How does it feel when your lungs collapse. Pneumothorax: Understanding Collapsed Lung Symptoms, Causes, and Treatment

03.08.202319.07.2023 by alexxlab

How does a collapsed lung feel. What are the common symptoms of pneumothorax. What causes a lung to collapse. How is a pneumothorax diagnosed and treated. Can a collapsed lung be prevented. What are the long-term effects of pneumothorax. When should you seek medical attention for chest pain or breathing difficulties.

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What is a Pneumothorax? Understanding the Basics of a Collapsed Lung

A pneumothorax, commonly known as a collapsed lung, occurs when air escapes from the lung and fills the space between the lung and chest wall. This condition prevents the lung from expanding normally during inhalation, potentially leading to serious health complications. While relatively rare, a pneumothorax can be life-threatening and requires immediate medical attention.

The severity of a pneumothorax can vary greatly, from a small air leak that resolves on its own to a complete lung collapse that necessitates emergency intervention. Understanding the signs, causes, and treatment options for this condition is crucial for anyone experiencing unexplained chest pain or breathing difficulties.

Recognizing the Symptoms: How Does a Collapsed Lung Feel?

Identifying the symptoms of a pneumothorax is crucial for seeking timely medical care. The onset of symptoms can be sudden and alarming, often mimicking other respiratory or cardiac conditions. Common signs of a collapsed lung include:

A dull, steady ache in the chest
Sharp pain when inhaling
Shortness of breath or difficulty breathing
Chest tightness or pressure
The sensation of being unable to draw a full breath
Cyanosis (bluish discoloration of the skin) due to lack of oxygen
Rapid heartbeat (tachycardia)

Is chest pain always indicative of a pneumothorax? While chest pain is a common symptom, it’s important to note that not all chest pain is caused by a collapsed lung. However, any persistent or severe chest pain, especially when accompanied by difficulty breathing, should be evaluated by a medical professional promptly.

Causes of Pneumothorax: From Trauma to Spontaneous Occurrences

Understanding the various causes of a pneumothorax can help identify risk factors and potentially prevent future occurrences. The causes of a collapsed lung can be broadly categorized into traumatic and non-traumatic events:

Traumatic Causes:

Blunt chest trauma: This is the leading cause of pneumothorax, often resulting from sports injuries, car accidents, or falls.
Penetrating chest wounds: Stab wounds, gunshots, or even accidental punctures from objects like pencils can lead to a collapsed lung.
Iatrogenic causes: Certain medical procedures, such as the insertion of central lines or lung biopsies, can inadvertently cause a pneumothorax.

Non-Traumatic Causes:

Spontaneous pneumothorax: This occurs without any apparent cause, typically in tall, thin young adults, especially males.
Underlying lung diseases: Conditions such as emphysema, chronic obstructive pulmonary disease (COPD), cystic fibrosis, and certain lung infections can increase the risk of pneumothorax.
Ruptured blebs or bullae: Small air-filled sacs on the lung surface can burst, leading to air leakage.

Can lifestyle factors contribute to the risk of pneumothorax? While some risk factors are beyond an individual’s control, certain lifestyle choices can influence the likelihood of developing a pneumothorax. Smoking, for instance, significantly increases the risk by damaging lung tissue and promoting the formation of blebs.

Diagnosing a Collapsed Lung: Medical Examinations and Imaging Tests

Prompt and accurate diagnosis of a pneumothorax is crucial for effective treatment. Healthcare providers employ a combination of physical examinations and imaging studies to confirm the presence and extent of a collapsed lung.

Physical Examination:

During a physical exam, the doctor will:

Listen to breath sounds using a stethoscope
Assess chest movement during breathing
Check for signs of respiratory distress
Evaluate skin color for signs of cyanosis

Imaging Studies:

To confirm the diagnosis and determine the severity of the pneumothorax, doctors may order:

Chest X-ray: The most common imaging test used to visualize a collapsed lung
CT scan: Provides more detailed images and can detect small pneumothoraces that may not be visible on X-rays
Ultrasound: Increasingly used in emergency settings for rapid diagnosis

How accurate are imaging tests in diagnosing pneumothorax? While chest X-rays are highly effective in detecting moderate to large pneumothoraces, they may miss smaller collapses. CT scans offer superior sensitivity and can identify even tiny air leaks, making them the gold standard for diagnosis in uncertain cases.

Treatment Approaches: From Observation to Surgical Intervention

The treatment of a pneumothorax depends on its size, cause, and the patient’s overall health. Management strategies range from conservative observation to invasive surgical procedures.

Conservative Management:

For small, uncomplicated pneumothoraces:

Observation: Patients may be admitted for monitoring, allowing the lung to heal naturally
Oxygen therapy: Supplemental oxygen can help absorb the trapped air and promote lung re-expansion

Needle Aspiration and Chest Tube Insertion:

For larger pneumothoraces or those causing significant symptoms:

Needle aspiration: A thin needle is inserted to remove excess air
Chest tube placement: A tube is inserted to continuously drain air and allow the lung to re-expand

Surgical Interventions:

For recurrent or persistent pneumothoraces:

Video-assisted thoracoscopic surgery (VATS): Minimally invasive procedure to repair lung blebs and prevent recurrence
Pleurodesis: A procedure to create scar tissue between the lung and chest wall, preventing future collapses

What factors determine the choice of treatment for pneumothorax? The decision on treatment approach considers the size of the pneumothorax, the patient’s symptoms, the presence of underlying lung disease, and the risk of recurrence. In general, larger pneumothoraces and those causing significant respiratory distress require more aggressive intervention.

Recovery and Prevention: Navigating Life After a Collapsed Lung

Recovering from a pneumothorax involves both physical healing and lifestyle adjustments to prevent future occurrences. The recovery process and preventive measures vary depending on the severity of the collapse and the treatment received.

Short-term Recovery:

Rest and gradual return to activities
Follow-up chest X-rays to ensure complete lung re-expansion
Pain management as needed

Long-term Prevention:

Smoking cessation
Avoiding activities that increase intrathoracic pressure (e.g., scuba diving, playing wind instruments) for a specified period
Regular medical check-ups, especially for those with underlying lung conditions

How long does it take to fully recover from a pneumothorax? Recovery time varies widely, ranging from a few days for small, spontaneous pneumothoraces to several weeks or months for more severe cases requiring surgical intervention. Complete healing of the lung tissue typically occurs within 6-8 weeks, but patients may be advised to avoid strenuous activities for up to 3 months.

Complications and Long-term Effects: Understanding the Risks

While most cases of pneumothorax resolve without long-term consequences, some patients may experience complications or lasting effects. Being aware of these potential issues is crucial for ongoing management and quality of life.

Potential Complications:

Recurrence: Especially common in cases of spontaneous pneumothorax
Tension pneumothorax: A life-threatening condition where air continues to accumulate, compressing the heart and blood vessels
Chronic pain: Some patients report persistent chest discomfort after recovery
Reduced lung function: In severe cases or after multiple occurrences

Long-term Effects:

Anxiety related to recurrence
Lifestyle modifications to prevent future episodes
Ongoing medical surveillance, particularly for those with underlying lung conditions

Can a pneumothorax have psychological impacts? Yes, experiencing a collapsed lung can lead to anxiety and fear of recurrence. Some patients report post-traumatic stress symptoms, especially if the initial event was particularly frightening or painful. Psychological support and counseling may be beneficial for those struggling with the emotional aftermath of a pneumothorax.

When to Seek Medical Attention: Recognizing the Red Flags

Given the potential seriousness of a pneumothorax, it’s crucial to know when to seek immediate medical care. While not all chest pain or breathing difficulties indicate a collapsed lung, certain symptoms should prompt urgent evaluation.

Seek Emergency Care If You Experience:

Sudden, severe chest pain
Rapid onset of shortness of breath
Chest pain that worsens with breathing or coughing
Bluish discoloration of the lips or skin
Confusion or loss of consciousness

Contact Your Healthcare Provider If You Have:

Persistent mild chest pain
Gradual increase in shortness of breath
History of lung disease and new respiratory symptoms
Recent chest injury, even if it seemed minor

How can you differentiate between pneumothorax and other causes of chest pain? While it can be challenging to distinguish between different causes of chest pain without medical evaluation, pneumothorax pain typically worsens with breathing and may be accompanied by a feeling of air hunger or inability to take a deep breath. However, given the potential seriousness of both pneumothorax and other causes of chest pain (such as heart attacks), it’s always best to err on the side of caution and seek medical attention.

Understanding the symptoms, causes, and treatment options for pneumothorax empowers individuals to recognize potential warning signs and seek timely medical care. While a collapsed lung can be a frightening experience, prompt diagnosis and appropriate treatment lead to positive outcomes in most cases. By staying informed and attentive to your body’s signals, you can navigate the challenges of this condition and maintain optimal lung health.

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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When Lungs Collapse | Cystic Fibrosis Foundation

I knew I had lousy lungs, but I never expected them to blow out like a tire on the highway. Before 2015, a pneumothorax (collapsed lung) was not in my medical vocabulary and I associated it only with action movies and the Discovery Health Channel, not with me or cystic fibrosis. I am now far too familiar with the signs, treatments, and recovery stages of a spontaneous lung collapse — I might even call myself an expert.

In 2015, I was a senior in high school when my left lung spontaneously collapsed, and I was vividly reminded that life is unpredictable. Fast forward to this summer (a rising senior in college) and my body reminds me, once again, that the unexpected can happen. This time it was my right lung that gave out, randomly, or as my doctor said, “dropped.” Both experiences were complicated and resulted in two-week hospital stays, many chest tubes, and required lung surgery to stop the air leak.

Me waking up in the ER after my chest tube placement. July 2018.

Before my first one, I knew absolutely nothing about pneumothoraces, or their relationship with CF, and that is why I was so afraid when it happened. I did not even know what the symptoms of a collapsed lung were. Was it the sudden inability to breathe? Nope! I could still breathe, walk, and talk when one lung was collapsed. I felt chest discomfort, tightness, shortness of breath, shoulder pain, and exhaustion — symptoms that I had experienced before with CF, but not all at once.

In 2015, it took me a few hours of feeling weird before I called my doctor who told me to go to the emergency room (ER) for an X-ray.

This summer, I ended up working an entire shift before realizing something was seriously wrong and telling my doctor I needed a chest X-ray. Those experiences taught me the importance of listening to my body and not ignoring the warning signs. If something feels wrong, something probably is wrong.

I later learned that CF did not cause the collapses directly. They were caused by a pulmonary bleb rupturing. Blebs are small air blisters that can develop on the lung’s surface — anyone can develop them! Although CF does not cause them, it is thought to provoke them because of the constant inflammation and irritation of the lung tissue. A bleb can pop randomly, leaving a hole in the lung lining — yikes! This is what happened to me, twice.

Because a thoracic surgeon repaired my pneumothorax, I was sent to the thoracic floor of the hospital to recover. I had to be my biggest advocate there as the nurses and doctors, who did not specialize in CF, were making decisions about me and my lungs.

This was difficult when I was on pain meds and wanted to sleep all day, but I used my best judgment and challenged the doctors’ orders if they seemed wrong. CF lungs are not regular lungs. They often need extra attention or care. In my experience, the standard procedure is not always the right procedure for people with CF.

After I was finally allowed outside post lung surgery. July 2018.

The two lung collapses were very low points in my 21-year life, mainly because of the uncertainty and fear I felt. The immobility and constant pain I dealt with was a nightmare at the time but left me with a lasting appreciation of my healthier days. It’s funny how hardship can lead to a new, uplifting perspective. If nothing else, at least now I have matching scars on both sides!

Join the conversation on Facebook.

Hogan was diagnosed with cystic fibrosis at age three and has been smiling, laughing, and coughing her entire life. She is a strong believer in the benefits of optimism and loves spreading enthusiasm and positivity. Hogan grew up on the coast of Maine and recently graduated from the University of Vermont. She is the leader of her Great Strides team, “Hogan’s Heroes,” and spends her springs fundraising for CF. Reach out to her on the Hogan’s Heroes team Facebook page.

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

Easy to check lungs | Articles of the clinic Medservice

May 22, 2018

Author of the article: Zolotareva Ekaterina Yurievna, doctor of functional diagnostics

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No breath means no life. To be healthy and energetic, you need to have even and easy breathing. What is your breath like? Maybe you don’t know something about yourself? This test should help determine if you have respiratory problems. Find out about the quality of your breathing by answering the following questions.

1. Do you breathe through your nose or sometimes through your mouth when you are at rest?
Inhalation should always be done through the nose, except in cases of pronouncing long phrases (verbal breathing), exhalation is also possible through the mouth.

2. How many inhalations and exhalations do you take per minute while at rest?
If your health is in order, in a calm state there should be from 8 to 12 respiratory cycles per minute.

3. Do you have breaks between inhalation and exhalation, between exhalation and the next inhalation?
In a calm state, your breathing should be continuous, that is, there should be no breaks between inhalation and exhalation.

4. Lean your back against a wall or back of a chair – in which part of your back do you feel movement as you inhale and exhale ?
It is normal if during inhalation you can feel the pressure of the back on the support in any of its areas. Most of the time it is best to breathe in the lower part of the lungs, pushing the stomach and lower back forward. This is the easiest breath.

5. Can you continuously make the sound “ah” for 20 seconds?
If the longest exhalation is noticeably shorter, your breathing is too shallow, then all your internal organs experience oxygen starvation.

6. Do you ever get told that you snore? Or maybe your voice gets low in the morning?
Being healthy means having no such symptoms.

Respiratory disorders are most often associated with illness or poor physical fitness. To be healthy, to maintain ease of breathing, go through spirography, find out everything about the functional state of the respiratory system.

If you are interested in the health of the respiratory tract, you often have a cough or runny nose, you smoke, often work outdoors, go in for sports, come to the Medservice clinic and undergo an examination of the function of external respiration (spirography). The procedure is painless, safe and informative.

Breathe easily and freely and be healthy!

Author of article

Zolotareva Ekaterina Yurievna

functional diagnostics doctor

Unique clinical experience was formed during the years of work in the women’s cardiology department of the Izhevsk Cardiology Center under the guidance of Associate Professor of the Department of Hospital Therapy Valeeva R. M. Ekaterina Viktorovna is often consulted by obstetricians and gynecologists who work with pregnant women with complex pathologies of the cardiovascular system.