How I approach membrane lung dysfunction in patients receiving ECMO

Abstract Background: Lung derecruitment is common during general anesthesia. Mechanical ventilation with physiological tidal volumes could magnify derecruitment, and produce lung dysfunction and inflammation. The authors used positron emission tomography to study the process of derecruitment in normal lungs ventilated for 16 h and the corresponding changes in regional lung perfusion and inflammation. Methods: Six anesthetized supine sheep were ventilated with VT = 8 ml/kg and positive end-expiratory pressure = 0. Transmission scans were performed at 2-h intervals to assess regional aeration. Emission scans were acquired at baseline and after 16 h for the following tracers: (1) 18F-fluorodeoxyglucose to evaluate lung inflammation and (2) 13NN to calculate regional perfusion and shunt fraction. Results: Gas fraction decreased from baseline to 16 h in dorsal (0.31 ± 0.13 to 0.14 ± 0.12, P < 0.01), but not in ventral regions (0.61 ± 0.03 to 0.63 ± 0.07, P = nonsignificant), with time constants of 1.5–44.6 h. Although the vertical distribution of relative perfusion did not change from baseline to 16 h, shunt increased in dorsal regions (0.34 ± 0.23 to 0.63 ± 0.35, P < 0.01). The average pulmonary net 18F-fluorodeoxyglucose uptake rate in six regions of interest along the ventral–dorsal direction increased from 3.4 ± 1.4 at baseline to 4.1 ± 1.5⋅10−3/min after 16 h (P < 0.01), and the corresponding average regions of interest 18F-fluorodeoxyglucose phosphorylation rate increased from 2.0 ± 0.2 to 2.5 ± 0.2⋅10−2/min (P < 0.01). Conclusions: When normal lungs are mechanically ventilated without positive end-expiratory pressure, loss of aeration occurs continuously for several hours and is preferentially localized to dorsal regions. Progressive lung derecruitment was associated with increased regional shunt, implying an insufficient hypoxic pulmonary vasoconstriction. The increased pulmonary net uptake and phosphorylation rates of 18F-fluorodeoxyglucose suggest an incipient inflammation in these initially normal lungs.

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The role of surfactant and distal lung dysfunction in the pathology of lysosomal storage diseases

Current Opinion in Physiology ◽

10.1016/j.cophys.2021.100467 ◽

2021 ◽

pp. 100467

Author(s):

Tamara L Paget ◽

Emma J Parkinson-Lawrence ◽

Sandra Orgeig

Keyword(s):

Lysosomal Storage Diseases ◽

Lysosomal Storage ◽

Storage Diseases ◽

Lung Dysfunction ◽

Distal Lung

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Serum IGFBP-2 in systemic sclerosis as a prognostic factor of lung dysfunction

Scientific Reports ◽

10.1038/s41598-021-90333-0 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Julien Guiot ◽

Makon-Sébastien Njock ◽

Béatrice André ◽

Fanny Gester ◽

Monique Henket ◽

...

Keyword(s):

Systemic Sclerosis ◽

Prognostic Factor ◽

Pulmonary Function ◽

Lung Disease ◽

Pulmonary Function Tests ◽

Serum Levels ◽

Roc Curve Analysis ◽

Significant Deterioration ◽

Lung Dysfunction

AbstractSystemic sclerosis (SSc) is a rare connective tissue disease associated with rapid evolving interstitial lung disease (ILD), driving its mortality. Specific biomarkers associated with the progression of this lung disease are highly needed. We aimed to identify specific biomarkers of SSc-ILD to predict the evolution of the disease. For this, we compared prospectively serum levels of several biomarkers associated with lung fibrosis in SSc patients (n = 102), among which SSc-no ILD (n = 63) and SSc-ILD (n = 39), compared to healthy subjects (HS) (n = 39). We also performed a longitudinal study in a subgroup of 28 patients analyzing biomarkers variations and pulmonary function tests over a period of 2 years. Serum level of IGFBP-2 was significantly increased in SSc patients compared to HS, and negatively correlated with pulmonary function (assessed by carbon monoxide transfer coefficient (KCO)) (r = − 0.29, p < 0.01). Two-year longitudinal analysis in a subgroup of 28 SSc patients determined that IGFBP-2 variation was positively correlated with KCO at 2-year follow-up (r = 0.6, p < 0.001). SSc patients with a lower variation of IGFBP-2 (less than 22%) presented significant deterioration of pulmonary function at 2-year follow-up (p < 0.01). ROC curve analysis enabled us to identify that baseline IGFBP-2 > 105 ng/ml was associated with a poor outcome (KCO < 70% predicted) at 2-year follow-up (AUC = 0.75, p < 0.05). We showed for the first time that serum levels of IGFBP-2 might be a prognostic factor of the development of SSc-ILD.

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A simple and inexpensive membrane “lung” for small organ perfusion

The Journal of Lipid Research ◽

10.1016/s0022-2275(20)36824-3 ◽

1974 ◽

Vol 15 (2) ◽

pp. 182-186

Author(s):

R.L. Hamilton ◽

M.N. Berry ◽

M.C. Williams ◽

E.M. Severinghaus

Keyword(s):

Organ Perfusion ◽

Membrane Lung

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Can Alveolar-Arterial Difference and Lung Ultrasound Help the Clinical Decision Making in Patients with COVID-19?

Diagnostics ◽

10.3390/diagnostics11050761 ◽

2021 ◽

Vol 11 (5) ◽

pp. 761

Author(s):

Gianmarco Secco ◽

Francesco Salinaro ◽

Carlo Bellazzi ◽

Marco La Salvia ◽

Marzia Delorenzo ◽

...

Keyword(s):

Decision Making ◽

Clinical Decision Making ◽

Lung Ultrasound ◽

Signs And Symptoms ◽

Clinical Decision ◽

Arterial Oxygen ◽

Arterial Blood Gas ◽

Arterial Blood ◽

Lung Dysfunction ◽

Close Relationship

Background: COVID-19 is an emerging infectious disease, that is heavily challenging health systems worldwide. Admission Arterial Blood Gas (ABG) and Lung Ultrasound (LUS) can be of great help in clinical decision making, especially during the current pandemic and the consequent overcrowding of the Emergency Department (ED). The aim of the study was to demonstrate the capability of alveolar-to-arterial oxygen difference (AaDO2) in predicting the need for subsequent oxygen support and survival in patients with COVID-19 infection, especially in the presence of baseline normal PaO2/FiO2 ratio (P/F) values. Methods: A cohort of 223 swab-confirmed COVID-19 patients underwent clinical evaluation, blood tests, ABG and LUS in the ED. LUS score was derived from 12 ultrasound lung windows. AaDO2 was derived as AaDO2 = ((FiO2) (Atmospheric pressure − H2O pressure) − (PaCO2/R)) − PaO2. Endpoints were subsequent oxygen support need and survival. Results: A close relationship between AaDO2 and P/F and between AaDO2 and LUS score was observed (R2 = 0.88 and R2 = 0.67, respectively; p < 0.001 for both). In the subgroup of patients with P/F between 300 and 400, 94.7% (n = 107) had high AaDO2 values, and 51.4% (n = 55) received oxygen support, with 2 ICU admissions and 10 deaths. According to ROC analysis, AaDO2 > 39.4 had 83.6% sensitivity and 90.5% specificity (AUC 0.936; p < 0.001) in predicting subsequent oxygen support, whereas a LUS score > 6 showed 89.7% sensitivity and 75.0% specificity (AUC 0.896; p < 0.001). Kaplan–Meier curves showed different mortality in the AaDO2 subgroups (p = 0.0025). Conclusions: LUS and AaDO2 are easy and effective tools, which allow bedside risk stratification in patients with COVID-19, especially when P/F values, signs, and symptoms are not indicative of severe lung dysfunction.

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Glutathione Replacement Preserves the Functional Surfactant Phospholipid Pool Size and Decreases Sepsis-Mediated Lung Dysfunction in Ethanol-Fed Rats

Alcoholism Clinical and Experimental Research ◽

10.1111/j.1530-0277.2002.tb02663.x ◽

2002 ◽

Vol 26 (8) ◽

pp. 1245-1251 ◽

Cited By ~ 57

Author(s):

Alvaro Velasquez ◽

Rabih I. Bechara ◽

James F. Lewis ◽

Jaret Malloy ◽

Lynda McCaig ◽

...

Keyword(s):

Pool Size ◽

Lung Dysfunction ◽

Phospholipid Pool

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A classification system for severity of lung dysfunction after lung transplantation: a predictor of outcome

The Journal of Heart and Lung Transplantation ◽

10.1016/s1053-2498(00)00491-5 ◽

2001 ◽

Vol 20 (2) ◽

pp. 223 ◽

Cited By ~ 1

Author(s):

Y. Sekine ◽

T. Waddell ◽

A. Matte-Martyn ◽

A. Pierre ◽

M. Deperrot ◽

...

Keyword(s):

Lung Transplantation ◽

Classification System ◽

Lung Dysfunction

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Artificial “membrane lung”

Biomedical Engineering ◽

10.1007/bf00557833 ◽

1976 ◽

Vol 10 (4) ◽

pp. 236-240

Author(s):

A. A. Pisarevskii ◽

A. S. Doletskii ◽

P. V. Kutepov ◽

A. B. Karasev

Keyword(s):

Artificial Membrane ◽

Membrane Lung

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Exogenous Surfactant Therapy for Pediatric Patients with Acute Respiratory Distress Syndrome

Canadian Respiratory Journal ◽

10.1155/1997/903459 ◽

1997 ◽

Vol 4 (1) ◽

pp. 21-26 ◽

Cited By ~ 13

Author(s):

James F Lewis ◽

Jasvinder S Dhillon ◽

Ram N Singh ◽

Craig C Johnson ◽

Timothy C Frewen

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Pilot Study ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Pediatric Patients ◽

Distress Syndrome ◽

Exogenous Surfactant ◽

Lung Dysfunction ◽

Surfactant Administration ◽

Severe Lung

Exogenous surfactant administration is currently being tested in patients with the acute respiratory distress syndrome (ARDS). The results of the studies have varied because several factors may influence the host’s response to this therapy. This clinical pilot study was designed to evaluate the safety and efficacy of exogenous surfactant administration in pediatric patients with ARDS. Surfactant was administered to 13 patients with severe lung dysfunction, and eight of these patients experienced a significant improvement in oxygenation after the first dose of surfactant. In these patients the exogenous surfactant was administered within 48 h of the diagnosis of ARDS, whereas in the five patients who did not respond, surfactant was administered several days after the onset of ARDS. Responders also spent fewer days on a mechanical ventilator and less time in intensive care compared with nonresponders. Based on the results of this pilot study, a more appropriate multicentre clinical trial should be designed to evaluate this treatment strategy.

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