胸腔血容量指数与外肺水指数对烧伤患者肺水肿的早期预测价值

目的研究胸腔血容量指数与外肺水指数对烧伤患者肺水肿的早期预测价值。方法选取2013年1月到2014年12月在我院烧伤科接受治疗及Pi CCO检测且伤后10天内发生肺水肿的严重烧伤患者42例,根据患者肺水肿类型分为肺损伤型组与静水压型组,对比两组Pi CCO监测指标及肺损伤评分,探索EVLWI与ITBVI、氧合指数的相关性。结果两组患者EVLWI水平相差不大,但静水压型组ITBVI及氧合指数均明显大于非损伤组,Murray评分明显低于肺损伤组;EVLWI与ITBVI呈显著正相关性,r=0.921,P0.05;EVLWI与氧合指数呈明显的负相关性,r=-0.718,P0.05。结论烧伤早期实行监测胸腔血容量指数与外肺水指数对患者发生肺水肿预测和鉴别具有重要参考意义。     

‘Lung age’ predicts post‐operative complications and survival in lung cancer patients

Background and objective: The Japanese Respiratory Society recently proposed ‘lung age’ as an easily understood concept of respiratory function. In this study, we evaluated whether ‘lung age’ could be a useful predictor of post‐operative respiratory complications and survival patients with lung cancer treated surgically. Methods: The study recruited 308 patients who underwent surgery for primary non‐small‐cell lung cancer. All patients had preoperative pulmonary function testing. ‘Lung age’ was determined using the methods advocated by the Japanese Respiratory Society. Based on the difference between ‘real age’ (R) and ‘lung age’ (L), patients were classified into five groups: group A: R?L > 15 (n = 37), B: 5 < R?L ≤ 15 (n = 50), C: ?5 ≤ R?L ≤ 5 (n = 73), D: ?15 ≤ R?L < ?5 (n = 54), E: ?15 > R?L (n = 94). Clinicopathological factors, post‐operative respiratory complications and survival were compared between the groups. Results: Gender, smoking status and index, histology, operative approach and FEV₁ were significantly associated with the group classification. The incidence of complications was significantly higher in group E compared with other groups (P = 0.003). Multivariate analysis showed that the group classification by ‘lung age’ was an independent predictor of post‐operative respiratory complications (P = 0.02). Overall survival differed significantly between the groups (P = 0.03). Conclusions: ‘Lung age’ could be useful for the prediction of post‐operative respiratory complications and survival in patients with lung cancer treated surgically.     

Transfusion‐related acute lung injury after intravenous immunoglobulin treatment in a lung transplant recipient

Three weeks after single‐lung transplantation for pulmonary fibrosis, a patient with high serum levels of de novo donor‐specific antibodies received high‐dose intravenous immunoglobulin (IVIG) infusion (scheduled dose: 2 g/kg on 2 days) to prevent antibody‐mediated rejection. Within the first hours after completion of infusions, he experienced acute lung injury involving the transplanted lung. Given the clinical evolution and the absence of an alternative diagnosis, transfusion‐related acute lung injury (TRALI) was diagnosed. The IVIG administered on each day was from the same batch. At day 110, because of an increase in the serum titers of donor‐specific antibodies, IVIG therapy was reintroduced but from a different batch, with excellent clinical tolerance. The lung injury was explored biologically, but no mechanism was revealed. Given the increasing use of IVIG in solid‐organ recipients, clinicians should be aware of possible TRALI after IVIG infusion.     

Occult nodal metastasis in patients with non‐small cell lung cancer at clinical stage IA by PET/CT

Background and objective: The introduction of ¹⁸F‐FDG PET/CT has enhanced the diagnostic accuracy of nodal staging for non‐small cell lung cancer (NSCLC). We analysed risk factors for occult nodal metastasis in patients with clinical stage IA NSCLC as determined by ¹⁸F‐FDG PET/CT. Methods: Data for 147 patients diagnosed as clinical stage IA NSCLC by PET/CT from 2005 to 2007 were retrospectively reviewed. All study patients underwent ¹⁸F‐FDG PET/CT for lung cancer staging. They also underwent cervical mediastinoscopy or systematic lymph node dissection. Results: Cervical mediastinoscopy was performed in 78 patients (53.1%), and N2 involvement was detected in 3.8% (3/78) of these patients. Thoracotomy with systematic lymph node dissection was done in 144 patients. Four patients (2.8%, 4/144) were diagnosed with N2 disease after systematic lymph node dissection. Total N2 involvement was 4.8% (7/147). As 9.5% (14/147) of study patients had N1 disease, 14.3% (21/147) of patients had occult nodal (N1 or N2) metastasis. In univariate analyses, larger tumour size and a higher primary tumour maximum standardized uptake value >7.3 (SUV_max) were associated with occult nodal metastasis. Multivariate analysis demonstrated that a primary tumour SUV_max >7.3 was an independent predictor of occult nodal metastasis (odds ratio: 7.574; P = 0.001). Conclusions: Preoperative PET/CT scans contribute to reduce the frequency of occult nodal metastasis compared with those reported in the pre‐PET/CT era. The higher SUV_max in primary tumour was an independent predictor of occult nodal metastasis in patients with clinical stage IA NSCLC by PET/CT.     

Antibody‐mediated transfusion‐related acute lung injury; from discovery to prevention

Transfusion‐related acute lung injury (TRALI), a syndrome of respiratory distress caused by blood transfusion, is the leading cause of transfusion‐related mortality. The majority of TRALI cases have been related to passive infusion of human leucocyte antigen (HLA) and human neutrophil antigen (HNA) antibodies in donor blood. In vitro, ex vivo and in vivo animal models have provided insight in TRALI pathogenesis. The various classes of antibodies implicated in TRALI appear to have different pathophysiological mechanisms for the induction of TRALI involving endothelial cells, neutrophils, monocytes and, as very recently has been discovered, lymphocytes. The HLA and HNA‐antibodies are found mainly in blood from multiparous women as they have become sensitized during pregnancy. The incidence of TRALI has decreased rapidly following the introduction of a male‐only strategy for plasma donation. This review focuses on pre‐clinical and clinical studies investigating the pathophysiology of antibody‐mediated TRALI.     

Vaping‐associated lung injury caused by inhalation of cannabis oil

Vaping is a growing concern in adolescents, and a growing proportion is using electronic devices to inhale cannabis oil. The short‐term and long‐term effects of cannabis oil inhalation are not well understood. We report on a case of severe acute lung injury secondary to inhalation of cannabis oil via a vape pen, and propose a new term that describes lung injury related to vaping.     

Transfusion‐related acute lung injury risk mitigation: an update

Transfusion‐related acute lung injury (TRALI) is a life‐threatening complication of transfusion. Greater understanding of the pathophysiology of this syndrome has much improved during the last two decades. Plasma‐containing components from female donors with leucocyte antibodies were responsible for the majority of TRALI fatalities before mitigation strategies were implemented. Over the past 15 years, measures to mitigate risk for TRALI have been implemented worldwide and they continued to evolve with time. The AABB requires that all plasma containing components and whole blood for transfusion must be collected from men, women who have not been pregnant, or women who have tested negative for human leucocyte antigen antibodies. Although the incidence of TRALI has decreased following the institution of TRALI mitigation strategies, TRALI is still the most common cause of transfusion‐associated death in the United States. In this review, we focus on TRALI risk mitigation strategies. We describe the measures taken by blood collection facilities to reduce the risk of TRALI in the United States, Canada and European countries. We also review the literature for the effectiveness of these measures.     

High MW hyaluronan inhibits smoke inhalation‐induced lung injury and improves survival

Background and objective: High MW hyaluronan (HMW HA) as opposed to low MW hyaluronan (LMW HA) has been shown to have anti‐inflammatory and anti‐apoptotic effects. We hypothesized that treatment with HMW HA would block smoke inhalation lung injury by inhibiting smoke‐induced lung inflammation and airway epithelial cell apoptosis. Methods: Anesthetized, intubated male rats were randomly allocated to either control or smoke inhalation injury groups. Rats were treated with 3‐mL subcutaneous normal saline solution (sham) or LMW HA (35 kDa) or HMW HA (1600 kDa) 18 h before exposure to 15 min of cotton smoke (n = 5 each). Rats were also treated post smoke inhalation with 1600 kDa HA by intra‐peritoneal injection (3 mL) or intra‐tracheal nebulization (200 µL). Lung neutrophil infiltration, airway apoptosis, airway mucous plugging and lung injury were assessed 4 h after smoke inhalation injury. Results: Rats pretreated with 1600 kDa HA had significantly less smoke‐induced neutrophil infiltration, lung oedema, airway apoptosis and mucous plugging. Pretreatment with 35 kDa HA, in contrast, increased smoke‐induced neutrophil infiltration and lung injury score. Intra‐tracheal administration of a single dose 1600 kDa HA, but not intra‐peritoneal injection, significantly improved survival post smoke inhalation. Conclusions: High MW hyaluronan (1600 kDa) may prove to be a beneficial therapy for smoke inhalation through inhibition of smoke‐induced inflammation, lung oedema, airway epithelial cell apoptosis and airway mucous plugging.     

Bronchoscopic bullectomy with a one‐way endobronchial valve to treat a giant bulla in an emphysematic lung: a case report

The conventional treatment for giant bullae in patients with chronic obstructive pulmonary disease is surgical bullectomy, but it is not possible in some patients with poor lung function. Bronchoscopic bullectomy involving implantation of an endobronchial valve (EBV) has emerged as a potential alternative. Here we describe how EBV implantation in a bullous emphysema with a giant bulla in the right middle lobe led to elimination of the bulla and improvements in pulmonary function, 6‐min walking distance during the 1‐year follow‐up. Our case suggests that bronchoscopic bullectomy with an EBV can be a safe and effective alternative to surgical bullectomy.     

Effects of bracing on lung function in idiopathic juvenile kyphosis

Although considerable information is available on the effects of bracing on lung function in kyphoscoliosis, there is a paucity of data on idiopathic juvenile kyphosis (IJK). The present study was designed to investigate the immediate effect of bracing on lung function in children and adolescents with mild-to-moderate IJK. Spirometry, measurement of lung volumes, and arterial oxyhemoglobin saturation (SaO(2)) were performed in 24 patients, 9-17 years of age, who were treated with a corrective brace for mild-to-moderate IJK (Cobb angle, 46-75 degrees ). Children were studied when braced and unbraced.When children were unbraced, mean percent predicted values (+/-standard deviation) for total lung capacity (TLC), vital capacity (VC), functional residual capacity (FRC), and forced expiratory volume in 1 sec (FEV(1)) were 100.0% (+/-13.0%), 92.7% (+/-14.2%), 108.2% (+/-20.4%), and 95.0% (+/-16.3%), respectively. With the brace on, significant reductions occurred in all lung function measurements: TLC decreased by 9.5% (P < 0.001), VC by 9.3% (P = 0.001), FRC by 14.2% (P = 0.005), and FEV(1) by 8.9% (P = 0.009). SaO(2) decreased from 96.2% (+/-1.6%) to 95.2% (+/-1.4%) (P = 0.027). An inverse relationship was observed between pre- and postbracing change in TLC and Cobb angle children (P = 0.021).Our findings indicate that corrective bracing in mild-to-moderate IJK results in mild lung restriction and a clinically insignificant drop in SaO(2). The effect of bracing on TLC decreases as the severity of kyphosis increases in these patients.