Tuberkuloz ve Toraks-Tuberculosis and Thorax最新文献

Introduction: We aimed to evaluate ventilator-associated pneumonia (VAP) incidence rate, risk factors, and isolated microorganisms in COVID-19 patients as the primary endpoint. Evaluation of VAP-associated intensive care unit (ICU) and hospital mortalities was the secondary endpoint.

Materials and methods: Records of patients admitted between March 2020- June 2021 to our pandemic ICU were reviewed and COVID-19 patients with VAP and non-VAP were evaluated retrospectively. Comorbidities, management, length of ICU stay, and outcomes of VAP and non-VAP patients, as well as risk factors for VAP mortality, were identified.

Result: During the study period, 254 patients were admitted to the ICU. After the exclusion, the data of 208 patients were reviewed. In total, 121 patients required invasive mechanical ventilation, with 78 (64.5%) developing VAP. Length of ICU and hospital stays were longer in VAP patients (p<0.01 and p<0.01 respectively). Steroid use was higher in VAP patients, although it was not statistically significant (p= 0.06). APACHE II score (p<0.01) was higher in non-VAP patients. ICU mortality was high in both groups (VAP 70%, non-VAP 77%). VAP mortality was higher in males (p= 0.03) and in patients who required renal replacement therapy (p= 0.01). Length of ICU stay (p= 0.04), and length of hospital stay (p<0.01) were both high in VAP survivors. The most common isolated microorganisms were Acinetobacter spp. and Klebsiella spp. in VAP patients and most of them were extensively drug-resistant.

Conclusions: Critically ill COVID-19 patients who required invasive mechanical ventilation developed VAP frequently. The length of ICU stay was longer in patients who developed VAP and ICU mortality was high in both VAP and non-VAP patients. The length of hospital and ICU stays among VAP survivors were also considerably high which is probably related to the long recovery period of COVID-19. The most frequently isolated microorganisms were Acinetobacter spp. and Klebsiella spp. in VAP patients.

Introduction: Omalizumab, a humanized monoclonal anti-IgE antibody, has largely demonstrated its efficacy in severe allergic asthma. There are limited data about the effectiveness of omalizumab in patients with non-atopic severe persistent asthma. In this study, we aimed to determine the effect of omalizumab in patients with non-atopic severe asthma and compare the data obtained with those in patients with allergic severe asthma.

Materials and methods: This study was an observational, retrospective, tertiary single-center study that assessed and compared the clinical outcome of adult patients with severe asthma (165 atopic and 41 non-atopic) who have been on omalizumab for one year or longer between January 2008 and January 2020. Effectiveness was assessed by considering symptom scores (GINA symptom control score), daily systemic corticosteroids (SCS) dosage, blood eosinophil counts, pulmonary function, and number of severe exacerbations and hospitalizations within the last one year.

Result: Omalizumab exhibited significant improvement in the clinical status of non-atopic asthma patients as measured by GINA symptom score [decreased from 3.77 ± 0.63 to 1.36 ± 1.27 (p<0.001)], the number of emergency room visits for asthma [decreased from 11.25 ± 14.69 to 0.25 ± 0.55 (p<0.001)], and the number of hospitalizations [decreased from 1.17 ± 2.87 to 0.14 ± 0.36 (p= 0.036)]. These results were not significantly different from those obtained in allergic asthma patients. FEV1 improved significantly from 2.08 ± 0.86 to 2.14 ± 0.84 (p= 0.041) and oral corticosteroid doses decreased significantly from 1.67 ± 7.49 to 0.46 ± 2.74 (p= 0.015) in the only atopic group.

Conclusions: Omalizumab, which is a proven and effective treatment option for allergic asthma, may also be an efficacious alternative option in non-atopic severe asthma.

The aim of this review is to elaborate the management of biologic therapy from initial selection to switching biologics in severe asthma. A nonsystematic review was performed for biological therapy management in severe asthma. Depending on clinical characteristics and biomarkers, selecting the preferred biologic based on super-responder criteria from previous studies may result in adequate clinical efficacy in most patients. On the other hand, no matter how carefully the choice is made, in some patients, it may be necessary to discontinue the drug due to suboptimal clinical response or even no response. This may result in the need to switch to a different biological therapy. How long the biological treatment of patients whose asthma is controlled with biologics will be continued and according to which criteria they will be terminated remains unclear. It has been shown that in patients with a long history of good response to biologics, asthma control may be impaired when biologics are discontinued, while it may persist in others. Therefore, discontinuation of biologics may be a viable strategy in a particular patient group. Clinicians should make the best use of all predictive factors to identify patients who will most benefit from each biologic. Patients who do not meet a predefined response criterion after sufficient time for response evaluation and who are eligible for one or more alternative biological agents should be offered the opportunity to switch to another biologic. There is no consensus on when the biologics used in severe asthma that produce favorable results should be discontinued. In our opinion, treatment should continue for at least five years, as premature termination may potentially deteriorate asthma control.

Introduction: Sarcopenia and frailty are critical factors linked with poor clinical outcomes among elderly individuals. This study aims to investigate the association between nutritional assessment tests and frailty with muscle thickness measured by ultrasound and their relationship with weaning among critically ill elderly patients.

Materials and methods: Patients who were over 65 years old and required invasive ventilation were assessed for nutritional status and clinical frailty scale upon admission to the intensive care unit. Additionally, the thickness of their rectus femoris and vastus intermedius muscles were measured by ultrasound within 48 hours of intubation. Correlation analysis was conducted to examine the relationship between screening tests, frailty, and ultrasound results. The association between these parameters and weaning success was also evaluated.

Result: Between May and August 2022, 32 consecutive patients were enrolled in the study. The mean age was 79.3 ± 7.9, and 18 (56.3%) of them were female. Median APACHE-II- and first-day SOFA scores were 22.5 (16.2-29.7) and 7 (5-10.75), respectively. There was a moderate negative correlation between the thickness of the rectus femoris and frailty (r= -0.41, p= 0.036), and there was a moderate positive correlation between the rectus femoris and geriatric nutritional risk index (r= 0.45, p= 0.017). Of them, 18 (56.3%) patients were classified as weaning failure in which the mean frailty score was higher (7.6 ± 0.9 vs 6.5 ± 1.7, p= 0.035), sepsis (18 vs 7, p<0.001) and use of vasopressor (17 vs 6, p= 0.004) more common, and in-hospital mortality were higher (18 vs 5, p<0.001).

Conclusions: Bedside ultrasound could be beneficial for detecting nutritional high-risk patients. Frailty was associated with muscle thickness, and it was also associated with weaning failure.

Introduction: Over the past few years, there has been an increase in lung and diaphragm ultrasound applications as a tool to evaluate the outcomes and settings of noninvasive respiratory supports. However, actual clinical practices in this field are yet to be known. The aim of this study was to investigate the current clinical utilization of ultrasound for noninvasive respiratory supports on an international level.

Materials and methods: The study employed an online survey consisting of 32 items, which was sent via email to intensivists, pulmonologists, emergency medicine physicians, and other specialists with expertise in using ultrasound and/or noninvasive respiratory supports.

Result: We collected 52 questionnaires. The ultrasound study of diaphragm dysfunction was well-known by the majority of respondents (57.7%). Diaphragm performance was used as a weaning failure predictor (48.5%), as a predictor of noninvasive ventilation failure (38.5%) and as a tool for the ventilator settings adjustment (30.8%). In patients with acute respiratory failure, 48.1% used ultrasound to assess the damaged lung area to set up ventilatory parameters, 34.6% to monitor it after noninvasive ventilation application, and 32.7% to match it with the ventilatory settings for adjustment purposes. When administering high flow nasal cannula - oxygen therapy, 42.3% of participants used ultrasound to evaluate lung involvement and assess flow parameters.

Conclusions: Lung and diaphragm ultrasound is an established clinical practice to evaluate noninvasive respiratory supports outcomes and settings. Further studies are needed to evaluate the educational aspects to increase confidence and indications for its use.

Hypersensitivity pneumonitis (HP) is an immunological lung disease that affects individuals who are sensitive and susceptible to occupational and environmental exposures. While clinical and radiological findings may resemble other interstitial lung diseases, identifying the causative agents can aid in the differential diagnosis. However, this can be challenging and may result in delayed diagnosis and poor prognosis. A gold standard test for diagnosis is currently unavailable, and therefore, a multidisciplinary approach involving a clinician, radiologist, and pathologist is necessary. Avoiding exposure is the first step in treatment, with immunosuppressive therapeutics also being used. Antifibrotic agents show promise for future treatment approaches. Despite recent advancements in data and guidelines, knowledge about managing occupational HP remains limited. This review provides a summary of the epidemiological, clinical, and radiological findings, as well as diagnostic and treatment principles of occupational HP based on current literature.

Introduction: There is evidence to suggest that dyspnea and impaired exercise capacity are associated with respiratory muscle dysfunction in idiopathic pulmonary fibrosis (IPF) patients. We aimed to evaluate the functions of the diaphragm with ultrasonography (US) and to determine the correlation of the data obtained with the pulmonary function parameters of the patients, exercise capacity, and the extent of fibrosis radiologically.

Materials and methods: Diaphragmatic mobility, thickness, and thickening fraction (TF) were measured by ultrasonography in IPF patients and the control group. The correlation between these measurements, pulmonary function tests (PFT), six-minute walking test (6MWT), mMRC score, and total fibrosis score (TFS) was evaluated.

Result: Forty-one IPF patients and twenty-one healthy volunteers were included in the study. No difference was found between the patient and control groups in diaphragmatic mobility during quiet breathing (QB) on ultrasound (2.35 cm and 2.56 cm; p= 0.29). Diaphragmatic mobility during deep breathing (DB) was found to be lower in the patient group when compared to the control group (5.02 cm and 7.66 cm; p<0.0001). Diaphragmatic thickness was found to be higher during QB and DB in IPF patients (0.33 cm and 0.31 cm, p= 0.043; 0.24 cm and 0.22 cm, p= 0.045). No difference was found between the two groups in terms of thickening fraction (39.37%, 44.16%; p= 0.49). No significant correlation was found between US measurements and PFT, 6MWT, mMRC score, and TFS in IPF patients (p> 0.05).

Conclusions: The functions of the diaphragm do not appear to be affected in patients with mild-to-moderate restrictive IPF. This study showed that there was no relationship between diaphragmatic functions and respiratory function parameters and the extent of fibrosis. Further studies, including advanced stages of the disease, are needed to understand the changes in diaphragmatic functions in IPF and to determine whether this change is associated with respiratory function parameters and the extent of fibrosis.

Introduction: The purpose of this study is to determine how long patients who developed pneumothorax were followed up on in the emergency department, how many patients required chest tube placement, and what factors influenced the need for a chest tube in patients who underwent computed tomography (CT)-guided percutaneous transthoracic fine needle aspiration biopsy (PTFNAB).

Materials and methods: Patients who developed pneumothorax following CT-guided PTFNAB were analyzed retrospectively. In cases with pneumothorax, the relationship between chest tube placement and the size of the lesion, the lesion depth from the pleural surface, the presence of emphysema, and the needle entry angle were investigated. It was determined how long the patients were followed up in the emergency department, when a chest tube was placed, and when patients who did not require chest tube placement were discharged.

Result: CT-guided PTFNAB was performed in 3426 patients within two years. Pneumothorax developed in 314 (9%) cases and a chest tube was placed in 117 (37%). The risk factor for chest tube placement was found to be the lesion depth from the pleural surface. The lesion depth from the pleural surface of >24 mm increased the risk of chest tube placement by 4.8 times. Chest tubes were placed at an average of five hours (5.04 ± 5.57).

Conclusions: This study has shown that in cases with pneumothorax that required chest tube placement, the lesion depth from the pleural surface is a risk factor. Patients who developed pneumothorax on CT during the procedure had chest tubes placed after an average of five hours.

Introduction: Post-illness pulmonary rehabilitation indications of Coronavirus disease-2019 (COVID-19) may include fatigue, respiratory restriction, exercise limitation, muscle weakness, deterioration in body composition, quality of life, and psychological status. Since tele-pulmonary rehabilitation (tele-PR) is the prominent approach in the current situation and questions such as who, how, and when are still unclear, in this study we aimed to investigate the efficacy of tele-PR as a hybrid model with face-to-face in post-COVID-19 patients.

Materials and methods: Thirty one patients who had completed viral infection treatment with the diagnosis of COVID-19 but still had persistent symptoms were enrolled in an eight-week synchronized video-conference mediated telePR program in a hybrid format, with the initial and final assessments and the first two sessions conducted in person. Before and after the tele-PR, pulmonary functions, exercise capacity, respiratory and peripheral muscle strength, body composition, quality of life, and psychological states were evaluated.

Result: After the tele-PR program; a statistically significant improvement was observed in dyspnea sensation evaluated with modified Medical Research Council (mMRC) and BORG levels, body mass index (BMI), incremental shuttle walk test (ISWT), endurance shuttle walk test (ESWT), handgrip test, deltoid, and quadriceps 1-repetition maximum (1RM) results, maximal inspiratory and expiratory pressure (MIP, MEP), peripheral muscle strengths, fatigue severity scale and Nottingham extended activities of daily living scale (NEADLS).

Conclusions: In this study, it has been shown that the hybrid model of tele-PR enables a comprehensive evaluation as well as the effective and safe applicability of a multidisciplinary and remotely directed program even in high workloads for post-COVID-19 patients.