Purpose: To assess the feasibility of micro-CT for obtaining quantitative volumetric and morphologic information of changes in soft tissue, respiratory tracts and vascularization in fibrotic, emphysematous and non-diseased human lung specimens. Materials and Methods: Specimens from autopsy or lung explantation with lung fibrosis of UIP pattern (n?=?22) or centrilobular emphysema (n?=?10) were scanned by micro-CT and compared to controls (n?=?22). Imaging was performed subsequent to intravascular contrast enhancement for the assessment of the vascular volume fraction. The soft tissue and air fraction were quantified after the fixation of ventilated lungs followed by tissue contrast enhancement using osmium. Aiming an artifact-free 3?D reconstruction of lung acini, synchrotron-based micro-CT scans of specimens with emphysema (n?=?5) and non-diseased tissue (n?=?6) was performed. Micro-CT imaging was complemented by histology for the demonstration of comparable findings. Results: Quantitative analysis showed a significant increase of the soft tissue fraction, equivalent to a decrease of the air fraction in fibrotic lungs compared to controls (p?0.001) and a significant reduction of the vascular volume fraction compared to controls (p?0.02). Specimens with emphysema demonstrated a significant increase of the air fraction with a decrease in soft tissue compared to controls (p?0.001). 3?D reconstructions of lung acini worked successfully in non-diseased tissue but failed in fibrotic and emphysematous lungs. Conclusion: Our findings indicate micro-CT?s technical feasibility to assess quantitative and morphological data from diseased and non-diseased human lung specimens. Citation Format:
Kritisch kranke Patienten, die spezialisierte diagnostische oder therapeutische Verfahren benötigen, jedoch in einem Krankenhaus ohne diesbezügliche Ausstattung versorgt werden, müssen unter Fortführung intensivmedizinischer Maßnahmen zu geeigneten Zentren transportiert werden. Solche Transporte sind herausfordernde Einsätze mit hohem Ressourcenbedarf und logistischem Aufwand, die durch ein spezialisiertes Team bewältigt werden müssen. Hierzu ist neben einem effizienten Crew Resource Management eine gute Planung des Einsatzes notwendig. Bei adäquater Vorbereitung sind solche Einsätze für den Patienten sicher und komplikationsarm durchführbar. Neben Routineintensivtransporten gibt es Sondereinsätze (z. B. isolationspflichtiger Patienten oder Patienten mit extrakorporaler Organunterstützung), die eine Anpassung des Teams oder des vorgehaltenen Materials erfordern. Dieser Beitrag beschreibt die Grundlagen des interhospitalen Intensivtransportes, seine Phasen und Sonderfälle.
Interhospital transport of acute respiratory distress syndrome (ARDS) patients bears transport-associated risks. It is unknown how interhospital extracorporeal membrane oxygenation (ECMO) transfer of COVID-19 patients by mobile ECMO units affects ARDS mortality. We compared the outcome of 94 COVID-19 patients cannulated in primary care hospitals and retrieved by mobile ECMO-teams to that of 84 patients cannulated at five German ECMO centers. Patients were recruited from March 2020 to November 2021. Twentysix transports were airborne, 68 were land-based. Age, sex, body-mass-index, Simplified Acute Physiology Score (SAPS) II, days invasively ventilated, and P/F-Ratio before ECMO initiation were similar in both groups. Counting only regional transports (≤250 km), mean transport distance was 139.5 km ± 17.7 km for helicopter (duration 52.5 ± 10.6 minutes) and 69.8 km ± 44.1 km for ambulance or mobile intensive care unit (duration 57.6 ± 29.4 minutes). Overall time of vvECMO support (20.4 ± 15.2 ECMO days for transported patients vs. 21.0 ± 20.5 for control, p = 0.83) and days invasively ventilated (27.9 ± 18.1 days vs. 32.6 ± 25.1 days, p = 0.16) were similar. Overall mortality did not differ between transported patients and controls (57/94 [61%] vs. 51/83 [61%], p = 0.43). COVID-19 patients cannulated and retrieved by mobile ECMO-teams have no excess risk compared with patients receiving vvECMO at experienced ECMO centers. Patients with COVID-19-associated ARDS, limited comorbidities, and no contraindication for ECMO should be referred early to local ECMO centers.
Online teilnehmen unter: www.springermedizin.de/cmeFür diese Fortbildungseinheit werden 3 Punkte vergeben.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.