Background: The coronavirus disease 2019 (COVID-19) has been identified in over 110 million people with no studies comparing pre-infection pulmonary function to post-infection. This study's aim was to compare preinfection and post-infection pulmonary function tests (PFT) in COVID-19 infected patients to better delineate between preexisting abnormalities and effects of the virus. Methods: This was a retrospective multi-center cohort study. Patients were identified based on having COVID-19 and a pre-and post-infection PFT within one year of infection during the time period of March 1, 2020 to November 10, 2020. Findings: There was a total of 80 patients, with an even split in gender; the majority were white (n = 70, 87¢5%) and never smokers (n = 42, 52¢5%). The majority had mild to moderate COVID-19 disease (n = 60, 75¢1%) with 25 (31¢2%) requiring hospitalization. There was no difference between the pre-and post-PFT data, specifically with the forced vital capacity (FVC) (p = 0¢52), forced expiratory volume in 1 s (FEV1) (p = 0¢96), FEV1/FVC(p = 0¢66), total lung capacity (TLC) (p = 0¢21), and diffusion capacity (DLCO)(p = 0¢88). There was no difference in the PFT when analyzed by hospitalization and disease severity. After adjusting for potential confounders, interstitial lung disease (ILD) was independently associated with a decreased FEV1 (-2¢6 [95% CI, -6¢7 to -1¢6] vs. -10¢3 [95% CI, -17¢7 to -2¢9]; p = 0¢03) and an increasing age (p = 0¢01) and cystic fibrosis (-1¢1 [95% CI, -4¢5 to-2¢4] vs. -36¢5 [95% CI, -52¢1 to -21¢0]; p < 0¢01) were associated with decreasing FVC when comparing pre and post infection PFT. Only increasing age was independently associated with a reduction in TLC (p = 0¢01) and DLCO (p = 0¢02) before and after infection. Interpretation: This study showed that there is no difference in pulmonary function as measured by PFT before and after COVID-19 infection in non-critically ill classified patients. There could be a relationship with certain underlying lung diseases (interstitial lung disease and cystic fibrosis) and decreased lung function following infection. This information should aid clinicians in their interpretation of pulmonary function tests obtained following COVID-19 infection.
Objectives:
Awareness of the impact of bedside ultrasound to reduce iatrogenic pneumothoraces while performing bedside pleural procedures has increased but with little understanding in how ultrasound is used for these procedures.
Design and Setting:
We conducted a retrospective chart review at a tertiary referral center in the United States from January 1, 2014, to March 31, 2017. Our study assessed adverse effect rates between real-time ultrasound-guided and ultrasound-marked thoracenteses and thoracostomy tube placements.
Patients:
Three-hundred ninety-four ICU patients were included in this study.
Measurements and Main Results:
There was a significant difference in the rate of adverse effects between real-time ultrasound-guided (0.63% [95% CI, 0.11–3.4%]) and ultrasound-marked (6.89% [95% CI, 4.15–11.24%]; p ≤ 0.01) procedures. More specifically, the rate of pneumothoraces was different between the two procedures (0.63% [95% CI, 0.11–3.4%] vs 4.43% [95% CI, 2.35–8.21%]; p = 0.02). In patients mechanically ventilated, there was a significant difference in overall adverse effect rates between groups of ultrasound use (p = 0.01).
Conclusions:
The use of real-time ultrasound guidance was associated with a lower rate of iatrogenic pneumothoraces.
The coexistence of expiratory central airway collapse and diaphragmatic paralysis presents a diagnostic and treatment challenge. Both entities are underrecognized causes of dyspnea, cough, sputum production, and orthopnea. Optimal treatment must be individualized and is best achieved by a multidisciplinary team. We present a case of a patient with profound functional impairment from dyspnea and hypoxemia due to expiratory central airway collapse, complicated by bronchiectasis from recurrent respiratory infections, and diaphragmatic paralysis.
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