Perioperative Pulmonary Atelectasis: Part I. Biology and Mechanisms

2021 ◽  
Author(s):  
Congli Zeng ◽  
David Lagier ◽  
Jae-Woo Lee ◽  
Marcos F. Vidal Melo
Keyword(s):  
Perioperative Period ◽  
Lung Compliance ◽  
Blood Oxygenation ◽  
Lung Damage ◽  
Liquid Interfaces ◽  
Pulmonary Atelectasis ◽  
Lung Fluid ◽  
Susceptibility To Infection ◽  
Diseased Lung ◽  
Alveolar Capillary

Pulmonary atelectasis is common in the perioperative period. Physiologically, it is produced when collapsing forces derived from positive pleural pressure and surface tension overcome expanding forces from alveolar pressure and parenchymal tethering. Atelectasis impairs blood oxygenation and reduces lung compliance. It is increasingly recognized that it can also induce local tissue biologic responses, such as inflammation, local immune dysfunction, and damage of the alveolar–capillary barrier, with potential loss of lung fluid clearance, increased lung protein permeability, and susceptibility to infection, factors that can initiate or exaggerate lung injury. Mechanical ventilation of a heterogeneously aerated lung (e.g., in the presence of atelectatic lung tissue) involves biomechanical processes that may precipitate further lung damage: concentration of mechanical forces, propagation of gas–liquid interfaces, and remote overdistension. Knowledge of such pathophysiologic mechanisms of atelectasis and their consequences in the healthy and diseased lung should guide optimal clinical management.

Pulmonary Atelectasis

2005 ◽  
Vol 102 (4) ◽  
pp. 838-854 ◽  
Author(s):  
Michelle Duggan ◽  
Brian P. Kavanagh ◽  
David C. Warltier
Keyword(s):  
Acute Lung Injury ◽  
Adverse Effects ◽  
Lung Injury ◽  
Preventive Measures ◽  
Perioperative Period ◽  
Lung Compliance ◽  
Review Article ◽  
Pulmonary Atelectasis ◽  
The Impact ◽  
Impact Outcome

Atelectasis occurs in the dependent parts of the lungs of most patients who are anesthetized. Development of atelectasis is associated with decreased lung compliance, impairment of oxygenation, increased pulmonary vascular resistance, and development of lung injury. The adverse effects of atelectasis persist into the postoperative period and can impact patient recovery. This review article focuses on the causes, nature, and diagnosis of atelectasis. The authors discuss the effects and implications of atelectasis in the perioperative period and illustrate how preventive measures may impact outcome. In addition, they examine the impact of atelectasis and its prevention in acute lung injury.

scholarly journals Effect of respiratory training apparatus and vibration expectoration vest on expectoration in patients with lung cancer resection

2018 ◽  
Vol 5 (4) ◽  
pp. 285-289
Author(s):  
Xiao-Jing Guo ◽  
Li-Li Wei ◽  
Xin-Hui Li ◽  
Ning- Ning Yu ◽  
Shao-Bo Gao ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Patients ◽  
Respiratory Function ◽  
Perioperative Period ◽  
Control Group ◽  
Observation Group ◽  
Pulmonary Atelectasis ◽  
Cancer Resection ◽  
Lung Cancer Patients ◽  
Respiratory Training

Abstract Objective The aim of this study was to explore the safe and effective method of expectoration in the preoperative period of patients with lung cancer resection and to promote the rehabilitation of patients. Methods A total of 100 cases of lung cancer patients undergoing elective surgery were divided into the observation group and the control group, with 50 cases in each group. The control group was treated with vibration expectoration vest for expectoration during the perioperative period, and the observation group was treated with respiratory function exerciser that has expectoration function in the perioperative period, three times a day, and the effect was evaluated after 5 days. Results The number of patients in the observation group after the first expectoration time was significantly less than that of the control group (P<0.001). Pain score, pulmonary atelectasis, and pulmonary infection rate of the observation group were significantly lower than those of the control group; the hospitalization time was significantly shorter than that of the control group; and the difference was statistically significant (P<0.05). Conclusions Lobectomy for lung cancer patients with perioperative respiratory training for respiratory function exercise, compared with conventional methods, is helpful for postoperative expectoration and to reduce the incidence of adverse events.

scholarly journals Bronchoscopy in COVID-19 patients: When, how and why. Experience in clinical practice

2021 ◽  
Vol 91 (2) ◽  
Author(s):  
Carmine Guarino ◽  
Cristiano Cesaro ◽  
Giuseppe Fiorentino ◽  
Francesco Rossi ◽  
Benedetto Maria Polverino ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Healthcare Professionals ◽  
Lung Damage ◽  
Operational Model ◽  
Technical Aspects ◽  
Airway Control ◽  
Technical Details ◽  
Virus Spreading ◽  
The Impact ◽  
Alveolar Capillary

Severe Acute Respiratory Syndrome due to Coronavirus-19 (SARS-CoV-2) is caused by combined alveolar-capillary lung damage, with bilateral pneumonia and thrombosis, which often causes respiratory failure. Proper COVID-19 management requires high skills in airway control and the need to perform aerosol-generating procedures such as bronchoscopy, which can increase the possibility of virus spreading among healthcare professionals. In an epidemiologically delicate moment, the multidisciplinary decision on “WHEN, HOW and WHY” to perform bronchoscopies minimizing the risk of COVID-19 transmission, represented a great challenge for all specialists engaged in bronchoscopic procedures. In this work authors want to share all technical aspects of 87 videobronchoscopies performed in confirmed or suspected COVID-19 patients, from 3rd to 6th January 2020, describing the reason, the organizational and operational model and patients characteristics. Was also evaluated the impact of high-risk procedures such as bronchoscopy on the personnel involved. The disclosure of all technical details, represents, in the opinion of the authors, an important contribution, capable of providing support to all physicians engaged in bronchoscopy procedures in confirmed or suspected COVID-19 patients.

Perioperative Management of Patients on Steroids Requiring Surgery

2017 ◽  
Author(s):  
Alexandra Reiher ◽  
Rebecca S. Sippel ◽  
Dawn M. Elfenbein
Keyword(s):  
Adrenal Insufficiency ◽  
Hpa Axis ◽  
Hormone Secretion ◽  
Perioperative Period ◽  
Solid Organ ◽  
Glucocorticoid Treatment ◽  
Clinical Algorithm ◽  
Susceptibility To Infection ◽  
Inflammatory Bowel ◽  
Endogenous Steroid

Patients with chronic lung disease, inflammatory bowel disease, rheumatoid arthritis, and solid-organ transplantations are often on steroid supplementation either intermittently or chronically. Endogenous steroid use results in decreased adrenocorticotropic hormone secretion by the pituitary gland through negative feedback mechanisms. Over several weeks, this can result in adrenal gland atrophy, eventually leading to secondary adrenal insufficiency. Appropriate management of perioperative glucocorticoid replacement therapy can be challenging, but appropriate replacement is essential to optimize patient outcomes. Insufficient dosing of glucocorticoids during the perioperative period can result in hypotension and even death. Excessive treatment with glucocorticoids decreases wound healing, increases the risk of hyperglycemia, and increases susceptibility to infection. This review covers the historical perspective, the hypothalamic-pituitary-adrenal (HPA) axis, when to suspect an impaired HPA axis, an argument against supraphysiologic glucocorticoid treatment in the perioperative period, the rationale for treating patients with impaired renal function, guidelines for dosing glucocorticoids in the perioperative period, and consulting a specialist. Figures show a clinical algorithm for evaluation and treatment of adrenal insufficiency in the perioperative period and the HPA axis. Tables list steroid conversions and perioperative glucocorticoid treatment recommendations.   This review contains 2 highly rendered figures, 2 tables, and 22 references.

scholarly journals Serum Amyloid P inhibits single stranded RNA-induced lung inflammation, lung damage, and cytokine storm in mice

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0245924
Author(s):  
Tejas R. Karhadkar ◽  
Darrell Pilling ◽  
Richard H. Gomer
Keyword(s):  
Wall Thickness ◽  
Serum Amyloid ◽  
Lung Damage ◽  
Mouse Lung ◽  
Alveolar Wall ◽  
Cytokine Storm ◽  
Lung Fluid ◽  
Serum Amyloid P ◽  
Ssrna Virus ◽  
Amyloid P

SARS-CoV-2 is a single stranded RNA (ssRNA) virus and contains GU-rich sequences distributed abundantly in the genome. In COVID-19, the infection and immune hyperactivation causes accumulation of inflammatory immune cells, blood clots, and protein aggregates in lung fluid, increased lung alveolar wall thickness, and upregulation of serum cytokine levels. A serum protein called serum amyloid P (SAP) has a calming effect on the innate immune system and shows efficacy as a therapeutic for fibrosis in animal models and clinical trials. Here we show that aspiration of the GU-rich ssRNA oligonucleotide ORN06 into mouse lungs induces all of the above COVID-19-like symptoms. Men tend to have more severe COVID-19 symptoms than women, and in the aspirated ORN06 model, male mice tended to have more severe symptoms than female mice. Intraperitoneal injections of SAP starting from day 1 post ORN06 aspiration attenuated the ORN06-induced increase in the number of inflammatory cells and formation of clot-like aggregates in the mouse lung fluid, reduced ORN06-increased alveolar wall thickness and accumulation of exudates in the alveolar airspace, and attenuated an ORN06-induced upregulation of the inflammatory cytokines IL-1β, IL-6, IL-12p70, IL-23, and IL-27 in serum. SAP also reduced D-dimer levels in the lung fluid. In human peripheral blood mononuclear cells, SAP attenuated ORN06-induced extracellular accumulation of IL-6. Together, these results suggest that aspiration of ORN06 is a simple model for both COVID-19 as well as cytokine storm in general, and that SAP is a potential therapeutic for diseases with COVID-19-like symptoms and/or a cytokine storm.

Implications for matrix metalloproteinases as modulators of pediatric lung disease

2003 ◽  
Vol 284 (4) ◽  
pp. L557-L565 ◽  
Author(s):  
Margaret K. Winkler ◽  
Jane K. Foldes ◽  
Robert C. Bunn ◽  
John L. Fowlkes
Keyword(s):  
Respiratory Failure ◽  
Matrix Metalloproteinases ◽  
Lung Disease ◽  
Lung Development ◽  
Large Family ◽  
Lung Damage ◽  
Gelatinase Activity ◽  
Normal Human ◽  
Pediatric Lung Disease ◽  
Diseased Lung

Matrix metalloproteinases (MMPs) are a large family (>20) of cation-dependent proteinases believed to be important modulators of normal human lung development and potentially harmful mediators of lung damage. Little is known about MMP production and secretion by the lung during childhood or how alterations in MMP levels may be involved in lung damage. We examined endotracheal aspirates from children (<19 years) without lung disease for the presence of MMP activity. Only gelatinase activity was detectable, and inhibitor profiles suggest they represented one or more MMPs. Comparison of gelatinase activity, MMP expression, and MMP activity in children without pulmonary disease with children who required mechanical ventilation for respiratory failure show: 1) gelatinase activity was approximately five- to sixfold higher in respiratory failure; 2) MMP-7, MMP-8, and MMP-9 concentrations and MMP-8 and MMP-9 activities were markedly elevated in respiratory failure; and 3) MMP-7, MMP-8, and MMP-9 levels were significantly correlated in children with lung disease. These studies provide compelling evidence that specific MMPs are present in the diseased lung and may participate in the pathogenesis of pediatric respiratory failure.

scholarly journals The Extent of Ventilator-Induced Lung Injury in Mice Partly Depends on Duration of Mechanical Ventilation

2013 ◽  
Vol 2013 ◽  
pp. 1-11 ◽  
Author(s):  
Maria A. Hegeman ◽  
Sabrine N. T. Hemmes ◽  
Maria T. Kuipers ◽  
Lieuwe D. J. Bos ◽  
Geartsje Jongsma ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Lung Injury ◽  
Capillary Permeability ◽  
Statistical Significance ◽  
Lung Compliance ◽  
Alveolar Cell ◽  
Mechanically Ventilated ◽  
Ventilator Induced Lung Injury ◽  
Cell Counts ◽  
Alveolar Capillary

Background. Mechanical ventilation (MV) has the potential to initiate ventilator-induced lung injury (VILI). The pathogenesis of VILI has been primarily studied in animal models using more or less injurious ventilator settings. However, we speculate that duration of MV also influences severity and character of VILI.Methods. Sixty-four healthy C57Bl/6 mice were mechanically ventilated for 5 or 12 hours, using lower tidal volumes with positive end-expiratory pressure (PEEP) or higher tidal volumes without PEEP. Fifteen nonventilated mice served as controls.Results. All animals remained hemodynamically stable and survived MV protocols. In both MV groups, PaO2to FiO2ratios were lower and alveolar cell counts were higher after 12 hours of MV compared to 5 hours. Alveolar-capillary permeability was increased after 12 hours compared to 5 hours, although differences did not reach statistical significance. Lung levels of inflammatory mediators did not further increase over time. Only in mice ventilated with increased strain, lung compliance declined and wet to dry ratio increased after 12 hours of MV compared to 5 hours.Conclusions. Deleterious effects of MV are partly dependent on its duration. Even lower tidal volumes with PEEP may initiate aspects of VILI after 12 hours of MV.

Cyclosporin A protects lung function from hyperoxic damage

1999 ◽  
Vol 276 (5) ◽  
pp. L786-L795 ◽  
Author(s):  
E. Matthew ◽  
R. Pun ◽  
M. Simonich ◽  
H. Iwamoto ◽  
J. Dedman
Keyword(s):  
Cyclosporin A ◽  
Neutrophil Infiltration ◽  
Lung Compliance ◽  
Lung Damage ◽  
Alveolar Type ◽  
Type Ii Cells ◽  
Protective Effects ◽  
Type Ii ◽  
Lung Weight ◽  
Lung Injuries

Cyclosporin A (CsA), an inhibitor of protein phosphatase 2B (calcineurin), has been shown to play a role in exocytosis and neutrophil mobility. Hyperoxia (>95% oxygen for 72 h) causes lung injury and reduces lung compliance. This model is indicative of deficiencies in surfactant and elicits a vigorous immune response leading to further damage. We examined the effects of CsA on surfactant-secreting lung alveolar type II cells. CsA enhances ATP-stimulated increases in whole cell capacitance in the presence of 2 mM extracellular Ca2+. This measurement corresponds with increases in exocytosis. Because of its effect on the immune system and exocytosis from type II cells, CsA was examined for its protective effects against hyperoxia-induced lung damage in mice. We found that CsA (50 mg ⋅ kg−1 ⋅ day−1) attenuated hyperoxia-induced reductions in lung compliance when administered before or during 72 h of >95% oxygen ( P < 0.05). CsA (10 mg ⋅ kg−1 ⋅ day−1) also had a protective effect against hyperoxia-induced changes in neutrophil infiltration, capillary congestion, edema, and hyaline membrane formation. Wet lung weight-to-dry lung weight ratios did not show any significant changes after hyperoxia or hyperoxia plus CsA ( P < 0.05). CsA may be useful to treat patients undergoing prolonged high-oxygen therapy and possibly other lung injuries.

scholarly journals Rapamycin Regulates Bleomycin-Induced Lung Damage in SP-C-Deficient Mice

2011 ◽  
Vol 2011 ◽  
pp. 1-12 ◽  
Author(s):  
Satish K. Madala ◽  
Melissa D. Maxfield ◽  
Cynthia R. Davidson ◽  
Stephanie M. Schmidt ◽  
Daniel Garry ◽  
...  
Keyword(s):  
Lung Diseases ◽  
Lung Compliance ◽  
Lung Damage ◽  
Small Subset ◽  
Fibrotic Disease ◽  
Rapamycin Treatment ◽  
Interstitial Pulmonary Fibrosis ◽  
Familial Cases ◽  
Therapeutic Administration ◽  
Deficient Mice

Injury to the distal respiratory epithelium has been implicated as an underlying cause of idiopathic lung diseases. Mutations that result in SP-C deficiencies are linked to a small subset of spontaneous and familial cases of interstitial lung disease (ILD) and interstitial pulmonary fibrosis (IPF). Gene-targeted mice that lack SP-C () develop an irregular ILD-like disease with age and are a model of the human SP-C related disease. In the current study, we investigated whether rapamycin could ameliorate bleomycin-induced fibrosis in the lungs of mice. and −/− mice were exposed to bleomycin with either preventative administration of rapamycin or therapeutic administration beginning eight days after the bleomycin injury. Rapamycin-treatment increased weight loss and decreased survival of bleomycin-treated and mice. Rapamycin did not reduce the fibrotic disease in the prophylactic or rescue experiments of either genotype of mice. Further, rapamycin treatment augmented airway resistance and reduced lung compliance of bleomycin-treated mice. Rapamycin treatment was associated with an increased expression of profibrotic Th2 cytokines and reduced expression of INF-γ. These findings indicate that novel therapeutics will be required to treat individuals with SP-C deficient ILD/IPF.

scholarly journals Effects of Lung Expansion Therapy on Lung Function in Patients with Prolonged Mechanical Ventilation

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Yen-Huey Chen ◽  
Ming-Chu Yeh ◽  
Han-Chung Hu ◽  
Chung-Shu Lee ◽  
Li-Fu Li ◽  
...  
Keyword(s):  
Muscle Strength ◽  
Pulmonary Function ◽  
Respiratory Muscle ◽  
Prolonged Mechanical Ventilation ◽  
Lung Compliance ◽  
Respiratory Muscle Strength ◽  
Respiratory Muscle Fatigue ◽  
Pulmonary Atelectasis ◽  
Lung Expansion ◽  
Successful Weaning

Common complications in PMV include changes in the airway clearance mechanism, pulmonary function, and respiratory muscle strength, as well as chest radiological changes such as atelectasis. Lung expansion therapy which includes IPPB and PEEP prevents and treats pulmonary atelectasis and improves lung compliance. Our study presented that patients with PMV have improvements in lung volume and oxygenation after receiving IPPB therapy. The combination of IPPB and PEEP therapy also results in increase in respiratory muscle strength. The application of IPPB facilitates the homogeneous gas distribution in the lung and results in recruitment of collapsed alveoli. PEEP therapy may reduce risk of respiratory muscle fatigue by preventing premature airway collapse during expiration. The physiologic effects of IPPB and PEEP may result in enhancement of pulmonary function and thus increase the possibility of successful weaning from mechanical ventilator during weaning process. For patients with PMV who were under the risk of atelectasis, the application of IPPB may be considered as a supplement therapy for the enhancement of weaning outcome during their stay in the hospital.

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