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https://www.readbyqxmd.com/read/29092970/extracorporeal-membrane-oxygenation-for-post-transplant-hypoxaemia-following-very-severe-hepatopulmonary-syndrome
#1
Lakshmi Kumar, Dinesh Balakrishnan, Rekha Varghese, Sudhindran Surendran
Hepatopulmonary syndrome (HPS) associated with end-stage liver disease has a high morbidity when room air PaO2 is less than 50 mm Hg. Safe levels of oxygenation to facilitate transplantation have not been defined despite advancement in care. Postoperatively, hypoxaemia worsens due to ventilation perfusion mismatch contributed by postoperative pulmonary vasoconstriction and due to decrease in endogenous nitric oxide. A 16-year-old boy with cirrhosis presented with HPS and a PaO2 of 37 mm Hg on room air and underwent living donor liver transplant...
November 1, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/29055626/pulmonary-arterial-hypertension-with-abnormal-v-q-single-photon-emission-computed-tomography
#2
Kenneth Chan, Stefanos Ioannidis, John G Coghlan, Margaret Hall, Benjamin E Schreiber
OBJECTIVES: This study aimed to evaluate the incidence and clinical outcomes of abnormal ventilation/perfusion (V/Q) single-photon emission computed tomography (SPECT) without thromboembolism, especially in patients with group I pulmonary arterial hypertension (PAH). BACKGROUND: American Heart Association/American College of Cardiology and European Society of Cardiology guidelines recommend V/Q scan for screening for chronic thromboembolic pulmonary hypertension...
October 16, 2017: JACC. Cardiovascular Imaging
https://www.readbyqxmd.com/read/29051337/gravity-outweighs-the-contribution-of-structure-to-passive-ventilation-perfusion-matching-in-the-supine-adult-human-lung
#3
Wendy Kang, Alys R Clark, Merryn H Tawhai
Gravity and matched airway/vascular tree geometries are both hypothesized to be key contributors to ventilation-perfusion (V/Q) matching in the lung, but their relative contributions are challenging to quantify experimentally. We used a structure-based model to conduct an analysis of the relative contributions of tissue deformation (the 'Slinky' effect), other gravitational mechanisms (weight of blood and gravitational gradient in tissue elastic recoil), and matched airway and arterial tree geometry to V/Q matching and therefore to total lung oxygen exchange...
October 19, 2017: Journal of Applied Physiology
https://www.readbyqxmd.com/read/29047091/hydrogen-sulfide-as-an-o2-sensor-a-critical-analysis
#4
Jesus Prieto-Lloret, Philip I Aaronson
There is increasing interest in the physiological actions and therapeutic potential of the gasotransmitter hydrogen sulfide (H2S). In addition to exerting antihypertensive, anti-inflammatory, antioxidant, and pro-angiogenic effects, H2S has been suggested to play a central and ubiquitous role in O2 sensing. According to this concept, because H2S is metabolized by oxidation, its cellular concentration varies inversely with the ambient pO2 such that hypoxia causes a rise in intracellular [H2S]; this then acts to induce appropriate cellular responses...
2017: Advances in Experimental Medicine and Biology
https://www.readbyqxmd.com/read/29019812/venous-thromboembolism-after-adult-lung-transplantation-a-frequent-event-associated-with-lower-survival
#5
Manuel L Ribeiro Neto, Marie Budev, Daniel A Culver, C Randall Lane, Marcelo Gomes, Xiao-Feng Wang, Paulo Novis Rocha, Mitchell A Olman
BACKGROUND: The incidence of venous thromboembolism (VTE) after lung transplantation (LTX) varies significantly across studies. Two studies have suggested that these thrombotic events are associated with a lower posttransplant survival. Herein, we sought to determine the incidence, predictors and impact of VTE on survival after LTX at a quaternary referral center. METHODS: This was a large cohort study of LTX recipients. Key outcome parameters were time to VTE after transplant and survival...
October 10, 2017: Transplantation
https://www.readbyqxmd.com/read/29019109/automatic-delineation-of-functional-lung-volumes-with-68-ga-ventilation-perfusion-pet-ct
#6
Pierre-Yves Le Roux, Shankar Siva, Jason Callahan, Yannis Claudic, David Bourhis, Daniel P Steinfort, Rodney J Hicks, Michael S Hofman
BACKGROUND: Functional volumes computed from (68)Ga-ventilation/perfusion (V/Q) PET/CT, which we have shown to correlate with pulmonary function test parameters (PFTs), have potential diagnostic utility in a variety of clinical applications, including radiotherapy planning. An automatic segmentation method would facilitate delineation of such volumes. The aim of this study was to develop an automated threshold-based approach to delineate functional volumes that best correlates with manual delineation...
October 10, 2017: EJNMMI Research
https://www.readbyqxmd.com/read/28993877/anxiety-depression-and-health-related-qol-in-patients-diagnosed-with-pah-or-cteph
#7
Elena Pfeuffer, Holger Krannich, Michael Halank, Heinrike Wilkens, Philipp Kolb, Berthold Jany, Matthias Held
BACKGROUND: Pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) are life-threatening diseases with a high burden of symptoms. Although depression, anxiety, and reduced health related quality of life (HRQOL) have also been reported, a comparative analysis which explores these traits and their underlying factors was lacking. METHODS: A retrospective analysis of depression, anxiety, and health related QOL was conducted using a Hospital anxiety and depression scale (HADS) as well as the SF-36 HRQOL questionnaire...
October 9, 2017: Lung
https://www.readbyqxmd.com/read/28993038/capnography-in-the-emergency-department-a-review-of-uses-waveforms-and-limitations
#8
Brit Long, Alex Koyfman, Michael A Vivirito
BACKGROUND: Capnography has many uses in the emergency department (ED) and critical care setting, most commonly cardiac arrest and procedural sedation. OBJECTIVE OF THE REVIEW: This review evaluates several indications concerning capnography beyond cardiac arrest and procedural sedation in the ED, as well as limitations and specific waveforms. DISCUSSION: Capnography includes the noninvasive measurement of CO2, providing information on ventilation, perfusion, and metabolism in intubated and spontaneously breathing patients...
October 6, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28977060/minute-ventilation-variability-during-cardiopulmonary-exercise-test-is-higher-in-sedentary-men-than-in-athletes
#9
Renata Rodrigues Teixeira de Castro, Sabrina Pedrosa Lima, Allan Robson Kluser Sales, Antonio Claudio Lucas da Nóbrega
BACKGROUND: The occurrence of minute-ventilation oscillations during exercise, named periodic breathing, exhibits important prognostic information in heart failure. Considering that exercise training could influence the fluctuation of ventilatory components during exercise, we hypothesized that ventilatory variability during exercise would be greater in sedentary men than athletes. OBJECTIVE: To compare time-domain variability of ventilatory components of sedentary healthy men and athletes during a progressive maximal exercise test, evaluating their relationship to other variables usually obtained during a cardiopulmonary exercise test...
September 2017: Arquivos Brasileiros de Cardiologia
https://www.readbyqxmd.com/read/28969765/applications-of-ventilation-perfusion-scintigraphy-in-surgical-management-of-chronic-obstructive-lung-disease-and-cancer
#10
REVIEW
Mark Tulchinsky, Joseph S Fotos, Kshama Wechalekar, Simin Dadparvar
Ventilation-perfusion scintigraphy (VPS) depicts the two main physiological processes that are fundamental to oxygen-dependent life. The test has affirmed its critical place in the evaluation of patients with lung cancer preparing for lung resection. The results of the study can differentiate patients who are very likely to survive surgery and the subsequent pulmonary function loss from those who are not. This review presents validated and evolving testing techniques for this critical indication. VPS has long been an integral part of the preoperative evaluation of lung transplant candidates, guiding the single lung grafts to the side with the worst function...
November 2017: Seminars in Nuclear Medicine
https://www.readbyqxmd.com/read/28966322/the-structure-of-a-chronic-total-occlusion-and-its-safe-treatment-in-a-patient-with-chronic-thromboembolic-pulmonary-hypertension
#11
Shun Minatsuki, Masaru Hatano, Hisataka Maki, Jiro Ando, Issei Komuro
A pouching defect, which is a type of angiographic classification in chronic thromboembolic pulmonary hypertension (CTEPH), is equivalent to a chronic total occlusion (CTO). Thus far, treating CTO involves high risk of the lung bleeding and is difficult because the structure and treating strategy have not been clarified, yet treating it has great potential to improve hemodynamic status and ventilation perfusion mismatch. Here, we describe a case of successfully treated the CTO. In this case, we treated it safely by two balloon pulmonary angiography (BPA) sessions...
October 21, 2017: International Heart Journal
https://www.readbyqxmd.com/read/28965822/a-new-method-for-noninvasive-measurement-of-pulmonary-gas-exchange-using-expired-gas
#12
John B West, G Kim Prisk
Measurement of the gas exchange efficiency of the lung is often required in the practice of pulmonary medicine and in other settings. The traditional standard is the values of the PO2, PCO2, and pH of arterial blood. However arterial puncture requires technical expertise, is invasive, uncomfortable for the patient, and expensive. Here we describe how the composition of expired gas can be used in conjunction with pulse oximetry to obtain useful measures of gas exchange efficiency. The new procedure is noninvasive, well tolerated by the patient, and takes only a few minutes...
September 29, 2017: Respiratory Physiology & Neurobiology
https://www.readbyqxmd.com/read/28964391/-bilateral-proximal-pulmonary-embolism-without-associated-hypoxemia-case-report
#13
M Bahloul, K Chtara, O Turki, M M Kammoun, W Bouaziz, M Bouaziz
INTRODUCTION: Pulmonary embolism is a classic complication in intensive care. It is characterized by hypoxemia secondary to perturbed ventilation/perfusion ratios. We report a case of proximal and bilateral pulmonary embolism that occurred without associated hypoxemia. A spiral computed tomography (CT) scan was performed to explore unexplained fever in a patient with a negative infectious investigation. We discuss the mechanisms underlying the absence of hypoxemia in this patient. CLINICAL CASE: A 43-year-old patient with no significant pathological history was admitted to intensive care for the management of multiple injuries following a road accident...
October 2017: J Med Vasc
https://www.readbyqxmd.com/read/28935434/diagnosis-of-venous-thromboembolism-in-pregnancy
#14
Wee-Shian Chan
The diagnosis of deep vein thrombosis (DVT) and pulmonary embolism (PE) during pregnancy still relies on objective imaging. Ancillary testing such as clinical prediction rules and D-dimer testing may have a role in excluding both DVT and PE in these pregnant patients even as we await results from prospective management studies. The anatomical distribution of DVT in pregnancy differs from those in non-pregnant patient with a greater propensity for proximal iliac vein thrombosis. Using leg ultrasonography with compression maneuvers from the femoral vein to popliteal vein and doppler assessment of the iliac vein in a single examination, appears adequate in most pregnant women with suspected DVT, in excluding DVT...
September 5, 2017: Thrombosis Research
https://www.readbyqxmd.com/read/28925655/pleuritic-chest-pain-sorting-through-the-differential-diagnosis
#15
Brian V Reamy, Pamela M Williams, Michael Ryan Odom
Pleuritic chest pain is characterized by sudden and intense sharp, stabbing, or burning pain in the chest when inhaling and exhaling. Pulmonary embolism is the most common serious cause, found in 5% to 21% of patients who present to an emergency department with pleuritic chest pain. A validated clinical decision rule for pulmonary embolism should be employed to guide the use of additional tests such as d-dimer assays, ventilation-perfusion scans, or computed tomography angiography. Myocardial infarction, pericarditis, aortic dissection, pneumonia, and pneumothorax are other serious causes that should be ruled out using history and physical examination, electrocardiography, troponin assays, and chest radiography before another diagnosis is made...
September 1, 2017: American Family Physician
https://www.readbyqxmd.com/read/28918335/modern-diagnosis-of-chronic-thromboembolic-pulmonary-hypertension
#16
Aileen Kharat, Anne-Lise Hachulla, Stéphane Noble, Frédéric Lador
Chronic thromboembolic pulmonary hypertension (CTEPH) should be suspected in patients presenting persistent dyspnea three months after a pulmonary embolism or in patients presenting with acute pulmonary embolism and suggestive images on the CT-scan. For these patients, a specific diagnostic work-up should be performed. First step consists of the ventilation/perfusion (V/Q) scan which is a good screening test due to its high sensitivity and high negative predictive value. Pulmonary angiography remains the gold standard approach for the confirmation of the diagnosis and pre-surgical evaluation of CTEPH...
September 9, 2017: Thrombosis Research
https://www.readbyqxmd.com/read/28910340/successful-1-1-proportion-ventilation-with-a-unique-device-for-independent-lung-ventilation-using-a-double-lumen-tube-without-complications-in-the-supine-and-lateral-decubitus-positions-a-pilot-study
#17
Michał Kowalczyk, Sławomir Sawulski, Wojciech Dąbrowski, Luiza Grzycka-Kowalczyk, Edyta Kotlińska-Hasiec, Agnieszka Wrońska-Sewruk, Artur Florek, Rafał Rutyna
INTRODUCTION: Adequate blood oxygenation and ventilation/perfusion matching should be main goal of anaesthetic and intensive care management. At present, one of the methods of improving gas exchange restricted by ventilation/perfusion mismatching is independent ventilation with two ventilators. Recently, however, a unique device has been developed, enabling ventilation of independent lungs in 1:1, 2:1, 3:1, and 5:1 proportions. The main goal of the study was to evaluate the device's utility, precision and impact on pulmonary mechanics...
2017: PloS One
https://www.readbyqxmd.com/read/28877099/risk-of-pulmonary-embolism-in-patients-with-isolated-great-saphenous-vein-thrombus
#18
Akshya Gupta, Vijay Pandya, Timothy Baran, Vikram S Dogra
Risks associated with isolated great saphenous vein (GSV) thrombosis remain controversial. The purpose of this study is to identify the risk of pulmonary embolism (PE) in patients with isolated GSV thrombosis, particularly those with thrombus within 3 cm of the sapheno-femoral junction. A retrospective chart review of color flow Doppler lower extremity venous ultrasound examinations from an academic hospital from 2011 to 2016 was conducted. Seventy-eight patients were identified as having acute thrombus in their GSV and were then further stratified based on the presence or absence of concomitant deep venous thrombosis (DVT)...
September 4, 2017: Ultrasound Quarterly
https://www.readbyqxmd.com/read/28871590/pulmonary-hypertension-in-diffuse-parenchymal-lung-diseases-is-there-any-benefit-of-pah-specific-therapy
#19
Monika Szturmowicz, Aneta Kacprzak, Jan Kuś
Pulmonary hypertension (PH) is diagnosed in 40-50% of the patients with end-stage diffuse parenchymal lung diseases (DPLD), and it is associated with significant worsening of life expectancy. Latest ERS/ESC guidelines recommend best available treatment of DPLD, and long-term oxygen therapy in the patients with PaO2 less than 60 mm Hg. Pulmonary arterial hypertension (PAH)-targeted drugs are not recommended in PH-DPLD patients, due to the risk of increasing the ventilation-perfusion mismatch, and consequently worsening of hypoxaemia...
2017: Advances in Respiratory Medicine
https://www.readbyqxmd.com/read/28869670/pulmonary-embolism-in-pregnant-patients-assessing-organ-dose-to-pregnant-phantom-and-its-fetus-during-lung-imaging
#20
Laleh Rafat Motavalli, Elie Hoseinian Azghadi, Hashem Miri Hakimabad, Parisa Akhlaghi
PURPOSE: The purpose of this study was to provide updated radiation dose from diagnostic exams performed for pregnant patients suspected of pulmonary embolism (PE) using the recently developed BREP phantoms of pregnant woman and the fetus. Also to challenge the validity of current recommendations suggest that ventilation/perfusion (V/Q) single photon emission computed tomography (SPECT) vs. computed tomography pulmonary angiography (CTPA) should be considered for diagnosis of PE in radiosensitive groups such as pregnant women...
September 4, 2017: Medical Physics
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