Open Respiratory Medicine Journal最新文献

Obstructive sleep apnea (OSA), characterised by apnea or hypopnea, often presents with symptoms such as gasping or snoring. However, these symptoms can be nonspecific and are frequently overlooked, particularly in pregnant women, where they are often attributed to normal physiological adaptations, leading to underdiagnosis and negative maternal and fetal outcomes. This narrative review examines the implications of OSA during pregnancy, highlighting the importance of early screening and evaluating available treatment options. We reviewed various articles on PubMed and Google Scholar about the impact of OSA during pregnancy, screening methodologies, and treatment effectiveness. OSA often increases sympathetic activity along with immune dysfunction, resulting in adverse outcomes like gestational hypertension, preeclampsia, gestational diabetes, cardiomyopathy, depression, and higher rates of cesarean deliveries, while the fetus suffers from intrauterine growth restriction (IUGR), preterm births, and perinatal mortality. Various screening tools, such as the Berlin Questionnaire, Epworth Sleepiness Scale (ESS), STOP-BANG, and Wisconsin questionnaires, aid in early diagnosis. Treatment options include lifestyle modifications, positive airway pressure (PAP) therapy, either continuous (CPAP) or bilevel (BiPAP), hypoglossal nerve stimulation (HGNS), mandibular advancement devices (MAD), and maxillomandibular advancement (MMA) surgery, with CPAP being identified as the preferred treatment. To reduce adverse outcomes for both the mother and the fetus, early detection and treatment of OSA in pregnant women are essential. Increased awareness among expectant mothers, routine screening using validated questionnaires, and appropriate treatment selection can not only decrease fetal complications but also reduce the risk of long-term adverse effects of OSA on maternal health.

Background: Glomus tumors are neoplasms typically arising from the glomus body in the skin or subcutaneous tissue. They are rarely found in visceral organs, including the respiratory tract. Glomangioma is a vascular variant, and its pulmonary subtype is challenging to predict due to the absence of specific symptoms or distinctive radiological features. While most glomangiomas are benign, in rare cases, they can exhibit aggressive clinical and histological characteristics, leading to severe conditions.

Case presentation: We report a case of malignant endobronchial glomangioma in a patient presenting with hemoptysis and atypical chest pain. Chest computed tomography (CT) revealed an endobronchial tumor in the left distal main stem bronchus, partially obstructing the lumen. The patient was clinically diagnosed with suspected metastatic lung cancer and was scheduled for bronchoscopy and biopsy. During the biopsy, a rounded, bulging mass was partially removed; however, significant intraoperative bleeding occurred, necessitating the formation of an intentional blood clot. Ongoing bleeding and airway necessitated emergency pneumonectomy after 24 hours. Unfortunately, the patient experienced cardiac arrest postoperatively and died. Pathological examination revealed a mass with prominent vascular components lined by endothelial cells, with immunohistochemistry showing positivity only for smooth muscle actin, supporting the diagnosis of glomangioma.

Conclusion: Although difficult to diagnose clinically prior to biopsy, malignant endobronchial glomangioma should be considered in certain patient populations due to its specific outcomes and complications. Preventive measures and targeted interventions should be implemented to manage iatrogenic bleeding complications associated with biopsy procedures.

Transthoracic Needle Aspiration (TTNA) is a medical procedure that involves the percutaneous insertion of a needle, typically guided by computed tomography, to aspirate lung tissue. During TTNA, the needle is often directed through the pleura and lung to reach and aspirate target tissues, such as the lung or lymph nodes. This procedure is commonly used to obtain tissue samples for diagnostic purposes. Over the past decade, invasive bronchoscopy, including endobronchial ultrasound biopsy (EBUS), radial probe, navigational, and robotic bronchoscopy, has improved the yield and safety profile of lung nodule biopsies while ensuring adequate lung tissue sampling. In this review article, we aim to compare the differences in efficacy, safety, and diagnostic yield among various diagnostic modalities in pulmonary medicine.

Introduction: Bronchiectasis is a chronic lung disease characterized by irreversible bronchial dilation, often accompanied by persistent infections. Compared to sputum, the microbiological results of bronchial lavage fluid (BLF) from stable bronchiectasis patients are typically less explored. There is emerging evidence on the role of non-tuberculous mycobacteria (NTM) in the progression of bronchiectasis. This study aims to investigate the microbiological profiles of BLF and the rate of NTM detection in stable bronchiectasis patients.

Methods: We conducted a prospective observational multicenter study at two endoscopy units of Cho Ray's Hospital and University Medical Center Ho Chi Minh City, from January 2023 to January 2024. Adult patients with bronchiectasis who underwent bronchoscopy were enrolled, and the BLF was collected. The BLF samples were analyzed for bacterial and fungal pathogens using culture methods, and for NTM using the multiplex polymerase chain reaction (PCR) technique.

Results: Of the 112 initially assessed patients, 99 were eligible for this study. The mean age was 63 years, and 55.6% were female. Bacterial cultures were positive in 41.9% of cases (36/86), predominantly with isolates of Klebsiella pneumoniae and Pseudomonas aeruginosa. Multi-drug resistant (MDR) K. pneumoniae and Acinetobacter baumannii were notably detected. Using PCR, NTM was detected in 52.5% of patients (52/99), predominantly slow-growing species such as Mycobacterium xenopi and Mycobacterium avium-intracellulare complex. Fungal cultures were positive in 24.6% of cases (17/69), primarily involving Candida spp. and Aspergillus spp. Patients with higher bronchiectasis severity index had higher rates of positive bacterial culture, but lower rates of NTM detection.

Discussion: The high NTM detection rate in this study may be attributed to the use of BLF and sensitive molecular techniques. The frequent detection of NTM in patients with milder disease suggests that these organisms may be present in the early stages, potentially acting as an early warning for future progression. The high prevalence of MDR bacteria isolated highlights the need for revised infection control policies and tailored antibiotic strategies.

Conclusion: This study demonstrated a microbial diversity in BLF, notably NTM and MDR bacteria in Vietnamese patients with bronchiectasis, emphasizing the need for routine, comprehensive microbial assessment for bronchiectasis patients. The incorporation of advanced molecular techniques can improve the detection of NTM in these patients.

Introduction: Glucagon-like Peptide-1 (GLP-1) agonists cause delayed gastric emptying by acting on vagal afferent nerves. Retained gastric contents (RGC) increase the risk of pulmonary aspiration, particularly under anesthesia in endoscopic procedures. This systematic review and meta-analysis aim to summarize the current evidence on pulmonary aspiration in patients receiving GLP-1 agonists undergoing endoscopy.

Methods: A systematic review was conducted using Cochrane, Embase, and PubMed from inception to May 2024, including studies and case reports examining GLP-1 agonists and pulmonary aspiration. Data on study characteristics, patient demographics, and GLP-1 agonist use were collected. A pooled analysis of retrospective studies was performed using RevMan version 5.4.1. The study protocol was registered in the PROSPERO database (ID CRD42024595241).

Results: A total of five case reports involving six patients and twelve studies including 210,216 patients were identified. Pulmonary aspiration occurred in 143 of 87,691 patients (0.16%) in the GLP-1 agonist group and 149 of 122,525 patients (0.12%) in the placebo group. Notably, three patients experienced aspiration despite stopping GLP-1 agonists more than six days prior and fasting for over eight hours. The meta-analysis showed an odds ratio of 1.23 (P = 0.59; 95% CI, 0.58 to 2.60) for pulmonary aspiration associated with GLP-1 agonist use, which was not statistically significant.

Discussion: This analysis did not find a statistically significant association between GLP-1 agonist use and pulmonary aspiration risk during endoscopic procedures. While the findings align with some existing studies suggesting minimal increased risk, the presence of aspiration cases despite prolonged fasting highlights potential gaps in current peri-procedural management. Limitations include reliance on retrospective data and case reports, as well as variability in fasting protocols.

Conclusion: The study found no significant association between GLP-1 agonist use and pulmonary aspiration risk during endoscopy. Further research is warranted to develop evidence-based fasting guidelines and optimize peri-procedural management for patients on GLP-1 agonists.

Background: Weaning from mechanical ventilation is an essential step in the care of critically ill patients. Central venous oxygen saturation (ScvO₂) could reflect tissue oxygenation.

Objective: The evaluation of the difference in ScvO₂ values at the beginning and end of the Spontaneous Breathing Trial (SBT) can be used as a predictor of successful extubation in critically ill patients.

Methods: This cross-sectional study was conducted in the ICU of Prof. Dr. I.G.N.G. Ngoerah Hospital from July to August 2024. This study involved 42 adult patients aged 18-65 who were using mechanical ventilation during their admission to the ICU. All patients had central venous access, were clinically ready for mechanical ventilation weaning, and could attempt SBT for 30-120 minutes with a rapid shallow breathing index (RSBI) of less than 105.

Results: All patients underwent 30-120 minutes of SBT. ScvO₂ levels were measured at the beginning of SBT (first minute) and at 30 minutes after SBT started, and the change in ScvO₂ level was recorded (ΔScvO₂). Patients with RSBI < 105 measured during SBT were extubated. Extubation failure was defined as the need for re-intubation, or patients died within 48 hours after extubation. Of 42 patients, 37 patients (89.1%) were successfully extubated. There was a significant difference in ΔScvO₂ between successfully extubated patients and those who failed 
(-2.89±1.63 vs. -8.2±4.27; p=0.049). The ROC curve analysis showed that a decrease in ScvO₂ ≤4.5% was the most optimal cut-off for a predictor of successful extubation with a sensitivity of 81.1%, specificity of 60%, positive predictive value of 93.8% and negative predictive value of 70%.

Conclusion: The difference in ScvO₂ between the beginning and after 30 minutes of SBT was a valuable early predictor for successful extubation from mechanical ventilation.

Objectives: Castleman disease (CD) is a very rare B-cell lymphoproliferative disorder marked by the abnormal enlargement of lymph node tissue. It can present as either unicentric (UCD) or multicentric, with the former often appearing in intrathoracic regions, although its presence within the lungs is uncommon.

Methods: We report the case of a 42-year-old woman who underwent resection of an 11 cm intrapulmonary UCD. Additionally, we conducted a systematic review of the demographics, clinical presentation, diagnosis, and treatment approaches for intrapulmonary UCD.

Results: Our review identified 35 documented cases of intrapulmonary UCD, including our case. The average age was 34 years, with a female predominance of 57.7%. Tumor sizes ranged from 1.5 to 11 cm, with our case being the largest. Of the 24 cases with reported anamnesis, 58.3% were asymptomatic, while 41.7% had nonspecific symptoms such as cough, chest pain, or fever (as in our case). Histological analysis was available for 24 cases, with 83.3% identified as the hyaline vascular type. Biopsies through small needle aspiration or fresh-frozen samples failed in all attempts, requiring resection for diagnosis and treatment. Due to high vascularity, delicate location, and lack of diagnosis, lobectomy or pneumonectomy was performed in 45.7% of cases. Among the 11 cases with reported follow-up, no disease recurrence was observed over an average of 3 years.

Conclusion: Our systematic review highlights the rarity of UCD in the lungs. The demographics of intrapulmonary UCD align with the general disease profile. Surgical removal is crucial for both diagnosis and treatment. The significant vascularity and pulmonary location of these tumors present challenges, requiring pre-operative awareness and precautions.

Background: Primary Ciliary Dyskinesia (PCD) is a rare genetic disorder characterized by impaired mucociliary clearance, resulting in chronic respiratory complications. While exercise benefits respiratory health, its impacts on PCD remain understudied.

Objective: The objective of this study was to assess how moderate aerobic exercise influences FEV1, SpO2, and nNO levels in PCD patients, with a focus on short-term post-exercise changes.

Methods: This is a matched case-control pilot study involving 12 PCD patients homozygous for the RSPH4A (c.921+3_921+6del) mutation and 12 healthy controls (HC). Baseline FEV1, SpO2, and nNO levels were measured before participants underwent a six-minute exercise challenge test (ECT) on a stationary bicycle. Post-exercise measurements included FEV1 at 5, 10, 15, and 20 minutes, nNO after final spirometry, and SpO2 at 5 minutes.

Results: The PCD group experienced a significant increase in SpO2 from 95.5% ± 2.1 to 97.7% ± 1.5 post-exercise (p < 0.05), while the HC group had stable SpO2 levels with a minor increase from 97.9% ± 1.5 to 98.9% ± 1.4 (p = 0.14). No significant changes in FEV1 or nNO levels were observed post-exercise in either group. One HC participant exhibited exercise-induced bronchoconstriction.

Conclusion: Aerobic exercise improves oxygenation in PCD patients without adverse effects on pulmonary function or nNO levels. Further research is necessary due to the small sample size and genetic homogeneity to confirm these findings and evaluate long-term outcomes. Moreover, this pilot study highlights the safety and potential respiratory benefits of aerobic exercise in PCD patients, supporting further investigation into its role in clinical management.

Pulmonary Arterial Hypertension (PAH) is a progressive vascular disease characterized by elevated Pulmonary Vascular Resistance (PVR) leading to Right Ventricular (RV) dysfunction and, ultimately, Right Heart Failure (RHF). Acute decompensation of PAH presents a life-threatening consequence marked by sudden worsening of clinical signs of right heart failure, systemic circulatory insufficiency, and multi-system organ failure. Clinicians are encountering more and more patients with PAH and RHF in the critical care units. These patients require admission and management in a critical care unit until they can be stabilized. The pathogenesis involves an imbalance between RV afterload and its adaptation capacity, ultimately resulting in RV dilation and failure. While the causes of acute decompensation remain subtle in many cases, infections, drug noncompliance, and pulmonary embolism are common culprits. Early identification of signs and symptoms of acute decompensation of RV failure, determination of possible etiology, and timely initiation of optimal treatment approaches are pivotal in avoiding detrimental outcomes. Optimization of pre-load and use of pulmonary vasodilators and inotropic agents are cornerstones of management. In refractory cases, mechanical circulatory support such as Extracorporeal Membrane Oxygenation (ECMO) or Right Ventricular Assist Devices (RVADs) may be necessary. Balloon Atrial Septostomy (BAS) serves as a bridge to definitive therapy, offering decompression of the right atrium and right ventricle. The prognosis of acute decompensated RV failure in PAH patients remains poor, highlighting the critical need for early diagnosis and intervention to improve outcomes. Currently, there are no strict standard guidelines to manage acute decompensated RV failure in PAH patients. We aim to revisit current evidence and practice trends in PAH and its acute decompensation.