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Thorough consideration of user experiences and the weighing of advantages and disadvantages are essential when implementing new technology in clinical practice. This article describes a primary care nurse's experience using two technologies to monitor lung congestion in six patient cases: a remote dielectric sensing device for non-invasive lung fluid measurement and a portable handheld ultrasound device. Both can support decision-making when assessing lung congestion in heart failure patients. However, technical difficulties and interpretational complexities are inherent in their use. Balancing these advantages and disadvantages and finding effective strategies to address challenges is crucial for successful clinical implementation., Competing Interests: Conflict of interest: none declared., (© The Author(s) 2025. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Background: Peripheral veno-arterial extracorporeal membrane oxygenation (ECMO) is a powerful life-saving tool; however, it can sometimes induce severe pulmonary edema in patients with critical heart failure. We report favorable outcomes in critically ill patients by using a central ECMO system with an innovative blood perfusion method., Methods: We analyzed 10 patients with severe heart failure and pulmonary edema who were treated with the central ECMO system at our institution between April 2022 and October 2023. The system consists of central cannulation with two inflows from the right atrium and left ventricle, and two outflows to the aorta and pulmonary artery, connected by two Y-connectors to a single ECMO circuit (RALV-AOPA ECMO). In this system, blood flow to the pulmonary artery is adjusted and mean pulmonary artery pressure is limited to <20 mm Hg, which reduces right ventricular afterload and prevents the worsening of pulmonary edema and hemorrhage., Results: Six patients were diagnosed with fulminant lymphocytic myocarditis, and four were diagnosed with coronavirus disease 2019-related myocardial injury. The ejection fraction was 6.5 ± 4.1%. The average intraoperative pulmonary vascular resistance was 4.6 ± 1.3 Wood units. After 24 h, the mean pulmonary arterial pressure was 12.8 ± 4.3 mm Hg, and pulmonary vascular resistance was 1.5 ± 0.3 Wood units. The duration of central RALV-AOPA ECMO was 3.7 ± 2.1 days. Finally, six patients were weaned, three received HeartMate3, and one received heart transplantation. At follow-up, all patients remained alive (428 ± 208 days), and two patients experienced cerebrovascular accidents without any lasting sequelae., Conclusions: The central RALV-AOPA ECMO is an innovative system that achieves early improvement in pulmonary vascular resistance and is safe and feasible for patients with acute biventricular failure and pulmonary edema., (© 2024 International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC.)

High-altitude pulmonary edema (HAPE) is a common disease observed in climbers, skiers and soldiers who ascend to high altitudes without previous acclimatization. Thus, a reliable and reproducible animal model that can mimic the mechanisms of pathophysiologic response in humans is crucial for successful investigations. Our results showed that exposure to 4500 m for 2 days had little influence on lung function or blood gas, and exposure to 6000 m for 2 or 3 days could change lung function and blood gas, but most parameters returned to nearly normal levels within 48 hours. This study indicates that exposure to 6000 m for 3 days may induce evident lung edema and significantly alter lung function and blood gas, which may mimic HAPE in clinical practice. Thus, this animal model of HAPE may be used in future studies on HAPE., (Copyright © 2024 Copyright: © 2024 Medical Gas Research.)

Bacteremia due to Moraxella Catarrhalis is rare. An 85-year-old Japanese woman had productive cough, dyspnea, and fever. She had type 2 diabetes mellitus and chronic heart failure. Infiltration shown on chest radiography could be explained by heart failure or pneumonia. Initial blood culture yielded Gram-negative cocci, identified as M. catarrhalis . We therefore diagnosed cardiogenic pulmonary edema and M. catarrhalis pneumonia. M. catarrhalis has a high prevalence of β-lactamase production, so treatment comprised ampicillin/sulbactam. The clinical outcomes were favorable. Our case shows the importance of consideration of M. catarrhalis when patients with heart failure have pneumonia and the importance of blood culture for such patients.

Swimming-induced pulmonary edema (SIPE) is an incompletely understood condition that is often seen in U.S. special operations candidates participating in maritime qualification training courses. We present a case of two monozygotic twins with the simultaneous onset of acute respiratory distress during a crucible event of a maritime assessment and selection course. Subsequent pulmonary ultrasonography in both candidates showed wedge-shaped hyperechoic lines (B-lines) extending from the pleural interface into the interstitium. Chest radiography of both candidates revealed bilateral asymmetric hazy opacities consistent with SIPE. Both candidates recovered with supportive measures but were medically removed from training. Given the near-identical exposures of the candidates to the same ambient and water temperatures, duration of water submersion, magnitude of physical stressors, and viral colonization, this case study suggests that there may be underlying genetic factors, in addition to environmental factors, that predispose individuals to developing SIPE. Further benchtop and clinical research must be performed to identify potential genetic polymorphisms that contribute to the development of SIPE and to investigate safe interventions that address the underlying etiologies of SIPE pathophysiology., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2024. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

Background: Hysteroscopic surgery, a minimally invasive technique prevalent in gynecology, exhibits an overall complication rate between 0.22% and 3.7%. Pulmonary bleeding post-hysteroscopy represents an exceedingly rare complication with only three reported cases to date; two involving high-viscosity solutions and one with hypertonicity solutions. Negative-pressure pulmonary hemorrhage, a seldomly encountered and lethal complication, manifests post-upper airway obstruction, with minimal documented cases, none within hysteroscopic procedures., Case Presentation: Regarding the case study, a 38-year-old female underwent hysteroscopic surgery and received 1600 milliliters of isosmotic low-viscosity uterine distension media (physiological saline) during the procedure. The patient experienced a transient upper airway obstruction lasting one minute due to anesthetic medication. 1 h after surgery, she exhibited positional coughing, expectorated pinkish diluted sputum, and displayed symptoms of hypoxemia. Physical examination revealed bilateral moist rales in the lung fields, while cardiac auscultation did not detect any abnormal murmurs. Diagnostic procedures included chest CT, echocardiography, and complete blood count. The chest CT illustrated diffusely reticular and patchy ground-glass opacities in both lungs, confirming the diagnosis of pulmonary edema with pulmonary bleeding. Treatment with dexamethasone and furosemide led to rapid improvement, meeting discharge criteria within 24 h post-surgery. Postoperative follow-ups showed no discomfort symptoms in the patient, with normal chest X-ray results., Conclusions: In conclusion, the observed upper airway obstruction during hysteroscopic surgery seemingly reduced the safe absorption threshold of isosmotic uterine distension media. Therefore, gynecologists and anesthesiologists should remain vigilant about this potential complication., Competing Interests: Declarations. Ethics approval and consent to participate: Ethical approval was obtained by Ethics Committee of Hangzhou First People’s Hospital (ethical review approval number: ZN-20240201-0025-01). Written informed consent was obtained from the patient before publishing. Consent for publication: Written informed consent was obtained from the patient for publication of this Case report and any accompanying images. A copy of the written consent is available for review by the Editor of this journal. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

This study aimed to investigate the predictive effect of static lung compliance (SLC) and airway resistance (AR) in patients undergoing minimally invasive cardiac surgery (MICS) with unilateral pulmonary edema (UPE). A total of 245 patients who underwent MICS via cardiopulmonary bypass and minimal right lateral thoracic incision port access were enrolled, with immediate postoperative SLC and AR data collected upon intensive care unit (ICU) admission. Cutoff values for grouping patients into high (H-) and low (L-) compliance/resistance categories were determined using receiver-operating characteristic curves and Youden indexes. The primary outcome was the incidence of radiographically and clinically defined UPE within the first 24 hours postoperatively, while the secondary outcomes included duration of mechanical ventilation, length of ICU stay, total hospitalization days, in-hospital mortality, and the highest sequential organ failure assessment (SOFA) and acute physiology and chronic health evaluation II (APACHE-II) scores within the first 24 hours post-surgery. Results showed that patients in the L-compliance group (SLC < 40 mL/cmH2O) had longer durations of mechanical ventilation, length of ICU stay, and total hospitalization days, along with higher SOFA and APACHE-II scores compared to those in the H-compliance group (SLC ≥ 40 mL/cmH2O) (P < .05), although there was no significant difference in in-hospital mortality. Conversely, patients in the H-resistance group (AR ≥ 11 cm H2O/[L·s]) exhibited longer durations of mechanical ventilation, length of ICU stay, and total hospitalization days, as well as significantly higher SOFA, APACHE-II scores, but lower in-hospital mortality rates than those in the L-resistance group (AR < 11 cm H2O/[L·s]) (P < .05). In summary, immediate postoperative SLC < 40 mL/cm H2O and AR > 11 cm H2O/(L·s) are potentially valuable indicators for predicting postoperative UPE in patients undergoing MICS., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2025 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: takotsubo syndrome (TTS) is an acute heart failure syndrome characterized by a relevant comorbid background, including chronic obstructive pulmonary disease (COPD). However, TTS patients with COPD are still not well characterized., Aim: to describe the clinical characteristics and outcomes of patients with TTS and COPD., Methods: n = 440 TTS patients were dichotomized according to the presence of COPD. Endpoint of the study were in-hospital complications (composite of death, major arrhythmias, cardiogenic shock and acute pulmonary edema), TTS recurrence and long-term mortality at follow-up., Results: mean age of the population was 72±11, 10 % males. COPD prevalence was 16 % (n = 69). On subgroup analysis, patients with COPD were more likely smokers (41 % vs 13 %, p < 0.001), with higher rates of dyspnea and physical triggers at presentation (52 % vs 18 %, p < 0.001 and 52 % vs 32 %, p = 0.001 respectively) and lower left ventricular ejection fraction (36 % vs 39 %, p = 0.035) In-hospital complications were more common in patients with COPD (26 % vs 13 %, p = 0.006), driven by higher rates of acute pulmonary edema (19 % vs 6 %, p < 0.001) and cardiogenic shock (10 % vs 4 %, p = 0.023). At multivariable logistic regression analysis, COPD was independently associated with in-hospital complications occurrence (Odds Ratio 2.10, 95 % CI 1.09-4.05; p = 0.027). At univariable Cox regression analysis COPD was associated with TTS recurrence (Hazard Ratio (HR 9.82, 95 % CI 3.2-30.12; p < 0.001)), at multivariable Cox regression analysis with long-term mortality (HR 2.97, 95 % CI 1.44-6.12; p = 0.003)., Conclusion: COPD marks a vulnerable TTS phenotype including higher risk of in-hospital complications, long-term recurrence and mortality., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Background: Occurrence of life-threatening scorpion sting in adults is a rare entity compared with children. Different cases of organ failure following scorpion sting have been reported but complications, such as acute toxic myocarditis, cardiogenic shock, pulmonary edema, acute kidney injury and toxic hepatitis occurring simultaneously in adult patients is exceedingly rare with no prior documented similar report. This case report explores the unique presentation of these complications occurring simultaneously and their management in resource limited setting., Case Presentation: A 31-year-old Eritrean female came to our emergency room with severe respiratory distress, persistent retching, drenching sweating, generalized pain and unrecordable blood pressure 12 hours after scorpion sting. Electrocardiography revealed signs of diffuse acute myocarditis. The diagnosis of cardiogenic shock and pulmonary edema owing to scorpion sting envenomation was made. The patient also developed acute kidney injury and toxic hepatitis. She recovered well after 10 days of hospital stay and further follow-up, with supportive management and scorpion antivenom. To date, over a period of more than 2 years the patient has no new complaint or complication., Conclusion: This case report highlights the clinical novelty of multiorgan failure following scorpion sting in adults. The unique presentation of acute toxic myocarditis, cardiogenic shock, pulmonary edema, acute kidney injury and toxic hepatitis in a 31-year-old female underscores the possibility of scorpion sting causing such life threatening envenomation after delayed presentation. This case contributes to the understanding of atypical presentations of scorpion sting in adults., Competing Interests: Declarations. Ethics approval and consent to participate: Not applicable. Obtaining ethical clearance from our Ministry of Health’s Ethical Clearance and Protocol Review Committee is not required for case reports. Consent for publication: Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal. Competing interests: The authors declare that there are no competing interests., (© 2025. The Author(s).)

The Qinghai-Tibet Plateau, famously known as the "Roof of the World", has witnessed a surge in individuals traveling or working there. However, a considerable percentage of these individuals may suffer from acute mountain sickness (AMS), with high-altitude pulmonary edema (HAPE) being a severe and potentially life-threatening manifestation. HAPE disrupts the balance of intrapulmonary tissue fluid, resulting in severe lung function impairment. Current therapeutic interventions for HAPE have limitations and are accompanied by significant side effects. Aldose reductase (AR), a crucial enzyme in the polyol metabolic pathway, has been implicated in various diseases. In this study, we sought to explore the role of AR in HAPE. Utilizing both in vivo and in vitro models, we investigated the impact of AR on hypoxia-induced pulmonary edema, vascular pressure, inflammatory factors, and oxidative stress. Our findings revealed that AR knockdown mitigated hypoxia-induced pulmonary edema, decreased the expression of vascular pressure and inflammatory factors, and enhanced the expression related to oxidative stress. These results indicate that AR may serve as a potential therapeutic target for HAPE, offering a plausible pathological basis and novel drug targets for the prevention and treatment of this condition.

Case Presentation: A 23-year-old man presented to the ED with a history of respiratory distress, cough, and fever for 10 days. He was evaluated in the ED, where he received a diagnosis of pulmonary edema, secondary to mitral regurgitation with mitral valve prolapse syndrome. He was treated with antibiotics and diuretics and discharged to home. Three months later, he returned to the ED with similar complaints, for which he was treated symptomatically and discharged. After 4 months, the patient once again appeared with worsening respiratory distress and cough with fever. The dyspnea was not accompanied by orthopnea, pedal edema, or palpitation. The patient was admitted to the medical ICU. He had no history of arthralgia, myalgia, skin rash, or other signs of autoimmune disease. He denied any history of smoking, work-related or occupational exposures, drug intake, or recent travel., Competing Interests: Financial/Nonfinancial Disclosures None declared., (Copyright © 2024 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)

Hypobaric hypoxia (HH) is regarded as the main cause of high-altitude pulmonary edema (HAPE), however, the effect of diurnal temperature fluctuation and exercise has been overlooked. The aim of current study was to elucidate the role of diurnal temperature fluctuation and exercise in the development of HAPE and establish a reliable experimental rat model. Male SPF Wistar rats were assigned to control group (1400 m, 25 °C) and five model groups: Model Ⅰ group (6000 m, 25 °C), Model Ⅱ group (6000 m, 2 °C), Model Ⅲ group (6000 m, 12 °C/2 °C light/dark cycle), Model IV group (6000 m, 2 °C, and exercise) and Model V group (6000 m, 12 °C/2 °C light/dark cycle, and exercise). After exposure for 72 h, the blood and lung tissues were collected for further research. The rats in Model I group did not show signs of HAPE. Compared with Model I group, the rats in Model II and Model III groups were suffered from more damage, evidence by enhanced oxidative stress and inflammatory reaction, but still did not show signs of HAPE. Model IV and Model V could induce HAPE, display the obvious pathological changes and edema, more serious oxidative stress and inflammatory reaction in lung tissues, suggesting that the key role of exercise in the development of HAPE. The rats in the Model V group showed the best performance in terms of modeling indicators, indicating that diurnal temperature fluctuation could further aggravate the degree of lung edema. In summary, HH combined with diurnal temperature fluctuation and exercise is a stable and reliable modeling method for HAPE, which can be used for subsequent research on the prevention and treatment of HAPE., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

This study investigated sex differences in the development of pulmonary edema and exercise-induced arterial hypoxemia (EIAH) in well-trained endurance athletes during near-maximal exercise in a real-world setting. Twenty participants (10M vs. 10F; V̇O 2 peak: 69.3 (8.8) vs. 50.7 (4.1) ml∙kg -1 ∙min -1 ) underwent a maximal incremental treadmill test (visit 1) and a time trial on a steep trail (~2.5 km, ~800 m elevation gain) in North Vancouver (visit 2). Pulmonary edema was evaluated using handheld lung ultrasound ~10-15 min post-exercise and oxygen saturation (SpO 2 ) was monitored using finger pulse oximetry. Males completed the time trial significantly faster than females (M: 31.5 (6.5) vs. F: 40.4 (7.5) min, p = 0.006), while females sustained a higher percentage of their visit 1 heart rate (M: 94 (1) vs. F: 96 (1) %max, p = 0.02). All participants developed EIAH, with no sex differences in end-exercise SpO 2 (M: 89 (4) % vs. F: 90 (3) %, respectively, p = 0.35). There was no evidence of pulmonary edema, assessed through ultrasound b-line scores, with no differences between sexes (M: 0.3 (1.0) vs. F: 0.5 (1.5), respectively, p = 0.60). Pulmonary edema is an unlikely contributor to EIAH in endurance athletes performing near-maximal time trial exercise in a real-world setting., (© 2025 The Author(s). Physiological Reports published by Wiley Periodicals LLC on behalf of The Physiological Society and the American Physiological Society.)

The gamut of connective tissue disorders (CTDs) is vast. In addition to involvement of the rheumatological system, other organs like the renal and pulmonary systems are frequently affected in CTDs over the course of illness. The involvement of the pulmonary system commonly includes interstitial lung disease (ILD) and infections, mainly due to immunosuppression. A chest radiograph is the basic investigation done in these patients. Some radiographic patterns have typically been attributed to specific diagnoses and etiologies. Here, we discuss a 40-year-old woman's case with undifferentiated connective tissue disease (UCTD) having a classic imaging picture of a photographic negative of pulmonary edema. However, despite a classic textbook radiographic picture suggesting an inflammatory condition of the lung, a final diagnosis of malignancy was reached on biopsy., (© Journal of The Association of Physicians of India 2025.)

Background: Lung edema is a significant factor in prolonged mechanical ventilation and extubation failure after cardiac surgery. This study assessed the predictive capability of point-of-care Lung Ultrasound (LUS) for the duration of mechanical ventilation and extubation failure in infants following cardiac procedures., Methods: We conducted a prospective observational trial on infants under 1 year, excluding those with pre-existing conditions or requiring extracorporeal membrane oxygenation. LUS was performed upon intensive care unit (ICU) admission and prior to extubation attempts. B-line density was scored by two independent observers. The primary outcomes included the duration of mechanical ventilation and extubation failure, the latter defined as the need for reintubation or non-invasive ventilation within 48 h post-extubation., Results: The study included 42 infants, with findings indicating no correlation between initial LUS scores and extubation timing. Extubation failure occurred in 21% of the patients, with higher LUS scores observed in these cases (p = 0.046). However, interobserver variability was high, impacting the reliability of LUS scores to predict extubation readiness., Conclusions: LUS was ineffective in determining the length of postoperative ventilation and extubation readiness, highlighting the need for further research and enhanced training in LUS interpretation., (© 2024 Wiley Periodicals LLC.)

We present the case of an 80-year-old female with acute pulmonary edema and a dual chamber pacemaker with intermittent short AV delays in the surface ECG after blocked premature atrial contractions (PACs). The behavior was consistent with the programmed Window of Atrial Rate Acceleration Detection (WARAD) and did not require further parameter modifications. As most cardiologists and emergency department physicians are not familiar with brand-specific algorithms, we believe that this case report will make these noncompetitive atrial pacing algorithms more accessible to non-cardiologists., (© 2024 The Author(s). Annals of Noninvasive Electrocardiology published by Wiley Periodicals LLC.)

Introduction: Residual congestion at hospital discharge predicts adverse outcomes in acute decompensated heart failure (ADHF). Lung ultrasound (LUS) is a reliable tool for assessing pulmonary congestion. This study aims to evaluate a simplified 4-zone LUS method for identifying heart failure patients at risk after discharge., Methods: This prospective study included adults hospitalized for ADHF without treatable secondary causes. We employed a 4-zone LUS method to quantify B-lines. The primary endpoint was a composite of mortality or rehospitalization within 180 days. We used univariate and multivariate Cox models to evaluate the prognostic value of B-lines. A receiver operating characteristic (ROC) curve identified the optimal B-lines threshold., Results: We included 155 patients (median age: 81 years [IQR 75-85]; 52.9 % male). After the follow-up period, 53 (34.2 %) patients met the primary endpoint. The ROC curve for the number of B-lines at discharge showed an AUC of 0.8, with 7 B-lines identified as the optimal cutoff (sensitivity: 70 %, specificity: 82 %). In univariate analysis, the global B-line count at discharge (HR: 1.33, 95 % CI 1.22-1.45) was significantly associated with the primary endpoint. Using a cutoff of ≥7 B-lines, the association was stronger (HR: 6.92, 95 % CI 3.80-12.60). After multivariable adjustment, ≥7 B-lines at discharge remained significant (HR: 4.41, 95 % CI 1.98-9.81)., Conclusion: In our population, the detection of 7 or more B-lines at discharge serves as a reliable marker for identifying patients at risk of mortality or rehospitalization within 180 days., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025. Published by Elsevier Inc.)

This joint position statement (JPS) on immersion pulmonary oedema (IPO) and diving is the product of a workshop held at the 52nd Annual Scientific Meeting of the South Pacific Underwater Medicine Society (SPUMS) from 12-17 May 2024, and consultation with the United Kingdom Diving Medical Committee (UKDMC), three members of which attended the meeting. The JPS is a consensus of experts with relevant evidence cited where available. The statement reviews the nomenclature, pathophysiology, risk factors, clinical features, prehospital treatment, investigation of and the fitness for future compressed gas diving following an episode of IPO. Immersion pulmonary oedema is a life-threatening illness that requires emergency management as described in this statement. A diver with previous suspected or confirmed IPO should consult a medical practitioner experienced in diving medicine. The SPUMS and the UKDMC strongly advise against further compressed gas diving if an individual has experienced an episode of IPO., Competing Interests: Dr Turner acts as a consultant and proctor for St Jude Medical, Medtronic and Edwards Lifesciences, as a consultant and lecturer for Gore Medical and performs PFO closures on private patients. The other authors declare that they have no conflicts of interest. Professor Mitchell is the editor of Diving and Hyperbaric Medicine Journal, but as a societal consensus guideline this manuscript was not subject to peer review and a resulting publication decision. No external funding was declared., (Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.)

Introduction: Breath-hold divers occasionally surface with signs of fluid accumulation and/or bleeding in air-filled spaces. This constellation of symptoms, recently termed 'freediving induced pulmonary syndrome', is thought to come from immersion pulmonary oedema and/or barotrauma of descent and is colloquially termed a 'squeeze'. There is limited understanding of the causes, diagnosis, management, and return to diving recommendations after a squeeze., Methods: We developed an online survey that queried breath-hold divers on the circumstances and management of individual squeeze events., Results: A total of 132 (94 M, 38 F) breath-hold divers filled out the survey. Most were recreational or competitive freedivers with mean age of 37 years old and nine years of experience. Of those, 129 (98%) held a certification in freediving from an accredited training agency. A total of 103 individuals reported 140 squeeze events from 2008-2023. The average depth at which a squeeze occurred was 43 m. The top contributors to lung squeezes were described as movement at depth, contractions, and inadequate warm-up. The most common symptoms of a squeeze were cough, sputum production, and fatigue. Divers were instructed to wait an average of two months before returning to diving after a squeeze. On average, divers were able to achieve the same depth of their squeeze event three months after the incident., Conclusions: Inadequate warm-up, contractions, and abnormal movement at depth are the most reported causes for a squeeze. Most divers do not seek medical treatment after a lung squeeze event and can return to the same depth within three months., Competing Interests: No conflicts of interest were declared., (Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.)

An otherwise healthy woman in her 30s presented with cardiogenic shock and acute pulmonary oedema (APO), subsequently requiring extracorporeal membrane oxygenation (ECMO). A CT scan revealed an adrenal mass that prompted the differential diagnosis of a pheochromocytoma crisis that was later further suggested by raised plasma metanephrines. In the absence of clear guidelines due to the clinical rarity, a decision was made to delay adrenalectomy and stabilise the patient from a cardiac perspective with the view to operate after improvement of cardiac function with adequate alpha and beta blockade. Despite multiple complications, the patient was discharged from the hospital on day 32. After stabilisation and improvement of cardiac function, the patient underwent laparoscopic adrenalectomy. She was haemodynamically stable throughout the operation and was discharged on postoperative day 1 from the ICU to home. Histology confirmed the diagnosis of pheochromocytoma. She has been stable on follow-up., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Rationale: Mirror syndrome is a rare pregnancy condition in which maternal edema is associated with fetal hydrops. Because of its rarity and overlapping symptoms, this condition is often misdiagnosed as another pregnancy complication., Patient Concerns: A 28-year-old pregnant Japanese woman presented with sudden 7.5-kg weight gain, leg edema, and increased d-dimer level., Diagnoses: Ultrasound revealed polyhydramnios and fetal hydrops, and findings of maternal edema and blood test results were suggestive of Miller syndrome. Although, the patient was initially misdiagnosed due to a lack of information and the rarity of this disease., Interventions: An emergency cesarean section was performed under spinal anesthesia at 36 weeks and 2 days of- pregnancy. We could not diagnose mirror syndrome., Outcomes: The newborn's Apgar scores were 2 and 5 at 1 and 5 minutes after delivery, respectively. The patient's SpO2 suddenly decreased to 86% during cesarean section and persisted for 2 days. Chest computed tomography revealed pleural effusion and pulmonary edema. The pleural effusions and lung edema spontaneously resolved after the cesarean section., Lessons: This case reports on Miller syndrome with maternal hypoxemia onset during an emergency cesarean section and highlights the potential for better perioperative management and improvement in maternal mortality through prompt diagnosis and appropriate treatment shared not only among obstetricians and pediatricians but also among anesthesiologists., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

A young female presented to our emergency department with sudden-onset shortness of breath and orthopnea. Her condition rapidly worsened. She developed severe respiratory failure and cardiogenic shock ensued. Noticeably, the patient's CT scan showed a unique pattern of right-sided unilateral pulmonary edema, a feature highly specific for severe mitral regurgitation. Echocardiography confirmed papillary muscle rupture and acute mitral valve prolapse to be the cause. Her condition improved significantly after mitral valve replacement and with respiratory and circulatory support, as well as with other heart failure treatment. The classic symptoms of acute left heart failure combined with the unique CT manifestation of predominantly right-sided pulmonary edema suggested severe mitral regurgitation. Prompt diagnosis and early initiation of treatment aimed at the underlying cause is of great significance in improving the patient's prognosis.

Background: Swimming-induced pulmonary edema (SIPE), also called immersion pulmonary edema, is a form of exertional pulmonary edema associated with swimming and/or water immersion without aspiration. Most case reports on SIPE feature young, healthy patients who were scuba-diving, surface swimming, snorkeling, or breath-hold diving before experiencing symptoms of dyspnea, chest pain/tightness, cough, and hemoptysis. The incidence of SIPE is thought to be between 0.4-5%. Although symptoms typically resolve with oxygenation and ventilation, SIPE can be fatal, making recognition of SIPE crucial, especially for operational medical providers overseeing water training events and exercises., Case Report: A 28-yr-old healthy man began experiencing severe shortness of breath during early morning pool training. Oxygen saturation was in the low 80s and the patient was put on 15-L supplemental oxygen via nonrebreathing mask. Rales were present bilaterally on lung auscultation. He denied aspiration of water. Due to his persistent hypoxia, the patient was transported to an emergency department. He received a two-view chest X-ray, showing only bibasilar pulmonary opacities. He maintained 100% saturation once oxygen was removed and was able to be discharged to continue in the selection course., Discussion: Although SIPE may affect a small percentage of swimmers, military training in extreme conditions such as cold, lack of sleep, and profound exertion increases the risk for SIPE. Additionally, a patient who develops SIPE in the water is at risk for drowning. As SIPE may be fatal, military providers, especially those working with Special Operations, must be aware of how to diagnose and treat SIPE. O'Keefe CL, Clemente Fuentes RW, Salinas E. Swimming-induced pulmonary edema in a member participating in a special tactics selection course. Aerosp Med Hum Perform. 2024; 95(12):937-939.

In the context of Acute Pulmonary Edema (APE), the old school moto was LMNOP, for "Lasix-Morphine-Nitrates-Oxygen-Positive Pressure". However, this mnemonic, while not entirely inaccurate, deserves revision or at least a slight reinterpretation. APE remains a well-known condition in emergency departments, with a high mortality rate. Despite its prevalence, management recommendations have seen minimal evolution over the past four decades, with references dating back to a 1974 article in the New England Journal of Medicine that already advocated for the triplet of Lasix-Oxygen-Nitrates, a recommendation still present in the 2021 ESC guidelines. In this article, we will discuss the management and potential updates in the treatment of this common pathology.

A four-month-old, 5.0-kg male castrated mixed-breed dog was presented for further evaluation of a heart murmur. A grade 6/6 left basilar, continuous heart murmur, and bounding femoral arterial pulses were observed, consistent with a patent ductus arteriosus (PDA). Transthoracic echocardiography confirmed the diagnosis of a large, left-to-right shunting PDA with severe left heart volume overload. Thoracic radiography revealed severe, alveolar lung disease in the right cranial, right middle, and right caudal lung lobes; no pulmonary infiltrate was observed in the left lung lobes. Unilateral pulmonary edema secondary to the PDA was diagnosed, which later resolved with medical management and transcatheter occlusion of the PDA with an Amplatz Canine Ductal Occluder. Unilateral pulmonary edema secondary to a PDA has not been previously reported in the dog., Competing Interests: Conflicts of Interest Statement The authors do not have any conflicts of interest to disclose., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: The dominant feature of COVID-19-associated ARDS is gas exchange impairment. Extravascular lung water index is a surrogate for lung edema and reflects the level of alveolocapillary disruption. The primary aim was the prediction of extravascular lung water index by the alveolar-arterial oxygen difference. The secondary aims were in determining the relationship between the extravascular lung water index and other oxygenation parameters, the [Formula: see text], end-tidal oxygen concentration, pulmonary oxygen gradient ([Formula: see text] minus end-tidal oxygen concentration), and [Formula: see text]., Methods: This observational prospective single-center study was performed at the Department of Anaesthesiology and Intensive Care, The University Hospital in Ostrava, The Czech Republic, during the COVID-19 pandemic, from March 20, 2020, until May 24, 2021., Results: The relationship between the extravascular lung water index and alveolar-arterial oxygen difference showed only a mild-to-moderate correlation (r = 0.33, P < .001). Other extravascular lung water index correlations were as follows: [Formula: see text] (r = 0.33, P < .001), end-tidal oxygen concentration (r = 0.26, P = .0032), [Formula: see text] minus end-tidal oxygen concentration (r = 0.15, P = .0624), and [Formula: see text] (r = -0.15, P = .01)., Conclusions: The alveolar-arterial oxygen difference does not reliably correlate with the extravascular lung water index and the degree of lung edema in COVID-19-associated ARDS., Competing Interests: The authors have disclosed no conflicts of interest., (Copyright © 2024 by Daedalus Enterprises.)

In recent years, twin pregnancies have become increasingly common. The aim of our study was to analyze the exposure to risk factors for postpartum pulmonary edema in twin pregnancies. We get all our data from the "DATADRYAD" database, which is available directly. We used a variety of statistical methods, including multivariate logistic regression analysis and smoothed curve fitting. The aim was to critically assess the relationship between height and the occurrence of postpartum pulmonary edema in pregnant women with twin pregnancies. Among pregnant women whose height was <154 cm, the risk of postpartum development of pulmonary edema gradually decreased with increasing height (OR = 0.65, P = .0104). There was no relationship between maternal height and postpartum development of pulmonary edema among pregnant women with height higher than 154 cm (P = .9142). Pregnant women who were taller than 154 cm had a 76% lower risk of developing pulmonary edema postpartum compared to pregnant women whose height was lower than 154 cm (P = .0005). Our study suggests that pregnant women with twin pregnancies whose height is <154 cm are more likely to suffer from postpartum pulmonary edema. Therefore, healthcare professionals and caregivers should pay closer attention to twin pregnancies with heights below 154 cm, be alert to the occurrence of pulmonary edema, and take preventive and therapeutic measures as early as possible. This will help prevent the development of pulmonary edema., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Re-expansion pulmonary oedema (RPE) is an uncommon complication that occurs when a collapsed lung suddenly re-expands, resulting in an osmotic shift of fluid from the blood vessels into the air spaces within the lungs. This condition can develop following thoracocentesis or intercostal chest drainage. We report two cases of RPE that developed after varying volumes of pleural drainage and at different times. Both patients responded well to non-invasive ventilation and hydrocortisone, making a full recovery. Early detection is crucial as RPE is associated with higher mortality rates, but a positive prognosis is attainable with prompt identification and intervention., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Peripartum cardiomyopathy (PPCM) is a rare but potentially life-threatening condition. Due to the scarcity of epidemiological data in North Africa, we conducted this study to assess the outcomes of PPCM in our region., Materials and Methods: This monocentric retrospective cohort study involving all patients diagnosed with PPCM was conducted between January 2010 and December 2022., Results: Twenty-seven PPCM patients, with a median age of 33 years (Interquartile range (IQR) = 9), were included. 52% of patients were diagnosed during the postpartum period. Dyspnea New York Heart Association III/IV(NYHA III/IV) was the most common functional symptom (85%). The median left ventricle ejection fraction (LVEF) was 30% (IQR = 11%). Atrial fibrillation occurred in 11.1% of patients, thromboembolic complications occurred in 18.5%, Pulmonary edema occurred in 85% of patients and cardiogenic shock occurred in 14.8% of patients, with two patients requiring Extracorporeal Membrane Oxygenation (ECMO) support. The predominant mode of delivery was a cesarean Sect. (82% of patients), and the indication for a cesarean delivery was obstetrical in 59% of patients. Prematurity occurred in 36% of newborns, and intrauterine fetal death occurred in one pregnancy. The median follow-up was 24 months [6-144 months]. LVEF recovery was noted in 67% of patients. Bromocriptine was administered to six patients (22%), and none of these patients died and out of them, five patients recovered their LVEF (83%). The overall mortality rate during the follow-up period was 15%, comprising three in-hospital cardiac deaths and one occurring two years later due to refractory advanced heart failure. No significant differences were observed between LVEF recovery and LVEF non-recovery groups. Factors significantly associated with mortality were multiparity, poor antenatal care (ANC) attendance, thromboembolic events, cardiogenic shock, and Pulmonary edema. Five patients with LV recovery subsequently became pregnant, none experienced a relapse of PPCM. However, one of the descendants of a patient was diagnosed with dilated cardiomyopathy., Conclusion: This study revealed that the diagnosis of PPCM in our hospital is often delayed until symptoms become more advanced, resulting in high morbi-mortality., (© 2024. The Author(s).)

Background: Postoperative negative pressure pulmonary edema (NPPE) can occur in any patient undergoing general anesthesia. There are several risk factors for it, especially postoperative laryngospasm. The disease is usually benign and quickly reversible. In our case the severity and need for advanced critical care therapy was unusual., Case: We report a severe case of postoperative negative pressure pulmonary edema in a 62-year-old male patient undergoing elective right-sided retroperitoneoscopic adrenalectomy. The patient developed a severe case of acute respiratory distress syndrome (ARDS) after postoperative laryngospasm, possibly in conjunction with a suspected anaphylactic reaction. The patient was consequently treated with a combination of invasive airway pressure release ventilation (APRV) and a prone positioning regimen. After drastic improvement in respiratory function, the patient was discharged from the intensive care unit after 10 days and from the hospital after 14 days., Conclusion: NPPE is a rare but relevant complication of anesthesia and laryngospasm. The disease can basically occur in any patient undergoing general anesthesia and therefore should be considered., (© 2024. The Author(s).)

The foramen ovale plays a vital role in sustaining life in-utero; however, a patent foramen ovale (PFO) after birth has been associated with pathologic sequelae in the systemic circulation including stroke/transient ischemic attack (TIA), migraine, high altitude pulmonary edema, decompression illness, platypnea-orthodeoxia syndrome (POS) and worsened severity of obstructive sleep apnea. Importantly, each of these conditions is most commonly observed among specific age groups: migraine in the 20 to 40s, stroke/TIA in the 30-50s and POS in patients >50 years of age. The common and central pathophysiologic mechanism in each of these conditions is PFO-mediated shunting of blood and its contents from the right to the left atrium. PFO-associated pathologies can therefore be divided into (1) paradoxical systemic embolization and (2) right to left shunting (RLS) of blood through the PFO. Missing in the extensive literature on these clinical syndromes are mechanistic explanations for the occurrence of RLS, including timing and the volume of blood shunted, the impact of age on RLS, and the specific anatomical pathway that blood takes from the venous system to the left atrium. Visualization of the flow pattern graphically illustrates the underlying RLS and provides a greater understanding of the critical flow dynamics that determine the frequency, volume, and pathway of flow. In the present review, we describe the important role of foramen ovale in in-utero physiology, flow visualization in patients with PFO, as well as contributing factors that work in concert with PFO to result in the diverse pathophysiological sequelae., Competing Interests: Conflict of Interest Dr. Horlick serves as a consult to Abbott Vascular. Dr. Carroll serves on the Steering Committee of the RESPECT trial and is a consultant to Abbott Vascular and Holistick Medical. Dr. Krasuski reports serving as a consultant to Actelion/Janssen Pharmaceuticals, Bayer Pharmaceuticals, Gore Medical and Neptune Medical. He receives research funding from the Adult Congenital Heart Association, Actelion, Artivion, Corvia, Medtronic and Edwards Lifesciences. Dr. Shah and Dr. Kass report no conflicts., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Newborns with critical congenital heart disease (CCHD) with increased pulmonary blood flow (PBF) are at high risk for congestive heart failure. In this study, we aimed to evaluate the presence and degree of pulmonary edema in newborns with CCHD using lung ultrasound (LUS) during the perioperative period., Methods: Prospective clinical trial, 44 newborn patients with CCHD were evaluated in this prospective clinical trial. LUS was repeatedly performed to determine the course of pulmonary edema during the perioperative period. LUS was performed simultaneously with chest radiography (CXR), which was the main part of patient management. The primary outcome of this study was to identify whether a correlation existed between LUS and CXR findings. The secondary outcomes were to determine the relationship between LUS and the need for respiratory support, diuretic use, vasoactive inotropic score (VIS), and pro-B-type natriuretic peptide (pro-BNP) levels during the perioperative period., Results: The mean gestational age of the patients was 38.3 ± 1.7 weeks, with a mean birth weight of 3026 ± 432 g. In the preoperative period, both LUS and CXR images were consistent with clinical signs of pulmonary edema. On the first postoperative day, pulmonary edema increased compared to the preoperative period but gradually decreased by the 6th day of surgery (p < 0.05). Positive correlations were observed between the LUS and CXR findings at all study points (p < 0.05). The LUS findings exhibited trends parallel to those of VIS, serum pro-BNP levels, need for respiratory support, and diuretic requirements. As expected, these trends were more pronounced in CCHDs where PBF increased., Conclusion: In CCHD, serial lung ultrasound (LUS) assessments, particularly in cases with increased PBF, can provide valuable guidance for managing patients during the perioperative period., Competing Interests: Declaration of competing interest The authors declare no conflicts of interest relevant to this article., (Copyright © 2024 Taiwan Pediatric Association. Published by Elsevier B.V. All rights reserved.)

We present a never-transfused girl with thalassemia intermedia who was admitted for febrile aplastic crisis due to human parvovirus B19. After a first transfusion of packed red blood cells, she developed pulmonary oedema. She improved with supportive care including the use of intravenous diuretics. Due to severe anaemia, she received a second blood transfusion, antibiotics for febrile neutropenia and intravenous γ globulin for control of the parvovirus infection. She had an uneventful recovery. The first of her male blood donors had an antibody against a patient's human leukocyte antigens type II antigen with a high mean fluorescent intensity. Our patient had clinical features and supportive laboratory evidence for mild transfusion-related acute lung injury (TRALI). However, she also met the criteria for transfusion-associated circulatory overload (TACO). We conclude that our patient likely suffered from TRALI/TACO, a consensus term proposed in 2019 for patients in whom TRALI cannot be distinguished from TACO or in whom both conditions occur simultaneously., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Pulmonary oedema is a feared and difficult to predict complication of severe malaria that can emerge after start of antimalarial treatment. Proinflammatory mediators are thought to play a central role in its pathogenesis., Methods: An exploratory study was conducted to evaluate the predictive capacity of biomarkers for development of clinical pulmonary oedema in patients with severe falciparum malaria at two hospitals in Bangladesh. Plasma concentrations of interleukin-6 (IL-6), IL-8, tumour necrosis factor (TNF), soluble Receptor of Advanced Glycation End-products (sRAGE), surfactant protein-D (SP-D), club cell secretory protein (CC16), and Krebs von den Lungen-6 (KL-6) on admission were compared with healthy controls. Correlations between these biomarker and plasma lactate and Plasmodium falciparum histidine-rich protein 2 (PfHRP2) levels were evaluated. Receiver Operating Characteristic (ROC) curves were constructed to assess the predictive capacity for clinical pulmonary oedema of the biomarkers of interest., Results: Of 106 screened patients with falciparum malaria, 56 were classified as having severe malaria with a mortality rate of 29%. Nine (16%) patients developed clinical pulmonary oedema after admission. Plasma levels of the biomarkers of interest were higher in patients compared to healthy controls. IL-6, IL-8, TNF, sRAGE, and CC16 levels correlated well with plasma PfHRP2 levels (r s = 0.39; P = 0.004, r s = 0.43; P = 0.001, r s = 0.54; P < 0.001, r s = 0.44; P < 0.001, r s = 0.43; P = 0.001, respectively). Furthermore, IL-6 and IL-8 levels correlated well with plasma lactate levels (r s = 0.37; P = 0.005, r s = 0.47; P < 0.001, respectively). None of the biomarkers of interest had predictive capacity for development of clinical pulmonary oedema., Conclusions: IL-6, IL-8, TNF, sRAGE, SP-D, CC16 and KL-6 cannot be used in predicting clinical pulmonary oedema in severe malaria patients., (© 2024. The Author(s).)

This paper reports a case of acute pulmonary edema caused by exertional heat stroke due to imbalance of body heat production and heat dissipation caused by high intensity military training physical activities. The patient's lesions developed rapidly and pulmonary edema progressed rapidly and diffusingly. After early identification, active invasive mechanical ventilation and hormone therapy, the pulmonary imaging lesions of pulmonary edema were rapidly absorbed, and the dyspnea was improved. This article discusses the incidence, imaging features and treatment of acute pulmonary edema caused by exertional heat stroke, and provides reference for clinical diagnosis and treatment.

Pulmonary congestion (PC) is common in hemodialysis (HD) patients. We explored the association of anemia and pulmonary congestion in HD patients. A prospective pilot observational study included 18 patients on maintenance HD. Individual B-lines scores (BLS; 8-sites method) were obtained by lung ultrasound, before and after the first two consecutive HD sessions of the week (HD1-HD2), with different inter-dialytic intervals (68 vs. 44 h). Bioimpedance spectroscopy body composition (BIS) was performed before each HD session. Hemoglobin (Hb) levels, in addition to circulating markers of chronic inflammation (soluble urokinase Plasminogen Activator Receptor [suPAR], soluble Suppression of Tumorigenicity 2 [sST2]) were obtained. Mean (±SD) BLS values were quite elevated at all time points: Pre-HD1 (16 ± 5.53), post-HD1 (15.3 ± 6.63), pre-HD2 (16.3 ± 5.26) and post-HD2 (13.6 ± 5.83), respectively. No direct significant correlation was found between inflammation markers levels and BLS. However, mean levels (±SD, ng/mL) of suPAR pre-HD1 (7.88 ± 3.07) and pre-HD2 (7.78 ± 3.02) remained significantly above the normal range (<4 ng/mL), and sST2 levels reached 2-fold the upper normal value in most patients (27.4 ± 17.8). Pulmonary congestion reflected by BLS was negatively correlated to Hb levels pre-HD1 (R² = 0.439, p = 0.003), and pre-HD2 (R² = 0.301, p = 0.018). In addition, Hb levels were negatively correlated to global volume status estimated by BIS (R² = 0.351, p = 0.009). Hemoglobin levels were negatively correlated to pulmonary congestion and to the global volume status evaluated by BIS. Chronic inflammation markers were increased in HD patients, suggesting a complex volume- and non-volume-dependent pathophysiology of pulmonary congestion in HD patients.

Abstract: Re-expansion pulmonary edema (RPE) is a rare complication of minimally invasive cardiac surgery (MICS). We present a case of RPE following atrial septal defect (ASD) closure using a thoracotomy approach and cardiopulmonary bypass (CPB). REP contributes to significant morbidity and extends the length of stays in the intensive care unit. Understanding the pathophysiology and risk factors of RPE allows us to prevent or minimize the incidence., (Copyright © 2024 Copyright: © 2024 Annals of Cardiac Anaesthesia.)

Aims: Lung ultrasound (LUS) is a sensitive tool to assess pulmonary congestion (PC). Few data are available on LUS-PC evaluation in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI). The aim of this study was to assess the prevalence and prognostic impact of LUS-PC in patients with severe AS before and after TAVI., Methods and Results: We designed a single-centre prospective study in patients referred for TAVI for severe AS (ClinicalTrials.gov identification number: NCT05024942). All patients underwent echocardiography and LUS (according to a simplified 8-zone scanning protocol) the day before and within 72 h after the procedure. The primary endpoint was the composite of all-cause mortality, hospitalization for heart failure and urgent medical visits for worsening dyspnoea at 12-month follow-up. A total of 127 patients were enrolled (mean age 81.1 ± 5.8 years; 54.3% female). Pre-TAVI LUS-PC was documented in 65 patients (51%). After TAVI, the prevalence of LUS-PC significantly decreased as compared to pre-TAVI evaluation, being documented in only 28 patients (22% vs. 51%, p < 0.001) with a median B-lines score of 4 (interquartile range [IQR] 0-11) versus 11 (IQR 6-19) pre-TAVI (p < 0.001). During a median follow-up of 12 (12-17) months, 25 patients (19.6%) met the composite endpoint. On multivariable Cox regression analysis, pre-TAVI LUS-PC was independently associated with cardiovascular events (hazard ratio 2.764, 95% confidence interval 1.114-6.857; p = 0.028)., Conclusions: Lung ultrasonography reveals a high prevalence of PC in patients with severe AS undergoing TAVI, which is significantly reduced by the procedure. Pre-TAVI PC, measured by LUS, is an independent predictor of 1-year clinical outcome., (© 2024 The Author(s). European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)

Background: Full-flow perfusion during prolonged ex situ lung perfusion (ESLP) results in unacceptable pulmonary edema formation. Clinical ESLP at 30% to 50% predicted cardiac output (CO) supports acceptable physiologic outcomes; however, progressive pulmonary edema still develops. Lower flow rates may provide equivalent physiologic preservation with less edema formation due to reduced hydrostatic pressures. We report our results of moderate-flow (MF; 30% CO) vs low-flow (LF; 10% CO) negative pressure ventilation (NPV)-ESLP with transplantation., Methods: Twelve pig lungs underwent 12-hours of NPV-ESLP with 30% or 10% CO (n = 6/group). Three left lungs per group were transplanted post-ESLP and assessed in vivo over 4 hours. Lung function was assessed by physiologic parameters, weight-gain, and pro-inflammatory cytokine profiles., Results: Results are MF vs LF (mean ± SEM). All lungs demonstrated acceptable oxygenation post-ESLP (454.2 ± 40.85 vs 422.7 ± 31.68, P = .28); however, after transplantation, the MF lungs demonstrated significantly better oxygenation (300.7 ± 52.26 vs 141.9 ± 36.75, P = .03). There was no significant difference in compliance after ESLP (21.38 ± 2.28 vs 16.48 ± 2.34, P = .08); however, pulmonary artery pressure (PAP; 10.89 ± 2.28 vs 21.11 ± 0.93, P = .06) and pulmonary vascular resistance (PVR; 438.60 ± 97.97 vs 782.20 ± 162.20, P = .05) were significantly higher in the LF group. Weight gain (%) post-ESLP and post-transplant was similar between groups (29.42 ± 5.72 vs 24.17 ± 4.42, P = .24; and 29.63 ± 7.23 vs 57.04 ± 15.78, P = .09). TNF-α and IL-6 were significantly greater throughout LF ESLP., Conclusions: The MF NPV-ESLP results in superior lung function with less inflammation compared to LF NPV-ESLP., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Hysteroscopic surgery is a safe procedure used for diagnosing and treating intrauterine lesions, with a low rate of intraoperative complications. However, it is important to be cautious as fluid overload can still occur when performing any hysteroscopic surgical technique., Case Presentation: In this case report, we present a unique instance where lung ultrasound was utilized to diagnose pulmonary edema in a patient following a hysteroscopic myomectomy procedure. The development of pulmonary edema was attributed to the excessive absorption of fluid during the surgical intervention. By employing lung ultrasound as a diagnostic tool, we were able to promptly identify and address the pulmonary edema. As a result, the patient received timely treatment with no complications. This case highlights the importance of utilizing advanced imaging techniques, such as lung ultrasound, in the perioperative management of patients undergoing hysteroscopic procedures., Conclusions: This case report underscores the significance of early detection and intervention in preventing complications associated with fluid overload during hysteroscopic myomectomy procedures., (© 2024. The Author(s).)

Objective: While the association between metabolic dysfunction-associated steatotic liver disease (MASLD) and long-term cardiovascular risks has been studied, the impact of MASLD on cardiovascular events during delivery hospitalizations remains relatively unexplored. This study aims to examine the prevalence of cardiovascular diseases (CVDs) and cardiac arrhythmias in pregnant patients with MASLD and identify potential risk factors., Methods: A retrospective analysis of hospital discharge records from the National Inpatient Sample database between 2009 and 2019 was conducted to assess maternal cardiovascular outcomes. Multivariable logistic regression models were employed, and adjusted odds ratios (AOR) were calculated to evaluate the association between MASLD and cardiovascular outcomes during pregnancy., Results: The study sample included 17 593 pregnancies with MASLD and 41 171 211 pregnancies without this condition. Women with MASLD exhibited an increased risk of congestive heart failure [AOR 3.45, 95% confidence interval (CI) 1.04-11.43], cardiac arrhythmia (AOR 2.60, 95% CI 1.94-3.49), and gestational hypertensive complications (AOR 3.30, 95% CI 2.93-3.72). Pregnancies with MASLD were also associated with a higher rate of pulmonary edema (AOR 3.30, 95% CI 1.60-6.81)., Conclusion: MASLD is an independent risk factor for cardiovascular complications during delivery hospitalizations, emphasizing the necessity for prepregnancy screening and targeted prevention strategies to manage CVD risks in expectant patients with MASLD., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Pulmonary edema, either cardiogenic or noncardiogenic, is caused by fluid accumulation in the alveolar spaces. Cardiogenic pulmonary edema (CPE), one of the causes of congestive heart failure (CHF), is treated with loop diuretics. Torsemide and furosemide were found to be useful in the treatment of CHF-associated pulmonary edema due to their ability to lower pulmonary capillary pressure and left ventricular end-diastolic pressure, respectively. Pharmacological features of torsemide, such as greater bioavailability, higher absorption rate, and efficacy, make it a better alternative for treating pulmonary edema than the regularly used loop diuretic, furosemide. Torsemide administered intravenously was found to be both efficacious and well tolerated in CPE. However, more research is needed to determine its usefulness in non-CPE., (© Journal of the Association of Physicians of India 2024.)

High-altitude pulmonary edema (HAPE) is a life-threatening, noncardiogenic pulmonary edema that occurs in unacclimatized individuals rapidly ascending to high altitudes above 2,500 m above sea level. Until the entity of HAPE was first identified in a case report published in Japan in 1966, the symptoms of severe dyspnea or coma occurring in climbers of the Japan Alps were incorrectly attributed to pneumonia or congestive heart failure. The Shinshu University Hospital serves as the central facility for rescuing and treating patients with HAPE in the region. Over the past 50 years, a series of studies have been conducted at Shinshu University to gain a better understanding of the characteristics of HAPE. This review summarizes the major achievements of these studies, including their clinical features, management, and pathogenesis of HAPE, particularly in the Japanese population.

Luks AM, Grissom CK. Evaluation and Management of the Individual with Recurrent HAPE. High Alt Med Biol. 25:238-246, 2024. Individuals with a history of acute altitude illness often seek recommendations from medical providers on how to prevent such problems on future ascents to high elevation. Although many of these cases can be managed with pharmacologic prophylaxis and counseling about the appropriate rate of ascent alone, there are some situations in which further diagnostic evaluation may also be warranted. One such situation is the individual with recurrent episodes of high altitude pulmonary edema (HAPE), as one of several predisposing factors may be present that warrants additional interventions beyond pharmacologic prophylaxis and slow ascent and may even preclude future travel to high altitude. This review considers this situation in greater detail. Structured around the case of an otherwise healthy 27-year-old individual with recurrent episodes of HAPE who would like to climb Denali (6,190 m), the review examines the known risk factors for disease and then provides guidance regarding when and how to evaluate such individuals and appropriate steps to prevent HAPE on further ascents to high elevation. Except in rare circumstances, a history of recurrent HAPE does not preclude further ascent to high elevation, as a multipronged approach including pharmacologic prophylaxis, careful planning about the rate of ascent, and the degree of physical effort and other strategies, such as preacclimatization, staged ascent, and use of hypoxic tents, can be employed to reduce the risk of recurrence with future travel.

Background: Immersion pulmonary edema (IPE) is a form of hemodynamic edema likely involving individual susceptibility., Research Question: Can assessing right ventricle (RV) systolic adaptation during immersion be a marker for IPE susceptibility?, Study Design and Methods: Twenty-eight divers participated: 15 study participants with a history of IPE (IPE group; mean ± SD age, 40.2 ± 8.2 years; two women) and 13 control participants (no IPE group; mean ± SD age, 43.1 ± 8.5 years; two women) underwent three transthoracic echocardiography studies under three different conditions: dry (participants were in the supine position on an examination table without immersion), surface immersion (participants were floating prone on the water's surface and breathing through a snorkel), and immersion and negative static lung load (divers were submerged 20 cm below the water's surface in the prone position using a specific snorkel connected to the surface for breathing). Echocardiographic measurements included tricuspid annular plane systolic excursion (TAPSE), tissue S' wave, and right ventricle global strain (RVGLS)., Results: For all divers, immersion increased RV preload. In the no IPE group, the increase in RV preload induced by immersion was accompanied by an improvement in the contractility of the RV, as evidenced by increases in TAPSE (17.08 ± 1.15 mm vs 20.89 ± 1.32 mm), S' wave (14.58 ± 2.91 cm/s vs. 16.26 ± 2.77 cm/s), and RVGLS (25.37 ± 2.79 % vs. 27.09 ± 2.89 %). Negative SLL amplified these RV adaptations. In contrast, among divers with IPE, the increase in RV preload did not coincide with an improvement in RV contractility, indicating altered adaptive responses. In the IPE group, the TAPSE values changed from 17.19 ± 1.28 mm to 21.69 ± 1.67 mm and then to 23.55 ± 0.78 mm, respectively, in the dry, surface immersion, and immersion and negative SLL conditions. The S' wave values changed from 13.42 ± 2.94 cm/s to 13.26 ± 2.96 cm/s and then to 12.49 ± 0.77 cm/s, respectively, and the RVGLS values changed from -24.09% ± 2.91% to -23.99% ± 3.38% and then to -21.96% ± 0.55%, respectively., Interpretation: Changes in RV systolic function induced by immersion (especially with the addition of negative static lung load) vary among divers based on the history of IPE. Analyzing ventricular contractility during immersion, particularly RVGLS, could help to identify individual susceptibility in divers. These findings provide insights for the development of preventive strategies., Trial Registry: Comité de Protection des Personnes; No.: 21.05.05.35821; Recherche Impliquant la Personne Humaine de type 1 (RIPH1) HPS; No.: 2021-A01225-36., Competing Interests: Financial/Nonfinancial Disclosures None declared., (Copyright © 2024 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)

Background and Objectives : Postoperative pulmonary complications (PPCs) are common in patients who undergo cardiac surgery and are widely acknowledged as significant contributors to increased morbidity, mortality rates, prolonged hospital stays, and healthcare costs. Clinical manifestations of PPCs can vary from mild to severe symptoms, with different radiological findings and varying incidence. Detecting early signs and identifying influencing factors of PPCs is essential to prevent patients from further complications. Our study aimed to determine the frequency, types, and risk factors significant for each PPC on the first postoperative day. The main goal of this study was to identify the incidence of pleural effusion (right-sided, left-sided, or bilateral), atelectasis, pulmonary edema, and pneumothorax as well as detect specific factors related to its development. Materials and Methods : This study was a retrospective single-center trial. It involved 314 adult patients scheduled for elective open-heart surgery under CPB. Results : Of the 314 patients reviewed, 42% developed PPCs within 12 h post-surgery. Up to 60.6% experienced one PPC, while 35.6% developed two PPCs. Pleural effusion was the most frequently observed complication in 89 patients. Left-sided effusion was the most common, presenting in 45 cases. Regression analysis showed a significant association between left-sided pleural effusion development and moderate hypoalbuminemia. Valve surgery was associated with reduced risk for left-sided effusion. Independent parameters for bilateral effusion include increased urine output and longer ICU stays. Higher BMI was inversely related to the risk of pulmonary edema. Conclusions : At least one PPC developed in almost half of the patients. Left-sided pleural effusion was the most common PPC, with hypoalbuminemia as a risk factor for effusion development. Atelectasis was the second most common. Bilateral effusion was the third most common PPC, significantly related to increased urine output. BMI was an independent risk factor for pulmonary edema development.