Integrating measurements of pulmonary gas exchange to answer clinically relevant questions

Neder, J. Alberto; Berton, Danilo Cortozi; O’Donnell, Denis E.

doi:10.1590/1806-3713/e20200019

Cited by 5 publications

(5 citation statements)

References 5 publications

(7 reference statements)

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“…Por outro lado, a redução da DL CO em pacientes sem restrição (ou obstrução) indica comprometimento da eficiência das trocas gasosas, o que, no presente contexto, indica doença pulmonar intersticial (destruição alveolar, espessamento alveolar ou desequilíbrio entre ventilação e perfusão) sem alterações mecânicas, ou indica doença vascular pulmonar. (30) Finalmente, a presença de CPT reduzida com DL CO preservada indica restrição extraparenquimatosa. (5) A complexidade de interpretar a DL CO , o volume pulmonar (ou melhor, o volume alveolar) e a relação entre os dois, torna difícil determinar a alteração (ou alterações) subjacente(s) com base nos dados disponíveis.…”

Section: Resultsunclassified

Impact of impaired pulmonary function on clinical outcomes in survivors of severe COVID-19 without pre-existing respiratory disease

et al. 2023

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Objective: To investigate the impact of impaired pulmonary function on patient-centered outcomes after hospital discharge due to severe COVID-19 in patients without preexisting respiratory disease. Methods: This is an ongoing prospective cohort study evaluating patients (> 18 years of age) 2-6 months after hospital discharge due to severe COVID-19. Respiratory symptoms, health-related quality of life, lung function, and the six-minute walk test were assessed. A restrictive ventilatory defect was defined as TLC below the lower limit of normal, as assessed by plethysmography. Chest CT scans performed during hospitalization were scored for the presence and extent of parenchymal abnormalities. Results: At a mean follow-up of 17.2 ± 5.9 weeks after the diagnosis of COVID-19, 120 patients were assessed. Of those, 23 (19.2%) reported preexisting chronic respiratory diseases and presented with worse lung function and exertional dyspnea at the follow-up visit in comparison with their counterparts. When we excluded the 23 patients with preexisting respiratory disease plus another 2 patients without lung volume measurements, a restrictive ventilatory defect was observed in 42/95 patients (44%). This subgroup of patients (52.4% of whom were male; mean age, 53.9 ± 11.3 years) showed reduced resting gas exchange efficiency (DLCO), increased daily-life dyspnea, increased exertional dyspnea and oxygen desaturation, and reduced health-related quality of life in comparison with those without reduced TLC (50.9% of whom were male; mean age, 58.4 ± 11.3 years). Intensive care need and higher chest CT scores were associated with a subsequent restrictive ventilatory defect. Conclusions: The presence of a restrictive ventilatory defect approximately 4 months after severe COVID-19 in patients without prior respiratory comorbidities implies worse clinical outcomes.

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Section: Resultsunclassified

Impact of impaired pulmonary function on clinical outcomes in survivors of severe COVID-19 without pre-existing respiratory disease

et al. 2023

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“…O Shunt FÍSIO (mistura venosa; normal ≤ 10%) pode ser subdividido em: a) shunt anatômico (Shunt ANAT ) via veias brônquicas, pleurais e cardíacas mínimas (normal ≤ 5%); b) shunt capilar (Shunt CAP ), que representa o sangue capilar pulmonar em contato com alvéolos completamente não ventilados; c) efeito shunt (isto é, mais perfusão que ventilação). (2) Diferentemente do gradiente alveoloarterial de O 2 , (4) o Shunt FÍSIO é independente da forma da curva de dissociação de O 2 , mas é necessária uma amostra de sangue arterial pulmonar para a obtenção de conteúdo venoso misto de oxigênio. Fazer o paciente respirar O 2 puro por tempo suficiente para eliminar o nitrogênio permite a medição da fração de mistura venosa causada por Shunt ANAT mais Shunt CAP (isto é, "shunt absoluto") sem a influência de confusão das desigualdades entre V/Q.…”

Section: Panoramaunclassified

Quantification of oxygen exchange inefficiency in interstitial lung disease

2021

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“…É possível que o VEF 1 por si só não seja suficiente para revelar reduções clinicamente relevantes dos volumes pulmonares e da eficiência das trocas gasosas. (5) Estabelecer se a taxa de declínio do VEF 1 na DPOC está acelerada ou não é ainda mais desafiador por causa das taxas altamente variáveis. Dos volumes pulmonares, a CRF é o que menos varia ao longo do tempo (± 10%), mas é extremamente sensível a aumentos do IMC ("paciente C").…”

Section: Visão Geralunclassified

“…Moreover, wide fluctuations in FEV 1 over time are characteristic of asthma. Clinically relevant reductions in lung volumes and gas exchange efficiency 5 might be missed by FEV 1 alone. Establishing whether the rate of decline in FEV 1 in COPD is accelerated or not is even more challenging because of highly variable rates.…”

Section: Overviewmentioning

confidence: 99%