Comparison of efficacy of lung ultrasound and chest X-ray in diagnosing pulmonary edema and pleural effusion in ICU patients: A single centre, prospective, observational study

Background and Aims While chest X-ray (CXR) has been a conventional tool in intensive care units (ICUs) to identify lung pathologies, computed tomography (CT) scan remains the gold standard. Use of lung ultrasound (LUS) in resource-rich ICUs is still under investigation. The present study compares the utility of LUS to that of CXR in identifying pulmonary edema and pleural effusion in ICU patients. In addition, consolidation and pneumothorax were analyzed as secondary outcome measures. Material and Methods This is a prospective, single centric, observational study. Patients admitted in ICU were examined for lung pathologies, using LUS by a trained intensivist;and CXR done within 4 hours of each other. The final diagnosis was ascertained by an independent senior radiologist, based on the complete medical chart including clinical findings and the results of thoracic CT, if available. The results were compared and analyzed. Results Sensitivity, specificity and diagnostic accuracy of LUS was 95%, 94.4%, 94.67% for pleural effusion;and 98.33%, 97.78%, 98.00% for pulmonary edema respectively. Corresponding values with CXR were 48.33%, 76.67%, 65.33% for pleural effusion;and 36.67%, 82.22% and 64.00% for pulmonary edema respectively. Sensitivity, specificity and diagnostic accuracy of LUS was 91.30%, 96.85%, 96.00% for consolidation;and 100.00%, 79.02%, 80.00% for pneumothorax respectively. Corresponding values with CXR were 60.87%, 81.10%, 78.00% for consolidation;and 71.3%, 97.20%, 96.00% for pneumothorax respectively. Conclusion LUS has better diagnostic accuracy in diagnosis of pleural effusion and pulmonary edema when compared with CXR and is thus recommended as an effective alternative for diagnosis of these conditions in acute care settings. Our study recommends that a thoracic CT scan can be avoided in most of such cases.

Emergency Hybrid Correction in a Newborn with Critical Aortic Valve Stenosis with Acute Pulmonary Edema in the First Hour after Birth

Critical aortic valve stenosis in newborns is the cause of a severe clinical condition with the onset of symptoms during first hours after birth.We present a clinical case of a successful surgical correction of a critical aortic stenosis using a hybrid method applied in a newborn during the first day of life.The infant was diagnosed with a hypoplastic left heart complex with an intact atrial septum(aortic and mitral valves stenosis variant),that led to the cardiogenic shock and acute pulmonary edema.The procedure included bilateral banding of the pulmonary artery branches and atrioseptostomy with stenting of the interatrial septum.The surgery was performed through a median sternotomy.

Unilateral pulmonary hemorrhage caused by negative pressure pulmonary edema:A case report

BACKGROUND Unilateral pulmonary hemorrhage is typically reported in young and healthy men with upper respiratory tract obstruction during anesthesia in special situations.Negative pressure in the lungs is created,resulting in negative pressure pulmonary edema(NPPE).CASE SUMMARY A 78-year-old male patient diagnosed with spinal stenosis was admitted to receive a unilateral laminectomy with bilateral decompression.The patient had been diagnosed with hypertension four years earlier and asthma more than 70 years earlier.We experienced a unilateral alveolar hemorrhage associated with NPPE that occurred in a longstanding asthma patient who bit the intubated endotracheal tube for a short period during posture change at the end of surgery.Because diffuse alveolar hemorrhage accompanied by NPPE was caused in this case by airway obstruction in an older patient with asthma without known risk factors,anesthesiologists should be careful not to induce airway irritation during anesthesia awakening in asthma patients.CONCLUSION Because diffuse alveolar hemorrhage accompanied by NPPE can occur,anesthesiologists should take care not to induce airway irritation.

Preoperative Atrial Fibrillation and T-Wave Inversion Associated with Postoperative Pulmonary Edema

Background: Atrial fibrillation (AF) and T wave inversion (TWI) are occasionally found on pre-operative electrocardiograms (EKG) of patients with long standing hy-pertension (HTN) associated with left ventricular hypertrophy (LVH). Each of these two pathologies, AF and LVH, can impose negative hemodynamic effects on the car-diac function. Case: We present a case of a patient with AF, TWI and long standing HTN that went into post-operative pulmonary edema. Conclusion: Even returning to base line poorly controlled hypertension, and even more so during a hypertensive cri-sis, their concurrent presence may inflict even more detrimental effect manifested by elevation of pulmonary venous pressure and pulmonary edema.

Neurogenic Pulmonary Edema after Subarachnoid Hemorrhage

Neurogenic Pulmonary edema(NPE)is a well known complication of severe central nervous system insult,such as subarachnoid hemorrhage(SAH).Endogenous catecholamines can result in NPE.Cardio-respira-tory dysfunction may present severer than the clinical symptom of SAH.ICU management for patients with NPE after SAH is recommended.We describe a patient with NPE after SAH.The rapid development of respiratory and cardiac impairment had masked the initial disease.

Treatment of acute pulmonary edema by blocking VEGF-induced vascular leakage

Pulmonary edema induces local and systemic hypoxia in lungs and other tissues and organs,entailing the development of acute respiratory distress syndrome(ARDS).Hypoxia triggers a myriad of pathological responses,including angiogenesis and hyperpermeability of blood vessels in the lung and other tissues.Vascular endothelial growth factor,also named vascular permeability factor(VPF),is one of the key hypoxia-targeted genes.It is probably the most potent VPF in the body.In this article,I will discuss the possibilities and mechanistic insights of blocking the VEGF signaling pathway for treating acute pulmonary edema.In particular,anti-VEGF drugs for treating Covid-19-induced pulmonary edema will be discussed.

Protective effect of extracorporeal membrane pulmonary oxygenation combined with cardiopulmonary resuscitation on post-resuscitation lung injury

BACKGROUND: Cardiac arrest(CA) is a critical condition that is a concern to healthcare workers. Comparative studies on extracorporeal cardiopulmonary resuscitation(ECPR) and conventional cardiopulmonary resuscitation(CCPR) technologies have shown that ECPR is superior to CCPR. However, there is a lack of studies that compare the protective effects of these two resuscitative methods on organs. Therefore, we aim to perform experiments in swine models of ventricular fibrillation-induced CA to study whether the early application of ECPR has advantages over CCPR in the lung injury and to explore the protective mechanism of ECPR on the post-resuscitation pulmonary injury.METHODS: Sixteen male swine were randomized to CCPR(CCPR;n=8;CCPR alone) and ECPR(ECPR;n=8;extracorporeal membrane oxygenation with CCPR) groups, with the restoration of spontaneous circulation at 6 hours as an endpoint. RESULTS: For the two groups, the survival rates between the two groups were not statistically significant(P>0.05), the blood and lung biomarkers were statistically significant(P<0.05), and the extravascular lung water and pulmonary vascular permeability index were statistically significant(P<0.01). Compared with the ECPR group, electron microscopy revealed mostly vacuolated intracellular alveolar type II lamellar bodies and a fuzzy lamellar structure with widening and blurring of the blood-gas barrier in the CCPR group.CONCLUSIONS: ECPR may have pulmonary protective effects, possibly related to the regulation of alveolar surface-active proteins and mitigated oxidative stress response postresuscitation.

Current status and prospects of basic research and clinical application of mesenchymal stem cells in acute respiratory distress syndrome

Acute respiratory distress syndrome(ARDS)is a common and clinically devastating disease that causes respiratory failure.Morbidity and mortality of patients in intensive care units are stubbornly high,and various complications severely affect the quality of life of survivors.The pathophysiology of ARDS includes increased alveolar–capillary membrane permeability,an influx of protein-rich pulmonary edema fluid,and surfactant dysfunction leading to severe hypoxemia.At present,the main treatment for ARDS is mechanical treatment combined with diuretics to reduce pulmonary edema,which primarily improves symptoms,but the prognosis of patients with ARDS is still very poor.Mesenchymal stem cells(MSCs)are stromal cells that possess the capacity to self-renew and also exhibit multilineage differentiation.MSCs can be isolated from a variety of tissues,such as the umbilical cord,endometrial polyps,menstrual blood,bone marrow,and adipose tissues.Studies have confirmed the critical healing and immunomodulatory properties of MSCs in the treatment of a variety of diseases.Recently,the potential of stem cells in treating ARDS has been explored via basic research and clinical trials.The efficacy of MSCs has been shown in a variety of in vivo models of ARDS,reducing bacterial pneumonia and ischemia-reperfusion injury while promoting the repair of ventilator-induced lung injury.This article reviews the current basic research findings and clinical applications of MSCs in the treatment of ARDS in order to emphasize the clinical prospects of MSCs.

Adverse Maternal Consequences Associated with Prolonged Acute-Onset Severe Systolic Hypertension during Pregnancy &Early Postpartum: Pitfalls in Practice &Lessons Learned

OBJECTIVE: To determine the types of major maternal-perinatal morbidity associated with prolonged, acute-onset severe systolic hypertension during pregnancy and postpartum. METHODS: A medicolegal database retaining only medical record data was created from all cases involving women with medical/hypertensive disorders of pregnancy evaluated by the first author between 1986-2015. Case files of women that experienced severe systolic hypertension (SSH) sustained for many hours to days were identified for study. RESULTS: Sixty six pregnant/postpartum women met study criteria. Stroke secondary to intracranial hemorrhage or thrombosis (65.2) and acute pulmonary edema (33%) were the leading causes of maternal morbidity and mortality, most often antepartum as a component of early-onset preeclampsia (≤34 weeks). Eclampsia, abruptio placenta and injury to heart, liver and/or kidneys were other frequent co-morbidities. Seven postpartum women developed sudden new-onset postpartum SSH and suffered a stroke 4 - 13 days after delivery. Maternal mortality (54.6%) and morbidity as persistent disability (24.2%) were high in this cohort. CONCLUSION: Failure to rapidly respond, reduce and sustain at a safe level acute-onset SSH poses a significant threat to the wellbeing of mothers and babies, before and in the weeks following delivery. Systems to implement safe practices to identify and emergently treat severe maternal hypertension are needed.

Acute Respiratory Distress Syndrome Following Anaphylactic Shock—“A Deadly Duel”—Case Report and Literature Review

A 58-year-old Asian female developed acute respiratory distress syndrome (ARDS) following anaphylactic shock. Several similar cases have been reported in the literature, attributed to the pathophysiological mechanisms of anaphylaxis or interestingly, the treatment itself;adrenaline, majority of the latter being related to administration of supra-therapeutic doses. According to our clinical experience, the possibility of ARDS should be considered in patients who develop unexplainable hypoxaemia following anaphylactic shock. This case report discusses the pathophysiology of ARDS both in anaphylaxis and following epinephrine treatment and key aspects of management of ARDS with a main focus on the role of high flow oxygen, diuretics and anxiolytics. The importance of avoiding drug administration errors is also highlighted.

High-altitude illnesses:Old stories and new insights into the pathophysiology,treatment and prevention

Areas at high-altitude,annually attract millions of tourists,skiers,trekkers,and climbers.If not adequately prepared and not considering certain ascent rules,a considerable proportion of those people will suffer from acute mountain sickness(AMS)or even from life-threatening high-altitude cerebral(HACE)or/and pulmonary edema(HAPE).Reduced inspired oxygen partial pressure with gain in altitude and consequently reduced oxygen availability is primarily responsible for getting sick in this setting.Appropriate acclimatization by slowly raising the hypoxic stimulus(e.g.,slow ascent to high altitude)and/or repeated exposures to altitude or artificial,nor-mobaric hypoxia will largely prevent those illnesses.Understanding physiological mechanisms of acclimatization and pathophysiological mechanisms of high-altitude diseases,knowledge of symptoms and signs,treatment and prevention strategies will largely contribute to the risk reduction and increased safety,success and enjoyment at high altitude.Thus,this review is intended to provide a sound basis for both physicians counseling high-altitude visitors and high-altitude visitors themselves.