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Bronchoscopy for specific situations
Published in Don Hayes, Kara D. Meister, Pediatric Bronchoscopy for Clinicians, 2023
Douglas Sidell, Christopher T. Towe, MyMy C. Buu
Many disease processes may lead to pulmonary hemorrhage. These include a myriad of diseases leading to diffuse alveolar hemorrhage syndrome (DAH), including infectious, malignant, and inflammatory etiologies. This section will focus only on bronchoscopic intervention associated with large-volume pulmonary hemorrhage or central airway bleeding events.
Radiology of Infectious Diseases and Their Potential Mimics in the Critical Care Unit
Published in Cheston B. Cunha, Burke A. Cunha, Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
Jocelyn A. Luongo, Boris Shapiro, Orlando A. Ortiz, Douglas S. Katz
Pulmonary hemorrhage may result from trauma, bleeding diathesis, infection, and autoimmune causes. It is also the most common non-infectious pulmonary complication of acute leukemia, in which case hemoptysis is uncommon. Radiographic findings include bilateral coalescent air-space opacities, which develop rapidly and commonly improve rapidly with a time course of hours, as opposed to days or weeks, such as with most patients with pneumonia [77,94].
Specific risks for the preterm infant
Published in Prem Puri, Newborn Surgery, 2017
Emily A. Kieran, Colm P. F. O’Donnell
Pulmonary hemorrhage—bleeding directly into the lung parenchyma—is reported in 3%–7% of preterm infants with RDS and is associated with significant mortality and morbidity.22,24 It is characterized by fresh blood seen coming up the trachea and into the mouth or out the endotracheal tube if the infant is receiving mechanical ventilation. The causes of pulmonary hemorrhage are poorly understood. It is thought to be associated with abnormal and rapidly changing blood flow in the vessels in the lungs over the first few days of life.23,25 Associated factors include RDS, invasive mechanical ventilation, patent ductus arteriosus (PDA), and coagulopathy. There is a statistically significant increased incidence in preterm infants who receive prophylactic surfactant, but not in infants who receive surfactant as a rescue therapy for RDS.26,27 There are few proven treatments for pulmonary hemorrhage. Strategies commonly used include measures to increase the mean airway pressure during mechanical ventilation (e.g., relatively higher positive end-expiratory pressure, high-frequency oscillation) and to close a PDA.
Preventing disease progression in Eisenmenger syndrome
Published in Expert Review of Cardiovascular Therapy, 2021
Ana Barradas-Pires, Andrew Constantine, Konstantinos Dimopoulos
Bleeding can manifest in many forms, including hemoptysis, epistaxis, mucocutaneous (gingival) and gastrointestinal bleeding, menorrhagia and cerebral bleeding. Hemoptysis is not infrequent, including in the context of a pneumonia, when it is usually mild and self-limiting. Life-threatening hemoptysis can occur in cases of significant pulmonary hemorrhage and requires emergency treatment, including urgent transfusion of red cells, platelets and other clotting factors, reversal of anticoagulation, lung isolation using single lung ventilation and involvement of interventional radiologists to embolize bleeding vessels (including hypertrophied bronchial arteries). Thoracic surgical involvement should be sought in severe cases, but rigid bronchoscopy and lobectomy carry their own risks. Hemoptysis has become less common as a mechanism of death since Paul Wood described his patient series over half a century ago, but pulmonary hemorrhage as a result of bronchial arterial bleeding, bleeding from aorto-pulmonary collaterals or aneurysmal pulmonary artery rupture remain most-often fatal events. Strategies for preventing this and other forms of bleeding need to be considered (Table 4), and managed with the appropriate specialist input, investigated and managed appropriately in a specialist center with PH and CHD input.
Evaluation of the diagnostic performance of an immunoblot for ANCA and anti-GBM antibody detection
Published in Autoimmunity, 2021
Matthias H. Busch, Joop P. Aendekerk, Joyce J. B. C. van Beers, Pieter van Paassen, Jan G. M. C. Damoiseaux
Limitations of our study are its retrospective design and relatively small number of controls. When a diagnostic test is used in a population with a lower disease prevalence, relatively more false-positive results will be found. It is therefore important that patients to be tested should be carefully selected based upon a given pre-test probability for AAV or anti-GBM disease (i.e. suspicion of RPGN or ANCA confirmatory settings). For this reason, we used disease controls with a diagnosis of non-ANCA vasculitis, which all together is a highly representative group to be tested for the presence of ANCA or anti-GBM antibodies. Moreover, the ANCA and anti-GBM cohort in this study are mainly patients with renal involvement. Patients with pulmonary haemorrhage may be underrepresented. On the other hand, 124 patients had biopsy-proven renal AAV or anti-GBM disease, which is a highly accurate diagnostic measure for active systemic vasculitis. Finally, the control group was used as disease-free reference group for the evaluation of the diagnostic accuracy of the immunoblot in the RPGN setting as well. RPGN was not primarily seen in this cohort, which differed from our disease group. This may partially explain the remarkably high diagnostic accuracy of the immunoblot for anti-GBM in our study.
Clinicopathological characteristics and predictors of poor outcome in anti-glomerular basement membrane disease – a fifteen year single center experience
Published in Renal Failure, 2021
Zafirah Zahir, Asif Sadiq Wani, Narayan Prasad, Manoj Jain
Patients <18 years of age were regarded as children. Microscopic hematuria was defined as at least 5 red cells per high-power field on microscopic examination or positive blood by urine dipstick. Nephrotic syndrome was defined as nephrotic range proteinuria of >3.5 g per 24 h per 1.73 m2 (in children, >40 mg/m2/hr or PCR >2000 mg/g [>200 mg/mmol] or >300 mg/dl or 3 + on urine dipstick) along with hypoalbuminemia and edema [7,8]. Rapidly progressive glomerulonephritis (RPGN) was defined as the rapid loss of renal function within days to weeks, accompanied by nephritic syndrome features (proteinuria, glomerular hematuria and often oliguria) [9]. Oliguria was defined as urinary output of <400 mL/24 h while anuria was defined as urinary output of <100 mL/24 h. Advanced renal failure at presentation was defined as serum creatinine >5.7 mg/dl, in accordance with a few previous studies [4]. Dialysis-dependent renal failure was defined as the need to dialyze the patient within 72 h of admission to the hospital [6]. A diagnosis of pulmonary hemorrhage was rendered in patients with overt hemoptysis and/or pulmonary interstitial opacities on computed tomography (CT) chest and/or bronchoalveolar lavage showing alveolar hemorrhage [10].