Annals of Thoracic Medicine最新文献

Objective: This review aimed to explore the pathophysiology and rehabilitation management of exercise intolerance in COVID-19 patients.

Methods: We reviewed articles published in 2019-2021 using PubMed, Google Scholar, and CINAHL databases as an electronic database. Data obtained were pathophysiology and rehabilitation management of exercise intolerance in COVID-19 survivors. Types of the article were original articles and systematic or narrative reviews, both published and preprint articles. Articles that were written in English and freely accessible in pdf or HTML format were included.

Results: There were 28 articles eligible for this review. Pathophysiology, rehabilitation management, and both pathophysiology and rehabilitation management were explained in 7, 24, and 4 articles, consecutively.

Discussion: Exercise intolerance is caused by some pathological processes in the respiratory, cardiovascular, and musculoskeletal systems as a result of systemic inflammation. Fatigue and shortness of breath during the activity were the most common symptom in the early phase of COVID-19 and persisted until the follow-up phase. Hospital admission, especially prolonged use of ventilators and immobilization worsen functional impairment resulting in persistent symptoms. Rehabilitation management begins with a functional assessment consisting of symptom assessment and physical examination of the body systems affected. The goals of rehabilitation management are to increase functional capacity, reduce symptoms, improve the ability to perform daily activities, facilitate social reintegration, and improve quality of life. Exercise is an effective intervention to reach these goals. Several studies recommend breathing, and aerobic exercises, as well as resistance exercises for peripheral and respiratory muscles, to improve symptoms and increase functional capacity.

Background: The long-term effects of respiratory function and related physiological characteristics of coronavirus disease 2019 (COVID-19) survivors have not yet been studied in depth.

Objective: To examine pulmonary function, exercise capacity, and health-related quality of life among COVID-19 survivors.

Methods: Eighty-five survivors with confirmed COVID-19 were evaluated at the end of 3 and 6 months after disease onset. The assessment included lung function, diffusing capacity, 6-min walk distance (6MWD), and health status by the 36-item Short-Form General Health Survey (SF-36) questionnaire.

Results: Totally 85 survivors, 48 (56.5%) were men. The mean (standard deviation) age was 34.6 (9.9) years. Thirteen patients (15.2%) had medical co-morbidities the mean length of hospitalization was 18.5 (5.6) days. 25 (29.4%) required intensive care unit admission, whereas 6 (7%) of them required invasive mechanical ventilation. No significant differences were observed between lung volume parameters. At 6 months, there was a significant reduction in diffusing capacity for carbon monoxide (DLCO), P = 0.02*. 25 (29.4%) of patients had impaired DLCO ≤80% predicted. Regarding 6MWD, a significant increase was noted in 6MWD from 486 ± 72 m at 3 months to 526 ± 82 m at 6 months (P = 0.001*). The 6MWD was lower than that for normal controls of the same age groups. There was significant impairment of health status assessed by SF-36 questionnaire among COVID-19 survivors at 6 months as compared with controls of the same age groups. There were significant positive correlations between lung function parameters (FVC, VC, FEV1, and DlCO) with several SF-36 domains.

Conclusion: In discharged survivors with COVID-19, 23.5% had significant impairment of diffusion capacity abnormality of lung function. The exercise capacity and health status were considerably lower than that of a normal population after 6 months postinfection.

Background: Pulmonary inflammatory myofibroblastic tumor (PIMT) is an extremely rare disease. The aim of this study was to share the surgical outcomes of these tumors.

Methods: Patients who were operated for pulmonary myofibroblastic tumors between January 2005 and January 2021 were determined by retrospectively scanning patient files. Patients' demographic characteristics, tumor location, surgical techniques, and other parameters were obtained from the patient files. The KaplanMeier method was used for survival calculations, whereas the log-rank test was used for comparison of survival calculations.

Results: PIMTs were noted in 14 patients (0.12%) in a total of 11,108 thoracic procedures performed in our institution between January 2005 and January 2021. The mean age of the patients was 28.2 (range: 2-67) years. Of the patients, six were male and eight were female, with 50% (n = 7) aged under 18 years. A total of 17 surgical procedures were performed on 14 patients. One patient underwent pneumonectomy, two patients lobectomy, ten0 patients wedge resection, and one patient underwent debulking surgery. A total of 11 patients had complete surgery, whereas three patients had incomplete surgery. The 10-year overall survival was 84.6% and the 10-year disease-free survival (DFS) was 75.0%. Complete resection was found to be the only and significant factor that had an effect on survival (P = 0.004) and DFS (P = 0.012).

Conclusion: PIMTs are extremely rare. Complete surgery should be considered an effective factor in survival and DFS.

Purpose: Muscle atrophy and diaphragm dysfunction are common with prolonged mechanical ventilation (PMV). Electrical stimulation on peripheral muscles has been shown to be beneficial in the improvement of muscle function. This study examined the effects of transcutaneous electrical diaphragmatic stimulation (TEDS) on respiratory muscle strength and weaning outcomes in patients with PMV.

Methods: Participants on ventilation for ≥21 days were randomly assigned to TEDS (n = 29) and control (n = 30) groups. The TEDS group received muscle electrical stimulation for 30 min/session/day throughout the intervention. Pulmonary function parameters (tidal volume, respiratory rate, and rapid shallow breathing index), and respiratory muscle strength (Pimax, Pemax) were assessed. The hospitalization outcome, including weaning rate and length of stay, was followed up until discharge.

Results: After TEDS, there was a significant increase in Pemax (10 [8-20] vs. 20 [10-22] cmH₂O, P = 0.034) in the intervention group. At the end of the study, the improvement of minute volume in the TEDS group (0.64 (-0.67) was significantly higher than the control group (-0.64 (-2.5-0.78) (P = 0.008). In the control group, there was no significant difference between pre- and post-measurement of weaning parameters. There was a significant difference between groups in the weaning rate, with a higher rate in the TEDS group (90%) when compared with that in the control group (66.7%) (P =0.021).

Conclusion: TEDS was significantly associated with increased respiratory muscle strength in patients with PMV. TEDS may be useful to facilitate weaning in this population.

Introduction: Coronavirus illness 2019, commonly referred to as COVID-19, is a highly infectious disease brought on by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 was declared a universal pandemic in March 2020 by the World Health Organization and is a severe health issue with unprecedented morbidity and mortality rates. Both surgical and mediastinal emphysema have been seen in cases of critically ill COVID-19 patients in several hospitals in the Eastern Province of Saudi Arabia.

Methods: This was a retrospective, cross-sectional, multicentric study involving several hospitals in the Saudi Arabian Eastern Province. Data were collected from intensive care units (ICUs) in these hospitals from March 2 to August 2, 2020. The inclusion criteria consisted of all patients who tested positive for SARS-CoV-2 and were admitted to a critical care unit.

Results: Thirty patients required thoracic consultation and management, including 26 males (81.3%) and 4 females (12.5%) (1:0.15) who developed surgical and mediastinal emphysema requiring thoracic surgery intervention. Most of the patients were on high ventilation settings, and the mean duration of ventilator support was 16.50 ± 13.98 days. Two patients (6.3%) required reintubation. The median positive end-expiratory pressure (PEEP) was 12 ± 2.80 cmH₂O with a median FiO2 of 70% ± 19.73. On average, thoracic complications occurred on day 3 (±6.29 days) postintubation. Ten patients (33.33%) experienced a pneumothorax associated with surgical emphysema (SE), 1 patient (3.33%) presented with only mediastinal emphysema; 17 patients (56.66%) with only SE, and 1 (3.33%) had mediastinal emphysema associated with SE. We noted a correlation between the duration of ventilator support, the length of ICU stay (P < 0.001), and the total length of stay (LOS) in the hospital (P < 0.001). Total length of hospital stay showed significant association with the onset of complications (P = 0.045) and outcomes (P = 0.006). A significant association between PEEP and the duration of ventilator support was also evident with a P value = 0.009 and the onset of complications (P = 0.043). In addition, we found a significant association between the group with pneumothorax in combination with SE, and their outcomes, with a P = 0.002.

Conclusion: Surgical and mediastinal emphysema in the critically ill patients are usually attributed to barotrauma and high ventilations settings. During COVID-19 pandemic, these entities were seen and the pathogenesis was revisited and some attributed its presence to the disease process and destruction on lung parenchyma. The associated with extended LOS and delayed recovery in addition to poor prognosis were seen. Their presence is an indicator to higher morbidity and mortality.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a highly transmissible and pathogenic coronavirus responsible for the pandemic coronavirus disease 19 (COVID-19). It has significant impact on human health and public safety along with negative social and economic consequences. Vaccination against SARS-CoV-2 is likely the most effective approach to sustainably control the global COVID-19 pandemic. Vaccination is highly effective in reducing the risk of severe COVID-19 disease. Mass-scale vaccination will help us in attaining herd immunity and will lessen the negative impact of the disease on public health, social and economic conditions. The present pandemic stimulated the development of several effective vaccines based on different platforms. Although the vaccine is safe and efficacious, rare cases of thrombosis and thrombocytopenia following the use of vaccination with the ChAdOx1 CoV-19 vaccine (AstraZeneca, University of Oxford, and Serum Institute of India) or the Ad26.COV2.S vaccine (Janssen/Johnson & Johnson) have been reported globally. This review focussed on the definition, epidemiology, pathogenesis, clinical features, diagnosis, and management of vaccine associated thrombosis.

Purpose: We conducted this study to evaluate the characteristics and outcomes exclusively in high-risk coronavirus disease 2019 (COVID-19) tertiary care patients with multiple comorbidities, as very few have reported outcomes in this specific cohort.

Methods: All patients, with two or more risk factors for COVID-19 and Charlson Comorbidity Index (CCI) of >2, who were admitted to intensive care unit (ICU) between March and December 2020 were included. Their characteristics, ICU course, and outcomes as well as differences between nonsurvivors and survivors were evaluated. The primary outcome was all-cause 28-day mortality.

Results: Out of 1152 COVID-19 patients, 101 met the inclusion criteria. The patients had an average of 4 or more comorbidities with a very high CCI of 5. The 28-day all-cause mortality was 23% and inhospital mortality was 32%. Among all risk factors, only age > 70 years, male gender, and chronic kidney disease were significant determinants of mortality (P < 0.03). Admission PaO₂/FiO₂ ratio and elevated inflammatory markers were same among survivors and nonsurvivors (P > 0.66). The mean time from presentation to ICU admission (59 vs. 38 h), APACHE II score (20.5 vs. 17), ICU length of stay (25 vs. 12 days), and hospital length of stay (28 vs. 20 days) were all higher in nonsurvivors as compared to survivors, respectively (P < 0.03). Fifty-four percent of the patients were intubated and had higher 28-day (40%) and inhospital (55%) mortality.

Conclusion: Tertiary care patients with multiple comorbidities have higher mortality than what is reported for mixed populations. Further studies are needed to determine realistic mortality benchmarks for these patients.

Objective: Sleep problems during the coronavirus disease 2019 (COVID-19) pandemic commonly affected general populations. Data on the effect of the COVID-19 pandemic on sleep quality in Saudi Arabia are scarce. Thus, the aim of our study was to evaluate sleep quality and assess the psychological burden of the pandemic in COVID-19 patients and the general population.

Methods: This was a multicenter, observational, cross-sectional survey. Participants with COVID-19 were recruited from different health-care centers in the western region during the lockdown period from May 13, 2020 to September 2, 2020. All participants completed a validated online survey. The control group comprised individuals from the general public who responded to the online survey through social media. Demographic data, COVID-19 status, and history of chronic diseases were collected. Sleep quality, depression, and insomnia were assessed using validated questionnaires.

Results: In total, 1091 participants were surveyed and 643 (58.9%) were positive for COVID-19. Poor sleep quality was reported in 66.1% of COVID-19 patients (mean score ± standard deviation [SD] 6.9 ± 4.0) and 72.8% of controls (mean score ± SD 7.6 ± 4.3). Insomnia affected 50.5% of COVID-19 patients (mean score ± SD 6.5 ± 5.5) and 58.5% of controls (mean score ± SD 7.6 ± 5.5). Depression was diagnosed in 39.5% of COVID-19 patients (mean score ± SD 4.7 ± 4.6) and 70.1% of controls (mean score ± SD 8.9 ± 6.7).

Conclusions: The COVID-19 pandemic had a great impact on mental health and sleep quality in both COVID-19 patients and the general population but more pronounced in the general population.