There appears to be redistribution of ventilation and perfusion to the contralateral lung following endobronchial valve placement. This may be of importance when assessing patients for unilateral BLVR. Selecting patients with heterogeneous disease is emphasized, taking into consideration not just comparison between upper and lower lobes, but between left and right lungs. A larger trial is currently underway, guided by these findings.
Barotrauma was observed in breath-hold divers who increased their lung volumes by GI. The long-term effects of this barotrauma are uncertain and longitudinal studies are required to assess cumulative lung damage.
Glossopharyngeal insufflation is used by competitive breath-hold divers to increase lung gas content above baseline total lung capacity (TLC) in order improve performance. Whilst glossopharyngeal insufflation is known to induce hypotension and tachycardia, little is known about the effects on the pulmonary circulation and structural integrity of the thorax.Six male breath-hold divers were studied. Exhaled lung volumes were measured before and after glossopharyngeal insufflation. On two study days, subjects were studied in the supine position at baseline TLC and after maximal glossopharyngeal insufflation above TLC. Tc 99 m labelled macro-aggregated albumin was injected and a computed tomography (CT) scan of the thorax was performed during breath-hold. Single photon emission CT images determined flow and regional deposition. Registered CT images determined change in the volume of the thorax.CT and perfusion comparisons were possible in four subjects. Lung perfusion was markedly diminished in areas of expanded lung. 69% of the increase in expired lung volume was via thoracic expansion with a caudal displacement of the diaphragm. One subject who was not proficient at glossopharyngeal insufflation had no change in CT appearance or lung perfusion.We have demonstrated areas of hyperexpanded, under perfused lung created by glossopharyngeal insufflation above TLC.KEYWORDS: Breath-hold diving, glossopharyngeal insufflation, hyperinflation, perfusion imaging, pulmonary perfusion B reath-hold diving, or freediving, is a highly organised, increasingly popular extreme sport. Many competitive breathhold divers perform glossopharyngeal breathing both as a training exercise and just prior to a dive or submersed breath-hold. Glossopharyngeal breathing, a pump-like action involving the glossopharyngeal structures and larynx that forces air into the airways [1], was originally developed as a therapeutic technique for neuromuscular patients to help expand tidal volume and cough effectiveness [2,3]. The increase in expired lung volume above baseline total lung capacity (TLC) using glossopharyngeal breathing is achieved by a combination of an increase in the Euclidian size of the lung and gas compression [4,5]. Participants refer to this technique as lung packing; however this is described in the literature as glossopharyngeal insufflation (GI) [1,5,6].In theory, GI above TLC has the potential to assist breath-hold diving performance by increasing available oxygen stores and providing a volume buffer against the compressive effects of hyperbaria. Improvements in both static apnoea duration and breath-hold diving performance have been shown [7]. The potential for adverse cardiocirculatory effects is also clear. The extremely high transpulmonary pressures achieved, of up to 80 cmH 2 O [5], are associated with tachycardia, hypotension and biventricular systolic dysfunction [8]. In keeping with these observations, adverse neurological symptoms (e.g. presyncopal episodes and light-headedness) have been associated with this manoe...
Background: Pulmonary thromboendarterectomy (PTE) is the gold standard treatment for patients with chronic thromboembolic pulmonary hypertension (CTEPH). However, the results are poorly quantified outside a few registry reports and several individual centers.Methods: A systematic review was performed searching five electronic databases assessing the outcomes for adult patients undergoing PTE for CTEPH. All articles that reported mortality data were included.Primary outcome measures were early/inpatient mortality; secondary outcomes were survival, pulmonary haemodynamics, morbidity and functional status following PTE for CTEPH. Results were pooled via a meta-analysis of proportions and meta-regression.Results: A total of 5,717 studies were identified, yielding sixty-one relevant papers. Thirty-day mortality ranged from 0.8% to 24.4%, and on meta-analysis was 8.4% [95% confidence interval (CI): 7.2-9.6%].Mortality was noted to decrease with increasing center volume of PTE cases (P<0.01). Residual pulmonary hypertension was reported in 8.2% to 44.5% of patients.Conclusions: CTEPH is associated with acceptable short-term mortality and an improvement in pulmonary hemodynamics. With increasing volume of experience and ongoing developments over time perioperative mortality continues to decrease.
Background: Management of type A intramural hematoma (IMH) remains controversial, with opinions divided as to whether patients should be treated with early aggressive surgery or a more conservative approach. The present systematic review aims to evaluate the mortality and morbidities following surgery for type A IMH. Methods: Electronic searches were performed on five databases from dates of inception to December 2018. All studies with surgical outcomes for type A intramural hematoma were identified by two independent researchers and relevant data extracted. Random-effects meta-analysis of proportions or meta-analysis of means were performed to aggregate the data. Survival data were pooled using reconstructed individual patient data derived from Kaplan-Meier curves. Results: Fifteen studies with 744 patients were identified. Ten studies were from Asian countries (73% of patients). Overall mortality was 8.2% [95% confidence interval (CI): 4.6-13.9%]. Mortality from Asian centers was 5.3% (95% CI: 3.6-7.7%) and 18.9% (95% CI: 7.0-40.4%) in Western centers. Postoperative complications were poorly reported and hence not analyzable. Overall pooled survival of 343 patients from four studies at 1-, 2-, 3-, 5-, and 10-year was 91.8%, 90.2%, 89.2%, 87.7%, and 71.1%, respectively. Conclusions: There is an acceptable level of risk of death after surgery for type A IMH, though significant variations exist between results from Asian and Western centers. More detailed studies are required to clarify the controversies surrounding management of type A IMH.
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