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SESSION TITLE: Critical Diffuse Lung Disease Cases 1 SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 12:45 pm INTRODUCTION: Acute exacerbations (AE) of idiopathic pulmonary fibrosis (IPF) are well recognized in the progression of this uniformly fatal disease. Here we describe a case of AE of undiagnosed IPF after ankle surgery. Our aim is to discuss the role of non-pulmonary surgery as a precipitating factor and its outcome. CASE PRESENTATION: The patient is a 61-year-old male with a medical history of chronic smoking, recent open reduction internal fixation of left ankle 5 days before the presentation, comes to the emergency room with acute onset, gradually worsening shortness of breath along with non-productive cough and pleuritic chest pain. He denied any sick contacts, COVID exposure, travel history, inhalation of toxic fumes, or any chemical/pets/bird exposure. He was saturating around 85% on room air, was switched to a nasal cannula with improvement in saturation. Computed tomography (CT) of the chest showed no evidence of pulmonary embolism but diffuse ground-glass opacities (GGO) were noted bilaterally with no effusion or emphysematous changes, which were new compared to CT chest 10 days prior (that is 5 days before ankle surgery) which showed only mild reticular opacity along anterior convexity of the lungs bilaterally. He was started on intravenous steroids with gradual improvement in clinical status. Bronchoscopy biopsies revealed no malignant cells, bronchoalveolar lavage with no infections, and a negative serum autoimmune panel. He was discharged with outpatient follow-up for a repeat CT chest 6 weeks later which showed improvement in GGO (not back to baseline) and he was still requiring oxygen support. DISCUSSION: The most common triggers for IPF are smoking, environmental toxins, viral (COVID infection) or bacterial infections, medications like antidepressants, beta-blockers, NSAIDs. There is increasing evidence that surgery can cause acute respiratory worsening in IPF, presumably through increased mechanical stress to the lungs. Prolonged mechanical ventilation, high tidal volume, and high concentration of supplemental oxygen during surgery have been proposed as potential causes(1). As per the results from the retrospective study, the incidence of postoperative AE of IPF in patients undergoing non-pulmonary surgery is slightly lower than in patients undergoing pulmonary surgery (2,3). As in our case, non-pulmonary surgery procedures can pose risk for IPF exacerbation, but at this time we have limited research evidence to conclude if this exacerbation can alter the course of the disease. Some studies showed preoperative elevated C-reactive protein as a possible risk factor for AE of IPF after a non-pulmonary surgery but a multicenter study is needed to clarify the preoperative risk factors for AE of IPF after non-pulmonary surgery. CONCLUSIONS: We need further studies to check risk factors and disease course alteration, to have better guidance to classify preoperative risk in our IPF patients. Reference #1: Acute Exacerbation of Idiopathic Pulmonary Fibrosis: A Proposal, PMID: 2441663 Reference #2: Exacerbations in idiopathic pulmonary fibrosis triggered by pulmonary and non-pulmonary surgery: a case series and comprehensive review of the literature, PMID: 22543997 Reference #3: Postoperative acute exacerbation of interstitial pneumonia in pulmonary and non-pulmonary surgery: a retrospective study DISCLOSURES: No relevant relationships by Arundhati Chandini Arjun No relevant relationships by Harshil Fichadiya no disclosure submitted for Boning Li;No relevant relationships by Gaurav Mohan No relevant relationships by Rana Prathap Padappayil No relevant relationships by Raghu Tiperneni
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SESSION TITLE: Imaging, ECMO, and other Procedures in the ICU Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: Inhalation of various organic and non-organic compounds like toxic fumes, batteries, and dust can result in lung irritation called chemical pneumonitis (1). Chemical Pneumonitis can cause acute complications like secondary pneumonia or long-term complications like bronchiectasis or lung destruction (2). Classical radiograph findings of chemical pneumonitis show pulmonary edema or radiographic opacities (3). This type of injury can initially present as no damage in radiograph scans, and the extent of damage can be difficult to determine initially. Chemical pneumonitis can also be difficult to distinguish from pneumonia caused by bacteria or a virus. CASE PRESENTATION: A 40-year-old male presented to the emergency department with an 18% total body surface area burn to his upper extremities from an oil pump battery explosion that released chemicals he likely aspirated. The patient was intubated and transferred to the Burn ICU where a bedside bronchoscopy was performed. It revealed no soot or signs of inhalation injury. On the day of admission, he had a 100% oxygen dependence. A CT scan was done and showed no lung damage. The patient was extubated and moved to a high-flow nasal cannula of 40 liters per minute. A repeat CT scan was performed of his chest on hospital day 4. The results appeared to be multifocal pneumonia eliciting a possible diagnosis of Covid 19 pneumonia. This delayed his excision and grafting by 5 days. Through aggressive respiratory therapy intervention, oxygen dependence was reduced until the patient was on room air. The patient was discharged to inpatient rehab on hospital day 21. DISCUSSION: There are several factors presented in this case that should be kept in mind when treating a patient exposed to compounds that can cause chemical pneumonitis. Chemical pneumonitis likely has no findings on bronchoscopy. Furthermore, previous literature has suggested that CT chest scans of chemical pneumonitis may initially present with no apparent injury. Regardless of these initial findings, it is important that patients receive intense pulmonary hygiene to avoid delays in other interventions. Chemical pneumonitis injuries can be associated with chemical burns, and it is imperative to avoid delays in interventions including excision and skin grafting. Findings from a chemical pneumonitis injury may present on a CT scan later in a patient's course of injury. The findings of the CT scan could resemble multifocal pneumonia. This may complicate treatment plans as SARS-CoV-2 is also known to cause multifocal pneumonia. CONCLUSIONS: This case highlights the complexity that chemical pneumonitis traumatic injury may present, and the various factors providers should keep in mind. In the aftermath of the COVID-19 pandemic, another factor has emerged: the resemblance of chemical pneumonitis to SARS-CoV-2 multifocal pneumonia. Reference #1: Andujar, P., & Nemery, B. (2009). Pathologies respiratoires aiguës et subaiguës d'origine toxique [Acute and subacute chemical pneumonitis]. Revue des maladies respiratoires, 26(8), 867–885. https://doi.org/10.1016/s0761-8425(09)73682-4 Reference #2: Neill, S., & Dean, N. (2019). Aspiration pneumonia and pneumonitis: a spectrum of infectious/noninfectious diseases affecting the lung. Current opinion in infectious diseases, 32(2), 152–157. https://doi.org/10.1097/QCO.0000000000000524 Reference #3:.White, C. S., & Templeton, P. A. (1992). Chemical pneumonitis. Radiologic clinics of North America, 30(6), 1231–1243. DISCLOSURES: No relevant relationships by Genesy Aickareth No relevant relationships by Deepak Bharadia No relevant relationships by John Griswold No relevant relationships by Alan Pang No relevant relationships by Jad Zeitouni
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Background & Objective: Every operating room has been associated with a variety of occupational hazards, but not many studies have been conducted to assess and address these hazards. We used a qualitative approach to explore operating room personnel's experiences of workplace hazards and how these hazards threaten their occupational safety and health (OSH). Methodology: This qualitative study was conducted in five teaching hospitals in the south-west of Iran from February 2019 to March 2021. The sample was 24 operating room personnel who were selected under convenient sampling technique. Data were collected using semi-structured, individual interviews, document review and non-participant observation. The collected data were analyzed according to the qualitative content analysis method using MAXQDA v. 2020. Results: After prolonged analysis of the data, the researchers extracted 644 codes, 13 subcategories, 4 categories, and 1 main theme. The main theme of the study was working in a context of occupational hazards. Conclusions: Operating rooms are full of potential dangers, which, when combined with the personnel's negligence and management inefficiencies, increase the risk of occupational health and safety. Therefore, making working conditions safe by providing adequate personal protective equipment (PPE), in-service training, and identifying and managing the causes of personnel negligence are recommended. Moreover, strategies should be introduced to manage stress and conflicts among the healthcare personnel, thus controlling psychological hazards.
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At the beginning of the COVID-19 pandemic, Cornell University depopulated its main campus and instructed laboratories to temporarily cease lab work. This presented the opportunity to shut off fume hoods to save energy. What was anticipated to be highly successful showed the need for improvements in methods. This paper offers steps for fume hood hibernation and system design elements that will allow for efficient shutdown that will make the hood hibernation program more effective.