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Predictors of Functional Impairment in Severe COVID-19 Patients Two Months After Discharge. 重症COVID-19患者出院后2个月功能损害的预测因素
0 RESPIRATORY SYSTEM Pub Date : 2024-12-19 eCollection Date: 2024-01-01 DOI: 10.1177/29768675241305102
Antoine El Kik, Hind Eid, Nabil Nassim, Karim Hoyek, Albert Riachy, Bassem Habr, Ghassan Sleilaty, Moussa Riachy

Background: The Post-COVID-19 Functional Status (PCFS) scale is a validated tool used to measure the functional status of patients discharged from the hospital.

Objectives: To describe the functional limitations of hospitalized COVID-19 patients at the time of discharge and two months afterward, and to identify risk factors associated with functional impairment.

Design: Retrospective study.

Methods: A total of 540 patients were included in this monocentric study. The functional status assessment using the PCFS scale and ventilatory needs were recorded at discharge and two months later. Univariate and multivariate analyses were performed in order to identify the risk factors of a high PCFS score.

Results: Two months after discharge, the PCFS grade was 0 in 60,6% of the survivors, 1 in 24.5%, 2 in 6.9%, 3 in 2.8%, and 4 in 5.3%. The identified risk factors of a high PCFS scale were: age, arterial hypertension, diabetes mellitus, immunosuppression, cardiovascular disease, high need for oxygen and high News2 score at admission, a high percentage of ground glass at chest CT scan performed at admission or during follow-up, elevated leukocytes, neutrophils, LDH, D-dimers, procalcitonin, and serum creatinine levels. During the hospital stay, treatment with steroids, tocilizumab, longer duration of hospitalization, ICU admission and prolonged stay, and the occurrence of thromboembolic or hemorrhagic events were also significantly associated with a higher PCFS. Multivariate analysis identified that only age and a high News2 score at admission were independent risk factors of a low PCFS score.

Conclusion: Multiple risk factors for a higher PCFS score were identified, but only age and a high News2 score at admission were found to be independent risk factors.

背景:新冠肺炎后功能状态(PCFS)量表是一种经过验证的用于衡量出院患者功能状态的工具。目的:描述COVID-19住院患者出院时和出院后2个月的功能限制情况,并确定与功能损害相关的危险因素。设计:回顾性研究。方法:本研究共纳入540例患者。出院时和2个月后分别用PCFS量表和通气需求进行功能状态评估。进行单因素和多因素分析,以确定高PCFS评分的危险因素。结果:出院2个月后,60例患者PCFS评分为0,6%的幸存者为1,24.5%的幸存者为1,6.9%的幸存者为2,2.8%的幸存者为3,5.3%的幸存者为4。确定的高PCFS评分的危险因素有:年龄、动脉高血压、糖尿病、免疫抑制、心血管疾病、入院时高氧需氧量和高News2评分、入院时或随访期间胸部CT扫描毛玻璃百分比高、白细胞、中性粒细胞、LDH、d -二聚体、降钙素原和血清肌酐水平升高。在住院期间,类固醇治疗、托珠单抗治疗、住院时间延长、ICU住院和住院时间延长以及血栓栓塞或出血事件的发生也与较高的PCFS显著相关。多因素分析发现,只有年龄和入院时的高News2评分是低PCFS评分的独立危险因素。结论:PCFS评分较高的危险因素有多种,但只有年龄和入院时News2评分高是独立的危险因素。
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引用次数: 0
A Narrative Review of Invasive Candidiasis in the Intensive Care Unit. 侵袭性念珠菌病在重症监护室的叙述回顾。
0 RESPIRATORY SYSTEM Pub Date : 2024-12-12 eCollection Date: 2024-01-01 DOI: 10.1177/29768675241304684
Elnè Noppè, Julian Robert Paul Eloff, Sean Keane, Ignacio Martin-Loeches

Candida species is the most common cause of invasive fungal infection in the critically ill population admitted to the intensive care unit (ICU). Numerous risk factors for developing invasive candidiasis (IC) have been identified, and some, like the breach of protective barriers, abound within the ICU. Given that IC carries a significant mortality, morbidity, and healthcare cost burden, early diagnosis and treatment have become an essential topic of discussion. Several expert panels and task forces have been established to provide clear guidance on the management of IC. Unfortunately, IC remains a diagnostic and therapeutic challenge attributable to the changing fungal ecology of Candida species and the emergence of multidrug-resistant strains. This narrative review will focus on the following: (1) the incidence, outcomes, and changing epidemiology of IC globally; (2) the risk factors for developing IC; (3) IC risk stratification tools and their appropriate use; (4) diagnosis of IC; and (5) therapeutic agents and regimens.

念珠菌是重症监护病房(ICU)危重患者侵袭性真菌感染的最常见原因。侵袭性念珠菌病(IC)的许多危险因素已被确定,其中一些,如保护屏障的破坏,在ICU内比比皆是。鉴于IC具有显著的死亡率、发病率和医疗成本负担,早期诊断和治疗已成为讨论的基本主题。已经成立了几个专家小组和工作组,为IC的管理提供明确的指导。不幸的是,由于念珠菌物种的真菌生态变化和多重耐药菌株的出现,IC仍然是诊断和治疗的挑战。这篇综述将集中在以下方面:(1)全球IC的发病率、结局和不断变化的流行病学;(2)发生IC的危险因素;(3) IC风险分层工具及其合理使用;(4) IC诊断;(5)治疗药物和方案。
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引用次数: 0
Bronchiectasis-COPD Overlap Syndrome: A Comprehensive Review of its Pathophysiology and Potential Cardiovascular Implications. 支气管扩张-慢性阻塞性肺病重叠综合征:其病理生理学和潜在心血管影响的综合综述。
0 RESPIRATORY SYSTEM Pub Date : 2024-12-09 eCollection Date: 2024-01-01 DOI: 10.1177/29768675241300808
Mohammad Ajaz Alam, Padmavathi Mangapuram, Fremita Chelsea Fredrick, Bhupinder Singh, Amishi Singla, Avi Kumar, Rohit Jain

Bronchiectasis-Chronic Obstructive Pulmonary Disease Overlap Syndrome (BCOS) is a complex pulmonary condition that merges bronchiectasis and chronic obstructive pulmonary disease (COPD), presenting unique clinical challenges. Patients with BCOS typically exhibit a range of symptoms from both conditions, including a chronic productive cough, reduced lung function, frequent exacerbations, and diminished exercise tolerance. The etiology of BCOS involves multiple factors such as genetic predisposition, respiratory infections, tobacco smoke, air pollutants, and other inflammatory mediators. Accurate diagnosis requires a comprehensive approach, incorporating pulmonary function tests to evaluate airflow limitation, radiographic imaging to identify structural lung abnormalities, and blood eosinophil counts to detect underlying inflammation. Treatment strategies are tailored to individual symptom profiles and severity, potentially including bronchodilators, inhaled corticosteroids, and pulmonary therapy to improve lung function and quality of life. Patients with BCOS are also at an increased risk for cardiovascular complications, such as stroke, ischemic heart disease, and cor pulmonale. Additionally, medications like beta-agonists and muscarinic antagonists used in COPD treatment can further affect cardiac risk by altering heart rate. This paper aims to provide a thorough understanding of BCOS, addressing its development, diagnosis, treatment, and associated cardiovascular complications, to aid healthcare providers in managing this multifaceted condition and improving patient outcomes.

支气管扩张-慢性阻塞性肺疾病重叠综合征(BCOS)是一种合并支气管扩张和慢性阻塞性肺疾病(COPD)的复杂肺部疾病,具有独特的临床挑战。BCOS患者通常表现出两种情况的一系列症状,包括慢性咳嗽、肺功能下降、频繁恶化和运动耐受性降低。BCOS的病因涉及多种因素,如遗传易感性、呼吸道感染、烟草烟雾、空气污染物和其他炎症介质。准确的诊断需要全面的方法,包括肺功能检查来评估气流限制,影像学检查来识别肺结构异常,以及血液嗜酸性粒细胞计数来检测潜在的炎症。治疗策略根据个体症状和严重程度量身定制,可能包括支气管扩张剂、吸入皮质类固醇和肺部治疗,以改善肺功能和生活质量。BCOS患者发生心血管并发症的风险也增加,如中风、缺血性心脏病和肺心病。此外,慢性阻塞性肺病治疗中使用的-受体激动剂和毒蕈碱拮抗剂等药物可以通过改变心率进一步影响心脏风险。本文旨在提供对BCOS的全面了解,解决其发展,诊断,治疗和相关心血管并发症,以帮助医疗保健提供者管理这种多方面的疾病并改善患者的预后。
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引用次数: 0
Comparison of the Effects of Diaphragmatic Breathing and Pursed-lip Breathing Exercises on the Sleep Quality of Elderly Patients with Chronic Obstructive Pulmonary Disease (COPD): A Clinical Trial Study. 横膈膜呼吸与闭口呼吸对老年慢性阻塞性肺疾病(COPD)患者睡眠质量影响的临床研究
0 RESPIRATORY SYSTEM Pub Date : 2024-12-05 eCollection Date: 2024-01-01 DOI: 10.1177/29768675241302901
Zahra Dodange, Azar Darvishpour, Mohamad Javad Ershad, Bahare Gholami-Chaboki

Background: Sleep-related disorders are common among older adults with chronic obstructive pulmonary disease (COPD). Breathing exercises, a key component of pulmonary rehabilitation programs, may improve sleep quality. However, there is a paucity of research on the impact of breathing exercises on sleep quality in elderly patients with COPD.

Objective: This study aimed to compare the effects of diaphragmatic breathing (DB) and pursed-lip breathing (PLB) exercises on sleep quality in elderly patients with COPD.

Design: Crossover clinical trial.

Methods: In this study, 60 elderly patients with COPD were randomly assigned to two groups: DB followed by PLB (Group 1) and PLB followed by DB (Group 2). Each exercise was performed for 4 weeks. Participants completed the Pittsburgh Sleep Quality Index (PSQI), Abbreviated Mental Test Score (AMTS), and COPD Assessment Test (CAT) questionnaires before training. Data were analyzed using descriptive and inferential statistics in SPSS version 21, with a significance level of 0.05.

Results: Both DB and PLB exercises significantly improved sleep quality in elderly patients with COPD (P < 0.05). No significant difference was found between the two exercises. However, the sequence of exercises in Group 1 (DB followed by PLB) resulted in greater improvement in average sleep quality compared to Group 2.

Conclusion: This study demonstrates that DB and PLB exercises enhance sleep quality in elderly patients with COPD. These exercises are recommended as an effective non-pharmacological approach to improve sleep quality in this population.

背景:睡眠相关障碍在老年慢性阻塞性肺疾病(COPD)患者中很常见。呼吸练习是肺部康复计划的关键组成部分,可以改善睡眠质量。然而,呼吸运动对老年COPD患者睡眠质量影响的研究尚不多见。目的:本研究旨在比较横膈呼吸(DB)和唇包呼吸(PLB)运动对老年COPD患者睡眠质量的影响。设计:交叉临床试验。方法:将60例老年COPD患者随机分为DB + PLB组(1组)和PLB + DB组(2组),每次运动4周。参与者在训练前完成匹兹堡睡眠质量指数(PSQI)、简短精神测试分数(AMTS)和COPD评估测试(CAT)问卷调查。数据分析采用SPSS 21版的描述统计和推理统计,显著性水平为0.05。结果:DB和PLB运动均可显著改善老年COPD患者的睡眠质量(P)。结论:本研究表明DB和PLB运动可改善老年COPD患者的睡眠质量。这些运动被推荐为一种有效的非药物方法来改善这一人群的睡眠质量。
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引用次数: 0
Multiple life-threatening complications in a patient who received lung transplantation due to cystic fibrosis and their management. 1例因囊性纤维化而接受肺移植的患者的多重危及生命的并发症及其处理。
0 RESPIRATORY SYSTEM Pub Date : 2024-12-05 eCollection Date: 2024-01-01 DOI: 10.1177/29768675241302903
Gizem Kececi Ozgur, Ali Ozdil, Pervin Korkmaz, Tevfik İlker Akcam

Cystic fibrosis patients may be considered for lung transplantation. Although these patients may experience more successful outcomes and survival rates compared to others, various complications can arise. In particular, infectious complications and septic deaths may be more prevalent in cystic fibrosis patients compared to other lung transplant indications. Considering all these factors, recognizing and managing complications that may arise during the postoperative period in this patient group are of critical importance. In this article, multiple life-threatening complications occurring in the post-transplant period in a patient who underwent lung transplantation due to cystic fibrosis are chronologically presented, and their management is discussed.

囊性纤维化患者可考虑肺移植。尽管与其他患者相比,这些患者可能经历更成功的结果和生存率,但可能出现各种并发症。特别是,感染性并发症和脓毒性死亡在囊性纤维化患者中可能比其他肺移植适应症更普遍。考虑到所有这些因素,识别和处理该患者组术后可能出现的并发症至关重要。在这篇文章中,我们按时间顺序介绍了一例因囊性纤维化而接受肺移植的患者在移植后发生的多种危及生命的并发症,并对其处理进行了讨论。
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引用次数: 0
Artificial Intelligence for Mechanical Ventilation: A Transformative Shift in Critical Care. 人工智能用于机械通气:重症监护领域的变革。
0 RESPIRATORY SYSTEM Pub Date : 2024-11-11 eCollection Date: 2024-01-01 DOI: 10.1177/29768675241298918
Giovanni Misseri, Matteo Piattoli, Giuseppe Cuttone, Cesare Gregoretti, Elena Giovanna Bignami

With the large volume of data coming from implemented technologies and monitoring systems, intensive care units (ICUs) represent a key area for artificial intelligence (AI) application. Despite the last decade has been marked by studies focused on the use of AI in medicine, its application in mechanical ventilation management is still limited. Optimizing mechanical ventilation is a complex and high-stake intervention, which requires a deep understanding of respiratory pathophysiology. Therefore, this complex task might be supported by AI and machine learning. Most of the studies already published involve the use of AI to predict outcomes for mechanically ventilated patients, including the need for intubation, the respiratory complications, and the weaning readiness and success. In conclusion, the application of AI for the management of mechanical ventilation is still at an early stage and requires a cautious and much less enthusiastic approach. Future research should be focused on AI progressive introduction in the everyday management of mechanically ventilated patients, with the aim to explore the great potentiality of this tool.

随着大量数据从已实施的技术和监控系统中产生,重症监护病房(ICU)成为人工智能(AI)应用的关键领域。尽管近十年来,有关人工智能在医学中应用的研究层出不穷,但其在机械通气管理中的应用仍然有限。优化机械通气是一项复杂且高风险的干预措施,需要对呼吸病理生理学有深入的了解。因此,人工智能和机器学习可为这一复杂任务提供支持。已发表的大多数研究都涉及使用人工智能预测机械通气患者的预后,包括插管需求、呼吸系统并发症、断奶准备和成功率。总之,人工智能在机械通气管理中的应用仍处于早期阶段,需要谨慎对待,更不能急于求成。未来的研究应侧重于在机械通气患者的日常管理中逐步引入人工智能,以探索这一工具的巨大潜力。
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引用次数: 0
Primary Pulmonary Leiomyosarcoma Managed With Pazopanib: A Case Report and Literature Review. 帕唑帕尼治疗原发性肺雷米肉瘤:病例报告与文献综述
0 RESPIRATORY SYSTEM Pub Date : 2024-10-21 eCollection Date: 2024-01-01 DOI: 10.1177/29768675241279709
Sahar Khosravi, Sana Keshtegar, Ali Tavakoli Pirzaman

Primary pulmonary leiomyosarcoma (PPL) arises from pulmonary smooth muscle tissue, with less than 0.5% incidence among pulmonary malignancies and 30% among primary pulmonary sarcomas. Here, we present a case of PPL managed with pazopanib. Moreover, a brief review of relevant literature was conducted. A 65-year-old female presented with chronic cough, weight loss, and recurrent pneumonia, with a medical history including diabetes mellitus, hypertension, and hyperlipidemia, as well as past surgical colectomy and hysterectomy (due to abnormal uterine bleeding with normal pathology and no evidence of uterine leiomyosarcoma). Upon admission, she exhibited fever, cough, dyspnea, and decreased breath sounds over the upper lung lobe. Diagnostic workups revealed a large pulmonary mass, diagnosed as leiomyosarcoma via core needle biopsy and subsequent immunohistochemical staining. Neoadjuvant treatment with ifosfamide and adriamycin followed by chemoradiotherapy was attempted, but surgery for tumor resection was not feasible. Then, gemcitabine and docetaxel were chosen as the new treatment after ifosfamide and adriamycin were not effective. Imaging revealed tumor not reacting to latest treatment, either. Given the disease's persistence and the patient's diminished capacity for chemotherapy, the patient is presently undergoing pazopanib treatment, with ongoing monitoring of its effects. After 3 months of treatment with pazopanib (administered orally at 200 mg twice daily), the patient experienced a significant reduction in tumor size, with a notable decrease from 135 mm to 80 mm, approximating one-third of the initial size, indicating a positive therapeutic effect. This case report provides preliminary evidence suggesting that pazopanib, an oral multi-tyrosine kinase inhibitor, may be a promising therapeutic option for the management of PPL. However, further in-depth and long-term studies are warranted to evaluate the clinical efficacy and superiority of this treatment.

原发性肺平滑肌肉瘤(PPL)来源于肺平滑肌组织,在肺部恶性肿瘤中的发病率不到 0.5%,而在原发性肺肉瘤中的发病率为 30%。在此,我们介绍一例帕唑帕尼治疗的PPL病例。此外,我们还对相关文献进行了简要回顾。一名 65 岁女性患者因慢性咳嗽、体重减轻和反复肺炎就诊,病史包括糖尿病、高血压和高脂血症,既往曾行结肠切除术和子宫切除术(因异常子宫出血,病理检查正常,未发现子宫良性肌瘤)。入院时,她表现出发热、咳嗽、呼吸困难和上肺叶呼吸音减弱。诊断性检查发现了一个巨大的肺部肿块,通过核心针活检和随后的免疫组化染色确诊为子宫肌瘤。患者接受了伊佛酰胺和阿霉素的新辅助治疗,随后接受了化放疗,但无法进行肿瘤切除手术。吉西他滨和多西他赛在伊佛酰胺和阿霉素无效后被选为新的治疗方案。影像学检查显示,肿瘤对最新治疗也没有反应。鉴于病情持续存在,且患者接受化疗的能力减弱,目前患者正在接受帕唑帕尼治疗,并持续监测治疗效果。帕唑帕尼(口服,每次 200 毫克,每天两次)治疗 3 个月后,患者的肿瘤体积明显缩小,从 135 毫米缩小到 80 毫米,约为初始体积的三分之一,显示出积极的治疗效果。本病例报告提供的初步证据表明,帕唑帕尼(一种口服多酪氨酸激酶抑制剂)可能是治疗 PPL 的一种很有前景的治疗选择。然而,要评估这种疗法的临床疗效和优越性,还需要进一步的深入和长期研究。
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引用次数: 0
Bullous Lung Disease due to Pulmonary Tuberculosis: A Rare Case Complicated With Tension Pneumothorax and Bronchopleural Fistula. 肺结核引起的大疱性肺病:并发张力性气胸和支气管胸膜瘘的罕见病例。
Pub Date : 2024-05-10 eCollection Date: 2024-01-01 DOI: 10.1177/29768675241249652
Cristian Morán-Mariños, María Vidal-Ruiz, Felix Llanos-Tejada, Antonella Chavez-Huamani, Juan Salas-Lopez, Renzo Villanueva-Villegas, Renato Casanova-Mendoza

Bullous lung disease caused by tuberculosis is rare, and complications have a poor prognosis with uncertain pathophysiologic mechanisms. We describe a 29-year-old male patient who was admitted to the emergency department due to bilateral tension pneumothorax, which was complicated by bronchopleural fistula. This was managed with the placement of chest tubes, continuity of anti-TB drug treatment, and Heimlich valve placement.

肺结核引起的大疱性肺病非常罕见,并发症的预后很差,病理生理机制也不确定。我们描述了一名因双侧张力性气胸并发支气管胸膜瘘而被急诊科收治的 29 岁男性患者。经过胸腔置管、持续抗结核药物治疗和海姆立克瓣膜置入术后,患者病情得到了控制。
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引用次数: 0
Introducing Therapeutic Advances in Pulmonary and Critical Care Medicine. 介绍肺部和重症监护医学的治疗进展。
Pub Date : 2024-02-08 eCollection Date: 2024-01-01 DOI: 10.1177/29768675231219385
Hussein D Foda, Lauren Kelly
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引用次数: 0
Review of Thromboelastography (TEG): Medical and Surgical Applications. 血栓弹性成像(TEG)回顾:医疗和外科应用。
Pub Date : 2023-12-14 eCollection Date: 2023-07-01 DOI: 10.1177/29768675231208426
T P Whitton, W J Healy

Thromboelastography (TEG) is a laboratory assay utilized to evaluate hemostatic properties of blood, identify coagulopathy, and guide blood product administration. While the clinical use of TEG started in the care of surgical patients, the assay has now been incorporated more routinely in the care of the medical patient as well. In this review, we explore the evolution of TEG from the historical perspective of its inception to the current state of the art of the assay. The TEG procedure and its measurements are illustrated along with a table that summarizes recommendations from across the medical and surgical literature. After each section, we review salient learning points to provide the busy clinician with information that can be immediately integrated at the bedside. We conclude with a series of summary questions to check for comprehension and direct the reader to additional resources to improve their knowledge of TEG.

血栓弹性成像(TEG)是一种实验室检测方法,用于评估血液的止血特性、确定凝血功能障碍并指导血液制品的使用。虽然 TEG 的临床应用始于外科手术患者的护理,但现在这种检测方法也更多地应用于内科患者的护理中。在这篇综述中,我们将从 TEG 诞生的历史角度探讨 TEG 的演变过程,以及该检测方法的当前技术水平。TEG 程序及其测量方法图文并茂,并附有一张表格,汇总了医学和外科文献中的建议。在每个章节之后,我们都会回顾突出的学习要点,为繁忙的临床医生提供可立即在床边使用的信息。最后,我们提出了一系列总结性问题,以检查读者的理解程度,并引导读者查阅其他资源,以提高他们对 TEG 的认识。
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引用次数: 0
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Therapeutic advances in pulmonary and critical care medicine
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