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دانلود کتاب Murray & Nadel's Textbook of Respiratory Medicine, Vol.2
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Murray & Nadel's Textbook of Respiratory Medicine, Vol.2
ویرایش: 7 نویسندگان: V.Courtney Broaddus MD (editor), Joel D Ernst MD (editor), Talmadge E King Jr MD (editor), Stephen C. Lazarus MD (editor), Kathleen F. Sarmiento MD (editor), Lynn M. Schnapp MD (editor), Renee D Stapleton MD PhD (editor), Michael B. Gotway MD (editor) سری: ISBN (شابک) : 0323655874, 9780323655873 ناشر: Elsevier سال نشر: 2021 تعداد صفحات: 1775 زبان: English فرمت فایل : PDF (درصورت درخواست کاربر به PDF، EPUB یا AZW3 تبدیل می شود) حجم فایل: 83 مگابایت
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i - 0 iii. - Front Matter Murray & Nadel’s Textbook of Respiratory Medicine iv. - Copyright Copyright v. - Dedication Dedication vi - Dedication Dedication viii - Contributors Contributors xxxii. - Preface to the Seventh Edition Preface to the Seventh Edition xxxiii - Contents id=R5UwEAAAQBAJ&pg=PR33&img=1&zoom=3&hl=en&bul=1&sig=ACfU3U3JN5 id=R5UwEAAAQBAJ&pg=PR34&img=1&zoom=3&hl=en&bul=1&sig=ACfU3U1SeF id=R5UwEAAAQBAJ&pg=PR35&img=1&zoom=3&hl=en&bul=1&sig=ACfU3U3XBB id=R5UwEAAAQBAJ&pg=PR36&img=1&zoom=3&hl=en&bul=1&sig=ACfU3U3jeO id=R5UwEAAAQBAJ&pg=PR37&img=1&zoom=3&hl=en&bul=1&sig=ACfU3U0xZ2 id=R5UwEAAAQBAJ&pg=PR38&img=1&zoom=3&hl=en&bul=1&sig=ACfU3U35HU id=R5UwEAAAQBAJ&pg=PR39&img=1&zoom=3&hl=en&bul=1&sig=ACfU3U2uR7 id=R5UwEAAAQBAJ&pg=PR40&img=1&zoom=3&hl=en&bul=1&sig=ACfU3U0zoQ id=R5UwEAAAQBAJ&pg=PR41&img=1&zoom=3&hl=en&bul=1&sig=ACfU3U2VVI 1005 - 73 - Lung Cancer_ Molecular Biology and Targets 73 - Lung Cancer: Molecular Biology and Targets INTRODUCTION Molecular Biology Carcinogens Metabolic Reprogramming Genomic Instability DNA Damage Response Host Tumor Interaction and Inflammation Cell of Origin Field of Cancerization Tumor Heterogeneity Tumor Invasion Clinically Relevant Molecular Targets in Lung Carcinoma EGFR/HER2 Pathway Targeted Agents and Clinical Concerns Prognosis and Outcomes KRAS Pathway Targeted Agents and Clinical Considerations Prognosis and Outcomes ALK/ROS1/NTRK Gene Fusions Targeted Agents and Clinical Considerations BRAF MET/PIK3CA Immunotherapy as Targeted Molecular Therapy Future Challenges in Targeted Therapy in Lung Carcinoma Acknowledgments Key Readings References 1018 - 74 - Lung Cancer_ Epidemiology 74 - Lung Cancer: Epidemiology Geographic, Gender, and Ethnic Variability Smoking Smoking Behavior and Risk for Lung Cancer Occupational and Environmental Factors Occupational Exposures Asbestos Diesel Exhaust Other Occupational Exposures Radiation High-LET Radiation: Radon Low-LET Radiation: X-Rays and γ-Rays Air Pollution Atmospheric Air Pollution Indoor Air Pollution Diet and Obesity Other Causative Associations Genetic Susceptibility to Lung Cancer High-Risk Syndromes Conferring an Increased Risk of Lung Cancer Common Low-Penetrance Genes: Genome-Wide Association Studies Acknowledgments Key Readings eFIGURE IMAGE GALLERY References 1029 - 75 - Lung Cancer_ Screening 75 - Lung Cancer: Screening Generalizability Components for Effective Lung Cancer Screening Patient Eligibility Patient Education and Shared Decision-Making Nodule Management Management of Other Screening-Detected Findings SMOKING Cessation (see Chapter 66) Implementation Types of Screening Programs A Framework for Implementation of Lung Cancer Screening Identification and Engagement of Individuals Eligible for Screening Resources for Ensuring Consistency of the Screening Test Communication Across the Screening Process Future Advances Implementation Screening Eligibility Molecular and Imaging Biomarkers Key Readings References 1039 - 76 - Lung Cancer_ Diagnosis and Staging 76 - Lung Cancer: Diagnosis and Staging Presentation/Initial Evaluation Tumor-Node-Metastasis Staging of Lung Cancer Eighth Edition Lung Cancer Stage Classification Staging of Small Cell Lung Cancer Quality Gaps in Lung Cancer Diagnosis and Staging Histology and Prognosis Approach to Staging Suspected Metastatic Disease Locally Advanced Disease/Suspected Mediastinal Involvement Noninvasive Staging Invasive Staging: Mediastinoscopy Key Readings Special Considerations in Lung Cancer Superior Vena Cava Syndrome Oligometastatic Non–Small Cell Lung Cancer Paraneoplastic Syndromes Musculoskeletal Effects Hematologic Effects Hypercalcemia Syndrome of Inappropriate Antidiuretic Hormone Secretion Ectopic Corticotropin Syndrome Neurologic Effects eFIGURE IMAGE GALLERY References 1052 - 77 - Lung Cancer_ Treatment 77 - Lung Cancer: Treatment INTRODUCTION Prognostic and Predictive Factors in Lung Cancer Treatment of Non–Small Cell Lung Cancer by Stage Stage I Non–Small Cell Lung Cancer Stage II Non–Small Cell Lung Cancer Stage III Non–Small Cell Lung Cancer Stage IIIA Stage IIIB and Stage IIIC Stage IV Non–Small Cell Lung Cancer First-Line Chemotherapy Maintenance Chemotherapy Second-Line Chemotherapy Targeted Therapy . Activating mutations in the tyrosine kinase domain of EGFR include exon 19 deletions and exon 21 (L858R) substitutions and wer... . The ALK-fusion gene is found in about 8% of NSCLC79 and is the second most common driver mutation for which there is an effec... . ROS1 gene rearrangements are observed in approximately 2% of patients with adenocarcinoma of the lung.4 Many TKIs approved for... . The most common mutation in v-raf murine sarcoma viral oncogene homolog B1 (BRAF) is the V600E mutation, which is observed in... . Additional mutations include RET fusions (2% of NSCLC),118 MET exon 14 skipping mutation (3–4%), HER2 dysregulation (2%),4 and... Immunotherapy . Second-line therapy is given when first-line therapy either fails or stops working. In two large phase III trials of patient... . Immune-related adverse events may develop anywhere throughout the body (colitis, thyroiditis, diabetes, neuropathy, myositis,... Oligometastatic Disease Treatment of Small Cell Lung Cancer Palliative Care Special Considerations in Lung Cancer Superior Sulcus Tumors and Pancoast Syndrome Superior Vena Cava Syndrome Key Readings eFIGURE IMAGE GALLERY References 1066 - 78 - Rare Primary Lung Tumors 78 - Rare Primary Lung Tumors Definition of Rare Pulmonary Tumors Rare Malignant Primary Pulmonary Epithelial Tumors Sarcomatoid Carcinomas Pneumoblastoma Mucoepidermoid Carcinoma Carcinoids and Large Cell Neuroendocrine Carcinoma Pathologic Features Carcinoid Tumors Large Cell Neuroendocrine Carcinoma Primary Pulmonary Lymphomas Mucosa-Associated Lymphoid Tissue–Type Lymphoma Lymphomatoid Granulomatosis Other Lymphomas and Lymphoproliferative Diseases Primary Pulmonary Sarcomas Parenchymal Sarcomas Vascular Sarcomas Pseudotumors and Borderline Entities Inflammatory Myofibroblastic Tumor Respiratory Tract Papillomatosis Pulmonary Langerhans Cell Histiocytosis (See Chapter 95) Lessons Learned for the Management of Rare Primary Pulmonary Tumors Clinical Strategy Distinguishing Primary Tumors From Metastases Molecular Profiling Treatment Principles Networks Key Readings efigure Image Galley References 1080 - 79 - Metastatic Malignant Tumors 79 - Metastatic Malignant Tumors Epidemiology Clinical History Mechanism of Metastasis to the Lung Diagnosis Differential Diagnosis Distinguishing Metastasis From Primary Lung Tumors Pathology Molecular Classification Options for Obtaining a Tissue Diagnosis Bronchoscopy Computed Tomography–Guided Biopsy (see Chapter 21) Surgery Treatment Multimodality Therapy of Potentially Curable Disease Stereotactic Radiotherapy Radiofrequency Ablation Surgical Resection of Metastases Palliative Care Special Cases Airway Metastasis Vascular Embolic Metastasis Pleural Metastases Key Readings efigure Image Gallery References 1091 - 80 – Benign Lung Tumors 80 - BENIGN LUNG TUMORS INTRODUCTION CLINICAL MANIFESTATIONS BENIGN EPITHELIAL LESIONS PAPILLOMAS ADENOMAS MICRONODULAR PNEUMOCYTE HYPERPLASIA BENIGN NONEPITHELIAL LESIONS HAMARTOMA AND RELATED LESIONS INFLAMMATORY MYOFIBROBLASTIC TUMOR SOLITARY FIBROUS TUMOR MENINGOTHELIAL-LIKE NODULES AND INTRAPULMONARY MENINGIOMA OTHER RARE ENTITIES Key Readings EFIGURE IMAGE GALLERY References 1101 - 81 - Pulmonary Thromboembolism_ Presentation and Diagnosis 81 - Pulmonary Thromboembolism: Presentation and Diagnosis Introduction Pathogenesis and Risk Factors Natural History: Deep Venous Thrombosis Natural History: Pulmonary Embolism Clinical Presentation Diagnosis of Venous Thrombosis Clinical Prediction Rules D-Dimer Assays Combination of Prediction Rules for DVT and D-Dimer Results Contrast Venography Duplex Ultrasonography Magnetic Resonance Imaging Computed Tomography Diagnosis of Pulmonary Embolism Clinical Prediction Rules D-Dimer Testing Standard Laboratory Evaluation Ventilation-Perfusion Scanning Ventilation-Perfusion Scanning With Spect Computed Tomography Pulmonary Angiography (See Also Chapter 20) Echocardiography Concurrent Lower Extremity Venous Evaluation Pulmonary Angiography Diagnostic Approach to Pulmonary Embolism: Summary Massive Pulmonary Embolism Risk Stratification Other Predictors of Mortality Pulmonary Embolism During Pregnancy Recurrent Pulmonary Embolism and Deep Venous Thrombosis Long-Term Consequences of Pulmonary Embolism Key Readings Other Forms of Embolism Schistosomiasis Air Embolism Fat Embolism Amniotic Fluid Embolism (See Chapter 129) Septic Embolism Other Emboli efigure Image Gallery References 1123 - 82 - Pulmonary Thromboembolism_ Prophylaxis and Treatment 82 - Pulmonary Thromboembolism: Prophylaxis and Treatment Prophylaxis Bioavailability of Subcutaneous Anticoagulants Differing Philosophies of Venous Thromboembolism Prophylaxis Venous Thromboembolism Prophylactic Drugs Unfractionated Heparin Low-Molecular-Weight Heparins Fondaparinux Oral Anticoagulants . Vitamin K antagonists, or warfarin in the United States and several other countries, was originally used for inpatient, and la... . Dabigatran is a direct inhibitor of thrombin. It is U.S. Food and Drug Administration (FDA) approved for prophylaxis solely in... . Rivaroxaban is a direct inhibitor of factor Xa. It is FDA approved for VTE prophylaxis in patients with hip (dosed for 35 day... Joint Replacement. In clinical trials, rivaroxaban 10 mg/day was superior to the European enoxaparin regimen, 40 mg once daily s... Internal Medicine. Rivaroxaban prophylaxis for 45 days was compared with placebo in approximately 12,000 discharged internal med... Cancer. Prophylaxis with rivaroxaban 10 mg/day for 6 months was compared with placebo in high–VTE risk ambulatory patients with ... . Another anti–factor Xa drug, apixaban, is begun 12 to 24 hours after hip or knee replacement surgery at 2.5 mg every 12 hours ... Joint Replacement. Approximately 1% of hip and knee replacement patients had symptomatic VTE during the trials’ observation peri... . Betrixaban is a longer-acting anti–factor Xa drug that is FDA approved for internal medicine patients for VTE prophylaxis of ... . Aspirin, long-recognized for its antiplatelet arterial antithrombotic properties through cyclooxygenase-1 inhibition of thro... Mechanical Prophylaxis Vena Cava Interruption Management of Prophylaxis Prophylaxis in COVID-19 Patients and Suspects Treatment of Pulmonary Embolism Overview Pathophysiology (See Chapter 81) Circulatory Compromise Respiratory Compromise Initial Management of Suspected Pulmonary Embolism Pulmonary Embolism Suspected in a Patient With Hypotension, Shock, or Cardiac Arrest Pulmonary Embolism Suspected in a Patient Without Hypotension, Shock, or Cardiac Arrest Initial Management of Confirmed Pulmonary Embolism Assessment of Pulmonary Embolism Mortality Risk Assessment of Bleeding Risk Assessment of Risk for Heparin-Induced Thrombocytopenia Assessment to Determine the Site of Pulmonary Embolism Treatment Telemedicine and Pulmonary Embolism Response Teams Initial Treatment of the Patient With Confirmed Pulmonary Embolism and Hypotension, Shock, or Cardiac Arrest . Systemic thrombolysis is indicated for patients with hypotension, shock, or cardiac arrest resulting from acute PE, provided t... . Low-dose thrombolysis represents an approach to maintain efficacy and reduce the rate of major bleeding complications observe... . Catheter-directed therapies aim to establish reperfusion in the setting of life-threatening PE while avoiding the major blee... . Surgical embolectomy is an option for patients with hypotension, shock, or cardiac arrest resulting from acute PE who are not ... . Extracorporeal membrane oxygenation and percutaneous RV assist have been reported as life-sustaining treatments that may lead... Initial Treatment of the Patient With Confirmed Pulmonary Embolism Without Hypotension, Shock, or Cardiac Arrest . Anticoagulants provide effective initial (day 1 to day 7), long-term (day 7 to 3 months), and extended (beyond 3 months) trea... Unfractionated Heparin. Continuous intravenous UFH provides highly effective treatment of acute VTE.42 However, proper dosing an... Low-Molecular-Weight Heparins. LMWHs are at least as effective and safe as UFH for the initial treatment of most patients with a... Fondaparinux. Fondaparinux is effective and safe to treat acute PE initially.166 The therapeutic dose depends on the patient’s w... Direct Inhibitors of Factor XA or Thrombin. DOACs are as effective as vitamin K antagonists for long-term treatment of VTE and ... . Current guidelines and treatment algorithms consistently recommend the insertion of vena cava filters to treat acute PE when a... . Recommendations regarding the duration of anticoagulant therapy have changed over time. There is general agreement that an acu... Special Problems Isolated Subsegmental Pulmonary Embolism Incidental Pulmonary Embolism Hemoptysis Pulmonary Embolism in Transit Paradoxical Embolism Cancer Pregnancy Recurrent Thromboembolism During Anticoagulant Therapy Key Readings References 1141 - 83 - Pulmonary Hypertension_ General Approach 83 - Pulmonary Hypertension: General Approach Definition of Pulmonary Hypertension Epidemiology Diagnostic Approach Populations at Risk FOR Pulmonary Arterial Hypertension Schistomiasis Scleroderma Other Connective Tissue Diseases Other at-Risk Cohorts Heritable Pulmonary Arterial Hypertension Exposures Diagnosis Clinical Presentation Diagnostic Testing Blood Testing Pulmonary Function Testing Six-Minute Walk Testing Nocturnal Oximetry and Sleep Testing Cardiopulmonary Exercise Testing Electrocardiography Transthoracic Echocardiography Cardiac Magnetic Resonance Imaging Computed Tomography Ventilation-Perfusion Scanning Right Heart Catheterization Performance Provocative Maneuvers . Vasoreactivity testing during RHC to determine acute responsiveness to a pulmonary vasodilator is not recommended in all types... . Exercise can be used during RHC to provoke changes in patients with normal resting hemodynamics, assess for occult left heart ... . Another provocative maneuver that can be used to unmask occult LHD (i.e., a PCWP of 15 mm Hg or less with an intermediate or h... Testing to Determine Prognosis Biomarkers Imaging Exercise Testing Group 2: Pulmonary Hypertension Treatment Considerations for Group 2 Pulmonary Hypertension Group 5: Pulmonary Hypertension Hematologic Disorders (See Chapter 127) Systemic and Metabolic Disorders Others Complex Congenital Heart Disease Treatment Considerations for Group 5 Pulmonary Hypertension Key Readings efigure Image Gallery References 1159 - 84 - Pulmonary Arterial Hypertension_ Group 1 84 - Pulmonary Arterial Hypertension: Group 1 Pathobiology Pulmonary Arterial Hypertension: Group 1 Pulmonary Arterial Hypertension Subgroups Idiopathic Heritable Drugs and Toxins Pulmonary Veno-Occlusive Disease/Pulmonary Capillary Hemangiomatosis Connective Tissue Disease Congenital Heart Disease Portal Hypertension Human Immunodeficiency Virus Supportive Therapies Exercise and Physical Activity Hypoxia and High Altitude Pregnancy and Birth Control Oral Anticoagulants Diuretics Calcium Channel Blockers Targeted Therapies Endothelin Receptor Antagonists Phosphodiesterase Type 5 Inhibitors Soluble Guanylyl Cyclase Activators Prostacyclin Analogues Epoprostenol Subcutaneous and Intravenous Treprostinil Sodium Epoprostenol and Treprostinil Dosing Inhaled Iloprost and Treprostinil Oral Treprostinil and Selexipag Combination Therapy Atrial Septostomy and Potts Shunt Mechanical Support Lung Transplantation Risk Assessment Approach to Therapy Acknowledgement Key Readings eFIGURE IMAGE GALLERY References 1171 - 85 – Pulmonary Hypertension Due to Lung Disease_ Group 3 85 - Pulmonary Hypertension Due to Lung Disease: Group 3 COPD Idiopathic Pulmonary Fibrosis Sleep-Disordered Breathing, Obesity Hypoventilation, and High Altitude Scleroderma Interstitial Lung Disease Other Lung Diseases Pathologic Changes and Pathogenesis Pulmonary Vascular Remodeling Pathogenesis Hypoxic Pulmonary Vasoconstriction Neurohormones . Angiotensin II is a potent vasoconstrictor of the pulmonary vascular bed. The pulmonary vasculature appears to be more sensiti... . Endothelin-1 (ET-1) is a 21–amino acid peptide secreted by vascular endothelial cells in response to stimuli, including puls... Inflammation Right Ventricle Lung Mechanics Clinical Presentation Symptoms and Signs B-Type Natriuretic Peptides Electrocardiography Chest Radiography Echocardiography Computed Tomography Cardiac Magnetic Resonance Imaging Right Heart Catheterization Summary Treatment Treatments Useful in all Patients With Pulmonary Hypertension Due to Chronic Lung Disease Lifestyle Modifications Oxygen Diuretics Treatment of Sleep-Disordered Breathing Lung Transplantation Treatments That May Be Considered in Selected Patients Lung Volume Reduction Surgery Phlebotomy for Polycythemia Iron Supplementation Pulmonary Arterial Hypertension–Specific Therapies Treatment of Decompensated Right Ventricular Failure . Calcium channel blockers are not useful in the treatment of CLD-PH. In a study of 53 patients with COPD and PH, treatment wit... . Three ERAs are approved by the Food and Drug Administration for the treatment of PAH. Bosentan and macitentan are dual ETA and... . Prostanoids such as epoprostenol are potent pulmonary vasodilators normally synthesized by the pulmonary vascular endothelium,... . NO is produced by the enzyme NO synthase within endothelial cells and activates guanylate cyclase, increasing smooth muscle ce... . Sildenafil and tadalafil are selective inhibitors of cyclic guanosine monophosphate–specific phosphodiesterase type 5 and caus... . Riociguat is a soluble guanylate cyclase agonist approved by the Food and Drug Administration in 2013 for the treatment of PAH... Key Readings eFIGURE IMAGE GALLERY References 1185 - 86 - Pulmonary Hypertension Due to Chronic Thromboembolic Disease_ Group 4 86 - Pulmonary Hypertension Due to Chronic Thromboembolic Disease: Group 4 INTRODUCTION Epidemiology and Risk Factors Pathogenesis Diagnostic Evaluation Ventilation-Perfusion Scanning, Echocardiography, and Exercise Testing Radiologic Imaging Determining Operability Pulmonary Thromboendarterectomy Inoperable Disease Medical Therapy Balloon Pulmonary Angioplasty Key Readings Key Points References 1194 - 87 - Pulmonary Vasculitis 87 - Pulmonary Vasculitis Classification Epidemiology Normal Vascular Anatomy and Histology Histopathology of Vasculitis Pathogenesis Initial Diagnosis Clinical Scenarios Suggestive of Vasculitis Chronic and/or Destructive Upper Airway Lesions Chest Imaging Findings of Cavitary or Nodular Disease Diffuse Alveolar Hemorrhage (See Chapter 94) Acute Glomerulonephritis Pulmonary-Renal Syndrome Palpable Purpura Mononeuritis Multiplex Eye Findings Multisystem Disease Specific Testing Antineutrophil Cytoplasmic Antibodies Other Laboratory Studies Chest Imaging Other Imaging Studies Bronchoscopy . Whereas a confident diagnosis may occasionally be made without tissue, diagnostic tissue biopsy remains necessary for a defini... Anchor 442 Specific Clinical Disorders Granulomatosis With Polyangiitis Eosinophilic Granulomatosis With Polyangiitis (see Chapter 96) Microscopic Polyangiitis Small Vessel Vasculitis Related to Immune Complexes Treatment General Principles Induction OF REMISSION In Non–Organ-Threatening Disease In Organ-Threatening or Life-Threatening Disease In Rapidly Progressive Renal Failure, DAH After Relapse of Organ- or Life-Threatening Disease In Refractory Disease Maintenance Specific Treatment Issues in EGPA Monitoring for Complications Key Readings eFigure Image GalleRy References 1212 - 88 - Pulmonary Vascular Anomalies 88 - Pulmonary Vascular Anomalies Pulmonary Arteriovenous Malformations Definition and Epidemiology Hereditary Hemorrhagic Telangiectasia Clinical Presentation Screening and Diagnosis Treatment Pulmonary Sequestration Intralobar Imaging Extralobar Imaging Treatment Pulmonary Vein Varix Clinical Presentation Imaging Treatment Pulmonary Artery Aneurysm Clinical Presentation Imaging Treatment Anomalies of Systemic Arterial Supply Clinical Presentation Imaging Treatment Key Readings eFIGURE IMAGE GALLERY References 1221 - 89 - Idiopathic Pulmonary Fibrosis 89 - Idiopathic Pulmonary Fibrosis Introduction Approach to Patients With Suspected Interstitial Lung Disease Clinical Assessment Chest Imaging Pulmonary Function Testing Laboratory Tests Bronchoalveolar Lavage Lung Biopsy Idiopathic Pulmonary Fibrosis Epidemiology Gross Appearance And Histopathology Etiologic Factors and Pathogenic Mechanisms Familial Pulmonary Fibrosis Clinical Features Blood and Serologic Studies Chest Imaging Chest Radiography High-Resolution Computed Tomography Other Imaging Techniques Pulmonary Function Tests Diagnosis Therapeutic Approach Era Before Antifibrotic Therapy Current Era . Pirfenidone (5-methyl-1-phenyl-2-[1H]-pyridone) is a novel antifibrotic agent that inhibits the progression of fibrosis ... . Nintedanib (BIBF-1120) is a tyrosine kinase inhibitor that targets the platelet-derived growth factor receptor, vascular end... Lung Transplantation (see Chapter 140) Management of Comorbidities and Palliative Care Gastroesophageal Reflux Pulmonary Hypertension Sleep-Related Issues Lung Cancer Other Comorbidities Rehabilitative and Palliative Care Prognosis Staging of IPF and Predicting Outcome Acute Exacerbations of Idiopathic Pulmonary Fibrosis Key Readings eFIGURE IMAGE GALLERY References 1235 - 90 - Nonspecific Interstitial Pneumonitis and Other Idiopathic Interstitial Pneumonias 90 - Nonspecific Interstitial Pneumonitis and Other Idiopathic Interstitial Pneumonias Major Idiopathic Interstitial Pneumonias Nonspecific Interstitial Pneumonia Clinical Features Laboratory Features Radiologic Features Histopathologic Features Differential Diagnosis Clinical Course and Outcome Cryptogenic Organizing Pneumonia Clinical Features Laboratory Features Radiologic Features Histopathologic Features Clinical Course and Outcome Acute Interstitial Pneumonia Clinical Features Radiologic Features .Diffuse, bilateral, air space opacification is seen on the chest radiograph (eFig. 90.9). 61-63 .The typical high-resolution CT (HRCT) features of AIP are bilateral, multifocal, or diffuse areas of ground-glass opacity and... Histopathologic Features Clinical Course and Outcome Respiratory Bronchiolitis–Associated Interstitial Lung Disease and Desquamative Interstitial Pneumonia Clinical Features Laboratory Features Radiographic Features .The chest radiograph is insensitive for detection of RB-ILD and is often normal. Sometimes, bronchial wall thickening or retic... .The key HRCT features of RB-ILD include central bronchial wall thickening proximal to segmental bronchi, peripheral bronchial ... Histopathologic Features Clinical Course and Outcome Rare Idiopathic Interstitial Pneumonias Idiopathic Lymphocytic Interstitial Pneumonia Clinical Features Laboratory Features Radiologic Features .The chest radiograph is nonspecific, with reticular opacities (eFig. 90.16) the most frequent abnormality. A mixed alveolar-in... .The main parenchymal abnormalities on CT scan consist of ground-glass opacities (eFig. 90.17), thickening of interlobular sept... Histopathologic Features Clinical Course and Outcome Idiopathic Pleuroparenchymal Fibroelastosis Clinical Features Laboratory Features Radiologic Features .In patients with early PPFE, chest radiography may be normal. With disease progression, bilateral, irregular pleural thickening... .The characteristic CT scan findings are dense, subpleural consolidations with associated traction bronchiectasis and architectu... Histopathologic Features Clinical Course and Outcomes Acknowledgment Key Readings eFIGURE IMAGE GALLERY Anchor 386 Anchor 387 Anchor 388 Anchor 389 Anchor 390 Anchor 391 References 1248 - 91 - Hypersensitivity Pneumonitis 91 - Hypersensitivity Pneumonitis Classification Epidemiology Etiology MICROBES Animal Proteins Chemical Sensitizers Immunopathogenesis Host Factors and Genetics Tobacco Use Viral Infections Pathogen Virulence Histopathology Diagnosis Exposure Assessment History Antibody Testing Inhalational Challenge Clinical Features Signs and Symptoms Lung Function Bronchoalveolar Lavage Chest Imaging Lung Biopsy Multidisciplinary Discussion Prognosis and Disease Behavior Management Antigen Avoidance Pharmacologic Therapy Lung Transplantation Prevention and Outbreak Identification Key Readings eFIGURE IMAGE GALLERY References 1262 - 92 - Connective Tissue Diseases 92 - Connective Tissue Diseases Approach to Diagnosing and Treating Connective Tissue Disease–Interstitial Lung Disease Clinical Features Radiologic Features Histopathologic Features Role of Autoantibodies in the Diagnosis of CTD-ILD Approach to Treatment of CTD-ILD Systemic Sclerosis (Scleroderma) Epidemiology and Risk Factors Chemically Induced Scleroderma-Like Disorders Pulmonary Manifestations Interstitial Lung Disease Pathogenesis . Individuals may be predisposed genetically to develop SSc, and there are emerging markers that define risks for diffuse lung d... Inflammation Amplification. A wide variety of cytokines identified in bronchoalveolar lavage (BAL) fluid clearly contribute to t... Fibrogenetic Factors. The hallmark of SSc in both lung and skin is the accumulation of connective tissue matrix cells and protei... Epithelial Damage. Although a key pathogenic event in idiopathic ILD, epithelial damage has been relatively underemphasized in d... Clinical Features Imaging Pulmonary Function Tests Bronchoalveolar Lavage Biopsy Serologic Investigations Prognosis Treatment Pulmonary Vascular Disease Other Pulmonary Complications Rheumatoid Arthritis Epidemiology and Risk Factors Pulmonary Manifestations Interstitial Lung Disease Organizing Pneumonia Bronchiolitis Obliterans Follicular Bronchiolitis Bronchiectasis Pulmonary Vasculitis Pulmonary Rheumatoid Nodules Pleural Disease Other Pulmonary Complications Drug-Induced Pulmonary Disease Acute Exacerbations of Interstitial Lung Disease Pulmonary Function Tests Radiologic Features Treatment of Pulmonary Complications Systemic Lupus Erythematosus Epidemiology and Risk Factors Pulmonary Manifestations Diffuse Lung Disease . ILD is uncommon in SLE, affecting only 1–15% of patients. It is usually mild, with slow progression or stability over time. IL... . Although seen in approximately 1–4% of SLE patients, acute lupus pneumonitis is often life-threatening, with a mortality rate ... Shrinking Lung Syndrome Diffuse Alveolar Hemorrhage (see Chapter 94) Pulmonary Arterial Hypertension Pleural Disease Sjögren Syndrome Epidemiology and Risk Factors Pulmonary Manifestations Interstitial Lung Disease Tracheobronchial Disease Polymyositis and Dermatomyositis Epidemiology and Risk Factors Pulmonary Manifestations Interstitial Lung Disease . The clinical features of diffuse lung disease in PM and DM depend on the nature of the lung process. Dyspnea and nonproductive... . Chronic diffuse lung disease is associated with peripheral reticular opacities, particularly in the lung bases. Acute pneumoni... . Lung function tests show a restrictive ventilatory defect with reduced DlCO. With recent hemorrhage or marked myopathy, there ... . BAL lymphocytosis and neutrophilia have been described in diffuse lung disease associated with PM/DM. The significance of BAL ... . Several studies have reported no association between creatine kinase levels and respiratory disease. In fact, the presence of ... Other Pulmonary Manifestations Treatment of Pulmonary Complications Mixed Connective Tissue Disease Idiopathic Pneumonia with Autoimmune Features Relapsing Polychondritis Behçet Syndrome Ankylosing Spondylitis Marfan Syndrome Key Readings eFIGURE IMAGE GALLERY References 1284 - 93 - Sarcoidosis 93 - Sarcoidosis Epidemiology Etiology, Immunology, and Genetics Etiology Diagnostic Approach General Considerations Extrapulmonary Involvement Radiographic Findings Serum Markers Histologic Examination Diagnosis of Sarcoidosis Without Confirmatory Biopsy Controversies Concerning the Number of Organs to Sample by Biopsy Evaluation of Pulmonary Disease Importance of Symptoms and Quality of Life Pulmonary Function Testing Lung Imaging Health-Related Quality of Life Sarcoidosis-Associated Pulmonary Hypertension Evaluation for Extrapulmonary Disease General Considerations Eye Skin Nervous System Heart Liver Vitamin D Dysregulation Parasarcoidosis Syndromes Treatment General Considerations Anti-Inflammatory Agents General Comments Corticosteroids Rationale for Corticosteroid-Sparing Agents Antimalarial Agents Antimetabolites Tumor Necrosis Factor Antagonists Approach to Extrapulmonary Disease Fibrotic Sarcoidosis Lung Transplantation Pulmonary Hypertension Fatigue Small Fiber Neuropathy Mycetoma Bone Health Key Readings eFIGURE IMAGE GALLERY References 1301 - 94 - Diffuse Alveolar Hemorrhage 94 - Diffuse Alveolar Hemorrhage INTRODUCTION Classification Clinical Presentation Laboratory Findings Radiologic Features Physiologic Features Histopathologic Features Diagnosis of Diffuse Alveolar Hemorrhage Diagnosis of Underlying Etiology Role of Surgical Lung Biopsy and Renal Biopsy Therapeutic Approach Specific Causes VASCULITIS (See Chapter 87) Granulomatosis With Polyangiitis Microscopic Polyangiitis Isolated Pulmonary Capillaritis Mixed Cryoglobulinemia Behçet Syndrome Henoch-Schönlein Purpura Pauci-Immune Glomerulonephritis Immunologic Disorders Anti–Glomerular Basement Membrane Disease (Goodpasture Syndrome) Connective Tissue Disease . Among the connective tissue diseases, SLE is the most common cause of DAH (eFig. 94.4).43,119–121 It is unusual for DAH to be ... . Antiphospholipid syndrome (APS) can manifest as a primary disorder; however, it is commonly seen in the setting of other under... . Other connective tissue diseases such as rheumatoid arthritis, polymyositis, dermatomyositis, scleroderma, and mixed connectiv... Immune Complex–Related Crescentic Glomerulonephritis Acute Pulmonary Allograft Rejection Coagulation Disorders Idiopathic Pulmonary Hemosiderosis Miscellaneous Causes Drugs and Toxins Diffuse Alveolar Damage Mitral Stenosis Pulmonary Veno-occlusive Disease Pulmonary Capillary Hemangiomatosis Lymphangioleiomyomatosis and Tuberous Sclerosis Key Readings efigure Image Gallery References 1314 - 95 - Pulmonary Langerhans Cell Histiocytosis and Other Rare Diffuse Infiltrative Lung Diseases 95 - Pulmonary Langerhans Cell Histiocytosis and Other Rare Diffuse Infiltrative Lung Diseases Pulmonary Langerhans Cell Histiocytosis Epidemiology Pathology Pathogenesis Radiographic Findings Pulmonary Function Testing Clinical Features and Diagnostic Evaluation Management Outcomes and Prognosis Rare Infiltrative Disorders of the Lung Neurofibromatosis Hermansky-Pudlak Syndrome Dyskeratosis Congenita Niemann-Pick and Gaucher Diseases Pulmonary Alveolar Microlithiasis Key Readings Complete reference list available at ExpertConsult.com eFIGURE IMAGE GALLERY References 1322 - 96 - Eosinophilic Lung Diseases 96 - Eosinophilic Lung Diseases Eosinophil Biology Physiologic Role of Eosinophils Differentiation and Recruitment of Eosinophils to the Lung Release of Preformed Proteins Targeting the Eosinophil Cell Lineage General Features of Eosinophilic Pneumonias Historical Perspective Clinical Presentation Pathology Diagnosis Idiopathic Chronic Eosinophilic Pneumonia Clinical Features Imaging Laboratory Studies Bronchoalveolar Lavage Differential Diagnosis Pulmonary Function Tests Treatment and Prognosis Idiopathic and Smoking-Related Acute Eosinophilic Pneumonia Clinical Features Exposure and Triggers Imaging Laboratory Studies Bronchoalveolar Lavage Pulmonary Function Tests Lung Biopsy Treatment and Prognosis Eosinophilic Granulomatosis With Polyangiitis History and Nomenclature Pathology Clinical Features Imaging Laboratory Studies and Bronchoalveolar Lavage Antineutrophil Cytoplasmic Antibodies Pathogenesis Diagnosis Treatment and Prognosis Allergic Bronchopulmonary Aspergillosis and Related Syndromes Pathogenesis Clinical Features and Diagnosis Laboratory Studies Imaging Treatment Other Allergic Bronchopulmonary Mycoses Bronchocentric Granulomatosis Hypereosinophilic Syndromes Definition and Classification Pathogenenesis Clinical and Imaging Features Treatment and Prognosis Idiopathic Hypereosinophilic Obliterative Bronchiolitis Eosinophilic Pneumonias of Parasitic and Infectious Origin (See Also Chapter 58) Tropical Pulmonary Eosinophilia Ascaris Pneumonia Eosinophilic Pneumonia in Larva Migrans Syndrome Strongyloides Stercoralis Infection Eosinophilic Pneumonias in Other Parasitic Infections Eosinophilic Pneumonias of Other Infectious Causes Drug-, Toxic Agent-, And Radiation-Induced Eosinophilic Pneumonias Medications and Illicit Drugs (see also Chapter 99) Radiation Therapy Eosinophilic Bronchitis Key Readings Hypereosinophilic Asthma Idiopathic Interstitial Pneumonias Pulmonary Langerhans Cell Histiocytosis Other Conditions eFigure Image Gallery References 1343 - 97 - Lymphangioleiomyomatosis 97 - Lymphangioleiomyomatosis Epidemiology Genetic and Molecular Basis of Tuberous Sclerosis Complex and Lymphangioleiomyomatosis Inheritance Molecular Pathogenesis Tumor Suppressor Proteins Control Cell Growth Tuberous Sclerosis Complex Proteins Regulate Signaling Through the Akt Pathway Tuberous Sclerosis Complex Mutations Are Found in the Lung and Kidney Lesions of Patients With Sporadic Lymphangioleiomyomatosis... Genetic Evidence Suggests that Lymphangioleiomyomatosis is a Metastatic Neoplasm Role of Lymphangiogenesis and Lymphatic Spread in Dissemination of Lymphangioleiomyomatosis Role of Estrogen in the Pathogenesis of Lymphangioleiomyomatosis Immune Evasion as a Mechanism for Lymphangioleiomyomatosis Cell Proliferation Mechanisms of Matrix Remodeling in Lymphangioleiomyomatosis Clinical Features Physical Examination Imaging Studies Pulmonary Function Testing Pathology Diagnosis Management Pharmacologic treatment Hormonal Agents Doxycycline Sirolimus Other Therapeutic Considerations General recommendations Screening Sporadic Lymphangioleiomyomatosis Tuberous Sclerosis–Associated Lymphangioleiomyomatosis Pregnancy Air Travel (see Chapter 106) Pleural Disease (see Chapters 110 and 111) LUNG Transplantation (see Chapter 140) Angiomyolipomas Disease Progression Prognosis Future Clinical Trials Key Readings Sirolimus Prescribing Guide Initiation Maintenance Other Useful Tips Other Advice Vaccinations in Patients With Lymphangioleiomyomatosis General Comments Pleural Disease in Lymphangioleiomyomatosis Spontaneous Pneumothorax Chylous Pleural Effusions or Chylothorax efigure Image Gallery References 1363 - 98 - Pulmonary Alveolar Proteinosis Syndrome 98 - Pulmonary Alveolar Proteinosis Syndrome Pathogenesis Granulocyte-Macrophage Colony-Stimulating Factor Murine Models of Disordered Surfactant Homeostasis Abnormal Surfactant Clearance Abnormal Surfactant Production Role of GM-CSF Autoantibodies Genetic Factors Hereditary PAP Pulmonary Surfactant Metabolic Dysfunction Disorders Disease Associations Environmental Factors Mechanisms of Disruption of Surfactant Homeostasis Primary Pulmonary Alveolar Proteinosis Secondary Pulmonary Alveolar Proteinosis Pulmonary Surfactant Metabolic Dysfunction Nomenclature and Classification Epidemiology Clinical Presentation Pulmonary Alveolar Proteinosis Pulmonary Surfactant Metabolic Dysfunction Evaluation and Differential Diagnosis Radiographic Appearance Pulmonary Function Testing Bronchoscopy, Bronchoalveolar Lavage Lung Biopsy Laboratory Studies Approach to Diagnosis Natural History Secondary Infections Pulmonary Fibrosis Spontaneous Resolution Treatment Autoimmune Pulmonary Alveolar Proteinosis Whole-Lung Lavage Granulocyte-Macrophage Colony-Stimulating Factor Targeting GM-CSF Autoantibodies Targeting Cholesterol Homeostasis Hereditary Pulmonary Alveolar Proteinosis Secondary PAP Surfactant Metabolic Dysfunction Disorders Key Readings eFIGURE IMAGE GALLERY References 1378 - 99 - Drug-Induced Pulmonary Disease 99 - Drug-Induced Pulmonary Disease Oncology Agents Antibiotic-Derived Agents Bleomycin Mitomycin C Alkylating Agents Busulfan Cyclophosphamide Chlorambucil Melphalan Other Alkylating Agents Antimetabolites Methotrexate Azathioprine and 6-Mercaptopurine Cytosine Arabinoside Gemcitabine Fludarabine Nitrosoureas Podophyllotoxins Etoposide and Teniposide Paclitaxel Docetaxel All-Trans Retinoic Acid and Differentiation Syndrome Molecularly Targeted Therapy Monoclonal Antibodies . Bevacizumab, a monoclonal antibody targeting vascular endothelial growth factor, is designed to inhibit tumoral neoangiogenesi... . Cetuximab and panitumumab are two monoclonal antibodies directed against the epidermal growth factor receptor (EGFR). Both hav... . Trastuzumab selectively binds the human epidermal growth factor receptor-2 (HER-2) protein and is an adjuvant treatment for ... . Rituximab is an anti-CD20 chimeric monoclonal. The most common side effect of rituximab is an infusion reaction in more than ... Tyrosine Kinase Inhibitors . Gefitinib is a selective EGFR tyrosine kinase inhibitor. Acute interstitial pneumonia has been associated with this drug, and ... . Erlotinib is another EGFR antagonist. Erlotinib has also been rarely associated with pulmonary toxicity, including fatalities.... . Imatinib is an inhibitor of the BCR-ABL, KIT, and platelet-derived growth factor receptor (PDGFR) tyrosine kinases.84 Fluid r... . Dasatinib is another BCR-ABL tyrosine kinase inhibitor. Dasatinib is associated with pleural effusions, pulmonary hypertension... . Sunitinib and sorafenib are small molecule tyrosine kinase inhibitors that block the intracellular domain of the vascular endo... . Ceritinib, alectinib, crizotinib, and brigatinib are inhibitors of anaplastic lymphoma kinase (ALK) and are used for treatment... Immunomodulatory Agents Interferons Rapamycin Analogues Immune Checkpoint Inhibitors Antimicrobial Agents Nitrofurantoin Acute Reaction Chronic Reaction Sulfasalazine Illicit drugs Heroin AND METHADONE Methylphenidate Cocaine Talc Granulomatosis Cardiovascular Drugs Angiotensin-Converting Enzyme Inhibitors Amiodarone β-Adrenergic Antagonists Tocainide and Flecainide Anti-Inflammatory Agents Aspirin Other Nonsteroidal Anti-Inflammatory Drugs Penicillamine Leflunomide Biologic Agents Leukotriene Antagonists Corticosteroids Drug-Induced Systemic Lupus Erythematosus Oxygen Miscellaneous Drugs and Agents Tocolytic-Induced Pulmonary Edema Hydrochlorothiazide Methysergide, Bromocriptine, and Cabergoline Amphetaminergic Agents Key Readings eFIGURE IMAGE GALLERY References 1395 - 100 - Asthma in the Workplace 100 - Asthma in the Workplace Introduction Definitions of Asthma in the Workplace Sensitizer-Induced Occupational Asthma Epidemiologic Aspects Causal Agents Pathophysiology Immunologic, Immunoglobulin E–Mediated Occupational Asthma Immunologic, Non–Immunoglobulin E–Mediated Occupational Asthma Risk Factors Environmental Factors Host-Related Factors Diagnosis Noninvasive Measures of Airway Inflammation Outcome And Management Prevention Socioeconomic Impact Irritant-Induced Asthma Epidemiologic Aspects Pathophysiology Risk Factors Diagnosis Outcome And Treatment Prevention Work-Exacerbated Asthma Epidemiologic Aspects Pathophysiology Work Exposures Associated With Work-Exacerbated Asthma Diagnosis Differentiating Work-Exacerbated Asthma From Non–Work-Related Asthma or Occupational Asthma Socioeconomic Impact Key Readings References 1409 - 101 - Pneumoconioses 101 - Pneumoconioses Pathogenesis and Exposure-Response Relationships Chest Imaging Silicosis Definition Industries and Occupations at Risk Pathology Pathogenesis Airflow Obstruction, Chronic Bronchitis, and Emphysema Connective Tissue Diseases, Renal Disease, and Cardiovascular Disease Lung Cancer Tuberculosis Clinical Features Radiographic Features Lung Function Diagnosis and Complications Management and Control Coal mine dust lung disease Definition Composition of Coal Mine Dust Pathology Epidemiology and Natural History Disease Phenotypes Classic Coal Workers’ Pneumoconiosis Rapidly Progressive Pneumoconiosis Dust-Related Diffuse Fibrosis Chronic Bronchitis, Emphysema, and Lung Function Impairment Rheumatoid Pneumoconiosis Lung Cancer Clinical Features Chest Imaging Lung Function Diagnosis Management Asbestos-Related Fibrosis of the Lungs (Asbestosis) and Pleura Industries and Occupations at Risk Pathogenesis Asbestosis (Pulmonary Parenchymal Fibrosis) Pathology Epidemiology and Natural History Clinical Features Radiographic Features Lung Function Diagnosis Pleural Plaques, Pleural Fibrosis, and Visceroparietal Reactions Pathology and Pathogenesis Epidemiology Clinical Features and Diagnosis Benign Asbestos-Related Pleural Effusions Management, Prevention, and Health Monitoring Beryllium lung disease Beryllium: Uses, Human Toxicity, and Exposures Pathology and Immune Pathogenesis Clinical Features Diagnosis and Management Acknowledgments Key Readings eFIGURE IMAGE GALLERY References 1423 - 102 - Indoor and Outdoor Air Pollution 102 - Indoor and Outdoor Air Pollution Air Pollutants Pollutants: What They Are and Why They Matter Mechanisms of Defense Against Air Pollution–Related Respiratory Effects Deposition of and Clearance of Particles (see Chapter 13) Gases: Deposition and Damage are Functions of Solubility Oxidative Stress Methods of Studying the Health Effects of Air Pollution Epidemiologic Studies Controlled Human Exposure Research Animal Research In Vitro Research Outdoor air Pollution: Standards and Adverse Respiratory Effects of Specific Pollutants Particulate Matter Sulfur Dioxide Nitrogen Dioxide Ozone Indoor air Pollution Sources of Indoor Pollution Indoor Combustion: Major Source of Indoor Air Pollution Secondhand Smoke and Obstructive Lung Disease Gas Stove Exposure: Cause of Asthma Exacerbation Wood Smoke Exposure: Respiratory Health Effects Respiratory Effects of Kerosene Heater Use Other Indoor Pollutants: “Toxic” Indoor Environment Key Readings References 1435 - 103 - Acute Responses to Toxic Exposures 103 - Acute Responses to Toxic Exposures INTRODUCTION Pathogenesis of Lung Injury From Inhaled Toxicants Patterns of Response to Irritant Inhalation General Management Principles Chronic Sequelae and Residual Effects Specific Exposures Chlorine, Chloramines, Hydrochloric Acid, and Related Chemicals Oxides of Nitrogen, Ozone, Sulfur Dioxide, and Acid Aerosols Military and Crowd-Control Agents Sulfur Mustard Phosgene Chloropicrin Neurotoxicants Chloroacetophenone (Mace), Other Tear Gas Agents, and Zinc Chloride Toxic Metals Cadmium, Mercury, and Nickel Other Metals Metal Fume Fever, Polymer Fume Fever, Organic Dust Toxic Syndrome, and Other Inhalation Fevers Fluorocarbon Aerosol Spray Pneumonitis Hydrocarbon Pneumonitis and Fire-Eater’s Lung Paraquat Smoke Inhalation Pharmacologic Syndromes Other Inhalant Exposures Ammonia Bromine and Methyl Bromide Hydrogen Sulfide Methyl Isocyanate and Methyl Isothiocyanate Miscellaneous Exposures Key Readings References 1447 - 104 - Trauma and Blast Injuries 104 - Trauma and Blast Injuries Introduction Resuscitative Thoracotomy Urgent Thoracotomy Delayed Thoracotomy Thoracic Cage Injuries Rib Fractures Lung Parenchyma Injuries Pulmonary Contusion Pulmonary Laceration Bronchopleural Fistula Pneumothorax Hemothorax (See Chapter 113) Chylothorax (see Chapter 111) Pneumatocele or Intraparenchymal Hematoma Tracheobronchial Injuries Diaphragm Injuries Blast Lung Injury Introduction Primary Blast Injuries Secondary Blast Injuries Tertiary Blast Injuries Quaternary Blast Injuries Physics Of The Blast Wave Spalling Forces Implosion Forces Inertia Forces Results of Blast Injury Management Key Readings eFIGURE IMAGE GALLERY References 1460 - 105 - High Altitude 105 - High Altitude INTRODUCTION ACCLIMATIZATION to High Altitude Pulmonary ACCLIMATIZATION Control of Ventilation Changes in Common Sea-Level Activities at High Altitude Sleep Exercise Maximal Work Ventilation Gas Exchange Cardiovascular Response Exercise Performance at High Altitude Training at High Altitude Maladaptation Problems of Lowlanders on Ascent to High Altitude Susceptibility to Altitude Illness Acute Mountain Sickness . AMS is marked by the presence of headache in addition to one or more other symptoms, including lassitude, anorexia, nausea, di... . Symptoms develop after 6 to 10 hours at a given elevation, not immediately. In a study of a general tourist population traveli... . Despite a considerable amount of research in this area, there is no coherent, unified explanation for why individuals develop ... . The pharmacologic and nonpharmacologic approaches to prevention and amelioration of AMS have been described in published guide... . Descent leads to resolution of all forms of altitude illness, but patients with mild AMS usually recover by simply resting at ... High-Altitude Cerebral Edema High-Altitude Pulmonary Edema . Typically manifesting within 2 to 4 days of ascent to altitudes higher than 2400 m, persons with HAPE usually present in the e... . HAPE is a form of noncardiogenic pulmonary edema marked by normal left ventricular function. Unlike the situation with AMS and... . The nonpharmacologic preventive measures previously described for AMS also apply to HAPE, with a slow ascent being the most im... . Proper treatment depends on the severity of the illness and the clinical setting. In remote locations with limited access to c... Problems of High-Altitude Residents Chronic Mountain Sickness . Symptoms of CMS resemble those found in persons with polycythemia at low altitude: headache, dizziness, lethargy, impaired mem... . The likely initiating factors for CMS are a blunted HVR and relative hypoventilation. Hypoventilation increases alveolar hypox... . The keys to treating CMS are to reduce the hypoxic stimulus for RBC production and to decrease RBC mass. Although relocation t... High-Altitude Pulmonary Hypertension Reentry and Resident Pulmonary Edema Preexisting Illness and High Altitude Respiratory Diseases Chronic Obstructive Pulmonary Disease Interstitial Lung Disease Asthma Pulmonary Vascular Disease Sleep Apnea Thromboembolic Disease Underlying Medical Problems and Altitude Illness Medications Key Readings eFIGURE IMAGE GALLERY References 1475 - 106 – Air Travel 106 - AIR TRAVEL INTRODUCTION EPIDEMIOLOGY AND GENERAL RISKS OF AIR TRAVEL PHYSIOLOGIC IMPACT OF COMMERCIAL AIR TRAVEL PREFLIGHT ASSESSMENT OF FITNESS TO FLY ASSESSING FOR IN-FLIGHT HYPOXEMIA IN PATIENTS WITH RESPIRATORY DISEASE ASSESSING FOR IN-FLIGHT HYPOXEMIA IN PATIENTS NOT USING SUPPLEMENTAL OXYGEN AT SEA LEVEL PRESCRIBING SUPPLEMENTAL IN-FLIGHT OXYGEN IN PATIENTS ALREADY USING SUPPLEMENTAL OXYGEN AT SEA LEVEL PROVIDING SUPPLEMENTAL IN-FLIGHT OXYGEN CONSIDERATIONS REGARDING SPECIFIC LUNG DISEASES AND AIR TRAVEL PNEUMOTHORAX LYMPHANGIOLEIOMYOMATOSIS BIRT-HOGG-DUBÉ SYNDROME PULMONARY HYPERTENSION SICKLE CELL DISEASE AND TRAIT RESTRICTIVE LUNG DISEASE DUE TO CHEST WALL DEFORMITY, NEUROMUSCULAR DISEASE, OR INTERSTITIAL LUNG DISEASE CYSTIC FIBROSIS TRANSMISSION OF RESPIRATORY INFECTIONS DURING AIR TRAVEL RISK OF VENOUS THROMBOEMBOLISM DURING AIR TRAVEL PRACTICAL ASPECTS OF ASSESSING THE PATIENT WITH PULMONARY SYMPTOMS IN FLIGHT SUMMARY Key Readings References 1486 - 107 - Diving Medicine 107 - Diving Medicine Adaptation to Diving Equipment and Techniques Breath-Hold Diving Open-Circuit Scuba Rebreather Diving Surface-Supplied Equipment Saturation Diving Disorders Related to Diving: Nomenclature Pressure Effects and Boyle’s Law Relation of Gas Volume to Depth Barotrauma Barotrauma of Descent Barotrauma of Ascent Dissolved Inert Gas effects and Henry’s Law Inert Gas Kinetics Inert Gas Supersaturation in Tissues Decompression Sickness Risk Factors Clinical Manifestations Diagnostic Testing Treatment Hyperbaric Therapy Inert Gas Narcosis Other Physiologic and Pathophysiologic Considerations for Diving Oxygen Toxicity Thermal Exposure High-Pressure Nervous Syndrome Water Immersion Immersion Pulmonary Edema Medical Clearance to Dive General Fitness for Diving Pulmonary Disorders Primary Spontaneous Pneumothorax (see Chapter 110) Asthma and COPD Energy Needs Bullous Lung Disease Cardiac Disorders Coronary Artery Disease Atrial Septal Defect Patent Foramen Ovale Dysrhythmias Neurologic Disorders Diabetes DROWNING Key Readings Drowning Pathophysiology Clinical Presentation Cardiovascular System Pulmonary System Central Nervous System Treatment Prognosis efigure Image Gallery References 1498 - 108 – Pleural Effusion 108 - PLEURAL EFFUSION INTRODUCTION APPROACH TO PATIENTS WITH PLEURAL EFFUSION DIFFERENTIAL DIAGNOSIS OF PLEURAL EFFUSION SEPARATION OF EXUDATES FROM TRANSUDATES DIFFERENTIATING EXUDATIVE PLEURAL EFFUSIONS Appearance of Pleural Fluid Pleural Fluid Protein Pleural Fluid Lactate Dehydrogenase Pleural Fluid Glucose Pleural Fluid White Cell Count and Differential Pleural Fluid Cytology Other Diagnostic Tests for Malignancy Culture and Bacteriologic Stains OTHER DIAGNOSTIC TESTS FOR PLEURAL FLUID N-Terminal Pro–Brain Natriuretic Hormone Pleural Fluid pH Pleural Fluid Amylase or Lipase Tests for Collagen Vascular Diseases Adenosine Deaminase PLEURAL MANOMETRY USEFUL RADIOGRAPHIC TESTS IN PATIENTS WITH SUSPECTED PLEURAL DISEASE Ultrasound Interferon Gamma Molecular Techniques for Diagnosis of Mycobacteria tuberculosis Computed Tomography Magnetic Resonance Imaging Positron Emission Tomography and Computed Tomography INVASIVE TESTS IN PATIENTS WITH UNDIAGNOSED EXUDATIVE PLEURAL EFFUSIONS Nonspecific Findings on Invasive Testing Needle Biopsy of the Pleura Image-Guided Pleural Biopsy Bronchoscopy Thoracoscopy or Video-Assisted Thoracic Surgery TRANSUDATIVE PLEURAL EFFUSIONS CONGESTIVE HEART FAILURE Pathophysiology (See Chapter 14) Clinical Manifestations Diagnosis and Management HEPATIC HYDROTHORAX (SEE CHAPTER 126) Pathophysiology Clinical Manifestations Diagnosis and Treatment Spontaneous Bacterial Pleuritis NEPHROTIC SYNDROME PERITONEAL DIALYSIS MYXEDEMA PERICARDIAL DISEASE CENTRAL VENOUS OBSTRUCTION VERY LOW PROTEIN TRANSUDATES Urinothorax Subarachnoid-Pleural Fistula Iatrogenic OTHER CAUSES OF TRANSUDATIVE PLEURAL EFFUSIONS EXUDATIVE PLEURAL EFFUSIONS PULMONARY EMBOLISM Clinical Manifestations Diagnosis Treatment ABDOMINAL DISEASES Esophageal Perforation . The symptoms associated with esophageal perforation result from the acute mediastinitis produced by contamination of the media... . The diagnosis of esophageal rupture should be considered in all acutely ill patients with an exudative pleural effusion. The b... . The treatment of the esophageal rupture may range from nonoperative stenting to primary repair to esophagectomy depending on t... Pancreatic Disease . In two prospective reports a decade apart, exactly 50% of the nearly 200 patients admitted with acute pancreatitis had a pleur... . Patients with chronic pancreatic disease often have a large chronic pleural effusion. When the pancreatic ductal system is dis... . Some patients with pancreatic disease develop ascites characterized by high amylase and protein levels. If these patients shou... Intra-abdominal Abscesses . Subphrenic abscess most commonly develops as a postoperative complication 1 to 3 weeks after intra-abdominal surgery.241 Sple... ?Diagnosis and Treatment. The diagnosis of intra-abdominal abscess is best established with an abdominal CT scan (eFig. 108.7 a... Post-abdominal Surgery Liver Transplantation Bilious Pleural Effusion INFLAMMATORY DISEASES Rheumatoid Pleuritis . Almost all patients with rheumatoid pleural effusions are older than 35 years. Approximately 80% are men, and approximately 80... . The diagnosis is suggested by the clinical picture of rheumatoid arthritis in the presence of a pleural effusion. The pleural ... . The natural history of rheumatoid pleuritis varies. Most patients experience a spontaneous resolution within 3 months, but the... Lupus Pleuritis . Most patients with lupus pleuritis have arthritis or arthralgias before the development of a pleural effusion. Almost all pati... . The possibility of lupus pleuritis should be considered in any patient with an exudative pleural effusion of unknown cause. Th... . The pleuritis with systemic lupus responds to corticosteroid administration. It is recommended that patients with lupus pleuri... Immunoglobulin G4–Related Pleuritis Sarcoidosis Asbestos-Related Disease . Patients with pleural effusion secondary to asbestos exposure have surprisingly few symptoms. In the series of Epler and cowor... . The diagnosis of benign asbestos effusion is one of exclusion. It requires the following criteria: history of direct or indire... . The natural history of the patient with an asbestos pleural effusion is one of chronicity, with frequent recurrences and somet... Uremia Post–Cardiac Injury Syndrome . The syndrome typically develops about 3 weeks after the injury, but it can happen any time between 3 days and 1 year. The two ... . The diagnosis of PCIS should be considered in any patient who develops a pleural effusion after injury to the heart. The diagn... . PCIS usually responds to treatment with anti-inflammatory agents, such as aspirin, colchicine or indomethacin. Corticosteroid... Post–Coronary Artery Bypass Surgery Drug-Induced Pleural Disease Other Inflammatory Diseases Miscellaneous Lung Transplantation Meigs Syndrome . Pleuropulmonary reactions occasionally result from the administration of nitrofurantoin. Such reactions can have an acute or a... . Dantrolene sodium is a long-acting skeletal muscle relaxant with a chemical structure similar to that of nitrofurantoin. Its ... . The administration of methysergide can lead to a pleuropulmonary disease similar to that seen with nitrofurantoin.301 Symptoms... . The administration of ergot alkaloid drugs, such as bromocriptine, ergotamine, dihydroergotamine, nicergoline, pergolide, and ... . There have been two detailed case reports of pleuropulmonary reactions consisting of chills, cough, dyspnea, and bilateral pul... . Amiodarone is an antiarrhythmic that may produce severe pulmonary toxicity. Pleural effusions are seen as a manifestation of a... . Recombinant IL-2 is sometimes used in the treatment of malignancies, especially melanoma or renal cell carcinoma. One of the ... . Dasatinib, an inhibitor of multiple tyrosine kinase inhibitors, is used primarily for treating adults with chronic myeloid leu... Endometriosis Ovarian Hyperstimulation Syndrome Trapped Lung (See Chapter 112) Yellow Nail Syndrome Misplaced Catheters Key Readings EFIGURE IMAGE GALLERY References 1524 - 109 - Pleural Infections 109 - Pleural Infections Bacterial Pleural Empyema Historical Perspective Incidence Epidemiology Pathogenesis Clinical Presentation Pleural Fluid Sampling Biochemistry Microbiology Antibiotic Selection and Duration Nutrition Early Risk Stratification Investigative Techniques for Pleural Infection Radiology Bronchoscopy Chest Tube Drainage Fibrinolytic Therapy Monitoring Response to Medical Management Surgical Options Pleural Tuberculosis Pathogenesis Clinical Manifestations Pleural Fluid Diagnosis Treatment Actinomycosis Nocardiosis Fungal Infections Aspergillosis Blastomycosis Coccidioidomycosis Primary Coccidioidomycosis Rupture of Coccidioidal Cavity Cryptococcosis Histoplasmosis Pneumocystis Jirovecii Viral Infections Primary Atypical Pneumonia Other Viruses Acquired Immunodeficiency Syndrome Parasitic Diseases Amebiasis Echinococcosis Paragonimiasis Key Readings eFIGURE IMAGE GALLERY References 1539 - 110 - Pneumothorax 110 - Pneumothorax SPONTANEOUS PNEUMOTHORAX Epidemiology Etiology Primary Spontaneous Pneumothorax Ectomorphic Body Shape Abnormal Lung Parenchyma and Smoking Traumatic Pneumothorax Diagnosis Treatment Iatrogenic Pneumothorax Diagnosis Treatment Catamenial Pneumothorax Pathogenesis Treatment Key Readings eFIGURE IMAGE GALLERY References 1551 - 111 - Chylothorax 111 - Chylothorax Overview of the Lymphatic System and Drainage of the Thoracic Duct Anatomy Components of Chyle Etiology and Clinical Manifestations of Chylothorax Etiology of Chylothorax Traumatic Chylothorax Nontraumatic Chylothorax Clinical Manifestations Specific Syndromes/Conditions Related to Chylothorax . LAM is a multisystem disease of women characterized by proliferation of abnormal smooth muscle–like LAM cells leading to cysti... . Chylothorax and chyloascites can present in patients with liver cirrhosis. High portal venous pressure can increase thoracic d... . Fetal chylothorax, sometimes termed primary fetal pleural effusion or congenital chylothorax, is rare with an incidence of 0.0... Diagnosis Fluid Appearance Biochemical Analysis Imaging Treatment General Approaches DRAIN THE PLEURAL FLUID Reduce the Flow of Chyle and Close the Defect Dietary Management Drugs Minimally Invasive Treatments: Lymphangiography, Embolization, and Disruption Surgery: Thoracic Duct Ligation REPLACE Chyle Components and Nutrients Treat the Underlying Disease Mediastinal Lymphadenopathy (Especially Lymphoma) and Obstructive Mediastinal Structures Lymphangioleiomyomatosis Hepatic Cirrhosis OBLITERATE the Pleural Space Pseudochylothorax Pathophysiology Clinical Manifestation Diagnosis Treatment Acknowledgment Prevention of Chylothorax During Surgery Prognosis Key Readings eFIGURE IMAGE GALLERY References 1560 - 112 – Pleural Fibrosis and Unexpandable Lung 112 - PLEURAL FIBROSIS AND UNEXPANDABLE LUNG INTRODUCTION DIAGNOSIS OF PLEURAL FIBROSIS AND OF UNEXPANDABLE LUNG GENERAL MANAGEMENT PRINCIPLES CAUSES OF PLEURAL FIBROSIS ASBESTOS-RELATED PLEURAL FIBROSIS RHEUMATOLOGIC DISEASES MALIGNANCY (SEE CHAPTER 114) UREMIA TUBERCULOSIS IMMUNOGLOBULIN G4–RELATED DISEASE AMYLOID MEDICATIONS AND IATROGENIC CAUSES PLEUROPARENCHYMAL FIBROELASTOSIS (SEE CHAPTER 90) PLEURAL INFECTION Anchor 248 POST–CORONARY ARTERY BYPASS GRAFT SURGERY HEMOTHORAX (SEE CHAPTER 113) Key Readings References 1570 - 113 - Hemothorax 113 - Hemothorax INTRODUCTION Diagnosis Etiology Traumatic Hemothorax Nontraumatic Hemothorax Iatrogenic HEMOTHORAX Management Complications of Hemothorax Surgical Intervention Key Readings References 1575 - 114 - Pleural Malignancy 114 - Pleural Malignancy Metastatic Pleural Disease Types Of Tumor Clinical Features Malignant Pleural Effusions Pleural Fluid Analysis Radiographic Evaluation Diagnosis Therapy and Palliation Prognosis Mesothelioma Incidence and Etiology Demographics Clinical Features Subtypes Diagnosis Radiographic Evaluation Pathologic Features Staging Prognosis Approach to Therapy Surgical Therapy Chemotherapy Immunotherapy Radiation Therapy Palliative Therapy Screening and Chemoprevention Solitary Fibrous Tumor of the Pleura Clinical Features Radiologic Features Pathologic Features Staging Primary Pleural Lymphoma Immune Checkpoint Inhibitor–Related Pleural Effusion efigure Image GalleRy References 1590 - 115 - Mediastinal Tumors and Cysts 115 - Mediastinal Tumors and Cysts Introduction Normal Anatomy of the Mediastinum Clinical Presentations of Mediastinal Disease Imaging the Mediastinum Conventional Radiographic Techniques Computed Tomography Magnetic Resonance Imaging Ultrasonography Nuclear Imaging Techniques for Obtaining Mediastinal Tissue Image-Guided Biopsy Endobronchial and Endoscopic Ultrasound-Guided Aspiration Transthoracic Needle Aspiration and Biopsy Surgical Biopsy Mediastinoscopy Video-Assisted Thoracoscopic Surgery Mediastinal Mass Classification Incidence Specific Mediastinal Tumors And Cysts Lesions of the Anterior Mediastinum Thymic Neoplasms Germ Cell Tumors Lymphoma Thyroid Lesions Parathyroid Lesions Mesenchymal Tumors NUT Carcinoma Lesions of the Middle Mediastinum Enlargement of Lymph Nodes Developmental Cysts Lesions of the Posterior Mediastinum Neurogenic Tumors Miscellaneous Mediastinal Masses Benign Lesions Vascular Masses and Enlargements Diaphragmatic Hernia General Approach to a Mediastinal Mass Initial Evaluation Surgical Management Acknowledgments Key Readings eFIGURE IMAGE GALLERY References 1605 - 116 - Mediastinitis and FIBROSING MEDIASTINITIS 116 - Mediastinitis and FIBROSING MEDIASTINITIS INTRODUCTION Acute Mediastinitis Anatomic Considerations Clinical Presentation Evaluation and Useful Studies Mediastinitis Resulting From Visceral Perforation Spontaneous Esophageal Rupture (Boerhaave Syndrome) Iatrogenic Injuries Other Visceral Insults Mediastinitis Secondary to Extension From Outside the Mediastinum Descending Necrotizing Mediastinitis Ascending and Other Uncommon Causes of Mediastinitis From Direct Extension Mediastinitis Following Cardiac Surgery “Spontaneous” OR “Primary” Mediastinitis Spontaneous Mediastinitis Hemorrhagic Mediastinitis Secondary to Inhalational Anthrax Management of Acute Mediastinitis Microbiology and Antimicrobial Selection Mechanical Débridement: Operative, Percutaneous, and Endoscopic Interventions FIBROSING MEDIASTINITIS and Mediastinal Granuloma FIBROSING MEDIASTINITIS Clinical Features Diagnosis Treatment Idiopathic Fibrosing Mediastinitis and Fibrosing Mediastinitis From Other Causes Mediastinal Granuloma Clinical Features Diagnosis Treatment Mediastinal Adenitis Clinical Features Diagnosis Treatment Acknowledgments Key Readings eFIGURE IMAGE GALLERY References 1618 - 117 - Control of Breathing and Upper Airways During Sleep 117 - Control of Breathing and Upper Airways During Sleep INTRODUCTION Generation of Wakefulness and Sleep Wakefulness Non-REM Sleep The “Sleep Switch” Effects of Common Neurodepressive Drugs on Brain Arousal State Application to Sleep and Drug-Induced Respiratory Depression Breathing and its Control Respiratory Neurons Organization Respiratory Rhythm and Motor Activation . The pre-Bötzinger complex is often emphasized given its role in respiratory rhythm generation. The pre-Bötzinger complex is ... . In expiration, the expiratory neurons of the Bötzinger complex inhibit inspiratory pre-motoneurons and motoneurons. Caudal VR... Respiratory Rhythm Generation and Central Apnea Respiratory Motor Pools and Muscle Activity Respiratory Muscles Vary in the Degree of Their Relationship to Breathing Effects of Sleep Chemosensors and Chemoreflexes Location and State Dependence of Responses Integrative Physiologic Mechanisms Underpinning Respiratory Dysfunction and Instability During Sleep Breathing is Dependent on Feedback Regulation in Sleep Principle Application Loop Gain and its Importance Principle Application Arousal from Sleep: A Consequence and Cause of Respiratory Disturbance Principle Application Principle Application Overarching Principle: Various Trajectories can Lead to a Sleep-Disordered Phenotype Clinically Relevant Concepts in Respiratory Control Obesity Principle Application Heart Failure Principle Application Aging Principle Application Other Clinical Conditions Principles Application . Patients with baseline hypercapnia often experience worsening hypercapnia during non-REM sleep. The effect of REM sleep is qu... . Patients with neuromuscular disease also experience deterioration of gas exchange during non-REM sleep with further worsening... Parenchymal Lung Disease. In patients with parenchymal lung disease, such as emphysema or pulmonary fibrosis, similar mechanisms... Individualized Therapy Targeting Underlying Mechanisms Key Readings eFIGURE IMAGE GALLERY References 1633 - 118 - Consequences of Sleep Disruption 118 - Consequences of Sleep Disruption Effects of Sleep Disruption on Acute and Chronic Disease Neurocognitive Changes Acute Effects Chronic Implications Psychiatric Disorders Pain Perception Acute Effects Chronic Implications Cardiovascular Disease Immune Function Endocrine and Metabolic Dysfunction Acute Effects Chronic Implications Cancer Risk Special Patient Populations Maternal-Fetal Health Critically Ill Patients Maternal Health Fetal Development Treatment of Sleep Disruption Sleep Hygiene Primary Sleep Disorders Comorbid Illnesses Acknowledgments Key Readings References 1643 - 119 - Sleep-Disordered Breathing_ A General Approach 119 - Sleep-Disordered Breathing: A General Approach Thinking Like a Sleep Pulmonologist The Golden 8 Hours Ventilation, Oxygenation, and Mechanics During Sleep Identifying Pulmonary Patients at Risk for Comorbid Sleep Disorders Taking a Relevant Sleep History Questionnaires Diagnostic Sleep Testing Navigating Devices and Technologies Common Clinical Scenarios to Consider Sleep-Disordered Breathing Arrhythmias Prevalence of Arrhythmias in Obstructive Sleep Apnea Contributing Mechanisms Impact of Obstructive Sleep Apnea Treatment on Arrhythmia Stroke Epidemiology of Obstructive Sleep Apnea and Central Sleep Apnea in Stroke Contributing Mechanisms Impact of Continuous Positive Airway Pressure on Stroke Risk Impact of Continuous Positive Airway Pressure on Neurologic Outcomes After Stroke Pulmonary Hypertension Inpatient and Intensive Care Unit Patients Perioperative Evaluation Chronic Obstructive Pulmonary Disease Asthma Key Readings eFIGURE IMAGE GALLERY References 1654 - 120 - Obstructive Sleep Apnea 120 - Obstructive Sleep Apnea Pathogenesis Upper Airway Dimensions Upper Airway Collapsibility Neuromuscular Factors Upper Airway Inflammation Fluid Shift Predisposing Factors Obesity Upper Airway Anatomic Abnormalities Gravity/Body Position Genetic Factors Endocrine Disturbances Smoking Alcohol, Drugs Epidemiology Prevalence Sex Differences Ethnicity Aging Pregnancy Clinical Evaluation Clinical Presentation Elements of a Complete Sleep History Measurement of Sleepiness Diagnosis Questionnaires/Prediction Equations Laboratory Polysomnography Unattended Sleep Studies In-Hospital Diagnosis Differential Diagnosis Periodic Hypersomnia Idiopathic Hypersomnia Movement Disorders During Sleep Circadian Rhythm Disorders Parasomnias Pathophysiology of Consequences Neurocognitive Sequelae Cardiometabolic Sequelae Consequences/Complications of OSA Neurobehavioral Complications of OSA Excessive Sleepiness and Motor Vehicle Operation Fatigue Mood Disturbances: Depression, Anxiety Quality of Life Cognitive Impairment Neurodegenerative Disease and Dementia Cardiometabolic Complications Hypertension Arrhythmias Myocardial Infarction Cerebrovascular Events Congestive Heart Failure Pulmonary Hypertension Renal Perfusion/Dysfunction Metabolic Disturbances: Insulin Resistance, Dyslipidemia Hepatic Sequelae/Steatohepatitis Mortality Other Complications Disease Management Strategies OSA and Ocular Disease Erectile Dysfunction OSA and Cancer Key Readings efigure Image Gallery References 1670 - 121 – Central Sleep Apnea 121 - Central Sleep Apnea Hypercapnic Central Sleep Apnea Secondary Forms of Hypercapnic Central Sleep Apnea Developmental and Degenerative Diseases Brainstem Tumors Cerebrovascular Disease Neuromuscular Diseases Primary Hypercapnic Central Sleep Apnea Central Alveolar Hypoventilation Syndrome Treatment Nonhypercapnic Central Sleep Apnea Secondary Forms of Nonhypercapnic Central Sleep Apnea Central Sleep Apnea in Association With Heart Failure: Cheyne-Stokes Respiration . Although symptoms of heart failure, including orthopnea, paroxysmal nocturnal dyspnea, witnessed apnea, fatigue, and insomnia ... . Because few symptoms have been attributed to CSR-CSA, symptomatic targets for therapy are difficult to identify. However, bec... . Because CSR-CSA arises as a consequence of heart failure, it would be reasonable to optimize pharmacologic and device treatme... Positive Airway Pressure Continuous Positive Airway Pressure. The effects of Continuous positive airway pressure (CPAP) have been studied extensively in ... Adaptive Servoventilation. Adaptive servoventilation (ASV) is a form of positive airway pressure specifically designed to allevi... Central Sleep Apnea Associated With Cerebrovascular Disease Central Sleep Apnea Associated With Atrial Fibrillation Central Sleep Apnea Associated With Renal Failure Central Sleep Apnea Associated With Acromegaly Central Sleep Apnea Associated With High Altitude (See Chapter 105) Central Sleep Apnea Associated With Opioid Use Complex Sleep Apnea Primary Nonhypercapnic Central Sleep Apnea Idiopathic Central Sleep Apnea Key Readings eFigure Image Gallery References 1687 - 122 - Sleep-Disordered Breathing_ Treatment 122 - Sleep-Disordered Breathing: Treatment Obstructive Sleep Apnea Nonsurgical Options Weight Loss Positional Therapy Positive Airway Pressure Adherence to Therapy Negative External Pressure Therapy Nasal Therapies Oral Appliances Nocturnal Supplemental Oxygen Pharmacologic Therapy Surgical Options: Anatomic Targets (See Chapter 70) How to Think About Upper Airway Surgery for Obstructive Sleep Apnea Nasal Procedures Soft Palate Procedures Tongue Muscle Strengthening: Genioglossus Advancement Tongue Volume Reduction: Lingual Tonsillectomy Hypoglossal Nerve Stimulation Maxillomandibular Advancement Applying These Concepts: an Algorithm Incorporating Surgical and Nonsurgical Treatments Sleep-Related Hypoventilation Syndromes Obesity Hypoventilation Syndrome Central Sleep Apnea Continuous Positive Airway Pressure Bilevel Positive Airway Pressure With Backup Rate Adaptive Servoventilation Supplemental Oxygen Compression Stockings Phrenic Nerve Stimulation Neuromuscular Disease COPD Key Readings eFigure Image Gallery References 1703 - 123 - Pulmonary Complications of HIV Infection 123 - Pulmonary Complications of HIV Infection Introduction Epidemiology Immunologic Abnormalities Diagnostic Approach CD4+ Lymphocyte Count Fiberoptic Bronchoscopy Infectious Complications Bacteria Other Bacteria Mycobacteria Mycobacterium tuberculosis Mycobacterium avium Complex Mycobacterium kansasii Other Mycobacteria Fungi Pneumocystis jirovecii Cryptococcus Species Histoplasma capsulatum Coccidioides immitis . The clinical presentation is often nonspecific; fever and chills (68%), night sweats (36%), and weight loss (50%) are all comm... . The risk of symptomatic disease is highest if CD4+ counts are less than 250 cells/μL.27 Most cases of disseminated coccidioido... . In a series of 91 HIV-infected patients with coccidioidomycosis, diffuse reticulonodular opacities (see Fig. 56.5) were seen ... . Serologic tests are useful in the evaluation of suspected coccidioidomycosis. Several studies have found an 80–90% sensitivity... . Either amphotericin B or a lipid formulation of amphotericin B is the treatment of choice for HIV-infected patients with seve... Aspergillus Species . The entire spectrum of Aspergillus-related lung disease (see Chapter 57) has been observed in HIV-infected persons, from col... . The definitive diagnosis of aspergillosis requires demonstration of tissue invasion and isolation of the organism by culture. ... . Compared with the fungi previously discussed, there is less experience treating aspergillosis in HIV-infected patients.223 Vo... Blastomyces dermatitidis . The largest case series reported 15 cases of HIV-associated blastomycosis; all but one patient had a CD4+ lymphocyte count le... . Intravenous amphotericin B is the treatment of choice for HIV-infected patients with severe disease.233,234 Treatment with am... Talaromyces marneffei . Most cases of talaromycosis are seen in patients with a CD4+ lymphocyte count less than 100 cells/μL. The clinical presentatio... . T. marneffei is most commonly a disseminated disease in HIV-infected patients, and the diagnosis is usually made by isolation... . Amphotericin B, followed by itraconazole, is the standard treatment for P. marneffei.27 Mild forms of disease can be treated i... Viruses Cytomegalovirus . Retinitis and gastrointestinal disease are the two most common forms of HIV-associated CMV disease. CMV is a frequent isolate... . The imaging findings of CMV pneumonia vary and include reticular or ground-glass, alveolar, and nodular opacities (eFig. 123.... . When CMV pulmonary disease is suspected in conjunction with other end-organ disease (e.g., retinitis), CMV therapy must be in... . Data for treatment of CMV pneumonia in HIV-infected patients are limited. Intravenous ganciclovir or foscarnet is recommended... Other Herpesviruses Influenza Coronavirus Disease 2019 Parasites Toxoplasma gondii . Central nervous system complications of T. gondii are well recognized in HIV disease and include encephalitis and focal brain ... . The chest radiograph usually reveals bilateral opacities, either in a fine reticulonodular pattern indistinguishable from PCP ... . The diagnosis of pulmonary toxoplasmosis is usually established by bronchoscopy and study of BAL fluid.254 T. gondii can be de... . The treatment for pulmonary toxoplasmosis is identical to that for central nervous system toxoplasmosis. First-line treatment... Other Parasites Noninfectious Disorders Malignancies Kaposi Sarcoma . Pulmonary KS is detected clinically in approximately one-third of patients with known KS, with the proportion detected at aut... . Pulmonary KS characteristically presents with bilateral opacities in a central or perihilar distribution, as shown in Figure 1... . The diagnosis of pulmonary KS is usually established by bronchoscopy. The observation of characteristic endobronchial, red or ... . Tumors can regress in size and number in response to ART, and therefore combination ART is recommended for all patients with K... Non-Hodgkin Lymphoma . Most HIV-infected patients with NHL present with disseminated disease and extranodal involvement.282 Frequent extranodal site... . The most common chest radiograph findings include single (Fig. 123.9; eFig. 123.32) or multiple parenchymal nodules (eFig. 123... . The diagnosis of NHL requires demonstration of malignant lymphocytes on cytology or biopsy specimens. Most often the diagnosis... . Pulmonary involvement in NHL is treated as part of systemic disease. Median survival from AIDS-related NHL has greatly improv... Primary Effusion Lymphoma Multicentric Castleman Disease Non–Small Cell Lung Cancer . HIV-infected patients develop lung cancer at slightly younger ages than do non–HIV-infected patients, after controlling for ... . Diagnosis and treatment of lung cancer in an HIV-infected patient is similar to that in a non–HIV-infected individual. Ongoi... Pulmonary Arterial Hypertension . In a review of 131 cases of PAH in HIV-infected patients,320 the presenting symptoms and radiographic, pulmonary function, el... . As with idiopathic PAH, the diagnosis of HIV-associated PAH requires confirmation of elevated pulmonary arterial pressures an... . The optimal treatment of HIV-associated PAH is unclear.322 In general, patients should receive antiretroviral therapy because... Obstructive Lung Disease COPD Asthma Treatment of COPD and Asthma Interstitial Pneumonitides Lymphocytic Interstitial Pneumonitis . The most striking feature of HIV-associated LIP is the effect of age on its incidence. Early in the AIDS epidemic, one-third... . The definitive diagnosis of LIP requires histologic confirmation by biopsy. There are so few studies of LIP among HIV-infecte... Nonspecific Interstitial Pneumonitis . The clinical features of NSIP are indistinguishable from those of PCP; however, NSIP may present at CD4+ lymphocyte counts gre... . The diagnosis of NSIP requires both histologic confirmation and the exclusion of other etiologies. The natural history of HIV-... Sarcoidosis Immune Reconstitution Inflammatory Syndrome . Numerous disease processes have been associated with IRIS. These include many infections, sarcoidosis, autoimmune conditions, ... . The diagnosis of IRIS requires compatible clinical features and exclusion of alternative causes for worsening clinical status.... Key Readings eFIGURE IMAGE GALLERY References 1728 - 124 - Pulmonary Complications of Primary Immunodeficiencies 124 - Pulmonary Complications of Primary Immunodeficiencies Diagnostic Workup Antibody Deficiencies Cellular Immunodeficiency Phagocyte Deficiencies Complement Deficiencies Anatomic Defects Genetic Testing Antibody Deficiencies X-Linked Agammaglobulinemia Common Variable Immunodeficiency Immunoglobulin A Deficiency Specific Antibody Deficiency Immunoglobulin G Subclass Deficiency Hyper–Immunoglobulin M Syndrome (B Cell Intrinsic) Mutations in AICD or UNG Deficiency in Both Cellular Immunity and Antibody Production (Combined Immunodeficiencies) Hyper–Immunoglobulin M Syndrome (Combined) X-Linked Hyper-IgM Syndrome Mutations of NF-κB Essential Modifier Combined Hyper-IgM Syndrome Caused by Other Mutations Severe Combined Immunodeficiency Combined Immunodeficiencies or Syndromic Immunodeficiencies Digeorge Syndrome Wiskott-Aldrich Syndrome Ataxia-Telangiectasia Hyper–Immunoglobulin E Syndrome Phagocyte Disorders Developmental Defects In Neutrophils Leukocyte Adhesion Deficiency Chronic Granulomatous Disease Gata-2 Deficiency Mendelian Susceptibility to Mycobacterial Disease Disorders in Innate Immunity Myd88 and Irak-4 Deficiencies Complement Deficiencies Key Readings References 1745 - 125 - Pulmonary Complications of Stem Cell and Solid Organ Transplantation 125 - Pulmonary Complications of Stem Cell and Solid Organ Transplantation Infectious Complications Bacterial Pneumonia Mycobacterial Infections Fungal Infections (See Chapter 57) Epidemiology and Clinical Characteristics Diagnostic Testing Treatment Pneumocystis jirovecii Pneumonia Viral Infections Herpesviruses Community-Acquired Respiratory Viruses Noninfectous Complications of Hematopoietic Cell Transplantation Early-Onset Complications Idiopathic Pneumonia Syndrome Pulmonary Alveolar Proteinosis Pulmonary Vascular Disease Late-Onset Complications Bronchiolitis Obliterans Syndrome Restrictive Lung Dysfunction and Interstitial Lung Disease Organizing Pneumonia Pleuropulmonary Fibroelastosis Noninfectious Complications in Solid Organ Transplantation Postoperative Respiratory Failure Pleural Effusions Diaphragmatic Dysfunction Metastatic Pulmonary Calcification Drug-Induced Pneumonitis Malignancy After Transplantation Acknowledgment Key Readings eFIGURE IMAGE GALLERY References 1758 - 126 - Pulmonary Complications of Abdominal Diseases 126 - Pulmonary Complications of Abdominal Diseases Gastroesophageal and Gastrointestinal Disorders Gastroesophageal Reflux Disease Pathophysiology Asthma Chronic Cough Other Lung Diseases Diagnosis and Treatment Inflammatory Bowel Disease Pulmonary Function Disturbances Intrinsic Pulmonary Complications Iatrogenic Pulmonary Complications Hepatic Diseases Pleural Effusion Pulmonary Function Disturbances Hepatopulmonary Syndrome Definition and Diagnosis Epidemiology Pathogenesis Clinical Manifestations Treatment Prognosis Portopulmonary Hypertension Definition and Diagnosis Epidemiology Pathogenesis Clinical Manifestations Treatment Prognosis Primary Biliary Cirrhosis Chronic Hepatitis C Sclerosing Cholangitis Alpha1-Antitrypsin Deficiency Pancreatic Diseases Acute Pancreatitis Early Respiratory Insufficiency and Imaging Abnormalities Acute Respiratory Distress Syndrome Delayed Complications of Acute Pancreatitis Autoimmune Pancreatitis Kidney Diseases Pulmonary Edema Pulmonary Hypertension Pleural Disease Pulmonary Calcification Sleep Disorders Hemodialysis-Induced Hypoxemia Key Readings eFIGURE IMAGE GALLERY References 1773 - 127 - Pulmonary Complications of Hematologic Diseases 127 - Pulmonary Complications of Hematologic Diseases Red Blood Cell Disorders Anemia Polycythemia Hemoglobinopathies Sickle Cell Disease Acute Chest Syndrome Activation of Inflammatory Pathways in Patients With Sickle Cell Disease Pulmonary Hypertension Pathogenesis Chronic Lung Disease Thalassemia Other Hemoglobin Disorders White Blood Cell Disorders Leukemias Plasma Cell Disorders Thrombosis and Disorders of Coagulation Inherited Thrombophilia Coagulopathies and Platelet Disorders Complications of Transfusion Transfusion-Associated Acute Lung Injury Epidemiology Pathogenesis Clinical Features and Evaluation Treatment Transfusion-Associated Circulatory Overload Key Readings eFIGURE IMAGE GALLERY References 1788 - 128 - Pulmonary Complications of Endocrine Diseases 128 - Pulmonary Complications of Endocrine Diseases Diabetes Ventilatory Impairment Lung And Chest Wall Restriction Loss of Alveolar Microvascular Reserves Respiratory Muscle Dysfunction Impaired Immune Defenses Comorbidities Role of Adipocyte-Derived Mediators Pulmonary Response to Glycemic Control Thyroid Disorders The Hypothalamic-Pituitary-Thyroid Axis Hypothyroidism Airway Obstruction or Laryngeal Dysfunction Pulmonary Dysfunction Alveolar Hypoventilation Sleep-Disordered Breathing Respiratory Muscle Dysfunction Pleural Effusion Hyperthyroidism Pulmonary Hypertension Thyrotoxicosis Lung Cancers Growth Hormone Disorders Acromegaly Anatomy and Respiratory Physiology Obstructive Sleep Apnea Association with Neoplasm Treatment Growth Hormone Deficiency Calcium Dysregulation and Pulmonary Calcification Parathyroid Hormone Pulmonary Causes of Hypercalcemia Dystrophic and Metastatic Pulmonary Calcification Radiographic Features Treatment Adrenal Disorders Adrenocortical Hormones and Lung Development Adrenal Insufficiency Cushing Syndrome Immune Checkpoint Inhibitors Key Readings efigure Image GalleRy References 1799 - 129 - The Lungs in Obstetric and Gynecologic Diseases 129 - The Lungs in Obstetric and Gynecologic Diseases INTRODUCTION Physiologic Alterations During Normal Pregnancy Alterations in Respiratory Physiology Upper Airway Chest Wall Lung Function Ventilation Alterations in Cardiovascular Physiology Lung Disorders in Obstetrics Obstructive Airway Disease Asthma Cystic Fibrosis Infectious Diseases Bacterial Pneumonia Viral Pneumonia Fungal Pneumonias Tuberculosis Pulmonary Edema and Pulmonary Vascular Disease Increased Pressure (Cardiogenic) Pulmonary Edema Tocolysis-Associated Pulmonary Edema Pulmonary Edema Associated with Preeclampsia Pulmonary Embolism Amniotic Fluid Embolism Arteriovenous Malformations Air Embolism Acute Lung Injury in Pregnancy Aspiration Pneumonitis Acute Respiratory Distress Syndrome Other Respiratory Diseases in Pregnancy Obstructive Sleep Apnea Interstitial Lung Disease Pleural Disease Lung Transplantation Lung Disorders in Gynecology Catamenial Pneumothorax Endometriosis Lymphangioleiomyomatosis Gestational Trophoblastic Disease Ovarian Hyperstimulation Syndrome Key Readings References 1812 - 130 - The Respiratory System and Neuromuscular Diseases 130 - The Respiratory System and Neuromuscular Diseases INTRODUCTION Functional Anatomy of the Respiratory System Central Nervous System Voluntary Breathing Controllers Automatic Breathing Controllers Spinal Cord Peripheral Nervous System Lower Motor Neurons Total Lung Capacity Controller Feedback Diseases Affecting the Respiratory System Central Nervous System Diseases Cortical and Brainstem Disorders . The pathways that connect the voluntary respiratory centers of the cortex with spinal motor neurons (corticospinal tracts) can... . Automatic breathing but not voluntary breathing is classically disrupted in central alveolar hypoventilation, otherwise known ... Diseases of the Spinal Cord . Spinal cord injury (SCI) is most commonly due to traumatic injury caused by motor vehicle accidents, falls, sports accidents, ... . For unknown reasons, the frequency of sleep apnea appears to be increased by as much as fourfold in patients with SCI compared... Peripheral Nervous System Diseases Diseases of Motor Nerves or Anterior Horn Cells and Diseases of the Neuromuscular Junction Acute Diseases Affecting Motor Nerves . Acute immune-mediated polyneuropathy, also referred to as Guillain-Barré syndrome, is a heterogeneous group of diseases now ... . Poliomyelitis is a viral disease affecting the anterior horn cell and motor nerve caused by a human enterovirus. Significant e... Chronic Diseases Affecting Motor Nerves . ALS is a progressive neurodegenerative disease with no known cure. The usual clinical presentation is that of an individual wi... Neuromuscular Junction Diseases . Myasthenia gravis is the most common disease affecting neuromuscular transmission. It is an autoimmune disease characterized b... . Botulism is a neuroparalytic syndrome caused by a toxin produced by the gram-positive bacterium Clostridium botulinum, which ... Other Neuromuscular Junction Toxins. A number of other toxins can affect the NMJ. The insecticides organophosphates and carbamat... Diseases of the Respiratory Muscles . Duchenne muscular dystrophy and Becker muscular dystrophy are the most common inherited muscle diseases found in childhood, af... . Dermatomyositis (DM), polymyositis (PM), and inclusion body myositis (IBM) are systemic inflammatory diseases of unknown etiol... Metabolic Myopathies . A number of enzyme deficiencies can lead to glycogen storage diseases characterized by the accumulation of glycogen in tissue,... . Disorders of lipid metabolism or defects directly involving the mitochondria can result in myopathy. Disorders of lipid metabo... Critical Illness Neuropathy and Myopathy Ventilator-Induced Diaphragm Dysfunction Unilateral Diaphragmatic Paralysis Bilateral Diaphragmatic Paralysis Approach to the Individual with Neuromuscular Disease Evaluation Background Clinical Assessment . Effective cough requires a coordinated maneuver starting with adequate inspiration to high volumes, followed by glottic closur... . Patients with neuromuscular diseases such as ALS frequently develop bulbar muscle dysfunction due to motor neuron involvement ... . Tests of pulmonary function are useful for initial assessment of and, often more important, follow-up of patients over time.1... . Carbon dioxide can be measured as arterial Pco2, the traditional measure of adequate ventilation, or as exhaled or end-tidal ... . Sleep-disordered breathing in neuromuscular disease is common, precedes diurnal hypoventilation, and predicts the onset of di... Diaphragm Imaging. Chest radiography may show unilateral or bilateral diaphragm elevation suggesting diaphragmatic paralysis. Th... . The gold standard diagnostic test is measurement of transdiaphragmatic pressure (Pdi) using thin balloon-tipped polyethylene ... Management Ventilatory Support Data Supporting Noninvasive Positive-Pressure Ventilation in Neuromuscular Disease . The use of nocturnal ventilation in patients with neuromuscular disease with sleep-disordered breathing has been shown to hav... Full-Time Ventilatory Support Cough Support Key Readings References 1829 - Chapter 131 - The Respiratory System and Chest Wall Diseases 131 - The Respiratory System and Chest Wall Diseases INTRODUCTION Kyphoscoliosis Diagnosis and Etiology Pathophysiology Pulmonary Function and Respiratory Mechanics Exercise Capacity Clinical Course Treatment Medical Treatment Surgical Treatment Thoracoplasty Pectus Excavatum Diagnosis and Etiology Pathophysiology Respiratory Mechanics and Exercise Capacity Treatment Flail Chest Diagnosis and Etiology Trauma and Flail Chest Pathophysiology Respiratory Mechanics Respiratory Failure Pulmonary Function Tests Treatment General Aspects Ankylosing Spondylitis Diagnosis and Etiology Pathophysiology Respiratory Mechanics Pulmonary and Respiratory Muscle Function Gas Exchange and Exercise Capacity Interstitial Lung Disease Treatment Obesity Diagnosis and Etiology Pathophysiology Pulmonary Function Respiratory Mechanics Gas Exchange Control and Pattern of Breathing Respiratory Muscle Function Exercise Capacity Treatment Pathogenic Aspects of Respiratory Failure in Chest Wall Diseases Key Readings eFIGURE IMAGE GALLERY Anchor 2555 eFigure 131.3Oleothorax seen on frontal chest radiograph.A homogeneous right upper thoracic opacity (arrowheads) represents extr... References 1843 - 132 - Acute Ventilatory Failure 132 - Acute Ventilatory Failure Introduction Pathophysiology Insufficient Ventilatory Drive Congenital Causes Acquired Causes Pharmacologic Causes Other Acquired Causes Principles of Management Neural Transmission Impairment (see Chapter 130) Cervical Spinal Cord Injury Motor Neuron Disease Injury or Disease Affecting the Phrenic Nerve Immunologic Neuropathies Neuromuscular Junction Impairment Immunologic Disease Infectious Disease Myopathies Pharmacologic Causes Neuromuscular Weakness Associated With Critical Illness Intensive Care Unit–Acquired Weakness Ventilator-Induced Diaphragmatic Dysfunction Assessment of Need for Mechanical Ventilation in Neuromuscular Weakness Principles of Ventilator Management Chest Wall Defects (see Chapter 131) Chest Wall Skeletal Abnormalities Pleural Disease Principles of Management Parenchymal Lung Disease Principles of Ventilator Management Airway Obstruction Upper Airway Obstruction COPD Pathophysiology Clinical Assessment Medical Therapy Noninvasive Ventilation (see Chapter 136) High Flow Nasal Cannula Oxygen Practical Application of Noninvasive Ventilation . Selection of appropriate patients is key to the successful application of NIV. The selection process should take into account ... . Tolerance of the mask is key to the success of NIV. Thus, the mask must fit well and be strapped on sufficiently to control ai... . In the acute setting, both “critical care” and “bilevel” ventilators (pressure-limited devices designed especially for the ad... . Initial ventilator pressures are usually set low to enhance patient comfort and acceptance but must often be adjusted upward a... . Most patients with COPD exacerbations do not have severe oxygenation defects and can be managed successfully with pressure-li... . Coaching and encouragement, especially during the first few hours, are critically important in achieving adaptation. Judicious... . Noninvasive ventilation is safe and well tolerated in most properly selected patients. The most commonly encountered problems ... Increasing Use of NIV and HFNC for COPD Invasive Mechanical Ventilation . Although invasive mechanical ventilation is being used less often for acute exacerbations, it still has an important role in s... . Volume-limited or pressure-limited modes can be used, but volume-limited assist-control is the most frequent choice initia... Asthma Medical Management of Acute Asthma Ventilatory Management . In patients with acute asthma exacerbations, ventilatory failure is unusual, but signs of severe respiratory distress, such as... . CPAP alone or NIV may ameliorate respiratory distress in asthmatics by reducing the work of breathing via a direct bronchodila... . The role of NIV in the management of asthma exacerbations has not been clearly defined.201 An early cohort study observed subs... . Invasive mechanical ventilation in patients with acute ventilatory failure due to asthma should be used as a last resort but i... . Extracorporeal membrane oxygenation has been used successfully to support patients with very severe asthma attacks when mechan... Vascular Impairment Key Readings References 1860 - 133 – Pulmonary Edema 133 - PULMONARY EDEMA INTRODUCTION PATHOPHYSIOLOGY INCREASED PRESSURE EDEMA Pathophysiology Mechanisms . Congestive heart failure is the most common cause of increased pressure edema. That is why increased pressure edema is often c... . The sum of driving pressures favoring flow out of the vasculature would increase if perimicrovascular hydrostatic pressure was... . Increased pressure pulmonary edema may also result from decreases in the protein osmotic pressure difference opposing the hydr... . Although the preceding section has focused mainly on driving pressures from the microvascular (endothelial) space to the inter... INCREASED PERMEABILITY EDEMA Pathophysiology Mechanisms CLINICAL ASSESSMENT SYMPTOMS AND SIGNS DIAGNOSTIC STUDIES CHEST IMAGING ARTERIAL BLOOD GAS STUDIES Measurement of Pulmonary Edema Fluid Protein Concentration MEASUREMENT OF LUNG WATER AND BARRIER FUNCTION Barrier Function Acute Decompensated Heart Failure: History and Biologic Markers Biologic Markers of Lung Injury TREATMENT EMERGENCY THERAPY INCREASED PRESSURE EDEMA General Principles Ventilatory Strategies Right Heart Catheterization Specific Pharmacologic Therapy . Depending on their specific therapeutic indications, vasodilators are used for hypertension, congestive heart failure, and ang... . Patients with symptoms of pulmonary edema, especially from increased vascular pressure, usually benefit from administration of... . Patients with cardiogenic shock and other cardiac catastrophes that lower systemic blood pressure often require inotropic agen... . Narcotics, and particularly morphine sulfate 2 to 4 mg or its equivalent, given intravenously over several minutes, has long b... INCREASED PERMEABILITY EDEMA General Principles Lung-Protective Ventilator Strategies . In tandem with lung-protective ventilation, a strategy of placing the patient in the prone position for at least 16 hours a d... Specific Pharmacologic Therapies OUTCOME RESOLUTION OF PULMONARY EDEMA . Of all the possible pharmacologic agents used to treat critical lung injuries, corticosteroids have the longest history. Despi... . When oxygen saturation is critically low, reducing oxygen consumption to the minimum is advised to reduce oxygen consumption, ... Extracorporeal Membrane Oxygenation Increased Pressure Edema Increased Permeability Edema Key Readings References 1880 - 134 - Acute Respiratory Distress Syndrome 134 - Acute Respiratory Distress Syndrome Incidence Pediatric Diagnostic Criteria Risk Factors Etiology and Pathogenesis of Ards Overview of Pathophysiology Pathology The Alveolar-Capillary Membrane Surfactant Neutrophils and Other Inflammatory Mediators Inflammation and Coagulation Na+ and Water Angiopoietins Ventilator-Induced Lung Injury Genetic Determinants of Acute Lung Injury Subphenotypes of ARDS Mortality and Complications of ARDS Mortality Predictors of Poor Prognosis Complications of ARDS Treatment Supportive Care Hemodynamic Management Nutrition Pharmacotherapy Corticosteroids Vasodilators Surfactant Antioxidants and Anti-Inflammatory Agents Other Than Steroids Catecholamines Mesenchymal Stem Cell Therapy Discrepancies Between Studies in Animals and Humans Mechanical Ventilation in ARDS Pressure and Volume Limitation Neuromuscular Blockade The Role of Peep and Recruitment Maneuvers Permissive Hypercapnia Mechanical Ventilation of Patients in the Prone Position (Proning) Volume-Control Versus Pressure-Control Ventilation High-Frequency Jet Ventilation and High-Frequency Oscillation Liquid Ventilation Summary Extracorporeal Membrane Oxygenation Long-Term Outcomes Physical Outcomes Psychological Outcomes Key Readings eFIGURE IMAGE GALLERY References 1903 - 135 – Mechanical Ventilation 135 - MECHANICAL VENTILATION INTRODUCTION POSITIVE-PRESSURE MECHANICAL VENTILATOR FUNCTION BASIC FEATURES OF A POSITIVE-PRESSURE BREATH DELIVERING VENTILATION: FLOW-TARGETED VERSUS PRESSURE-TARGETED BREATHS MODES OF VENTILATION OTHER ASPECTS OF VENTILATOR FUNCTION PHYSIOLOGIC EFFECTS OF POSITIVE-PRESSURE MECHANICAL VENTILATION VENTILATION AND RESPIRATORY SYSTEM MECHANICS CO2 Clearance: Alveolar Ventilation and the Equation of Motion ALVEOLAR RECRUITMENT AND GAS EXCHANGE PEEPi and the Ventilatory Pattern PATIENT-VENTILATOR INTERACTIONS POSITIVE-PRESSURE VENTILATION AND CARDIAC FUNCTION COMPLICATIONS OF POSITIVE-PRESSURE MECHANICAL VENTILATION VENTILATOR-INDUCED LUNG INJURY VENTILATOR-INDUCED DIAPHRAGM DYSFUNCTION Disuse Atrophy (Over-assistance Myotrauma) Load-Induced Diaphragm Injury (Under-assistance and Eccentric Myotrauma) OXYGEN TOXICITY PATIENT-VENTILATOR INTERFACE COMPLICATIONS PATIENT-VENTILATOR DYS-SYNCHRONY Breath Triggering Dys-synchrony Flow Pattern Dys-synchrony Breath Cycling Dys-synchrony Clinical Implications Managing Dys-synchronies APPLYING MECHANICAL VENTILATORY SUPPORT MECHANICAL VENTILATORY SUPPORT INVOLVES TRADEOFFS CONSIDERATIONS IN CHOOSING VENTILATOR SETTINGS FOR DIFFERENT FORMS OF RESPIRATORY FAILURE Parenchymal Lung Injury Obstructive Airway Disease Neuromuscular Respiratory Failure Resolving Respiratory Failure: Liberation from Mechanical Ventilation INNOVATIONS IN MECHANICAL VENTILATORY SUPPORT ALTERNATIVE STRATEGIES FOR “LUNG PROTECTION” Positive-Pressure Ventilation in the Prone Position Airway Pressure Release Ventilation and High-Frequency Oscillatory Ventilation AUTOMATED WEANING STRATEGIES OPTIMIZING SYNCHRONY DURING ASSISTED MECHANICAL VENTILATION Proportional Assist Ventilation Neurally Adjusted Ventilatory Assist BEDSIDE IMAGING DURING MECHANICAL VENTILATION ACKNOWLEDGMENT Key Readings References 1918 - 136 - Noninvasive Support of Ventilation 136 - Noninvasive Support of Ventilation Pathophysiology, Rationale, and Expected Benefits COPD Exacerbation Cardiogenic Pulmonary Edema Hypoxemic Acute Respiratory Failure Practical and Technical Aspects Modes of Ventilation and Settings Continuous Positive Airway Pressure and Bilevel Positive Airway Pressure Asynchrony under BPAP Other Modalities Ventilators Interfaces Indications Exacerbation of COPD Asthma Exacerbation of Other Chronic Lung Diseases Cardiogenic Pulmonary Edema HYPOXEMIC RESPIRATORY FAILURE NIV to Prevent Intubation in de Novo Respiratory Failure NIV for Pneumonia NIV for ARDS NIV in Immunocompromised Patients Prevention of Postoperative Complications Pathophysiology of Postoperative Respiratory Complications Prophylactic NIV in the Postoperative Period Therapeutic NIV in the Postoperative Period Chest Trauma Do-Not-Intubate Patients During the Weaning Process and Post-extubation Weaning Post-extubation Preventive Use During Procedures Endoscopic Procedures Endotracheal Intubation Epidemiology of Noninvasive Ventilation in Acute Care Home Noninvasive Ventilation Epidemiology Pathophysiology Indications for Home NIV Special Features in NMD Special Features of OHS Home NIV for Chronic Hypercapnic COPD Importance of Monitoring Home NIV Key Readings References 1931 - 137 - Noninvasive Support of Oxygenation 137 - Noninvasive Support of Oxygenation Indications for Oxygen Therapy Devices and Interfaces Low-Flow Systems Nasal Cannula Simple Face Mask or Hudson Mask Reservoir Systems Partial-Rebreathing Mask Non-rebreathing Mask High-Flow Systems Venturi Mask Continuous Positive Airway Pressure High-Flow Nasal Cannula Indications FOR High-Flow Nasal Cannulas Acute Hypoxemic Respiratory Failure Pediatric Populations Pneumonia Acute Respiratory Distress Syndrome Immunocompromise Cardiogenic Pulmonary Edema Other Hypoxemic Lung Diseases Hypercarbic Hypoxemic Respiratory Failure Post-Extubation SUPPORT Preoxygenation for Intubation Perioperative Period and During Procedures Patients Near the End of Life or Not Wishing to be Intubated Key Readings References 1939 - 138 - Extracorporeal Support of Gas Exchange 138 - Extracorporeal Support of Gas Exchange Principles of Extracorporeal Membrane Oxygenation Historical Perspective Veno-Venous Extracorporeal Membrane Oxygenation Indications Components Oxygenators Pumps Cannulas Tubing Cannulation Patient-Machine Interaction Effect on Oxygenation Membrane Lung Native Lung O2 Transfer by the Membrane Lung. depends on three main factors (see Fig. 138.3) Mixed Venous Blood Oxygenation. During VV-ECMO, the main determinants of mixed venous So2 are the oxygen saturation of the bloo... Oxygen Uptake from the Native Lung. The NL will contribute to arterial oxygenation by adding oxygen to the mixed venous blood ac... Effect on CO2 Removal Management of the Membrane Lung Ventilatory Management of the Native Lung Anticoagulation and Hematologic Monitoring Complications Weaning From Veno-Venous Extracorporeal Membrane Oxygenation Low-Flow Co2 Removal Indications Co2 Removal for Ultraprotective Ventilation in Acute Respiratory Distress Syndrome CO2 Removal for COPD Extracorporeal Membrane Oxygenation as Bridge to TRANSPLANTATION Key Readings eFigure Image Gallery References 1951 - 139 - Pulmonary Rehabilitation 139 - Pulmonary Rehabilitation Indications and Candidacy Components Exercise Training Education Psychosocial Support Nutritional Support Inspiratory Muscle Training, Breathing Training, and Chest Physical Therapy Promoting Physical Activity Long-Term Outcomes and Maintenance of Benefits Obstacles to Patient Participation and Adherence Comorbidities Program Organization Outcome Assessment and Measurement Novel Models Pulmonary Rehabilitation Following Copd Exacerbation Pulmonary Rehabilitation for Disorders Other than COPD Policy and Access Issues Acknowledgements Key Readings The Future of Pulmonary Rehabilitation References 1964 - 140 – Lung Transplantation 140 - LUNG TRANSPLANTATION INTRODUCTION INDICATIONS AND CANDIDATE SELECTION TIMING OF REFERRAL AND LISTING ALLOCATION SYSTEM BRIDGING TO TRANSPLANTATION: ARTIFICIAL LUNG TECHNOLOGIES DONOR SELECTION AND MANAGEMENT LUNG PRESERVATION AVAILABLE SURGICAL TECHNIQUES SINGLE LUNG TRANSPLANTATION BILATERAL LUNG TRANSPLANTATION HEART-LUNG TRANSPLANTATION BILATERAL LOBAR TRANSPLANTATION ROUTINE POSTTRANSPLANTATION MANAGEMENT OUTCOMES SURVIVAL PULMONARY FUNCTION EXERCISE CAPACITY HEMODYNAMICS QUALITY OF LIFE COMPLICATIONS PRIMARY GRAFT DYSFUNCTION AIRWAY COMPLICATIONS PHRENIC NERVE INJURY NATIVE LUNG HYPERINFLATION INFECTION Bacteria Cytomegalovirus Aspergillus REJECTION AND CHRONIC LUNG ALLOGRAFT DYSFUNCTION Hyperacute Rejection Acute Cellular Rejection Acute Antibody-Mediated Rejection Bronchiolitis Obliterans Syndrome (See Chapter 72) Restrictive Allograft Syndrome POSTTRANSPLANTATION LYMPHOPROLIFERATIVE DISORDER LUNG CANCER RECURRENCE OF PRIMARY DISEASE RETRANSPLANTATION KEY READINGS FUTURE DIRECTIONS EFIGURE IMAGE GALLERY References 1980 - 141 – End-of-Life Care in Respiratory Failure 141 - END-OF-LIFE CARE IN RESPIRATORY FAILURE INTRODUCTION PREDICTING THE OUTCOME OF RESPIRATORY FAILURE TREATMENT GOALS AT THE END OF LIFE WHERE AND HOW PATIENTS DIE ETHICAL AND LEGAL JUSTIFICATION FOR END-OF-LIFE CARE JUSTIFICATION FOR WITHHOLDING AND WITHDRAWING LIFE-SUSTAINING THERAPY: A HISTORY REQUESTS FOR NONBENEFICIAL TREATMENTS JUSTIFICATION FOR ADMINISTERING PALLIATIVE CARE Administering Medications for Symptom Relief During the Dying Process Physician-Assisted Dying MEDICAL DECISION MAKING AT THE END OF LIFE IMPORTANCE OF PHYSICIAN, PATIENT, AND FAMILY COMMUNICATION IMPROVING COMMUNICATION AND THE QUALITY OF CARE AT THE END OF LIFE UNDERSTANDING WHAT PATIENTS, FAMILIES, AND CLINICIANS NEED AT THE END OF LIFE PROVIDING APPROPRIATE SETTINGS FOR DYING PATIENTS EMOTIONAL AND SPIRITUAL SUPPORT SYMPTOM MANAGEMENT WHY SYMPTOMS MAY BE POORLY MANAGED MANAGEMENT OF PAIN MANAGEMENT OF ANXIETY MANAGEMENT OF DELIRIUM MANAGEMENT OF DYSPNEA MANAGEMENT OF NAUSEA AND VOMITING MANAGEMENT OF HUNGER AND THIRST WITHHOLDING AND WITHDRAWAL OF LIFE-SUSTAINING THERAPY WHAT THERAPIES ARE WITHHELD AND WITHDRAWN WITHHOLDING AND WITHDRAWAL OF INTUBATION AND MECHANICAL VENTILATION Key Readings eFigure Image Gallery References 2052 - APPENDIX GLOSSARY OF TERMS AND STANDARD SYMBOLS Glossary of Terms and Standard Symbols 2056 - Index id=R5UwEAAAQBAJ&pg=RA2-PA1&img=1&zoom=3&hl=en&bul=1&sig=ACfU3U2 id=R5UwEAAAQBAJ&pg=RA2-PA2&img=1&zoom=3&hl=en&bul=1&sig=ACfU3U0 id=R5UwEAAAQBAJ&pg=RA2-PA3&img=1&zoom=3&hl=en&bul=1&sig=ACfU3U3 id=R5UwEAAAQBAJ&pg=RA2-PA4&img=1&zoom=3&hl=en&bul=1&sig=ACfU3U1 id=R5UwEAAAQBAJ&pg=RA2-PA5&img=1&zoom=3&hl=en&bul=1&sig=ACfU3U2 id=R5UwEAAAQBAJ&pg=RA2-PA6&img=1&zoom=3&hl=en&bul=1&sig=ACfU3U1 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