Pulmonary Disease: Treatment and Critical Care

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Pulmonology".

Deadline for manuscript submissions: 20 June 2024 | Viewed by 5824

Special Issue Editors


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Guest Editor
Faculty of Medicine, School of Health Sciences, University Hospital of Larissa, University of Thessaly, 41110 Larissa, Greece
Interests: ARDS; mechanical ventilation; sepsis; hemodynamics; echocardiography; respiratory muscles; diaphragm; esophageal pressure; neuromonitoring; COVID-19
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Guest Editor
Critical Care Department, Hippokration Hospital Thessaloniki, 54942 Thessaloniki, Greece
Interests: infectious disease; especially infectious of multidrugresistant bacteria in icu patients and transplant recipients

Special Issue Information

Dear Colleagues,

Pulmonary disease has been the main focus of research during recent years, especially in the COVID-19 pandemic era which the world has experienced, and the scientific community has struggled to resolve therapeutic dilemmas facing the most vulnerable patients. The diversity of pathophysiological mechanisms underlying pulmonary infections such as community-acquired pneumonia, healthcare-acquired pneumonia, and acute respiratory distress syndrome have called for the individualization of treatments. Moreover, patients with acute respiratory failure may experience complications related to cardiomyopathy and heart failure. It is increasingly clear that cellular and molecular mechanisms should be considered for an optimal therapeutic approach. Classical treatment protocols have been questioned and novel treatment algorithms are evaluated for the management of patients with lung infections, chronic obstructive lung disease, and interstitial pneumonias. The treatment of pulmonary embolism is rather challenging in critically ill patients, considering the altered hemostasis mechanisms that are present. This Special Issue entitled “Pulmonary Disease: Treatment and Critical Care” focuses on patients with pulmonary disease that warrant critical care management. We warmly welcome a broad assortment of submissions, including original papers and reviews, covering areas on the use of mechanical ventilation, extracorporeal treatment modalities and pharmacological treatments to manage pulmonary disease.

Dr. Vasiliki Tsolaki
Dr. Eleni Massa
Guest Editors

Manuscript Submission Information

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Keywords

  • pulmonary infections
  • community-acquired pneumonia
  • hospital-acquired pneumonia
  • ventilator-associated pneumonia
  • ventilator-associated tracheobronchitis
  • ARDS
  • acute exacerbation of COPD
  • mechanical ventilation
  • antimicrobial resistance
  • COVID-19

Published Papers (3 papers)

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Research

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15 pages, 1981 KiB  
Article
PEEP-Induced Lung Recruitment Maneuver Combined with Prone Position for ARDS: A Single-Center, Prospective, Randomized Clinical Trial
by Lan Lan, Yuenan Ni, Yubei Zhou, Linxi Fu, Wentao Wu, Ping Li, He Yu, Guopeng Liang and Fengming Luo
J. Clin. Med. 2024, 13(3), 853; https://doi.org/10.3390/jcm13030853 - 1 Feb 2024
Viewed by 689
Abstract
Background: Prone position (PP) and the positive end-expiratory pressure (PEEP)-induced lung recruitment maneuver (LRM) are both efficient in improving oxygenation and prognosis in patients with ARDS. The synergistic effect of PP combined with PEEP-induced LRM in patients with ARDS remains unclear. We aim [...] Read more.
Background: Prone position (PP) and the positive end-expiratory pressure (PEEP)-induced lung recruitment maneuver (LRM) are both efficient in improving oxygenation and prognosis in patients with ARDS. The synergistic effect of PP combined with PEEP-induced LRM in patients with ARDS remains unclear. We aim to explore the effects of PP combined with PEEP-induced LRM on prognosis in patients with moderate to severe ARDS and the predicting role of lung recruitablity. Methods: Patients with moderate to severe ARDS were consecutively enrolled. The patients were prospectively assigned to either the intervention (PP with PEEP-induced LRM) or control groups (PP). The clinical outcomes, respiratory mechanics, and electric impedance tomography (EIT) monitoring results for the two groups were compared. Lung recruitablity (recruitment-to-inflation ratio: R/I) was measured during the PEEP-induced LRM procedure and was used for predicting the response to LRM. Results: Fifty-eight patients were included in the final analysis, among which 28 patients (48.2%) received PEEP-induced LRM combined with PP. PEEP-induced LRM enhanced the effect of PP by a significant improvement in oxygenation (∆PaO2/FiO2 75.8 mmHg vs. 4.75 mmHg, p < 0.001) and the compliance of respiratory system (∆Crs, 2 mL/cmH2O vs. −1 mL/cmH2O, p = 0.02) among ARDS patients. Based on the EIT measurement, PP combined with PEEP-induced LRM increased the ventilation distribution mainly in the dorsal region (5.0% vs. 2.0%, p = 0.015). The R/I ratio was measured in 28 subjects. The higher R/I ratio was related to greater oxygenation improvement after LRM (Pearson’s r = 0.4; p = 0.034). Conclusions: In patients with moderate to severe ARDS, PEEP-induced LRM combined with PP can improve oxygenation and dorsal ventilation distribution. R/I can be useful to predict responses to LRM. Full article
(This article belongs to the Special Issue Pulmonary Disease: Treatment and Critical Care)
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13 pages, 555 KiB  
Article
Respiratory Muscle Function in Older Adults with Chronic Respiratory Diseases after Pulmonary Rehabilitation in Subterranean Salt Chambers
by Sylwia Mętel, Magdalena Kostrzon, Justyna Adamiak and Paweł Janus
J. Clin. Med. 2023, 12(15), 5120; https://doi.org/10.3390/jcm12155120 - 4 Aug 2023
Cited by 1 | Viewed by 1066
Abstract
Training the respiratory muscles is a crucial aspect of pulmonary rehabilitation. The purpose of this study was to assess the function of respiratory muscles in older adults both before and after a period of pulmonary rehabilitation and treatment stay within the underground chambers [...] Read more.
Training the respiratory muscles is a crucial aspect of pulmonary rehabilitation. The purpose of this study was to assess the function of respiratory muscles in older adults both before and after a period of pulmonary rehabilitation and treatment stay within the underground chambers of a salt mine. A total of 50 patients aged 65 years and older with chronic respiratory conditions was enrolled in the study. These participants underwent a 3-week subterranean pulmonary rehabilitation (PR) program in the “Wieliczka” Salt Mine. Levels of sniff nasal inspiratory pressure (SNIP), maximum inspiratory pressure (MIP), and maximum expiratory pressure (MEP) were measured using the MicroRPM both before and after the outpatient PR program conducted 135 m underground. A total of 44 patients with a mean age of 68.8 ± 2.9 years who completed the PR program and tests were included in the analysis. The average changes in the parameters of pulmonary function before and after the PR were: MIP 8.8 cmH2O, MEP 7.1 cmH2O, and SNIP 11.2 cmH2O (for p < 0.05). For patients older than 70 years, beneficial changes were only observed for MEP, which increased by 9.3 cmH2O (for p < 0.05). Speleotherapy combined with pulmonary rehabilitation improves respiratory muscle function in older adults with chronic respiratory diseases, mainly in terms of MEP. Therefore, a greater emphasis on inspiratory muscle training in the rehabilitation program should be considered. Full article
(This article belongs to the Special Issue Pulmonary Disease: Treatment and Critical Care)
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Review

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17 pages, 2130 KiB  
Review
Critical Care Management of Severe Asthma Exacerbations
by Shameek Gayen, Stephen Dachert, Bilal H. Lashari, Matthew Gordon, Parag Desai, Gerard J. Criner, Juan Carlos Cardet and Kartik Shenoy
J. Clin. Med. 2024, 13(3), 859; https://doi.org/10.3390/jcm13030859 - 1 Feb 2024
Viewed by 3737
Abstract
Severe asthma exacerbations, including near-fatal asthma (NFA), have high morbidity and mortality. Mechanical ventilation of patients with severe asthma is difficult due to the complex pathophysiology resulting from severe bronchospasm and dynamic hyperinflation. Life-threatening complications of traditional ventilation strategies in asthma exacerbations include [...] Read more.
Severe asthma exacerbations, including near-fatal asthma (NFA), have high morbidity and mortality. Mechanical ventilation of patients with severe asthma is difficult due to the complex pathophysiology resulting from severe bronchospasm and dynamic hyperinflation. Life-threatening complications of traditional ventilation strategies in asthma exacerbations include the development of systemic hypotension from hyperinflation, air trapping, and pneumothoraces. Optimizing pharmacologic techniques and ventilation strategies is crucial to treat the underlying bronchospasm. Despite optimal pharmacologic management and mechanical ventilation, the mortality rate of patients with severe asthma in intensive care units is 8%, suggesting a need for advanced non-pharmacologic therapies, including extracorporeal life support (ECLS). This review focuses on the pathophysiology of acute asthma exacerbations, ventilation management including non-invasive ventilation (NIV) and invasive mechanical ventilation (IMV), the pharmacologic management of acute asthma, and ECLS. This review also explores additional advanced non-pharmacologic techniques and monitoring tools for the safe and effective management of critically ill adult asthmatic patients. Full article
(This article belongs to the Special Issue Pulmonary Disease: Treatment and Critical Care)
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