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      Postoperative acute exacerbation of interstitial pneumonia in pulmonary and non-pulmonary surgery: a retrospective study

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          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Background

          Acute exacerbation of interstitial pneumonia (AE-IP) is a serious complication of pulmonary surgery in patients with IP. However, little is known about AE-IP after non-pulmonary surgery. The aim of this study was to determine the frequency of AE-IP after non-pulmonary surgery and identify its risk factors.

          Methods

          One hundred and fifty-one patients with IP who underwent pulmonary surgery and 291 who underwent non-pulmonary surgery were retrospectively investigated.

          Results

          AE-IP developed in 5 (3.3%) of the 151 patients in the pulmonary surgery group and 4 (1.4%) of the 291 in the non-pulmonary surgery group; the difference was not statistically significant. A logistic regression model showed that serum C-reactive protein (CRP) was a predictor of AE-IP in the non-pulmonary surgery group (odds ratio 1.187, 95% confidence interval 1.073–1.344, P = 0.002).

          Conclusions

          This is the first study to compare the frequency of AE-IP after pulmonary surgery with that after non-pulmonary surgery performed under the same conditions. The results suggest that the frequency of AE-IP after non-pulmonary surgery is similar to that after pulmonary surgery. A high preoperative C-reactive protein level is a potential risk factor for AE-IP after non-pulmonary surgery.

          Electronic supplementary material

          The online version of this article (10.1186/s12931-019-1128-5) contains supplementary material, which is available to authorized users.

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          Most cited references 32

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          Acute respiratory distress syndrome: the Berlin Definition.

          The acute respiratory distress syndrome (ARDS) was defined in 1994 by the American-European Consensus Conference (AECC); since then, issues regarding the reliability and validity of this definition have emerged. Using a consensus process, a panel of experts convened in 2011 (an initiative of the European Society of Intensive Care Medicine endorsed by the American Thoracic Society and the Society of Critical Care Medicine) developed the Berlin Definition, focusing on feasibility, reliability, validity, and objective evaluation of its performance. A draft definition proposed 3 mutually exclusive categories of ARDS based on degree of hypoxemia: mild (200 mm Hg < PaO2/FIO2 ≤ 300 mm Hg), moderate (100 mm Hg < PaO2/FIO2 ≤ 200 mm Hg), and severe (PaO2/FIO2 ≤ 100 mm Hg) and 4 ancillary variables for severe ARDS: radiographic severity, respiratory system compliance (≤40 mL/cm H2O), positive end-expiratory pressure (≥10 cm H2O), and corrected expired volume per minute (≥10 L/min). The draft Berlin Definition was empirically evaluated using patient-level meta-analysis of 4188 patients with ARDS from 4 multicenter clinical data sets and 269 patients with ARDS from 3 single-center data sets containing physiologic information. The 4 ancillary variables did not contribute to the predictive validity of severe ARDS for mortality and were removed from the definition. Using the Berlin Definition, stages of mild, moderate, and severe ARDS were associated with increased mortality (27%; 95% CI, 24%-30%; 32%; 95% CI, 29%-34%; and 45%; 95% CI, 42%-48%, respectively; P < .001) and increased median duration of mechanical ventilation in survivors (5 days; interquartile [IQR], 2-11; 7 days; IQR, 4-14; and 9 days; IQR, 5-17, respectively; P < .001). Compared with the AECC definition, the final Berlin Definition had better predictive validity for mortality, with an area under the receiver operating curve of 0.577 (95% CI, 0.561-0.593) vs 0.536 (95% CI, 0.520-0.553; P < .001). This updated and revised Berlin Definition for ARDS addresses a number of the limitations of the AECC definition. The approach of combining consensus discussions with empirical evaluation may serve as a model to create more accurate, evidence-based, critical illness syndrome definitions and to better inform clinical care, research, and health services planning.
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            Diagnosis of Idiopathic Pulmonary Fibrosis. An Official ATS/ERS/JRS/ALAT Clinical Practice Guideline

            This document provides clinical recommendations for the diagnosis of idiopathic pulmonary fibrosis (IPF). It represents a collaborative effort between the American Thoracic Society, European Respiratory Society, Japanese Respiratory Society, and Latin American Thoracic Society.
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              Acute Exacerbation of Idiopathic Pulmonary Fibrosis. An International Working Group Report.

              Acute exacerbation of idiopathic pulmonary fibrosis has been defined as an acute, clinically significant, respiratory deterioration of unidentifiable cause. The objective of this international working group report on acute exacerbation of idiopathic pulmonary fibrosis was to provide a comprehensive update on the topic. A literature review was conducted to identify all relevant English text publications and abstracts. Evidence-based updates on the epidemiology, etiology, risk factors, prognosis, and management of acute exacerbations of idiopathic pulmonary fibrosis are provided. Finally, to better reflect the current state of knowledge and improve the feasibility of future research into its etiology and treatment, the working group proposes a new conceptual framework for acute respiratory deterioration in idiopathic pulmonary fibrosis and a revised definition and diagnostic criteria for acute exacerbation of idiopathic pulmonary fibrosis.
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                Author and article information

                Contributors
                t-miyamura@nagasaki-u.ac.jp
                nsakamot@nagasaki-u.ac.jp
                tomoyukikakugawa@gmail.com
                vkvkv10101@gmail.com
                h_yura.5994@me.com
                shonaka@nagasaki-u.ac.jp
                h-ishimoto@nagasaki-u.ac.jp
                t-kido@nagasaki-u.ac.jp
                dt_dt0729@hotmail.com
                miyataku@nagasaki-u.ac.jp
                tomoshi@nagasaki-u.ac.jp
                s-tsutsui@nagasaki-u.ac.jp
                yamaguchi-hiroyuki@umin.ac.jp
                obaseya@nagasaki-u.ac.jp
                yuji-i@nagasaki-u.ac.jp
                ashi@nagasaki-u.ac.jp
                nagayasu@nagasaki-u.ac.jp
                hmukae@nagasaki-u.ac.jp
                Journal
                Respir Res
                Respir. Res
                Respiratory Research
                BioMed Central (London )
                1465-9921
                1465-993X
                15 July 2019
                15 July 2019
                2019
                : 20
                Affiliations
                [1 ]ISNI 0000 0000 8902 2273, GRID grid.174567.6, Department of Respiratory Medicine, , Nagasaki University Graduate School of Biomedical Sciences, ; 1-7-1 Sakamoto, Nagasaki, 852-8501 Japan
                [2 ]ISNI 0000 0000 8902 2273, GRID grid.174567.6, Department of Surgical Oncology, , Nagasaki University Graduate School of Biomedical Sciences, ; 1-7-1 Sakamoto, Nagasaki, 852-8501 Japan
                [3 ]ISNI 0000 0000 8902 2273, GRID grid.174567.6, Department of Nursing, , Nagasaki University Graduate School of Biomedical Sciences, ; 1-7-1 Sakamoto, Nagasaki, 852-8520 Japan
                [4 ]ISNI 0000 0000 8902 2273, GRID grid.174567.6, Department of Clinical Oncology, , Nagasaki University Graduate School of Biomedical Sciences, ; 1-7-1 Sakamoto, Nagasaki, 852-8501 Japan
                Article
                1128
                10.1186/s12931-019-1128-5
                6631983
                31307466
                © The Author(s). 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                Categories
                Research
                Custom metadata
                © The Author(s) 2019

                Respiratory medicine

                acute exacerbation, c-reactive protein, interstitial pneumonia, surgery

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