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Positive expiratory pressure

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https://www.readbyqxmd.com/read/28736528/linking-ventilator-injury-induced-leak-across-the-blood-gas-barrier-to-derangements-in-murine-lung-function
#1
Bradford J Smith, Elizabeth Bartolak-Suki, Bela Suki, Gregory S Roy, Katharine L Hamlington, Chantel M Charlebois, Jason H T Bates
Mechanical ventilation is vital to the management of acute respiratory distress syndrome, but it frequently leads to ventilator-induced lung injury (VILI). Understanding the pathophysiological processes involved in the development of VILI is an essential prerequisite for improving lung-protective ventilation strategies. The goal of this study was to relate the amount and nature of material accumulated in the airspaces to biomarkers of injury and the derecruitment behavior of the lung in VILI. Forty-nine BALB/c mice were mechanically ventilated with combinations of tidal volume and end-expiratory pressures to produce varying degrees of overdistension and atelectasis while lung function was periodically assessed...
2017: Frontiers in Physiology
https://www.readbyqxmd.com/read/28736210/effects-of-positive-expiratory-pressure-on-chest-wall-volumes-in-subjects-with-stroke-compared-to-healthy-controls-a-case-control-study
#2
Elis E A Cabral, Vanessa R Resqueti, Illia N D F Lima, Lucien P Gualdi, Andrea Aliverti, Guilherme A F Fregonezi
BACKGROUND: Alterations in respiratory system kinematics in stroke lead to restrictive pattern associated with decreased lung volumes. Chest physical therapy, such as positive expiratory pressure, may be useful in the treatment of these patients; however, the optimum intensity to promote volume and motion changes of the chest wall remains unclear. OBJECTIVE: To assess the effect of different intensities of positive expiratory pressure on chest wall kinematics in subjects with stroke compared to healthy controls...
July 8, 2017: Brazilian Journal of Physical Therapy
https://www.readbyqxmd.com/read/28734021/effect-of-fixed-value-positive-end-expiratory-pressure-valves-on-canine-thoracic-volume-and-atelectasis
#3
A Allison, X Huizing, C Jolliffe, I Schaafsma
OBJECTIVES: The objective of this study was to investigate whether a fixed 10 cm H2 O positive end-expiratory pressure valve would increase the aeration of, and reduce atelectasis formation in, the lungs after induction of anaesthesia in dogs undergoing thoracic CT. MATERIALS AND METHODS: 28 dogs were paired based on breed, bodyweight and body condition score and then randomly allocated to either Group Z (0 cm H2 O) or Group P (10 cm H2 O positive end-expiratory pressure valve) immediately after the induction of anaesthesia...
July 22, 2017: Journal of Small Animal Practice
https://www.readbyqxmd.com/read/28733314/effects-of-an-airway-clearance-device-on-inflammation-bacteriology-and-mucus-transport-in-bronchiectasis
#4
Joana Tambascio, Hugo Celso Dutra de Souza, Roberto Martinez, José Antônio Baddini-Martinez, Peter John Barnes, Ada Clarice Gastaldi
BACKGROUND: Bronchiectasis is characterized by abnormal and permanent dilation of the bronchi, caused by the perpetuation of inflammation and impairment of mucociliary clearance. Physiotherapy techniques can help to decrease the retention of respiratory secretions. The flutter valve combines high-frequency oscillation and positive expiratory pressure to facilitate the removal of secretions. We evaluated the effects of the flutter valve on sputum inflammation, microbiology, and transport of respiratory secretions in patients with bronchiectasis...
August 2017: Respiratory Care
https://www.readbyqxmd.com/read/28730574/mechanical-ventilation-guided-by-electrical-impedance-tomography-in-pediatric-acute-respiratory-distress-syndrome
#5
Jeffrey Dmytrowich, Tanya Holt, Karen Schmid, Gregory Hansen
Mechanical ventilation strategies in pediatric acute respiratory distress syndrome (pARDS) continue to advance. Optimizing positive end expiratory pressure (PEEP) and ventilation to recruitable lung can be difficult to clinically achieve. This is in part, due to disease evolution, unpredictable changes in lung compliance, and the inability to assess regional tidal volumes in real time at the bedside. Here we report the utilization of thoracic electrical impedance tomography to guide daily PEEP settings and recruitment maneuvers in a child with pARDS...
July 20, 2017: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/28730554/bedside-selection-of-positive-end-expiratory-pressure-by-electrical-impedance-tomography-in-hypoxemic-patients-a-feasibility-study
#6
Nilde Eronia, Tommaso Mauri, Elisabetta Maffezzini, Stefano Gatti, Alfio Bronco, Laura Alban, Filippo Binda, Tommaso Sasso, Cristina Marenghi, Giacomo Grasselli, Giuseppe Foti, Antonio Pesenti, Giacomo Bellani
BACKGROUND: Positive end-expiratory pressure (PEEP) is a key element of mechanical ventilation. It should optimize recruitment, without causing excessive overdistension, but controversy exists on the best method to set it. The purpose of the study was to test the feasibility of setting PEEP with electrical impedance tomography in order to prevent lung de-recruitment following a recruitment maneuver. We enrolled 16 patients undergoing mechanical ventilation with PaO2/FiO2 <300 mmHg...
December 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/28725445/manual-ventilation-and-open-suction-procedures-contribute-to-negative-pressures-in-a-mechanical-lung-model
#7
Espen Rostrup Nakstad, Helge Opdahl, Fridtjof Heyerdahl, Fredrik Borchsenius, Ole Henning Skjønsberg
INTRODUCTION: Removal of pulmonary secretions in mechanically ventilated patients usually requires suction with closed catheter systems or flexible bronchoscopes. Manual ventilation is occasionally performed during such procedures if clinicians suspect inadequate ventilation. Suctioning can also be performed with the ventilator entirely disconnected from the endotracheal tube (ETT). The aim of this study was to investigate if these two procedures generate negative airway pressures, which may contribute to atelectasis...
2017: BMJ Open Respiratory Research
https://www.readbyqxmd.com/read/28725332/thyrotoxic-valvulopathy-case-report-and-review-of-the-literature
#8
Keniel Pierre, Sushee Gadde, Bassam Omar, G Mustafa Awan, Christopher Malozzi
We report a 42-year-old female who was admitted for abdominal pain, and also endorsed dyspnea, fatigue and chronic palpitations. Past medical history included asthma, patent ductus arteriosus repaired in childhood and ill-defined thyroid disease. Physical examination revealed blood pressure of 136/88 mm Hg and heart rate of 149 beats per minute. Cardiovascular exam revealed an irregularly irregular rhythm, and pulmonary exam revealed mild expiratory wheezing. Abdomen was tender. Electrocardiogram revealed atrial fibrillation with rapid ventricular response which responded to intravenous diltiazem...
June 2017: Cardiology Research
https://www.readbyqxmd.com/read/28722077/invasive-haemodynamic-evaluation-of-the-pulmonary-circulation-in-pulmonary-hypertension
#9
Alberto Pagnamenta, Andrea Azzola, Maurice Beghetti, Frédéric Lador, On Behalf Of The Swiss Society Of Pulmonary Hypertension
The term pulmonary hypertension refers to a serious condition characterised by high pulmonary vascular pressure, mainly as a consequence of various cardiac and respiratory diseases. Current clinical classification of pulmonary hypertension considers five distinct groups. Transthoracic echocardiography represents the first and most important noninvasive screening tool for estimating the probability of pulmonary hypertension. The diagnostic approach to pulmonary hypertension is supported by a proposed algorithm, which identifies the underlying cause...
July 19, 2017: Swiss Medical Weekly
https://www.readbyqxmd.com/read/28711371/extubation-to-high-flow-nasal-cannula-in-critically-ill-surgical-patients
#10
Navpreet K Dhillon, Eric J T Smith, Ara Ko, Megan Y Harada, Danielle Polevoi, Richard Liang, Galinos Barmparas, Eric J Ley
BACKGROUND: High-flow nasal cannula (HFNC) is increasingly used to reduce reintubations in patients with respiratory failure. Benefits include providing positive end expiratory pressure, reducing anatomical dead space, and decreasing work of breathing. We sought to compare outcomes of critically ill surgical patients extubated to HFNC versus conventional therapy. METHODS: A retrospective review was conducted in the surgical intensive care unit of an academic center during August 2015 to February 2016...
July 12, 2017: Journal of Surgical Research
https://www.readbyqxmd.com/read/28708679/transpulmonary-pressure-describes-lung-morphology-during-decremental-positive-end-expiratory-pressure-trials-in-obesity
#11
Jacopo Fumagalli, Lorenzo Berra, Changsheng Zhang, Massimiliano Pirrone, Roberta R De Santis Santiago, Susimeire Gomes, Federico Magni, Glaucia A B Dos Santos, Desmond Bennett, Vinicius Torsani, Daniel Fisher, Caio Morais, Marcelo B P Amato, Robert M Kacmarek
OBJECTIVES: Atelectasis develops in critically ill obese patients when undergoing mechanical ventilation due to increased pleural pressure. The current study aimed to determine the relationship between transpulmonary pressure, lung mechanics, and lung morphology and to quantify the benefits of a decremental positive end-expiratory pressure trial preceded by a recruitment maneuver. DESIGN: Prospective, crossover, nonrandomized interventional study. SETTING: Medical and Surgical Intensive Care Units at Massachusetts General Hospital (Boston, MA) and University Animal Research Laboratory (São Paulo, Brazil)...
August 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28707173/intraoperative-ventilation-of-morbidly-obese-patients-guided-by-transpulmonary-pressure
#12
Lars Eichler, Katarzyna Truskowska, A Dupree, P Busch, Alwin E Goetz, Christian Zöllner
BACKGROUND: Bariatric surgery has proven a successful approach in the treatment of morbid obesity and its concomitant diseases such as diabetes mellitus and arterial hypertension. Aiming for optimal management of this challenging patient cohort, tailored concepts directly guided by individual patient physiology may outperform standardized care. Implying esophageal pressure measurement and electrical impedance tomography-increasingly applied monitoring approaches to individually adjust mechanical ventilation in challenging circumstances like acute respiratory distress syndrome (ARDS) and intraabdominal hypertension-we compared our institutions standard ventilator regimen with an individually adjusted positive end expiratory pressure (PEEP) level aiming for a positive transpulmonary pressure (P L) throughout the respiratory cycle...
July 14, 2017: Obesity Surgery
https://www.readbyqxmd.com/read/28701178/the-future-of-mechanical-ventilation-lessons-from-the-present-and-the-past
#13
REVIEW
Luciano Gattinoni, John J Marini, Francesca Collino, Giorgia Maiolo, Francesca Rapetti, Tommaso Tonetti, Francesco Vasques, Michael Quintel
The adverse effects of mechanical ventilation in acute respiratory distress syndrome (ARDS) arise from two main causes: unphysiological increases of transpulmonary pressure and unphysiological increases/decreases of pleural pressure during positive or negative pressure ventilation. The transpulmonary pressure-related side effects primarily account for ventilator-induced lung injury (VILI) while the pleural pressure-related side effects primarily account for hemodynamic alterations. The changes of transpulmonary pressure and pleural pressure resulting from a given applied driving pressure depend on the relative elastances of the lung and chest wall...
July 12, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/28698373/genetic-identification-of-a-hindbrain-nucleus-essential-for-innate-vocalization
#14
Luis Rodrigo Hernandez-Miranda, Pierre-Louis Ruffault, Julien C Bouvier, Andrew J Murray, Marie-Pierre Morin-Surun, Niccolò Zampieri, Justyna B Cholewa-Waclaw, Elodie Ey, Jean-Francois Brunet, Jean Champagnat, Gilles Fortin, Carmen Birchmeier
Vocalization in young mice is an innate response to isolation or mechanical stimulation. Neuronal circuits that control vocalization and breathing overlap and rely on motor neurons that innervate laryngeal and expiratory muscles, but the brain center that coordinates these motor neurons has not been identified. Here, we show that the hindbrain nucleus tractus solitarius (NTS) is essential for vocalization in mice. By generating genetically modified newborn mice that specifically lack excitatory NTS neurons, we show that they are both mute and unable to produce the expiratory drive required for vocalization...
July 11, 2017: Proceedings of the National Academy of Sciences of the United States of America
https://www.readbyqxmd.com/read/28695586/intra-operative-protective-mechanical-ventilation-in-lung-transplantation-a-randomised-controlled-trial
#15
G L Verbeek, P S Myles, G P Westall, E Lin, S L Hastings, S F Marasco, J Jaffar, A C Meehan
Primary graft dysfunction occurs in up to 25% of patients after lung transplantation. Contributing factors include ventilator-induced lung injury, cardiopulmonary bypass, ischaemia-reperfusion injury and excessive fluid administration. We evaluated the feasibility, safety and efficacy of an open-lung protective ventilation strategy aimed at reducing ventilator-induced lung injury. We enrolled adult patients scheduled to undergo bilateral sequential lung transplantation, and randomly assigned them to either a control group (volume-controlled ventilation with 5 cmH2 O, positive end-expiratory pressure, low tidal volumes (two-lung ventilation 6 ml...
August 2017: Anaesthesia
https://www.readbyqxmd.com/read/28685539/respiratory-training-during-rehabilitation-of-acute-organic-fluorine-poisoned-patients-treated-by-non-invasive-positive-pressure-ventilation
#16
L Liu, D Z Liu, Q P Wang, Z L Zhu, H M Li, X Y Lu
This paper aimed to analyze the effects of respiratory training on pulmonary function during the rehabilitation period for acute organic fluorine-poisoned patients treated by non-invasive positive pressure ventilation (NIPPV). Sixty-two acute organic fluorine-poisoned patients admitted to the Xinxiang Central Hospital, Xinxiang City, China, from May 2012 to March 2016 were selected and randomly divided into an observation group and a control group, with 31 cases in each. Both groups received NIPPV. The patients in the control group exercised daily, while the patients in the observation group received contracting lips-abdominal breathing training...
April 2017: Journal of Biological Regulators and Homeostatic Agents
https://www.readbyqxmd.com/read/28683216/pulmonary-drug-delivery-following-continuous-vibrating-mesh-nebulization-and-inspiratory-synchronized-vibrating-mesh-nebulization-during-noninvasive-ventilation-in-healthy-volunteers
#17
Jean-Bernard Michotte, Enrico Staderini, Anne-Sophie Aubriot, Emilie Jossen, Jonathan Dugernier, Giuseppe Liistro, Gregory Reychler
BACKGROUND: A breath-synchronized nebulization option that could potentially improve drug delivery during noninvasive positive pressure ventilation (NIPPV) is currently not available on single-limb circuit bilevel ventilators. The aim of this study was to compare urinary excretion of amikacin following aerosol delivery with a vibrating mesh nebulizer coupled to a single-limb circuit bilevel ventilator, using conventional continuous (Conti-Neb) and experimental inspiratory synchronized (Inspi-Neb) nebulization modes...
July 6, 2017: Journal of Aerosol Medicine and Pulmonary Drug Delivery
https://www.readbyqxmd.com/read/28679201/physiological-effects-of-the-open-lung-approach-during-laparoscopic-cholecystectomy-focus-on-driving-pressure
#18
Davide D'Antini, Michela Rauseo, Salvatore Grasso, Lucia Mirabella, Luigi Camporota, Antonella Cotoia, Savino Spadaro, Alberto Fersini, Rocco Petta, Rosaria Menga, Alberto Sciusco, Michele Dambrosio, Gilda Cinnella
BACKGROUND: During laparoscopy, respiratory mechanics and gas exchange are impaired because of pneumoperitoneum and atelectasis formation. We applied an open lung approach (OLA) consisting in lung recruitment followed by a decremental positive-end expiratory pressure (PEEP) trial to identify the level of PEEP corresponding to the highest compliance of the respiratory system (best PEEP). Our hypothesis was that this approach would improve both lung mechanics and oxygenation without hemodynamic impairment...
July 5, 2017: Minerva Anestesiologica
https://www.readbyqxmd.com/read/28678876/survival-predictor-in-patients-with-acute-respiratory-distress-syndrome-and-diffuse-alveolar-damage-undergoing-open-lung-biopsy
#19
Kuo-Chin Kao, Chih-Hao Chang, Chen-Yiu Hung, Li-Chung Chiu, Chung-Chi Huang, Han-Chung Hu
BACKGROUND: Diffuse alveolar damage (DAD) is a typical pathological finding of open lung biopsies in patients with acute respiratory distress syndrome (ARDS). Patients with ARDS and DAD have been reported to have a poorer prognosis than those without DAD. The aim of this study was to investigate the survival predictors in patients with ARDS and DAD. METHODS: We retrospectively reviewed all ARDS patients who underwent an open lung biopsy which showed evidence of DAD from January 2006 to June 2015 at Chang Gung Memorial Hospital...
2017: PloS One
https://www.readbyqxmd.com/read/28675548/neopuff-t-piece-resuscitator-mask-ventilation-does-mask-leak-vary-with-different-peak-inspiratory-pressures-in-a-manikin-model
#20
Rajesh Maheshwari, Mark Tracy, Murray Hinder, Audrey Wright
AIM: The aim of this study was to compare mask leak with three different peak inspiratory pressure (PIP) settings during T-piece resuscitator (TPR; Neopuff) mask ventilation on a neonatal manikin model. METHODS: Participants were neonatal unit staff members. They were instructed to provide mask ventilation with a TPR with three PIP settings (20, 30, 40 cm H2 O) chosen in a random order. Each episode was for 2 min with 2-min rest period. Flow rate and positive end-expiratory pressure (PEEP) were kept constant...
July 4, 2017: Journal of Paediatrics and Child Health
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