What are the signs of a collapsed lung. How is pneumothorax diagnosed and treated. Can a collapsed lung be life-threatening. What precautions should be taken after recovering from pneumothorax.

What is Pneumothorax and How Does it Occur?

Pneumothorax, commonly known as a collapsed lung, is a condition where air escapes from the lung and fills the space between the lung and chest wall. This accumulation of air prevents the lung from expanding normally during inhalation, potentially leading to serious respiratory complications.

The severity of pneumothorax can vary greatly, ranging from a small, localized collapse to a complete lung collapse. In some cases, it can be life-threatening, especially if not promptly diagnosed and treated.

Types of Pneumothorax

• Spontaneous pneumothorax: Occurs without any apparent cause, often in tall, thin young adults
• Traumatic pneumothorax: Results from chest injuries or medical procedures
• Tension pneumothorax: A severe form where air continues to accumulate, putting pressure on the heart and other lung

Is pneumothorax a common condition. While not extremely common, it affects approximately 17 out of 100,000 men and 3 out of 100,000 women each year in the United States. Certain risk factors, such as smoking, underlying lung diseases, and genetic predisposition, can increase the likelihood of experiencing a collapsed lung.

Recognizing the Symptoms of a Collapsed Lung

Identifying the symptoms of pneumothorax is crucial for seeking timely medical attention. The onset of symptoms can be sudden and alarming, often mimicking other respiratory or cardiac conditions.

Common Symptoms of Pneumothorax

• Sudden, sharp chest pain that worsens with breathing or coughing
• Shortness of breath or difficulty breathing
• Rapid heartbeat (tachycardia)
• Bluish skin color (cyanosis) due to lack of oxygen
• Fatigue and weakness
• Dry, hacking cough

Do all cases of pneumothorax present with the same symptoms. Not necessarily. The severity and presentation of symptoms can vary depending on the extent of the lung collapse and the individual’s overall health. Some people may experience mild discomfort, while others might face severe respiratory distress.

Causes and Risk Factors of Pneumothorax

Understanding the causes and risk factors associated with pneumothorax can help in prevention and early detection. While some cases occur spontaneously, others are the result of specific triggers or underlying conditions.

Primary Causes of Pneumothorax

1. Chest trauma: Blunt or penetrating injuries to the chest
2. Medical procedures: Certain invasive procedures like central line placement or lung biopsy
3. Lung diseases: Conditions such as COPD, cystic fibrosis, or lung cancer
4. Genetic factors: Inherited disorders affecting lung structure
5. Mechanical ventilation: Rarely, it can occur as a complication of ventilator use

Are some individuals more prone to experiencing pneumothorax. Yes, certain groups are at higher risk:

• Smokers
• Tall, thin men between 20 and 40 years old
• People with a family history of pneumothorax
• Those with chronic lung diseases
• Individuals who have had previous episodes of pneumothorax

Diagnosing Pneumothorax: Medical Approaches and Techniques

Accurate diagnosis of pneumothorax is essential for appropriate treatment. Healthcare providers use a combination of physical examination and imaging studies to confirm the presence and extent of a lung collapse.

Diagnostic Methods for Pneumothorax

• Physical examination: Listening to breath sounds and checking for decreased chest movement
• Chest X-ray: The primary imaging tool for visualizing air in the pleural space
• CT scan: Provides more detailed images, especially for small pneumothoraces
• Ultrasound: Increasingly used for rapid bedside diagnosis, particularly in emergency settings

Can pneumothorax be mistaken for other conditions. Indeed, the symptoms of pneumothorax can mimic other respiratory or cardiac conditions, such as heart attacks or pulmonary embolisms. This is why thorough diagnostic procedures are crucial for accurate identification and appropriate treatment.

Treatment Options for Collapsed Lung

The treatment approach for pneumothorax depends on the severity of the collapse, the underlying cause, and the patient’s overall health status. The primary goal is to remove the excess air from the pleural space and prevent recurrence.

Conservative Management

For small, uncomplicated pneumothoraces, a watch-and-wait approach might be sufficient. This involves close monitoring and oxygen therapy to help the body reabsorb the trapped air naturally.

Needle Aspiration and Chest Tube Insertion

Larger collapses often require more invasive interventions. Needle aspiration involves using a needle to remove air from the pleural space. For more significant collapses, a chest tube may be inserted to continuously drain air and allow the lung to re-expand.

Surgical Interventions

In cases of recurrent pneumothorax or when conservative measures fail, surgical options may be considered:

• Thoracoscopy: A minimally invasive procedure to repair lung blebs or close air leaks
• Pleurodesis: A procedure to create scar tissue between the lung and chest wall, preventing future collapses
• Bullectomy: Surgical removal of large air-filled sacs (bullae) in the lungs

How long does it take to recover from pneumothorax. Recovery time varies depending on the severity of the collapse and the treatment method. Minor cases may resolve in a few days, while more severe cases requiring surgery might take several weeks for full recovery.

Preventing Recurrence and Long-term Management

After experiencing pneumothorax, preventing recurrence becomes a primary concern. While not all cases of pneumothorax are preventable, certain lifestyle changes and precautions can significantly reduce the risk of future episodes.

Lifestyle Modifications

• Smoking cessation: Quitting smoking is crucial, as it’s a major risk factor for pneumothorax
• Avoiding high-pressure environments: Scuba diving and high-altitude activities may need to be limited
• Regular medical check-ups: Especially important for those with underlying lung conditions

Activity Restrictions

Following treatment for pneumothorax, certain activities should be avoided for a period to allow full healing:

1. Air travel: Generally avoided for 1-2 weeks after full lung re-expansion
2. Contact sports: Typically restricted for several weeks to months
3. Heavy lifting: Limited until cleared by a healthcare provider

What is the likelihood of pneumothorax recurring. The recurrence rate varies, but it can be as high as 50% for spontaneous pneumothorax. This risk is higher in the first year after the initial episode and decreases over time.

Complications and Long-term Effects of Pneumothorax

While many cases of pneumothorax resolve without long-term consequences, some individuals may experience complications or lasting effects. Understanding these potential issues is crucial for comprehensive management and follow-up care.

Potential Complications

• Tension pneumothorax: A life-threatening condition where air continues to accumulate, compressing the heart and blood vessels
• Respiratory failure: In severe cases, especially if both lungs are affected
• Pleural effusion: Accumulation of fluid in the pleural space
• Empyema: Infection in the pleural space, often as a complication of chest tube insertion

Long-term Effects

Most people recover fully from pneumothorax without lasting effects. However, some may experience:

• Chronic pain: Persistent chest discomfort, especially at the site of chest tube insertion
• Reduced lung function: Particularly in cases of recurrent pneumothorax or those requiring extensive surgery
• Psychological impact: Anxiety or fear of recurrence, affecting quality of life

Can pneumothorax lead to permanent lung damage. While rare, repeated episodes of pneumothorax or severe cases that require extensive treatment may result in some degree of permanent lung function impairment. Regular follow-up with a pulmonologist can help monitor and manage any long-term effects.

Advances in Pneumothorax Research and Treatment

The field of pneumothorax management is continually evolving, with new research and technological advancements improving diagnosis, treatment, and prevention strategies. These developments aim to enhance patient outcomes and reduce the risk of recurrence.

Innovative Diagnostic Techniques

• Portable ultrasound devices: Enabling rapid, bedside diagnosis in emergency settings
• Advanced imaging software: Improving the accuracy of CT scans in detecting small pneumothoraces
• Biomarker research: Exploring potential blood tests to aid in early detection and risk assessment

Emerging Treatment Approaches

New treatment modalities are being developed and refined to offer more effective and less invasive options:

1. Endobronchial valves: One-way valves placed in the airways to help seal air leaks
2. Autologous blood patch pleurodesis: Using the patient’s own blood to seal small air leaks
3. Minimally invasive surgical techniques: Refining thoracoscopic procedures for better outcomes and faster recovery

How are these advancements improving patient care. These innovations are leading to faster diagnoses, more targeted treatments, and reduced hospital stays. They also offer hope for patients with recurrent pneumothorax by providing new options for prevention and management.

Future Directions in Pneumothorax Research

Ongoing research is focusing on several key areas:

• Genetic studies: Identifying genetic markers that may predispose individuals to pneumothorax
• Personalized medicine approaches: Tailoring treatments based on individual risk factors and genetic profiles
• Tissue engineering: Exploring the potential of bioengineered lung tissue to repair damaged areas
• Preventive strategies: Developing new methods to strengthen the pleural membrane in high-risk individuals

These ongoing research efforts hold promise for improving our understanding of pneumothorax and developing more effective prevention and treatment strategies in the future.

Know the Signs of a Collapsed Lung

You may have heard of a collapsed lung, but what exactly does that mean, and how do you treat it? 

A collapsed lung, or pneumothorax, happens when air escapes from your lung and fills the space between the lung and chest wall. The lung is then not able to expand normally when you take a breath. The condition is rare but could be life-threatening, so you should seek immediate care.

Symptoms of a collapsed lung include:

• Dull, steady ache in the chest
• Pain upon inhaling
• Shortness of breath
• Chest tightness
• The sensation that you can’t draw breath
• Face turning blue due to lack of oxygen
• Very fast heartbeat

What Causes a Collapsed Lung?

Impact with Blunt Object. This is the leading cause of a collapsed lung. It can happen when playing sports where you might collide with a ball or person. A car crash can also involve an impact to the chest wherein this injury could occur.

Puncture. Any penetrating wound to the chest can puncture the lung. This could be something violent, like a knife or stab wound. It could also be the result of vigorous play, such as a pencil stabbing. An aerosol can exploding could also cause a collapsed lung.

Disease. Diseases such as emphysema and COPD can lead to a collapsed lung. Certain infections, such as pneumonia, can be the culprit, too.

Spontaneous pneumothorax. Very tall and typically very thin male young adults are especially prone. For these people, the pneumothorax can just occur; you don’t need to be hit in the chest or have other trauma for it to happen.    

Hospital procedures. In the hospital, some medical procedures, such as the insertion of a chemotherapy port to your chest, can also sometimes damage your lung.

What To Do Immediately After Injury

The most pressing concern is to make sure oxygen is flowing. Emergency services should be called immediately, and you will be administered oxygen as you are transported to a hospital.

When oxygen escapes from the lungs, they can’t function fully and properly. Supplying oxygen keeps the lungs working and helps replace some of the missing air. Psychologically, the sooner your breathing returns to a more normalized state, the sooner your body receives the signal to relax. Supplied oxygen can help the pneumothorax get smaller too. 

How a Collapsed Lung Is Treated

Treatment is determined by how much of the lung is collapsed. If just a small portion is affected, your doctor may admit you to the hospital for observation. If you have a tiny wound, it can easily seal over.

If the affected area is larger, your doctor will evacuate the air that has escaped from the lung and is gathering in the chest cavity. Each time air gets pushed out from the lung, it is then trapped and pushing against the lung. Picture your lung as a balloon, and in this case, it’s pushed against a wall. This misplaced air can also exert pressure on the heart, which is another reason to address the problem quickly.

Your doctor will explore all nonsurgical options. One of the first steps is to place a small chest tube with a suction device to evacuate the air from outside the lung.

A second course of treatment might be a patch through which your own blood can be inserted to seal the injury. Alternatively, another substance may be inserted through the chest tube to intentionally irritate the lung lining, causing it to stick together and seal up.

If the affected lung area doesn’t seal with these measures, your doctor can perform a video-assisted surgery to find where the air is escaping and repair it.

Your doctor will make the most conservative treatment choice possible, escalating only when necessary.

What To Do After Treatment

After the wound has been treated, it’s important that, for the next two to four weeks, you avoid:

• Flying on airplanes
• Scuba diving
• Playing a wind instrument
• Playing contact sports or participating in anything where a chest hit might occur

Once the injury has fully healed, you’re safe to resume these activities and your normal lifestyle.

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What Is a Collapsed Lung?

by Editorial Staff |
April 24, 2019

Topics:

• Health & Wellness

Our lungs are responsible for bringing oxygen into the bloodstream and removing carbon dioxide from our bodies. Each lung expands like a balloon when we inhale air, but what happens if the balloon cannot inflate?

That’s what is called a collapsed lung, a term that you might have heard before—it happens sometimes when there is trauma, such as a rib puncturing the lung—like what happened to UFC fighter Paul Felder in a recent match. But there are many reasons it can occur—ruptured air sacs, issues from underlying lung diseases like COPD and cystic fibrosis, even screaming too hard at a One Direction concert. What exactly makes a lung collapse? Introducing pneumothorax.

First some lung basics: Your lungs are located inside the chest wall. Each lung is divided into lobes which are similar to balloons filled with sponge-like tissue. The lobes are surrounded by the visceral pleura, membranes that separate your lungs from your chest wall. As you breathe in and out, the lungs slide against the parietal pleura – a plastic wrap-like membrane that covers the chest wall. However, if one of your “balloons” leaks, for example when COPD causes holes in the lung tissue, the air you inhale is going to travel through the leak and into space between your lungs and chest, called the pleural cavity. Similarly, if there is a hole in the parietal pleura (like a bullet through the chest wall, for example), that can cause air to enter the pleural cavity directly from the outside.

“Because that air has nowhere to go, it keeps accumulating inside this space and builds up pressure between the chest wall and the lungs.  As the pressure and amount of air in this cavity increase it compresses your lung further and further, making it unable to expand when you breathe. That is a pneumothorax.” says Dr. Rutland, pulmonary and critical care physician and American Lung Association volunteer spokesperson. Pneumothorax is the medical term most people associate with a lung collapse but actually means “air in the pleura space causing your lungs to collapse or be compressed.” The pressure from the air keeps your lungs from being able to fully expand.

The term “collapsed lung” is often used in everyday speech as being the same as a pneumothorax.  However, a lung can collapse in two general ways—pressure from “outside” the lung as in pneumothorax described above or from lack of flow “into” the lung because the bronchial tubes or “pipes” are blocked by mucus, a polyp or a tumor. This type of collapsed lung is medically termed an atelectatic lung or atelectasis and is treated differently.

What are the symptoms of a pneumothorax

Symptoms of pneumothorax include shortness of breath, chest pain on one side, and experiencing pain when breathing. If you suspect you have pneumothorax, go to the emergency room right away. A chest X-ray will confirm this.

How is a pneumothorax treated?

Depending on the cause and the size of the leak, the lung can often heal itself, but in order to do so, the extra air in the pleura space needs to be removed to reduce the pressure so the lung can re-expand. If the size of the pneumothorax is large and creating significant distress, an emergency procedure includes the doctor placing a needle in the chest to remove the pressure quickly. This is then followed by placing a tube in the chest that is kept in place for a day or two until the leak is healed and closed and the lung is re-expanded. ” 

This hollow tube is inserted between the ribs and is attached to a suction device to remove the air in the pleura space.⁵ Once this chest tube is inserted, it typically takes about 48 hours or so for the lung to heal.

Dr. Rutland says a simple test is performed to tell if the lung has healed. First, the chest tube is hooked up to a chamber system with water. Then the patient is instructed to cough. If air is escaping from the lung into the tube, bubbles will appear in the water chamber. “Once there are no more bubbles rushing through when I tell my patients to cough, then I know that the lung is healed, and I can take the tube out.”

How can I prevent pneumothorax?

While most cases cannot be prevented, discontinuing the use of tobacco products can reduce your risk of lung disease associated with pneumothorax. While males are generally more likely to experience pneumothorax, your genetics can also predispose you to certain types.

• Sources
  1. https://www. lung.org/about-us/blog/2017/07/how-your-lungs-work.html
  2. https://www.lung.org/lung-health-and-diseases/how-lungs-work/
  3. Dr. Rutland interview
  4. https://www.mayoclinic.org/diseases-conditions/atelectasis/symptoms-causes/syc-20369684
  5. https://www.health.harvard.edu/a_to_z/pneumothorax-a-to-z
  6. https://www.mayoclinic.org/diseases-conditions/pneumothorax/symptoms-causes/syc-20350367

Blog last updated: November 17, 2022

Our difficult ones

The death toll from the COVID-2019 disease caused by the new coronavirus SARS-CoV-2 has exceeded seven thousand people worldwide. As a rule, all these people died from the symptoms of pneumonia, an acute respiratory disease that has been known for almost two centuries. At the request of N + 1 , pulmonologist Vasily Shtabnitsky spoke about what pneumonia is, what it happens, how it proceeds and what exactly threatens the body.

What are the types of pneumonia?

“Classic”, or bacterial, pneumonia was scientifically described as early as the 19th century, and around the same time, the first known pathogens, pneumococci, were isolated. In this type of pneumonia – also called “typical pneumonia” – an infection in the lower respiratory tract provokes inflammation and fluid accumulation in the alveoli, exudate forms, and respiratory failure occurs.

Closer to the middle of the twentieth century, SARS was described, which can be provoked by many pathogens – chlamydia, mycoplasmas, legionella and viruses. It does not give a clinical picture characteristic of the “classics”, it may not be accompanied by high fever, wheezing, sputum with blood. In its course, general signs of intoxication and a dry cough may prevail. On radiographs, as a rule, only an indistinct infiltrate is visible.

A discussion began among the medical profession, which continues to this day, about whether the virus can cause pneumonia. The classical mechanism of pneumonia is associated with certain properties of bacteria, with the substances they secrete and with the immune response that they provoke. Against this background, viruses either do not cause pneumonia at all, or, if they do, then atypical.

Pneumonia of this type can be called interstitial, since the fluid is formed not in the alveoli, but in the interstitium, that is, in the connective tissue space between them. This contributes to the formation of a non-specific picture, when “everything is fine” in the alveoli. Such inflammation can only be seen with the help of a CT scan – the so-called “frosted glass” or some other interstitial pattern is visible there.

The outbreak of severe acute respiratory syndrome (SARS) in the early 2000s, followed by the h2N1 flu pandemic in 2009-10, caused many deaths. People were dying from what was called viral pneumonia and, in some cases, acute respiratory distress syndrome (ARDS).

What is this syndrome?

ARDS is a non-specific lung injury that can develop in response to various stimuli – infection, injury, inhalation of some substance, such as poison gas, say, chlorine, used in the First World War.

In order to explain its effect, it is necessary to talk about the structure of the lungs. This is a system that transfers oxygen from air to a liquid, that is, to the blood. It is necessary to drive oxygen into the aquatic environment, and at the same time prevent the liquid from filling the alveoli. To do this, there are structures in the lungs – the endothelium and the alveolar-capillary membrane, which keep fluid from passing into the alveoli.

In ARDS, these structures begin to collapse, they no longer hold back the fluid, and it immediately, along the pressure gradient, fills the alveoli. The so-called non-cardiogenic pulmonary edema is formed.

Acute respiratory distress syndrome (ARDS)

ARDS develops extensive inflammation of the lungs, which leads to severe respiratory failure. This condition appears not only with pulmonary pathologies, it can be the result of many life-threatening conditions.

Conditions that have a direct damaging effect on the lungs include pneumonia, lung injuries. When they violated the integrity of the epithelium of the bronchi and alveoli. This contributes to blockage of the bronchi, subsidence of lung areas, the development of pulmonary edema (alveolar and interstitial).

The most common conditions in which the lungs are indirectly affected are severe infections (sepsis, peritonitis), acute pancreatitis, severe trauma, massive blood transfusions. With them, the epithelium of the pulmonary capillaries is damaged, which leads to the release of plasma and blood cells into the interstitium. As a result, the interalveolar septa become thicker, gas exchange becomes more difficult. In the future, severe disturbances in the microcirculation of the lungs develop, the fluid enters the alveoli.

Symptoms of ARDS include a feeling of lack of air, frequent wheezing, cyanosis, tachycardia, arterial hypertension, they are often accompanied by anxiety and agitation. ARDS develops within hours or days after exposure to a damaging factor. Usually it is accompanied by a violation of the work of other organs (multiple organ failure).

Source

The direct damaging effect of the virus plays some role in this. It seems to multiply in the alveolar epithelium, and the infected cells cease to perform their function. In addition, apoptosis, programmed cell death, is activated in cells; they can be destroyed by macrophages.

But the body’s immune response also plays a very important role. The virus does not just multiply in cells, it leaves its antigen on the surface of the cell. By this antigen, the cells of the immune system recognize her as sick. The massiveness of cell damage to viruses is also important here, and also, perhaps, the absence of some other, more targeted tools of immunity. When more targeted immunity fails, the “big artillery” kicks in to help the virus destroy the lungs.

This does not mean that if we turn off immunity, the patient will be fine, and this does not mean that, say, immunodeficient persons will not suffer from such severe viral pneumonia. But, in general, the mechanism is mainly associated with the immune response.

This happens not only in the case of pneumonia, but also, for example, in sepsis and septic shock. The severity of a person’s condition can be affected not only by infection of the blood with bacteria, but by the reverse immune response of our body.

Now, if possible, explain step by step: bacteria enter the respiratory system and begin to multiply there, and then?

Bacteria enter the lungs and continue to multiply there. Inside the alveoli in the lungs there are so-called alveolar macrophages. They get a bacterium, destroy it, and expose its antigens to other immune cells that start to study them, and at the same time throw out a lot of mediators that attract other cells.

Other macrophages come to the focus of inflammation, neutrophils come there – this is already an “atomic weapon” of the immune system, destroying everything to zero. B- and T-lymphocytes come to the focus of inflammation. B-lymphocytes produce immunoglobulins that bind to bacterial antigens, which helps recruit other immune cells to attack. The role of T-cells here is slightly less, they are able to destroy bacteria directly.

Bacteria are destroyed, toxic substances are released, and this leads to an increase in temperature. The arachidonic acid system is activated, prostaglandins are formed, which increases blood flow to the site of inflammation, and the rate of biochemical reactions increases. Further, if the body is strong, then it destroys it all itself and does not allow the infection to spread.

If the body is not strong, bacteria can multiply and move to other organs. Sepsis can develop: this is a condition in which bacteria enter the bloodstream. A massive release of some bacterial toxins can lead to the development of a systemic reaction: to the development of hypotension, shock.

This is how pneumonia triggered by a bacterial infection works. But the mechanism is about the same in the case of viruses. However, compared to a bacterium, a virus is more generalized, it infects many tissues, and viruses are more difficult to fight, they do not have a cell wall that can be destroyed.

The virus is constantly infecting new cells, and they themselves become the source of a new virus. Therefore, several other mechanisms of immunity work here – just T-cells, macrophages, antibodies.

Is it true that in severe pneumonia the lungs stop oxygenating the blood and the person dies of suffocation?

In the case of bacterial pneumonia, the structures are destroyed, the alveoli are filled with an infiltrate containing cell debris, bacteria, cells of the immune system. Essentially, the lung becomes a fluid-filled sponge. The larger part of the lung is occupied by the infiltrate, the worse the person breathes. At some point, he simply develops critical respiratory failure.

This may be accompanied by a violation of cardiac activity, cerebral edema may form. But a decrease in the concentration of oxygen in the blood is inevitable, and it can fall to a level incompatible with life.

And this process can be stopped with antibiotics?

Yes, drugs that kill all bacteria. The immune system will simply have to clear these dead fields with macrophages, and the patient will have to wait until the lungs are cleared.

But antibiotics are not a 100% guarantee against ARDS. I myself have seen such situations many times: with intensive treatment with antibiotics, a large number of bacteria can be destroyed, which leads to the release of a large amount of toxins into the bloodstream.

And how does it work in the case of viruses, when there are no foreign cells?

There are cells infected with a virus. Each virus exposes its antigens to the surface of the cell, and it becomes a target for our immune system. The immune system begins to fight this cell, to destroy it.

It happens that a virus in the lungs has infected many cells, but the immune system did not work well at first. Then, in response to a massive infection, the body may overreact and destroy too many cells. From such a “nuclear war” at the level of the immune system, ARDS can also develop.

It is not entirely clear why some viruses cause more ARDS than others, but the “old” SARS virus and avian influenza virus, and even more so the new coronavirus, can cause such a reaction.

You mentioned that viral pneumonia has a different picture, that it is interstitial pneumonia. What’s the difference?

The lungs consist of air “sacs” – alveoli, and between the groups of these sacs is the interstitium. This can be compared to bunches of grapes, which are each packed in a separate bag. If you cut a tangerine, then between the lobules we will find large partitions – just like that between the alveoli there is this intermediate interstitial space.

In bacterial pneumonia, the infiltrate can fill the alveoli, while in viral pneumonia it enters the interstitial space, and this can cause serious respiratory failure. At the same time, nothing can be seen on the x-ray, but there will be some slight changes on the CT scan. With coronavirus pneumonia, this is what happens: severe shortness of breath, signs of respiratory failure – and slight changes in computed tomography.

Is there any way to stop the slide into pneumonia in the early stages? In the case of a bacterial infection, you can drink antibiotics, but in the case of a virus?

This is a different case. There are no proven ways to prevent pneumonia, drugs for specific antiviral therapy in Russia, and we cannot recommend anything yet.

The Chinese have described the use of chloroquine, an antimalarial drug they claim has an antiviral effect. But these data need to be investigated. Antibiotics prophylactically, I think, should be prescribed, because no one has canceled a secondary bacterial infection. But, apparently, it does not play a big role.

Hormones don’t seem to be working. Antiviral drugs probably don’t work either, although various options have been tried, both anti-flu drugs and anti-HIV drugs. (For more on Chinese doctors’ attempts to use these and other drugs, see our material “At the bottom of the first-aid kit.” – Note N + 1 .)

What happens in an emergency when the lungs stop working? You can turn on the ventilator, but this requires that the lungs themselves absorb oxygen. What if they are filled with liquid?

To combat hypoxemia in patients, there are many different methods: you can manually inflate the lungs, even sticky alveoli can be expanded. All this works for the time being. But, probably, one of the best for today is ECMO, extracorporeal membrane oxygenation.

We create a special membrane through which blood flows. The membrane allows the blood to be oxygenated in the same way that it is saturated when it passes through the lungs. That is, we create, as it were, artificial lungs, such gills.

This may save the person, although not always. Just last year, one of the randomized trials on ECMO ended, and it did not show a reduction in the risk of death in patients with ARDS, although previous studies showed it. And yet, some patients recover very quickly after ARDS, it does not give one hundred percent mortality.

In general, you need to understand that when a patient is in such a critical condition that ECMO is required, then, as a rule, the situation is not limited to the lungs alone. He develops multiple organ failure. We’re saving lungs, and his kidneys are failing. Save the kidneys – brain loss begins.

Can the lungs recover, can a person return after ECMO?

We have stem cells that can regenerate the lungs to some extent. There are, of course, certain “buts”. New lungs cannot grow, but the epithelium can change, the membrane can recover.

There are several scenarios for ARDS. When favorable, the cells begin to regenerate. But in an unfavorable scenario, the basement membrane dies and instead of regeneration, fibrosis begins, when connective tissue begins to grow instead of cells. This is not fatal, but with fibrosis, lung function is impaired due to the fact that the architecture of the alveoli, the pulmonary lobe, is lost.

But at the stage when you have to use mechanical ventilation, is it still possible to restore health?

Perhaps, of course. According to statistics, at least 50 percent of patients survive. In some centers, I think, with super-expertise, super-elaborated protocols, mortality is no more than 20-25 percent of cases.

How long can a person live on mechanical ventilation?

This period is not limited – if there is no damage to the lungs, a person can live on a ventilator for life. But usually regeneration occurs somewhere in a month.

In other words, in the absence of antiviral agents, in the fight against viral pneumonia, we can only rely on our own immune system? Hoping that she will crush the infection in time and not kill her master in the process?

Yes. But the scenario for most cases of a new coronavirus infection is as follows: 80 percent of the sick suffer it in a mild form, 15 percent in a moderate form. In both situations, as a rule, mechanical ventilation is not required. And only due to the most severe cases – this is 5 percent of the sick – basically, the mortality rate is growing.

Are these people whose immune system is not working properly – at the wrong time or too much?

Apparently, it’s a matter of age. The role of angiotensin receptors is discussed, because in hypertensive patients the density of these receptors in the lungs is greater, and they are the target for the virus – with a large number of these receptors, the effect of the virus is enhanced. But this is only a theory, and the discussion about why hypertensive patients are at risk continues. Maybe this is due to comorbidity, concomitant diseases, or maybe, indeed, because of these receptors.

From a doctor’s point of view, how important is it to know whether a patient is infected with the coronavirus or not? Does it change anything in the practice of treatment?

I think not in general. It is clear that all sorts of epidemiological measures will have to be taken. Proper triage and isolation of patients is very important. But the tactics of treatment it changes slightly.

If we test negative for a bacterial infection, we may choose not to prescribe antibiotics to reduce the burden on the body. We can prepare a ventilator for the patient. Early intubation, connection to a ventilator is one of the methods for preventing severe ARDS. It is believed that in this case, ARDS flows more easily than if you give him a few days of spontaneous breathing.

What advice would you give to people who are beginning to feel like something is wrong with them? When they don’t have a high fever, but they cough. Either they sit at home, or run for a fluorography, or something else. How to behave in this situation?

If a person does not have risk factors associated with coronavirus infection – this is age 60-65 years and older, hypertension, cardiovascular disease, diabetes mellitus, a number of other concomitant diseases – if this is a generally healthy young person and he feels relatively well, he will most likely have symptoms like a common cold.

You can notify the clinic. Call, say: I have a cold, consult. If they say to come, come. But I wouldn’t.

Because now staying at home is an additional measure to prevent the spread of infection. That is, if a person feels sick, he should isolate himself as much as possible. It is most important. I cannot insist that everyone call the clinic and demand the arrival of a doctor. Because the resources of doctors are very limited, especially during the epidemic.

But it would be right to notify the clinic and find out about the red flags. This is increasing shortness of breath, constantly high fever, weakness that prevents movement, sputum with blood. These bad symptoms are a reason to call an ambulance to go to the hospital.

But 8 out of 10, even 9 out of 10 people will have a mild illness. And you just need to isolate yourself, try not to infect anyone, remember that the majority of the sick – according to Chinese data – are clusters in the family. When one person in a family gets sick, the whole family gets sick. It is difficult to isolate a family because a person is contagious even before symptoms appear. But, for example, if guests, weddings, and other family events are planned, it is better to postpone them to the post-epidemic threshold.

Wash your hands, wash your face, minimize meetings with people, work remotely if possible, do not use public transport, walk, or now it is possible to bike, or take a car or taxi. Don’t shake hands. Just stop shaking hands altogether. Well, try not to use common things, such as a common mug somewhere in the office. Everything must be individual.

Well, at the first signs of SARS, stay at home and do not go anywhere in any case until a negative result for coronavirus infection is obtained.

Text prepared by Andrey Ukrainskiy

Omicron deceiver: what doctors are afraid of

A new strain of the omicron coronavirus has become dominant in Russia and has already been detected almost everywhere. The good news is that most people who get sick, especially those who are vaccinated, have mild or no symptoms. The number of hospitalizations did not noticeably increase. So what else is known about the “omicron” in Russia, how will we win?

Immunologists believe that “omicron” is the last strong outbreak. Coronavirus, of course, will not go anywhere, but it will be weaker. Everything points to the common cold. You feel tired, your throat hurts like it’s being scratched, your nose doesn’t breathe, and you have “brain fog”. The virus infects the upper respiratory tract without descending into the lungs. Sick almost do not complain that they breathe hot air. And doctors are less and less unraveling the white web of frosted glasses.

In two years we learned almost the entire Greek alphabet. Only the first variant of SARS-CoV-2 continues to be called “Wuhan”. Each subsequent strain was assigned a Greek letter. There are seven of them: alpha, beta, gamma, delta, lambda, mu and omicron. The same virus in different faces.

“Omicron” we will compare with “delta” – the most evil strain encountered during the pandemic. If you look at the statistics of cases today, it is gradually approaching six-digit numbers. But the danger of the strain is evaluated according to other criteria. First of all, look at the number of hospitalizations. With a positive PCR test and symptoms of covid, the chance of a patient with “omicron” being in the hospital is half as much. The probability of getting not just to the hospital, but to the intensive care unit is four times lower than with the “delta”. And the most telling criterion is lethality. “Omicron” also leads to death, although many consider it easier. It is lighter in comparison with the “delta”, the lethality of which is up to 15%: in “omicron” – at the level of 1%.

The mild course of the disease is associated with the infectivity of the new strain. The Wuhan variant of the virus matured in cells for 7 to 14 days before it showed painful symptoms. “Delta” matured twice as fast. “Omicron” is developing at lightning speed. And for a long time in the “away” does not linger.

“The most unpleasant thing is that due to its rapid multiplication, you can already become a spreader of the virus not 3-4 days after infection, but by the evening. If you become infected in the morning, then in the evening you can start infecting others and continue to infect them enough for a long time. Now, due to its more aggressive nature, it has become sharper, it is excreted faster. In general, it comes out in a week, “said Alexander Semenov, head of the Yekaterinburg Research Institute of Viral Infections of the Vector Center of Rospotrebnadzor.

In December, virologist Alexander Semyonov spent three weeks in South Africa studying a new strain of coronavirus. This “rookie” only seems harmless. He famously bypasses the immune system. The probability of contracting the omicron strain in those who have already had covid is approximately 15-20%. Compared with the “delta”, the risk of re-infection increases by almost 7 times.

“Diabetics are also seriously ill. People with arterial hypertension, with chronic renal failure, that is, with all severe systemic diseases, especially uncompensated ones, they get sick. And they will be seriously ill. I saw with my own eyes how a 15-year-old girl with diabetes left . These are not jokes,” says Semyonov.

In the first wave, the coronavirus hit the elderly, rejuvenated with each new outbreak. Today it infects children more and more.

– What stage is this?

– I do not presume to say that this is the final stage. We are talking to you now, and at this time, an infinite number of new variants of the COVID-19 pathogen are emerging,” explained Alexander Gintsburg, Director of the Gamaleya Research Center for Epidemiology and Microbiology, Academician of the Russian Academy of Sciences.

– Do you think a more pathogenic strain of coronavirus could emerge?

– Yes, it certainly can appear. Because we absolutely do not know the natural reservoirs of the COVID-19 pathogen. For every move of the virus, we, of course, find opposition with you, but the virus continues to play the game with white pieces, while you and I play with black pieces. For now, we’re just dealing with the consequences. Very serious. We start extinguishing the fire when it is already burning.

The life cycle of new strains comes in waves. When a strong, agile and fast appears, he begins to actively pull ahead until he reaches the maximum. The classic infectious process lasts 90 days. That is, from the beginning of the incidence and until the moment when the curve bends down, a month and a half passes. In Russia, this schedule looks somewhat different. At first, our megacities get sick – Moscow and St. Petersburg, then the wave covers the regions: the Volga region, the Urals, Siberia, rushes to the north and the Far East. The experience of South Africa and Britain suggests that the peak will be narrow and the outbreak itself shorter.

“Omicron” is already in Chelyabinsk. Therapist Marina Syrtseva notes: 50 people at the reception, which means that the wave has begun. In his area, the doctor persuaded everyone to be vaccinated. Then she waved her hand – still they did not listen. “The campaign has been going on for two years, the third. How can you gather so much?! I’ve been re-vaccinating all of my own.”

She retired and stayed at home for a year. But when the waves roll in one after another, there are not enough doctors in polyclinics. I had to put on a white coat again.

– With what problems in primary care are we approaching the wave that will hit polyclinics, outpatient clinics, and first aid centers the most?

– Answering your question, what is the main problem, I will answer you: personnel. Today this is the biggest problem we have. In the last two years, the number of health workers, including doctors, has been growing in our country. But these are dozens of people, and we need thousands of people in order to completely cover the need for our healthcare, – said Alexei Teksler, Governor of the Chelyabinsk Region.

At a meeting of the operational headquarters, Governor Texler himself reports: the situation is tense. Now, if necessary, doctors will be transferred from hospitals to polyclinics – here the main influx of patients. There are more calls to the ambulance, the ambulance takes calls without interruption. There are 40 phones ringing in a call center at the same time.

“The fact of the increase in infections is obvious, so we are mobilizing our health care,” Texler assured.

A covid dispensary has been opened in the city – this was not the case in previous outbreaks of coronavirus. Only patients with obvious symptoms are admitted here: fever, cough. Immediately they do a test, give out medicine.

– Under what condition will a person be hospitalized?

– If a lung injury is detected, we hospitalize, and also if a person has some serious systemic diseases, the temperature persists, a pronounced toxic syndrome, – said Mikhail Verbitsky, chief physician of the Chelyabinsk OKB 2.

Covid-19 hospitals are rapidly filling up. A week ago, 30 patients were admitted here a day, today – 80. Almost a threefold increase. Pneumonia is indeed less common. But it’s too early to talk about a mild course. According to the experience of British colleagues who survived the peak of the “omicron” wave, by 9-10 day of illness the condition may worsen.

“We are afraid of the omicron’s deception that it will flow more easily and patients will feel relief while taking the medicine. And, knowing our Russian soul, as soon as it became easier, the disease ended, I stop drinking medicine, I allow myself to go to the store. Here no matter how badly Omicron played a cruel joke. Because the covid was not cured. We see such cases when patients left the hospital earlier, and then returned to us with more severe pneumonia, “Mikhail Verbitsky emphasized.

Those vaccinated against the coronavirus tolerate the new strain more easily. In the laboratory of the Gamaleya Center, an experiment was conducted with the blood serum of vaccinated people. Antibodies have a neutralizing effect even a year after the Sputnik injection.

– How effective is the Sputnik V vaccine against Omicron today?

– If serum is taken from among those twice vaccinated, then 75% of the vaccinated contain virus-neutralizing antibodies to the omicron strain. If we take the serum from people who were not only vaccinated with Sputnik V, but also boosted with Sputnik Light, then within three months after boosting, 100% of the vaccinated people had virus-neutralizing antibodies,” said Alexander Gintsburg.

Some experts suggest that everyone get sick – to acquire natural immunity. But the cost of such immunization may be too high. Some more statistics. In the case of the use of vaccines with proven efficacy, lethal outcomes are calculated in isolated cases – two people or one person will die per 1 million vaccinated. Or maybe no one will die. In the case of “omicron”, 1 person dies per thousand infected.

Little time has passed to understand what the post-covid syndrome will be like in those who have recovered from “omicron”. But doctors are already noting damage to the nervous system, all the same thrombosis and complications in the lungs.

“From what is new for us, which was not there before, is the destruction of sections of the lungs after suffering a covid infection. This problem occurs not only in patients with covid infection, sometimes even after clinical recovery, after removal from the body The virus can cause a pulmonary complication. And there are a fairly large number of such patients,” said Evgeny Tarabrin, head of the scientific department of emergency thoracoabdominal surgery, chief freelance thoracic surgeon at the Moscow Health Department.

The Sklifosovsky Research Institute has been working on two fronts since March 2020. There are almost a hundred resuscitation beds in the covid hospital, where they nurse extremely seriously ill patients with severe lung damage. And the main hospital, where planned and emergency care was not stopped for a single day.

“We started doing something new. This is also neurosurgical care. Certain innovations were introduced there in the surgery of vertebral spinal trauma and in general injuries and diseases of the spine. In the treatment of the brain. This is cardiac surgery, because it has become less invasive. And in last year, a direction was activated again, which is quite rare for cardiac surgery – heart transplantation, – said Sergey Petrikov, director of the Sklifosovsky Research Institute for Emergency Medicine.0005

The healed heart beats faster with excitement. She survived two operations – not everyone will survive. When the capital’s hospitals took the covid blow, the Sklif doctors took their load.

“The work continues around the clock. Sometimes three patients with aortic lesions arrive. Operations go one after another,” explained Marat Sagirov, head of the 1st cardiac surgery department of the Research Institute for Emergency Medicine named after. Sklifosovsky.

In the operating room, endoscopists begin the myotomy. Eliminate the pathology in the esophagus, when a person cannot swallow, responding with spasms. A rare operation – no more than 10 of them are performed per year. The next day the patient will be discharged home.

“Given the specifics of our institute, patients come to us in an emergency, with acute pain. We can and do help this category of patients,” said Ali Hasanov, senior researcher at the Department of Emergency Surgery.

Institute Director Sergei Petrikov starts every morning with a round. First, in intensive care, from there he goes to the covid hospital. The infection is difficult to contain – the virus knows no boundaries. When an emergency patient is brought in with injuries, they may already be infected.