoscopy with bronchoalveolar lavage showed growth of stenotrophomonas and patient received a course of trimethoprim-sulfamethoxazole. Patient was subsequently extubated and transitioned to high flow nasal cannula. Two weeks later, she developed acute respiratory deterioration due to a right sided pneumothorax requiring emergent pigtail placement and subsequent intubation. She was noted to have a persistent airleak from the chest tube and imaging showed a persistent pneumothorax with possible malpositioning of the chest tube. Despite repositioning of the previous chest tube and a second chest tube insertion, patient's PAL persisted and she underwent video assisted thoracoscopic surgery (VATS) that showed a large bronchopleural fistula emanating from the right upper and middle lobes requiring stapling and surgical pleurodesis. Bronchoscopy prior to VATS did not show any signs of obstruction. Due to prolonged intubation, she underwent tracheostomy placement followed gradually by chest tube removal when no air leak was appreciated. After the removal of the chest tube, her lung gradually formed multiple bullae with no functional residual lung. Despite this, her respiratory status stabilized and she was discharged to a LTACH. DISCUSSION: The likely cause of APF here was the emergent chest tube insertion. APF and PALs are most seen following pulmonary resection or biopsy but can also be seen following spontaneous pneumothorax or traumatic chest tube insertions. Although an endobronchial valve was entertained, the lung damage was extensive enough to have no change in patient's outcome. CONCLUSIONS: Our case demonstrates a rare but complicated hospital course of a patient where a chest tube insertion resulted in non-resolving APF with PAL despite therapeutic interventions in an unfortunate case of "functional pneumonectomy". Underlying pneumonia may have also contributed to the APF resulting in PAL. Reference #1: 1. Liberman M, Muzikansky A, Wright CD, et al. Incidence and risk factors of persistent air leak after major pulmonary resection and use of chemical pleurodesis. Ann Thorac Surg 2010;89:891. Reference #2: 2. DeCamp MM, Blackstone EH, Naunheim KS, et al. Patient and surgical factors influencing air leak after lung volume reduction surgery: lessons learned from the National Emphysema Treatment Trial. Ann Thorac Surg 2006;82:197. Reference #3: 3. Rivera C, Bernard A, Falcoz PE, et al. Characterization and prediction of prolonged air leak after pulmonary resection: a nationwide study setting up the index of prolonged air leak. Ann Thorac Surg 2011;92:1062. DISCLOSURES: No relevant relationships by Mohammed Halabiya No relevant relationships by Rajapriya Manickam No relevant relationships by Rutwik Patel