scholarly journals Evaluation of Recruited Lung Volume at Inspiratory Plateau Pressure With PEEP Using Bedside Digital Chest X-ray in Patients With Acute Lung Injury/ARDS

2013 ◽  
Vol 58 (3) ◽  
pp. 416-423 ◽  
Author(s):  
F. Wallet ◽  
B. Delannoy ◽  
A. Haquin ◽  
S. Debord ◽  
V. Leray ◽  
...  
Keyword(s):  
Acute Lung Injury ◽  
Lung Injury ◽  
Lung Volume ◽  
Plateau Pressure ◽  
X Ray ◽  
Digital Chest ◽  
Chest X Ray

scholarly journals Transfusion-related acute lung injury (TRALI) in two thalassaemia patients caused by the same multiparous blood donor

2017 ◽  
Vol 9 (1) ◽  
pp. e2017060
Author(s):  
George J Kontoghiorghes
Keyword(s):  
Acute Lung Injury ◽  
Lung Injury ◽  
Blood Donor ◽  
Intensive Therapy ◽  
Hla Antigens ◽  
Hla Class I ◽  
Intensive Therapy Unit ◽  
X Ray ◽  
Red Blood Cell Transfusions ◽  
Chest X Ray

Two separate episodes of transfusion-related acute lung injury (TRALI) in thalassaemia patients caused by red blood cell transfusions from the same multiparous blood donor are reported. Both cases had the same symptomatology and occurred 10-60 minutes of transfusion. The patients presented dyspnea, sweating, fatigue, dizziness, fever, and sense of losing consciousness. The chest x-ray showed a pulmonary oedema-like picture with both lungs filled with fluid. The patients were treated in the intensive therapy unit. They were weaned off the ventilator and discharged following hospitalization 7 and 9 days respectively. The TRALI syndrome was diagnosed to be associated with HLA-specific donor antibodies against mismatched HLA-antigens of the transfused patients. Haemovigilance improvements are essential for reducing the morbidity and mortality in transfused patients. Blood from multiparous donors should be tested for the presence of IgG HLA-Class I and –Class II antibodies before being transfused in thalassaemia and other chronically transfused patients.

scholarly journals Transfusion related acute lung injury-TRALI: a review

2019 ◽  
Vol 7 (5) ◽  
pp. 1985
Author(s):  
Javier Alcazar-Castro ◽  
Alejandro Zarate-Aspiros ◽  
Elias Andrade-Cuellar ◽  
Brenda Alvarez-Perez ◽  
Alan I. Valderrama-Treviño ◽  
...  
Keyword(s):  
Acute Lung Injury ◽  
Lung Injury ◽  
Bacterial Contamination ◽  
Biological Response ◽  
Sudden Onset ◽  
X Ray ◽  
Pulmonary Damage ◽  
Hemodynamic Overload ◽  
Chest X Ray ◽  
Complications Of Blood Transfusion

Acute pulmonary damage caused by transfusion is characterized by the sudden onset of respiratory distress in newly transfused patients within 6 hours after the transfusion, bilateral infiltrative changes in chest X-ray, PaO2/FIO2 <300 mmHg, absence of other risk factors for acute lung injury and absence of signs suggesting cardiogenic origin of pulmonary edema. Being one of the most serious complications of blood transfusion, plasma is the most involved factor, although all blood components can cause it, and is caused by antigen reactions/leukocyte antibody and lipid activity with ability to modify the biological response on primitive leukocytes. The diagnosis is based on the integration of clinical, radiological and gasometric elements, ruling out the rest of the possible causes of acute lung injury. Its differential diagnosis should include hemodynamic overload, anaphylactic reaction, bacterial contamination of transfused blood products and transfusion hemolytic reaction. The treatment is supportive measures based on the needs and does not differ from the treatment of acute lung injury secondary to other etiologies, severe cases require endotracheal intubation and mechanical ventilation while the non-severe can be managed with oxygen therapy.

scholarly journals Acute Lung Injury – From Pathophysiology to Treatment

2021 ◽  
pp. S353-S366
Author(s):  
D Mokra
Keyword(s):  
Acute Lung Injury ◽  
Lung Injury ◽  
Lung Compliance ◽  
Acute Onset ◽  
Consensus Conference ◽  
Response To Treatment ◽  
Lung Protective Ventilation ◽  
General Description ◽  
X Ray ◽  
Chest X Ray

Acute lung injury is characterized by acute respiratory insufficiency with tachypnea, cyanosis refractory to oxygen, decreased lung compliance, and diffuse alveolar infiltrates on chest X-ray. The 1994 American-European Consensus Conference defined “acute respiratory distress syndrome, ARDS” by acute onset after a known trigger, severe hypoxemia defined by PaO2/FiO2≤200 mm Hg, bilateral infiltrates on chest X-ray, and absence of cardiogenic edema. Milder form of the syndrome with PaO2/FiO2 between 200-300 mm Hg was named „acute lung injury, ALI“. Berlin Classification in 2012 defined three categories of ARDS according to hypoxemia (mild, moderate, and severe), and the term “acute lung injury” was assigned for general description or for animal models. ALI/ARDS can originate from direct lung triggers such as pneumonia or aspiration, or from extrapulmonary reasons such as sepsis or trauma. Despite growing understanding the ARDS pathophysiology, efficacy of standard treatments, such as lung protective ventilation, prone positioning, and neuromuscular blockers, is often limited. However, there is an increasing evidence that direct and indirect forms of ARDS may differ not only in the manifestations of alterations, but also in the response to treatment. Thus, individualized treatment according to ARDS subtypes may enhance the efficacy of given treatment and improve the survival of patients.

Interstitial Pneumonia in Patients with Idhiopatic Thrombocytopenic Purpura.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 3953-3953
Author(s):  
Vincenzo Fontana ◽  
Elio Donna ◽  
Pamela Dudkiewicz ◽  
Gabriella Lander ◽  
Yeon S. Ahn
Keyword(s):  
Acute Lung Injury ◽  
Pulmonary Fibrosis ◽  
Lung Injury ◽  
Interstitial Pneumonia ◽  
Lung Diseases ◽  
Interstitial Lung Diseases ◽  
Mild Symptom ◽  
Thrombocytopenic Purpura ◽  
X Ray ◽  
Chest X Ray

Abstract INTRODUCTION: Idhiopatic thrombocytopenic purpura (ITP) is an autoimmune disease characterized by a premature destruction of platelets by macrophage, especially in the spleen. However in some cases, platelet sequestration and destruction may occur in other organs. Chromium labeled platelet sequestration study revealed that liver or precordial area are prominent sites of sequestration in some cases, suggesting that the lung might be the site in certain cases. Some cases of interstitial pneumonia are associated with immunologic injury to the lung and seen in patients with some autoimmune diseases, infections, drugs and transfusion related acute lung injury (TRALI) in which transfusions of platelets and blood products induce acute lung injury due to sequestration of platelets and neutrophils in lungs, sometimes leading to ARDS. We describe here an unusual association between ITP and interstitial pneumonia, suggesting that a lung injury similar to TRALI is involved in acute and recurrent ITP. METHODS: We have identified patients with ITP who developed interstitial pneumonia during the course of ITP. We reviewed their charts and analyzed their clinical courses of ITP and interstitial lung diseases. Laboratory tests and chest X ray or CAT scans were reviewed. The laboratory study included CBC, platelets and platelets activation was measured by PMP (platelet microparticles), expression of CD62p flowcytometrically. RESULTS: We have identified 6 patients with ITP who developed interstitial pneumonia during the course of ITP. In two of six, interstitial pneumonia was detected at the presentation of acute ITP. ITP was severe with platelet counts less than 10.000. Interstitial pneumonia was discovered incidentally by chest X ray and confirmed by CAT scans. A mild symptom of dyspnea was detected in careful examination. One underwent lung biopsy which showed findings consistent with brochiolitis obliterans organizing pneumonia. Repeated CAT scans in 1–3 months revealed marked improvement but residual interstitial infiltrates still persisted. Four others had a long standing chronic ITP with clinical courses characterized by frequent relapses in spite of surgical and medical therapy. Four of six patients had splenectomy. Interstitial lung diseases were detected at the time of a severe relapse with platelet counts of less than 20.000. One patient underwent chromium labeled platelet sequestration study which revealed rapid sequestration of platelets in the lung. Interstitial infiltrates improved following improvement of ITP but two progressed to interstitial pulmonary fibrosis. CD62P measured by flowcytometry was very high in all 3 patients tested, indicating persisting platelet activation in this clinical setting. SUMMARY: We report interstitial pneumonia developing in 6 patients with ITP. Clinically all were asymptomatic and detection of interstitial pneumonia was incidental radiology finding. A mild symptom of exertional dyspnea was present in careful investigation. Chest X ray or CT scans showed nonspecific interstitial infiltrates and showed an overall improvement within months but residual infiltrates persisted. Two progressed to pulmonary fibrosis. We suggest that platelets are sequestered and destroyed in the lung in some patients with ITP, to generate cytokines and lipid mediators that lead to a nonspecific interstitial lung disease.

Complement Activation in Transfusion Related Acute Lung Injury (TRALI).

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 954-954
Author(s):  
Daniel R. Ambruso ◽  
Christopher C. Silliman ◽  
Marguerite Kelher ◽  
Gail Thurman ◽  
Patsy Giclas
Keyword(s):  
Acute Lung Injury ◽  
Lung Injury ◽  
Complement Activation ◽  
Class Ii ◽  
Hla Class Ii ◽  
X Ray ◽  
Factor Xi Deficiency ◽  
Activation Products ◽  
Chest X Ray ◽  
Priming Activity

Abstract Background: TRALI is defined as acute lung injury occurring within six hours of a transfusion of blood products. Two major etiologies have been identified and include leukocyte antibodies activating complement. We report two patients with TRALI reactions who had documented activation of complement. Case Studies. Case 1: A 59 year old male with Factor XI deficiency and hematochezia was given 3 units of fresh frozen plasma (FFP). During infusion of the third unit, the patient developed dyspnea and cyanosis requiring ventilator support. A chest x-ray showed new diffuse infiltrates; CVP and an echocardiogram were normal. The symptoms resolved in 3 days. Case 2: An 87 year old female required surgical repair of a hip fracture. Four units were infused and with the last one, the patient developed chills, fever and tachypnea. On 6 l/min of O2, she had a saturation of 58%. Chest x-ray showed bilateral infiltrates; the echocardiogram was normal. The patient sustained a cardiac arrest and could not be resuscitated. Methods: Samples from donors or FFP units were screened for HLA and granulocyte antibodies. Priming of the fMLP stimulated neutrophil oxidase activity was performed by standard assay. Plasma from products implicated in TRALI and plasma samples from patients before and during the TRALI reaction were assayed for priming of the fMLP stimulated respiratory burst in neutrophils; C3a, C4a, C5a, C5–9, and Bb were measured by standard techniques. Results: In Case 1, HLA Class II, IgG reactivity by flow cytometry was documented with plasma from the implicated donor and recipient cells. Priming of neutrophils was detected in the implicated unit as well as the recipient’s plasma during the reaction in comparison to pre-transfusion specimen. Complement activation products were increased in samples during the reaction and the product being infused at the onset of TRALI. In the second case, HLA Class II antibodies with a specificity which would interact with the recipient’s antigens were detected in the product related to the TRALI reaction. Priming activity of the neutrophil oxidase was documented in the infused product and in post vs. pre reaction patient samples. Complement activation products were increased in the implicated FFP unit and C5a was increased in the patient’s post samples. Additional cases are being assessed for complement activation. Conclusions: In these cases of TRALI, the implicated products exhibited priming activity as well as antibodies which reacted with recipient antigens by flow crossmatch or by documentation of the cognate antigen. Complement activation was documented in patient samples during the reaction as opposed to those collected before the transfusion. Most importantly, complement was activated in the product transfused during the onset of TRALI symptoms. Thus, complement activation in the product is the most likely cause of the TRALI reaction. Infusion of products containing activated complement components may provide an alternative mechanism for TRALI reactions.

scholarly journals Effect of Recruitment and Body Positioning on Lung Volume and Oxygenation in Acute Lung Injury Model

2008 ◽  
Vol 36 (6) ◽  
pp. 792-797 ◽  
Author(s):  
H. G. Ryu ◽  
J.-H. Bahk ◽  
H.-J. Lee ◽  
J.-G. Im
Keyword(s):  
Acute Lung Injury ◽  
Oleic Acid ◽  
Lung Injury ◽  
Lung Volume ◽  
Supine Position ◽  
Recruitment Manoeuvre ◽  
Prone Positioning ◽  
Dependent Lung ◽  
Arterial Blood Gas ◽  
Arterial Blood

The mechanism of oxygenation improvement after recruitment manoeuvres or prone positioning in acute lung injury or acute respiratory distress syndrome is still unclear. We tried to determine the mechanism responsible for the effects of recruitment manoeuvres or prone positioning on lung aeration using a whole lung computed tomography scan in an oleic acid induced acute lung injury canine model. Twelve adult mongrel dogs were allocated into either the supine group (n=6) or the prone group (n = 6). After the establishment of acute lung injury, three recruitment manoeuvres were performed at one-hour intervals. Haemodynamic and ventilatory variables, arterial blood gas analyses and CT scans of the whole lung were obtained 90 minutes after oleic acid injection and five minutes before and after each recruitment manoeuvre. Recruitment manoeuvres in the supine position improved oxygenation (P=0.025) that correlated with increase of the poorly- and well-aerated dorsal (dependent) lung volume (r=0.436, P=0.016). Prone positioning increased oxygenation (P=0.004) that also correlated with increase of the poorly- and well-aerated dorsal (nondependent) lung volume (r=0.787, P <0.001). However, the recruitment manoeuvre in the prone position had no effect on oxygenation despite an increase in ventral (dependent) lung volume. The increase in PO2 after recruitment manoeuvres in the supine position or after prone positioning is related to the increase of the poorly- and well-aerated dorsal lung.

Acute lung injury monitored with radiolabelled transferrin and lung volume measurements

1989 ◽  
Vol 33 (5) ◽  
pp. 359-368 ◽  
Author(s):  
T. Wetterberg ◽  
E. Svensjö ◽  
A. Larsson ◽  
G. Sigurdsson ◽  
Z. G-Wagner ◽  
...  
Keyword(s):  
Acute Lung Injury ◽  
Lung Injury ◽  
Lung Volume ◽  
Lung Volume Measurements ◽  
Volume Measurements

Effects of frequency and inspiratory plateau pressure during recruitment manoeuvres on lung and distal organs in acute lung injury

2009 ◽  
Vol 35 (6) ◽  
pp. 1120-1128 ◽  
Author(s):  
Paula W. Steimback ◽  
Gisele P. Oliveira ◽  
Andréia F. Rzezinski ◽  
Pedro L. Silva ◽  
Cristiane S. N. B. Garcia ◽  
...  
Keyword(s):  
Acute Lung Injury ◽  
Lung Injury ◽  
Plateau Pressure

scholarly journals Chest x-ray findings versus lung volume as measured by the SF6 washout technique in ventilated preterm infants. † 1606

1997 ◽  
Vol 41 ◽  
pp. 270-270
Author(s):  
Ulrich Thome ◽  
Andreas Töpfer ◽  
Peter Schaller ◽  
Frank Pohlandt
Keyword(s):  
Preterm Infants ◽  
Lung Volume ◽  
X Ray ◽  
Chest X Ray

scholarly journals Automated chest radiograph diagnosis: A Twofer for Tuberculosis and Covid-19

2020 ◽  
Author(s):  
Mitushi Verma ◽  
Deepak Patkar ◽  
Madhura Ingalharikar ◽  
Amit Kharat ◽  
Pranav Ajmera ◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
X Ray ◽  
Recent Onset ◽  
Radiology Reports ◽  
Fast Spreading ◽  
Digital Chest ◽  
Chest X Ray ◽  
End To End ◽  
The Times

AbstractCoronavirus disease (Covid 19) and Tuberculosis (TB) are two challenges the world is facing. TB is a pandemic which has challenged mankind for ages and Covid 19 is a recent onset fast spreading pandemic. We study these two conditions with focus on Artificial Intelligence (AI) based imaging, the role of digital chest x-ray and utility of end to end platform to improve turnaround times. Using artificial intelligence assisted technology for triage and creation of structured radiology reports using an end to end platform can ensure quick diagnosis. Changing dynamics of TB screening in the times of Covid 19 pandemic have resulted in bottlenecks for TB diagnosis. The paper tries to outline two types of use cases, one is COVID-19 screening in a hospital-based scenario and the other is TB screening project in mobile van setting and discusses the learning of these models which have both used AI for prescreening and generating structured radiology reports.

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