13개 논문이 있습니다.
Post-intensive care unit (ICU) syndrome may occur after ICU treatment and includesICU-acquired weakness (ICU-AW), cognitive decline, and mental problems. ICU-AWis muscle weakness in patients treated in the ICU and is affected by the period of mechanicalventilation. Diaphragmatic weakness may also occur because of respiratorymuscle unloading using mechanical ventilators. ICU-AW is an independent predictor ofmortality and is associated with longer duration of mechanical ventilation and hospitalstay. Diaphragm weakness is also associated with poor outcomes. Therefore, pulmonaryrehabilitation with early mobilization and respiratory muscle training is necessaryin the ICU after appropriate patient screening and evaluation and can improve ICU-relatedmuscle weakness and functional deterioration.
Interstitial lung diseases (ILDs) are a diverse collection of lung disorders sharing similarfeatures, such as inflammation and fibrosis. The diagnosis and management ofILD require a multidisciplinary approach using clinical, radiological, and pathologicalevaluation. Progressive pulmonary fibrosis (PPF) is a distinct form of progressive andfibrotic disease, occurring in ILD cases other than in idiopathic pulmonary fibrosis (IPF). It is defined based on clinical symptoms, lung function, and chest imaging, regardlessof the underlying condition. The progression to PPF must be monitored through a combinationof pulmonary function tests (forced vital capacity [FVC] and diffusing capacityof the lung for carbon monoxide), an assessment of symptoms, and computed tomographyscans, with regular follow-up. Although the precise mechanisms of PPF remainunclear, there is evidence of shared pathogenetic mechanisms with IPF, contributing tosimilar disease behavior and worse prognosis compared to non-PPF ILD. Pharmacologicaltreatment of PPF includes immunomodulatory agents to reduce inflammation andthe use of antifibrotics to target progressive fibrosis. Nintedanib, a known antifibroticagent, was found to be effective in slowing IPF progression and reducing the annualrate of decline in FVC among patients with PPF compared to placebos. Nonpharmacologicaltreatment, including pulmonary rehabilitation, supplemental oxygen therapy,and vaccination, also play important roles in the management of PPF, leading to comprehensivecare for patients with ILD. Although there is currently no cure for PPF, thereare treatments that can help slow the progression of the disease and improve quality oflife.
Interstitial lung abnormalities (ILAs) are radiologic abnormalities found incidentallyon chest computed tomography (CT) that can be show a wide range of diseases, fromsubclinical lung fibrosis to early pulmonary fibrosis including definitive usual interstitialpneumonia. To clear up confusion about ILA, the Fleischner society published aposition paper on the definition, clinical symptoms, increased mortality, radiologic progression,and management of ILAs based on several Western cohorts and articles. Recently,studies on long-term outcome, risk factors, and quantification of ILA to addressthe confusion have been published in Asia. The incidence of ILA was 7% to 10% for Westerners, while the prevalence of ILA was about 4% for Asians. ILA is closely relatedto various respiratory symptoms or increased rate of treatment-related complicationin lung cancer. There is little difference between Westerners and Asians regarding theclinical importance of ILA. Although the role of quantitative CT as a screening tool forILA requires further validation and standardized imaging protocols, using a thresholdof 5% in at least one zone demonstrated 67.6% sensitivity, 93.3% specificity, and 90.5%accuracy, and a 1.8% area threshold showed 100% sensitivity and 99% specificity inSouth Korea. Based on the position paper released by the Fleischner society, I wouldlike to report how much ILA occurs in the Asian population, what the prognosis is, andreview what management strategies should be pursued in the future.
The consequences of coronavirus disease 2019 (COVID-19) are particularly severe inolder adults with a disproportionate number of severe and fatal outcomes. Therefore,this integrative review aimed to provide a comprehensive overview of the clinical characteristics,management approaches, and prognosis of older patients diagnosed withCOVID-19. Common clinical presentations in older patients include fever, cough, anddyspnea. Additionally, preexisting comorbidities, especially diabetes and pulmonaryand cardiovascular diseases, were frequently observed and associated with adverseoutcomes. Management strategies varied, however, early diagnosis, vigilant monitoring,and multidisciplinary care were identified as key factors for enhancing patient outcomes. Nonetheless, the prognosis remains guarded for older patients, with increasedrates of hospitalization, mechanical ventilation, and mortality. However, timely therapeuticinterventions, especially antiviral and supportive treatments, have demonstratedsome efficacy in mitigating the severe consequences in this age group. In conclusion, while older adults remain highly susceptible to severe outcomes from COVID-19, earlyintervention, rigorous monitoring, and comprehensive care can play a pivotal role in improvingtheir clinical outcomes.
Background: Exercise capacity is associated with lung function decline in chronicobstructive pulmonary disease (COPD) patients, but a discrepancy between exercisecapacity and airflow limitation exists. This study aimed to explore factors contributingto this discrepancy in COPD patients. Methods: Data for this prospective study were obtained from the Korean COPD SubgroupStudy. The exercise capacity and airflow limitation were assessed using the6-minute walk distance (6-MWD; m) and forced expiratory volume in 1 second (FEV1). Participants were divided into four groups: FEV1 >50%+6-MWD >350, FEV1 >50%+6-MWD ≤350, FEV1 ≤50%+6-MWD >350, and FEV1 ≤50%+6-MWD ≤350 and their clinicalcharacteristics were compared. Results: A total of 883 patients (male:female, 822:61; mean age, 68.3±7.97 years) wereenrolled. Among 591 patients with FEV1 >50%, 242 were in the 6-MWD ≤350 group, andamong 292 patients with FEV1 ≤50%, 185 were in the 6-MWD >350 group. The multipleregression analyses revealed that male sex (odds ratio [OR], 8.779; 95% confidence interval[CI], 1.539 to 50.087; p=0.014), current smoking status (OR, 0.355; 95% CI, 0.178to 0.709; p=0.003), and hemoglobin levels (OR, 1.332; 95% CI, 1.077 to 1.648; p=0.008)were significantly associated with discrepancies in exercise capacity and airflow limitationin patients with FEV1 >50%. Meanwhile, in patients with FEV1 ≤50%, diffusioncapacity of carbon monoxide (OR, 0.945; 95% CI, 0.912 to 0.979; p=0.002) was significantlyassociated with discrepancies between exercise capacity and airflow limitation. Conclusion: The exercise capacity of COPD patients may be influenced by factors otherthan airflow limitation, so these aspects should be considered when assessing andtreating patients.
Background: The prevalence of small airway dysfunction (SAD) in patients with chronicobstructive pulmonary disease (COPD) across different ethnicities is poorly understood. This study aimed to estimate the prevalence of SAD in stable COPD patients. Methods: We conducted a cross-sectional study of 196 consecutive stable COPD patients. We measured pre- and post-bronchodilator (BD) lung function and respiratoryimpedance. The severity of COPD and lung function abnormalities was graded in accordancewith the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. SAD was defined as either difference in whole-breath resistance at 5 and 19 Hz >upper limit of normal or respiratory system reactance at 5 Hz < lower limit of normal. Results: The cohort consisted of 95.9% men, with an average age of 66.3 years. Themean forced expiratory volume 1 second (FEV1) % predicted was 56.4%. The medianCOPD assessment test (CAT) scores were 14. The prevalence of post-BD SAD acrossthe GOLD grades 1 to 4 was 14.3%, 51.1%, 91%, and 100%, respectively. The post-BDSAD and expiratory flow limitation at tidal breath (EFLT) were present in 62.8% (95%confidence interval [CI], 56.1 to 69.9) and 28.1% (95% CI, 21.9 to 34.2), respectively. COPD patients with SAD had higher CAT scores (15.5 vs. 12.8, p<0.01); poor lung function(FEV1% predicted 46.6% vs. 72.8%, p<0.01); lower diffusion capacity for CO (4.8mmol/min/kPa vs. 5.6 mmol/min/kPa, p<0.01); hyperinflation (ratio of residual volumeto total lung capacity % predicted: 159.7% vs. 129%, p<0.01), and shorter 6-minute walkdistance (367.5 m vs. 390 m, p=0.02). Conclusion: SAD is present across all severities of COPD. The prevalence of SAD increaseswith disease severity. SAD is associated with poor lung function and highersymptom burden. Severe SAD is indicated by the presence of EFLT.
Background: Results of studies investigating the association between body mass index(BMI) and mortality in patients with coronavirus disease-2019 (COVID-19) have beenconflicting. Methods: This multicenter, retrospective observational study, conducted between January2020 and August 2021, evaluated the impact of obesity on outcomes in patientswith severe COVID-19 in a Korean national cohort. A total of 1,114 patients were enrolledfrom 22 tertiary referral hospitals or university-affiliated hospitals, of whom 1,099were included in the analysis, excluding 15 with unavailable height and weight information. The effect(s) of BMI on patients with severe COVID-19 were analyzed. Results: According to the World Health Organization BMI classification, 59 patientswere underweight, 541 were normal, 389 were overweight, and 110 were obese. Theoverall 28-day mortality rate was 15.3%, and there was no significant difference accordingto BMI. Univariate Cox analysis revealed that BMI was associated with 28-day mortality(hazard ratio, 0.96; p=0.045), but not in the multivariate analysis. Additionally, patientswere divided into two groups based on BMI ≥25 kg/m2 and underwent propensityscore matching analysis, in which the two groups exhibited no significant difference inmortality at 28 days. The median (interquartile range) clinical frailty scale score at dischargewas higher in nonobese patients (3 [3 to 5] vs. 4 [3 to 6], p<0.001). The proportionof frail patients at discharge was significantly higher in the nonobese group (28.1%vs. 46.8%, p<0.001). Conclusion: The obesity paradox was not evident in this cohort of patients with severeCOVID-19. However, functional outcomes at discharge were better in the obese group.
Background: The mechanisms leading to lung fibrosis are still under investigation. Thisstudy aimed to demonstrate whether antacids could prevent the development of interstitiallung disease (ILD). Methods: This population-based longitudinal cohort study was conducted betweenJanuary 2006 and December 2010 in South Korea. Eligible subjects were ≥40 years ofage, exposed to proton pump inhibitors (PPI)±histamine-2 receptor antagonists (H-2blockers) or H-2 blockers only, and had no history of ILD between 2004 and 2005. Exposure to antacids was defined as the administration of either PPI or H-2 receptorantagonists for >14 days, whereas underexposure was defined as antacid treatmentadministered for less than 14 days. Newly developed ILDs, including idiopathic pulmonaryfibrosis (IPF), were counted during the 5-year observation period. The associationbetween antacid exposure and ILD development was evaluated using adjusted Coxregression models with variables, such as age, sex, smoking history, and comorbidities. Results: The incidence rates of ILD with/without antacid use were 43.2 and33.8/100,000 person-years, respectively and those of IPF were 14.9 and 22.9/100,000person-years, respectively. In multivariable analysis, exposure to antacid before the diagnosisof ILD was independently associated with a reduced development of ILD (hazardratio [HR], 0.57; 95% confidence interval [CI], 0.45 to 0.71; p<0.001), while antacidexposure was not associated with development of IPF (HR, 0.88; 95% CI, 0.72 to 1.09;p=0.06). Conclusion: Antacid exposure may be independently associated with a decreased riskof ILD development.
Background: In recent years, medical thoracoscopy has been well established to playan important role in undiagnosed pleural effusion; however, this procedure is underutilizeddue to limited availability of the instruments it requires. This study analysed the outcomeof single port rigid thoracoscopy in patients with undiagnosed pleural effusions. Methods: This study retrospectively analysed the outcomes of all patients with undiagnosedpleural effusion presenting to our centre between 2016 to 2020 who underwentsingle port rigid medical thoracoscopy as a diagnostic procedure. Results: In total, 92 patients underwent single port rigid medical thoracoscopy. Themost common presenting symptom was shortness of breath. A majority of the patientshad lymphocytic exudative pleural effusion. The average biopsy sample size was 18mm, and no major complication was reported in any of the patients. Conclusion: Single port rigid thoracoscopy is a safe and well-tolerated procedure thatyields a biopsy of a larger size with high diagnostic yield. Moreover, the low cost of theinstruments required by this procedure makes it particularly suited for use in developingcountries.
.
.
.
.