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PubMed1979

Demonstration of interlobar collateral ventilation.

In an ongoing series of experiments on mongrel dogs, three dogs were observed to have incomplete lobar fissures (interlobar connection present) between the left upper and left lower lobes. With the interlobar connection unclamped, selective hypoxia of the left lower lobe caused the electromagnetically measured blood flow to the left lower lobe to decrease 41 +/- 4%, whereas with the interlobar connection clamped selective hypoxia of the left lower lobe caused a 52 +/- 4% decrease in left lower lobe flow (P less than 0.05). Following 100% O2 ventilation and with the interlobar connection unclamped, complete occlusion of the left lower lobe bronchus caused no atelectasis or decrease in left lower lobe blood flow, whereas with the interlobar connection clamped complete occlusion of the left lower lobe bronchus caused complete left lower lobe atelectasis and a 58 +/- 3% decrease in left lower lobe blood flow. Histological confirmation of interlobar pulmonary parenchymal connection was obtained in each dog. We conclude that a sufficient amount of interlobar collateral ventilation can occur in dogs with incomplete lobar fissures to prevent absorption atelectasis and alter lobar blood flow reduction usually caused by selective lobar hypoxia.

Animals↗
PubMed1994

Lung parenchyma and type II cell morphometrics: effect of surfactant treatment on preterm ventilated lamb lungs.

The effect of exogenous surfactant treatment on lung and type II cell structure of ventilated lambs of 137-138 days gestational age was studied. Thirty-four lambs were delivered and randomized to control or 100 mg/kg of natural sheep surfactant treatment groups. Lungs from one group of lambs not treated with surfactant were fixed before ventilation, and the other animals were ventilated to maintain normal blood gas values for 3, 24, or 48 h. Morphometric assessment of the inflation-fixed lung parenchyma of ventilated lungs was compared with the architectural appearance of alveoli and alveolar ducts in the unventilated lungs. Mechanical ventilation resulted in distension of alveolar ducts accompanied by the shallowing and loss of well-defined alveoli and areas of atelectasis at 3 h. These abnormalities increased in severity after 24 and 48 h of ventilation. Surfactant treatment before ventilation significantly reduced the extent and degree of dilatation and concomitant atelectasis. The fraction of normal parenchyma was 38 +/- 7% in untreated lambs vs. 64 +/- 6% in treated lambs after 24 h of ventilation. After 48 h of ventilation, significant differences between control (39 +/- 6%) and surfactant-treated (55 +/- 6%) lambs were still evident. Alveolar type II cells contained approximately 15% lamellar bodies by volume. Neither surfactant treatment nor time of ventilation altered the volume density of lamellar bodies or other organelles, except for a decrease in glycogen from 8% in nonventilated lungs to 2.5% in lungs ventilated for 24 h. These findings indicate that a surfactant treatment at birth results in the maintenance of more normal parenchyma with less atelectasis during prolonged ventilation of the immature lung.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMedDate not supplied

Pulmonary migraine.

Although it is not uncommon in bronchoesophagological practice to be consulted in cases of unexplained atelectasis, patients presenting with painful atelectasis are indeed rare. Three such cases will be described. The first case, previously unreported, for which Dr. M. E. Avery suggested the term "pulmonary migraine" is that of a 14-year-old Caucasian female with a history of recurrent "asthma" chest pain, atelectasis and migraine headache. On investigation there was demonstrable spastic obliteration of the lumen of a lobar bronchus. Two similar cases are described.

Adolescent↗
PubMed2001

Helical computer assisted tomography in pulmonary hypertension complicating left-to-right shunts--correlation with pulmonary hemodynamics.

The present study analyzed the helical computer-assisted tomography (CAT) findings in 30 patients with pulmonary hypertension (PH) associated with left-to-right shunts; specifically, ventricular septal defect, 23; atrioventricular septal defect, 6; patent ductus arteriosus, 1. Eight patients had 21 trisomy. Age ranged from 1 to 18 (mean, 4.1) months, and body weight ranged from 2.6 to 10.7 (mean, 4.9) kg. In all patients, the chest CAT revealed patchy areas of high and low attenuation (mosaic pattern) and regional atelectasis in the lung fields. The volume of low attenuated lesions and of atelectasis, and the total lung volume were derived from integration of areas measured on the CAT image. The ratios of low attenuated lesion/total lung volume (Lo), volume of atelectasis/ total lung volume (Ate) and low attenuated lesion and volume of atelectasis/total lung volume (Lo&Ate) were compared with hemodynamic parameters measured at cardiac catheterization. The pulmonary to systemic resistance ratio correlated with Lo (r=0.61, p<0.01) and Lo&Ate (r=0.69, p<0.01), whereas the pulmonary vascular resistance correlated with Ate (r=0.53, p<0.01). Lo, Ate and Lo&Ate in the chest CAT are reliable parameters that can be used to estimate pulmonary vascular resistance in patients with PH associated with left-to-right shunts.

Cardiac Catheterization↗
PubMed1992

Atelectatic lung escaping radiation pneumonitis.

An 80-year-old man was admitted to our division because of hemosputum, cough, and chest pain for three months. A chest roentgenogram, chest CT scanning, and bronchoscopic examinations revealed adenocarcinoma of the lung with atelectasis of the right upper lobe. The patient developed radiation pneumonitis after receiving radiation therapy (5,100 cGy) for lung cancer. At the same time, the right upper lobe atelectasis improved and movement of infiltrates consistent with radiation pneumonitis to the middle lung fields occurred. A chest roentgenogram taken when the atelectasis had improved revealed the absence of pneumonitis shadows in the right upper lobe, suggesting that the atelectatic lung escaped radiation pneumonitis.

Aged↗
PubMed1996

The effect of physical therapy on respiratory complications following cardiac valve surgery.

STUDY OBJECTIVE: To determine whether higher personnel intensive chest physical therapy can prevent the atelectasis that routinely follows cardiac valve surgery. DESIGN: Randomized, controlled trial. SETTING: Tertiary care hospital. PATIENTS: Seventy-eight patients undergoing elective cardiac valve surgery between October 1991 and April 1993 were enrolled. INTERVENTIONS: Patients were randomized in an unmasked fashion to receive early mobilization and sustained maximal inflations (lower-intensity treatment) or to receive early mobilization, sustained maximal inflations, and single-handed percussions (higher-intensity treatment.) MEASUREMENTS AND RESULTS: Clinical efficacy was determined by extent of atelectasis, length of ICU stay, total length of hospital stay, and personnel costs. The extent of postoperative atelectasis was similar in both groups on the fifth postoperative day. Postoperative values of FVC and FEV1 were reduced to a similar extent in both groups. Hospital stays and ICU stays were similar regardless of treatment. Physical therapy costs were highest in the higher-intensity therapy group. CONCLUSIONS: Postoperative respiratory dysfunction is common but does not usually cause significant morbidity or prolong hospital stay. The routine prescription of high-intensity physical therapy does not improve patient outcomes but does add significantly to patient costs.

Aged↗
PubMed1997

Complete lobar collapse following pulmonary lobectomy. Its incidence, predisposing factors, and clinical ramifications.

STUDY OBJECTIVE: To define the most severe form of postlobectomy atelectasis and determine its incidence, predisposing factors, and clinical ramifications. DESIGN: Retrospective case control. SETTING: The thoracic surgery unit at a 900-bed tertiary care hospital. PATIENTS OR PARTICIPANTS: Two hundred eighteen patients undergoing pulmonary lobectomy or bilobectomy over a 7-year time period. MEASUREMENTS AND RESULTS: Severe postlobectomy atelectasis (SPLA) was defined as complete ipsilateral lobar or bilobar collapse with whiteout of the involved lobe(s) and mediastinal shift on the chest radiograph. Data were collected consisting of patient age, lobe(s) resected, type of postoperative pain control, length of hospital and ICU stay, preoperative pulmonary function, and single- vs double-lumen tube intubation during surgery. The incidence of SPLA was 7.8%, comprising 24.6% of all postoperative complications seen. There was no statistically significant difference in patient age, preoperative room air PO2, and preoperative FEV1/FVC ratio for the SPLA group vs the group without this complication. Patients with SPLA had significantly longer ICU stays (112.7 h vs 28.4 h; p < 0.001) and hospital stays (14.7 days vs 9.3 days; p < 0.001) than the patients without complications. Patients undergoing right upper lobectomy, both alone or in combination with the right middle lobe, had a significantly higher incidence of SPLA when compared with all other types of resections (15.5% vs 3.0%; p < 0.005). There was no influence on the incidence of SPLA when the types of postoperative pain control regimen and endotracheal tubes used were examined. CONCLUSIONS: We conclude that SPLA as defined in this study is an important postoperative complication with a significant incidence. Although patients undergoing right upper lobectomy are markedly predisposed to this problem, the exact pathophysiology remains unclear. Factors shown to be causes of less severe forms of postoperative atelectasis do not seem to contribute to the formation of SPLA, indicating that these two complications may be two unrelated entities.

Aged↗
PubMed1998

Respiratory complications after coronary artery bypass surgery with unilateral or bilateral internal mammary artery grafting.

BACKGROUND AND STUDY OBJECTIVE: Use of bilateral internal mammary artery (IMA) grafts during coronary artery revascularization procedures carries the potential for increased incidence of postoperative respiratory complications compared with use of unilateral IMA grafts. The purpose of this study was to compare the incidence of respiratory complications such as hypoxemia, atelectasis, pleural effusion, and diaphragmatic dysfunction in patients who received one or both IMAs as conduit grafts. DESIGN: Prospective, comparative study. SETTING: Surgical ICU at a tertiary teaching hospital. PATIENTS: Seventy-five patients with bilateral and 75 patients with unilateral IMA grafts. MEASUREMENTS: Serial postoperative PaO2/fraction of inspired oxygen measurements, radiographic scores of atelectasis and pleural effusion, duration of mechanical ventilation, length of ICU and hospital stay, and incidence of pneumothorax, pneumonia, and wound infection. RESULTS: There was a higher incidence (51% vs 25%; p=0.002) and severity (0.48+/-0.09 vs 0.15+/-0.05 on the first postoperative day, 0.39+/-0.07 vs 0.27+/-0.07 on the fourth postoperative day, mean+/-SEM; p=0.004) of postoperative right lower lobe atelectasis in the group who received bilateral IMA grafts than in those who received left IMA grafts. This finding probably reflects the effects of additional surgical intervention on the right side of the chest. Incidence and severity of pleural effusion, gas exchange impairment, duration of mechanical ventilation, ICU and hospital stay, and incidence of pneumothorax, pneumonia, and wound infection were not influenced by use of bilateral IMA grafts (p>0.05). CONCLUSION: We conclude that use of bilateral IMA grafts during coronary artery revascularization does not increase the incidence of postoperative respiratory complications compared with unilateral IMA grafting.

Case-Control Studies↗
PubMed2004

Changing pattern of ventilator settings in patients without acute lung injury: changes over 11 years in a single institution.

STUDY OBJECTIVES: To determine whether the widely accepted concept of using lower tidal volume (Vt) values in patients with ARDS or obstructive lung disease has affected the pattern of ventilator settings in mechanically ventilated patients who do not have one of these conditions. DESIGN AND PATIENTS: We performed a retrospective chart review of all patients who had experienced out-of-hospital cardiac arrest and had received ventilatory support for > or = 1 day at a university-affiliated county hospital during the years 1990, 1991, 1992, 1995, 1998, 1999, and 2000. RESULTS: In 139 such patients, the mean final Vt values used on the first day of mechanical ventilation were 11.7, 12.4, 11.3, 9.6, 9.7, 9.2, and 9.8 mL/kg in those years, respectively. Multivariate analysis revealed that increasing year (beta-coefficient = -0.24; p = 0.001) and the presence of pulmonary edema (beta-coefficient = -1.2; p = 0.001) were independent predictors of the use of lower Vt values. Patients managed with a low Vt (ie, < 10 mL/kg; mean [+/- SD] Vt, 8.4 +/- 1.3 mL/kg) had a significantly higher incidence of atelectasis than the patients who were managed with traditional, larger Vt values (ie, > or = 10 mL/kg; mean Vt, 11.8 +/- 1.5 mL/kg) [61.1% vs 36.7%, respectively; p = 0.02]. Multivariate analysis revealed that the mean Vt used on days 1, 2, and 3 (<10 mL/kg or > or = 10 mL/kg) was the only predictor of the development of atelectasis during the first 3 days of mechanical ventilation (odds ratio, 0.33; p = 0.015). There was no difference in the incidence of pneumonia, the number of days spent receiving mechanical ventilation, Pao(2)/fraction of inspired oxygen ratio, or respiratory system compliance between the low Vt group and the traditional Vt group. CONCLUSION: Currently, physicians at our hospital use lower Vt values than they have in the past. This is associated with the increase in the incidence of atelectasis in the patients who received ventilation using low Vt values.

Aged↗
PubMed2005

Manual hyperinflation improves alveolar recruitment in difficult-to-wean patients.

STUDY OBJECTIVES: To investigate the effect of manual hyperinflation (MH) in patients with atelectasis associated with ventilation support. DESIGN: Patients were randomized to either an experimental group or a control group. SETTING: Pulmonary ICUs from two hospitals. PATIENTS: Twenty-three patients with atelectasis associated with ventilation support. INTERVENTIONS: The MH technique was at a rate of 8 to 13 breaths/min for a period of 20 min each session, three times per day for 5 days. The control group received their standard prescribed mechanical ventilation without supplemental MH. Sputum contents (wet/dry weight ratio, viscosity), respiratory system capacity (spontaneous tidal volume [Vt], maximal inspiratory pressure, rapid shallow breathing index [f/Vt], chest radiograph signs, and Pa(O2)/fraction of inspired oxygen [Fi(O2)]) were measured just prior to the MH at day 0 as baseline, and at day 3 and day 6 of the study. MEASUREMENTS AND RESULTS: There were significant improvements in scores over the 6-day study in the experimental group compared to the control group in spontaneous Vt (p = 0.035) and chest radiograph signs (p = 0.040), and a trend toward improvement of f/Vt (p = 0.066) and Pa(O2)/Fi(O2) (p = 0.061) after adjustment for covariates. Other outcome variables did not differ significantly between the experimental and control groups. CONCLUSIONS: MH performed on patients with atelectasis from ventilation support significantly improved alveolar recruitment.

Aged↗
PubMed1980

Comparison of three methods of respiratory care following upper abdominal surgery.

Incentive spirometry, as a method for preventing postoperative atelectasis, was compared with intermittent positive-pressure breathing (IPPB) and resistance breathing in 126 patients undergoing upper-abdominal surgery, most of whom had cholecystectomy. There was no statistically significant difference in the incidence of atelectasis among the three groups, who were matched for age, sex, smoking history, previous respiratory disease, and duration of surgery. There was a significantly higher incidence of atelectasis in patients over the age of 50 years (P = 0.004) than in younger subjects, where the incidence was not different among the three groups. Incentive spirometric therapy, as used in this study, offered no advantage over the other methods of treatment.

Abdomen↗
PubMed1986

Positive end-expiratory pressure following coronary artery bypass grafting.

Pulmonary dysfunction commonly follows open heart surgery. To evaluate the effects of positive end-expiratory pressure (PEEP) upon the course and severity of impaired oxygen transfer and roentgenographic evidence of atelectasis after coronary artery bypass grafting (CABG), we randomly assigned 44 patients to positive pressure ventilation and 0, 5, or 10 cm H2O PEEP. Study groups did not differ with respect to preoperative P(A-a)O2 or time on cardiopulmonary bypass. We observed a significant reduction of P(A-a)O2 during positive pressure ventilation with 10 cm H2O PEEP and FIO2 = 0.6 (182 +/- 6 vs 135 +/- 7 mm Hg, p less than .005). Following extubation, P(A-a)O2 measurements of the three groups did not differ when compared 24, 48, 72, 96, or 120 hours after surgery. Roentgenographic atelectasis scores did not differ on the fifth postoperative day. Five days after CABG, P(A-a)O2 exceeded preoperative P(A-a)O2 (29 +/- 1 vs 18 +/- 1 mm Hg, p less than .001), although the roentgenographic distances from hemidiaphragm to lung apex were unchanged (21.2 +/- 0.9 vs 22.0 +/- 0.9 cm). We conclude that routine PEEP improves pulmonary oxygen transfer but, once discontinued, PEEP offers no sustained beneficial effect upon impaired oxygen transfer or roentgenographic evidence of atelectasis following CABG.

Blood Gas Analysis↗
PubMed1981

Pulmonary cystic fibrosis in the adult: early and late radiologic findings with pathologic correlations.

Radiographs of 50 patients age 17 or more with documented cystic fibrosis were reviewed. Peripheral nodular and nonvascular linear densities were common early abnormalities. Specific findings of bronchiectasis were found in 90% of all cases. Hyperinflation was seen in 76% of cases, especially in the lower lobes; atelectasis and all other abnormalities were more common in the upper (and middle) lobes. Cystic air spaces developed in 24% of cases. The severity of abnormalities (including hyperinflation, atelectasis, and bronchial changes) increased in 30 of the 39 patients with follow up for a year or more. Eight of the 15 patients who died came to autopsy. The lungs showed acute and chronic inflammation of airways, including peripheral bronchioles, with adjacent parenchymal inflammation of airways peripheral bronchioles, with adjacent parenchymal infiltrates and fibrosis. The surrounding alveoli were aerated and enhanced the visibility of the thick-walled airways, except in regions of lobar atelectasis, scarring, or active pneumonia. Large and small airway shadows can be described more precisely than by the terms "honeycombing," "interstitial" or "bronchovascular markings".

Adolescent↗
PubMedDate not supplied

[Morphological changes in lung tissue developing during controlled respiration in patients with severe neurological diseases].

Morphological analysis of lungs was carried out in patients dying in the Department of Neurology who were treated before death by controlled respiration with respirators. Changes in the pulmonary tissue included mainly atelectasis and chronic oedema. For a better analysis the material was divided into 4 groups. Group I included earliest changes with slight atelectasis and hyperaemia of alveolar septa. Group II comprised cased with advanced atelectasis and manifest oedema. Group III contained cases with hyaeline membrane presence. In group IV pulmonary fibrosis was found. These findings were similar to those observed in other patients treated with respirators.

Autopsy↗
PubMed1976

[The therapeutic significance of bronchial suction-drainage in infants].

Bronchial suction-drainage in infants--according to our observations--is a life-saving procedure in cases of aspiration, severe bronchitis and retention of bronchial secretion. It can also be very effective in atelectasis, bronchopneumonia and pulmonary abscess. The earlier the drainage the quicker the clearing up of the atelectasis. An additional indication for performing bronchial suction in severe lower respiratory tract infections is to gagain secretion for bacterial culture. This is especially important in the Gram negative and Staphylococcus infections of young infants. The right upper pulmonary lobe is the most common localisation for atelectasis and pneumonia in this age group. One possible explanation for this could be that malformed bronchi are more frequently found in the right than in the left upper lobe. It is such a characteristical phenomenon in infancy that we called it "the right upper lobe syndrome".

Bronchi↗
PubMed1992

Postoperative respiratory function after laparoscopic cholecystectomy.

Open cholecystectomy causes changes in pulmonary function test volumes; such changes can be related to respiratory complications of hypoxemia and atelectasis. Little data is available on lung volume changes after laparoscopic cholecystectomy. We measured preoperative and postoperative vital capacity (VC), functional residual capacity (FRC), arterial PO2, and chest X-ray atelectasis in 31 patients undergoing laparoscopic cholecystectomy and found small but significant decreases (p < 0.01) in VC (13 +/- 19%) and FRC (7 +/- 17%). The PO2 decreased from 89 +/- 11 mm Hg to 82 +/- 14 mm Hg, with only one patient's PO2 less than 60 mm Hg. Three patients demonstrated new segmental lobar collapse on postoperative chest X-ray. The postoperative changes in FRC (R2 = 0.40, p < 0.04) and atelectasis (R2 = 0.46, p < 0.03) could be predicted by multiple regression of risk factors, including obesity, smoking, use of narcotics, age, and symptoms of prior respiratory disease. We conclude that the respiratory changes after laparoscopic surgery are small in comparison to those expected after open cholecystectomy.

Cholecystectomy, Laparoscopic↗
PubMed2004

The influence of cardiopulmonary bypass on respiratory dysfunction in early postoperative period.

BACKGROUND AND OBJECTIVE: Pulmonary dysfunction is one of the most serious problems in an early postoperative period after cardiac surgery. This study was designed to reveal the impact of performed cardiopulmonary bypass on pulmonary function during early postoperative period by evaluating the intrapulmonary shunt. MATERIAL AND METHODS: Twenty-one patients undergoing elective myocardial revascularization surgery were analyzed. The patients were divided into two groups. Group 1 included 11 patients who underwent cardiac surgery on cardiopulmonary bypass. Group 2 included 10 patients who underwent cardiac surgery without cardiopulmonary bypass. Preoperative data were similar in the both groups. Blood gas analysis for intrapulmonary shunt calculations was made at 20 minutes after the induction of anesthesia and at 4 hours after the surgery. Intrapulmonary shunt size (Qs/Qt) was also calculated and the records were studied for additional data. RESULTS: At 4 hours after surgery Qs/Qt increased, compared to the preoperative data in Group 1 (from 8.6+/-2.1 to 16.8+/-2.6%, p<0.02). Intrapulmonary shunt was great in Group 1 compared with Group 2 at four hours after the surgery (16.8+/-2.6 and 7.8+/-2.1%, p<0.02). In Group 1 80 % of alterations in a pulmonary function were caused by atelectasis, detected by chest X-ray. In Group 2 no increase in intrapulmonary shunt and no atelectasis were determined. CONCLUSIONS: Arterial hypoxemia and increase in intrapulmonary shunt (due to atelectasis) have proven that alterations in pulmonary function are found more often and are more pronounced in patients after surgery on cardiopulmonary bypass.

Adult↗
PubMed2004

Effect of kinetic therapy on pulmonary complications.

BACKGROUND: Optimal turning of critically ill patients is not well established. Kinetic therapy (systematic mechanical rotation of patients with 40 degree turns) may improve pulmonary function more than the improvement in function achieved via the standard of care (turning patients every 2 hours). OBJECTIVE: To determine (1) if patients receiving mechanical ventilation who tolerate kinetic therapy have better pulmonary function than do patients treated with standard turning and (2) the cost-effectiveness of kinetic therapy. METHODS: A prospective, randomized, multicenter study including 234 medical, surgical, and trauma patients (137 control patients, 97 patients receiving kinetic therapy). RESULTS: Kinetic therapy significantly decreased the occurrence of ventilator-associated pneumonia and lobar atelectasis. The risk of pneumonia developing was lower (P = .002) in patients receiving kinetic therapy than in the control patients. The risk of lobar atelectasis developing was decreased (P = .02) for the patients receiving kinetic therapy. Lengths of stay in the intensive care unit and in the hospital did not differ between the groups. Charges for intensive care were less in the kinetic therapy group (81,700 dollars) than in the control group (84,958 dollars), but not significantly less. Twenty-one patients did not tolerate kinetic therapy and were not included in the analysis. CONCLUSION: Kinetic therapy helps prevent ventilator-associated pneumonia and lobar atelectasis in critically ill patients. Costs to rent the bed may be offset by the potential cost reduction associated with kinetic therapy.

Cost-Benefit Analysis↗