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https://www.readbyqxmd.com/read/29792537/recognizing-quantifying-and-managing-patient-ventilator-asynchrony-in-invasive-and-noninvasive-ventilation
#1
Eugenio Garofalo, Andrea Bruni, Corrado Pelaia, Luisa Liparota, Nicola Lombardo, Federico Longhini, Paolo Navalesi
Patient-ventilator asynchrony may occur with modes of partial ventilatory support. Because this problem is associated with worsened outcomes, identifying and managing asynchronies has been recognized as a relevant clinical problem during both invasive and non-invasive (NIV) mechanical ventilation. Areas covered: In this review article, we first describe the different forms of patient-ventilator asynchrony and how they are classified and quantified. Then, we show how these asynchronies can be recognized, considering the techniques used to properly detect asynchronies, by either ventilator waveform observation, or through systems based on more complexes mathematical algorithms, by means of adjunctive signals, such as the electrical activity of the diaphragm or esophageal pressure...
May 24, 2018: Expert Review of Respiratory Medicine
https://www.readbyqxmd.com/read/29788275/feasibility-and-effectiveness-of-laparoscopic-transgastric-stapler-assisted-circumferential-esophageal-mucosectomy-and-simultaneous-fundoplication-in-a-pig-model
#2
D C Steinemann, P C Müller, A-C Schwarz, A Zerz, G R Linke, B P Müller-Stich
Laparoscopic transgastric stapler-assisted mucosectomy (SAM) has been described for minimally invasive circumferential en bloc resection of Barrett's esophagus (BE). Conceivably long-term disease control might be achieved by adding antireflux surgery after resection of BE by SAM. The aim of this study was to assess the feasibility of combined SAM and fundoplication in one laparoscopic procedure in six pigs. Furthermore, the competence of the gastroesophageal junction (GEJ) was assessed at baseline, after SAM, and after subsequent laparoscopic fundoplication...
May 21, 2018: Diseases of the Esophagus: Official Journal of the International Society for Diseases of the Esophagus
https://www.readbyqxmd.com/read/29788157/weight-loss-in-achalasia-is-determined-by-its-phenotype
#3
D A Patel, R Naik, J C Slaughter, T Higginbotham, H Silver, M F Vaezi
Patients with achalasia present with dysphagia, regurgitation, and varying degrees of weight loss. However, despite it being a disorder of the lower esophageal sphincter with functional obstruction in all patients, it is unclear why certain patients lose significantly more weight compared to others. The aims of this study are to assess demographic, clinical, and manometric characteristics of a large cohort of patients with achalasia to determine potential correlates of weight loss in this population. Patients with diagnosis of achalasia referred to our center between 2009 and 2016 were evaluated...
May 18, 2018: Diseases of the Esophagus: Official Journal of the International Society for Diseases of the Esophagus
https://www.readbyqxmd.com/read/29786596/-coexistence-of-asthma-and-obstructive-sleep-apnea-syndrome-review-of-the-literature
#4
Magdalena Pawelec-Winiarz, Anna Brzecka
Both asthma and obstructive sleep apnea (OSA) syndrome are frequent diseases and their coexistence may implicate important consequences. The incidence of OSA syndrome among the patients with asthma is higher than in the general population, especially in the patients with nocturnal symptoms persisting despite treatment, in patients frequently admitted to hospital because of the exacerbations of asthma, and in obese patients. The causes of frequent coexistence of asthma and OSA syndrome are not fully elucidated...
2018: Wiadomości Lekarskie: Organ Polskiego Towarzystwa Lekarskiego
https://www.readbyqxmd.com/read/29781584/erythema-ab-igne
#5
Isabelle Marie
A 41 year-old woman was diagnosed as having limited cutaneous systemic sclerosis (SSc) in March 2012. The cutaneous impairment of SSc was characterized by sclerodactyly associated with pitting scars; systemic manifestations of SSc included esophageal involvement, with both absence of peristalsis in the lower two-thirds of the oesophageal body and low pressure in the lower oesophageal sphincter. In 2017, the patient presented with livedo reticularis lesions of her abdomen (Panel A) evolving for one month. The patient denied pruritus, pain, or exposure of abdomen to irritants prior to lesion onset...
May 21, 2018: Arthritis & Rheumatology
https://www.readbyqxmd.com/read/29771711/respiratory-muscle-effort-during-expiration-in-successful-and-failed-weaning-from-mechanical-ventilation
#6
Jonne Doorduin, Lisanne H Roesthuis, Diana Jansen, Johannes G van der Hoeven, Hieronymus W H van Hees, Leo M A Heunks
BACKGROUND: Respiratory muscle weakness in critically ill patients is associated with difficulty in weaning from mechanical ventilation. Previous studies have mainly focused on inspiratory muscle activity during weaning; expiratory muscle activity is less well understood. The current study describes expiratory muscle activity during weaning, including tonic diaphragm activity. The authors hypothesized that expiratory muscle effort is greater in patients who fail to wean compared to those who wean successfully...
May 16, 2018: Anesthesiology
https://www.readbyqxmd.com/read/29756692/the-presence-of-elastic-compression-stockings-reduces-the-fluid-responsiveness-of-patients-in-the-operating-room
#7
Elie Zogheib, Julien Maizel, Nabil Cherradi, Ammar Benammar, Béatrice Labont, Abdel Hchikat, Michael Bernasinski, Faouzi Trojette, Michel Slama, Hervé Dupont
BACKGROUND: To investigate whether elastic compression stockings (ECS) can affect fluid responsiveness parameters before and during passive leg raising (PLR) maneuvers. METHODS: In the operating room (OR), we performed a prospective study including patients referred for cardiac surgery. Blood pressure (BP), ΔPP, heart rate (HR), central venous pressure (CVP), stroke volume (SV) and aortic blood flow (ABF) (by esophageal doppler) were measured according to four conditions: supine position without ECS (baseline 1), lower limbs raised to an angle of 45° (PLR 1), returned to the supine position with ECS (baseline 2), then a second PLR maneuver with ECS was performed (PLR 2)...
May 11, 2018: Minerva Anestesiologica
https://www.readbyqxmd.com/read/29756656/pathophysiology-and-treatment-of-achalasia-in-a-muscle-mechanical-perspective
#8
REVIEW
Hans Gregersen, Kar Man Lo
This review provides a biomechanical perspective on the pathophysiology and treatment of achalasia. The esophagus is efficient in transporting ingested material to the stomach in healthy subjects. A fine balance exists between the peristaltic forces generated in the esophageal body (which herein is defined as the preload) and the resistance in the outlet, the esophago-gastric junction (which is defined as the afterload). Achalasia is a rare esophageal disease that progressively over many years challenges esophageal efficacy...
May 14, 2018: Annals of the New York Academy of Sciences
https://www.readbyqxmd.com/read/29742979/electrical-stimulation-of-the-lower-esophageal-sphincter-to-treat-gastroesophageal-reflux-after-poem
#9
Erwin Rieder, Matthias Paireder, Ivan Kristo, Katrin Schwameis, Sebastian F Schoppmann
As per-oral endoscopic myotomy (POEM) is not followed by any anti-reflux procedure, a common concern is the risk of postoperative gastro-esophageal reflux disease (GERD). Electrical stimulation of the lower esophageal sphincter (LES-EST) could be an option for post-POEM GERD. A 68-year old male obese patient underwent successful POEM but developed GERD not responsive to proton pump inhibitors. Consecutively, the patient had implanted an electrical LES stimulation device, consisting of bipolar LES-electrodes connected to a subcutaneous pulse generator...
May 1, 2018: Surgical Innovation
https://www.readbyqxmd.com/read/29733830/genesis-of-esophageal-pressurization-and-bolus-flow-patterns-in-patients-with-achalasia-esophagus
#10
Subum Park, Ali Zifan, Dushyant Kumar, Ravinder K Mittal
BACKGROUND & AIMS: In patients with achalasia esophagus, swallows induce simultaneous pressure waves known as esophageal pressurization. We studied the mechanism of esophageal pressurization and bolus flow patterns in patients with type 2 or type 3 achalasia. METHODS: We recorded high-resolution manometry with impedance and intraluminal ultrasound images concurrently in patients with type 2 achalasia (n=6) or type 3 achalasia (n=8) and in 10 healthy subjects (controls) during swallows of 5 ml, 0...
May 4, 2018: Gastroenterology
https://www.readbyqxmd.com/read/29723676/towards-optimal-intraoperative-conditions-in-esophageal-surgery-a-review-of-literature-for-the-prevention-of-esophageal-anastomotic-leakage
#11
REVIEW
Boukje Titia Bootsma, Daitlin Esmee Huisman, Victor Dirk Plat, Linda Jeanne Schoonmade, Jurre Stens, Guy Hubens, Donald Leonard van der Peet, Freek Daams
BACKGROUND: Esophageal anastomotic leakage (EAL) is a severe complication following gastric and esophageal surgery for cancer. Several non-modifiable, patient or surgery related risk factors for EAL have been identified, however, the contribution of modifiable intraoperative parameters remains undetermined. This review provides an overview of current literature on potentially modifiable intraoperative risk factors for EAL. MATERIALS AND METHODS: The PubMed, EMBASE and Cochrane databases were searched by two researchers independently...
April 30, 2018: International Journal of Surgery
https://www.readbyqxmd.com/read/29708892/continuous-negative-abdominal-pressure-reduces-ventilator-induced-lung-injury-in-a-porcine-model
#12
Takeshi Yoshida, Doreen Engelberts, Gail Otulakowski, Bhushan Katira, Martin Post, Niall D Ferguson, Laurent Brochard, Marcelo B P Amato, Brian P Kavanagh
BACKGROUND: In supine patients with acute respiratory distress syndrome, the lung typically partitions into regions of dorsal atelectasis and ventral aeration ("baby lung"). Positive airway pressure is often used to recruit atelectasis, but often overinflates ventral (already aerated) regions. A novel approach to selective recruitment of dorsal atelectasis is by "continuous negative abdominal pressure." METHODS: A randomized laboratory study was performed in anesthetized pigs...
April 27, 2018: Anesthesiology
https://www.readbyqxmd.com/read/29707346/a-comparison-between-two-lung-ventilation-with-co-2-artificial-pneumothorax-and-one-lung-ventilation-during-thoracic-phase-of-minimally-invasive-esophagectomy
#13
Miao Lin, Yaxing Shen, Hao Wang, Yong Fang, Cheng Qian, Songtao Xu, Di Ge, Mingxiang Feng, Lijie Tan, Qun Wang
Background: To investigate the feasibility and safety of two lung ventilation with artificial pneumothorax in minimally invasive esophagectomy (MIE) through a comparison with conventional one lung ventilation. Methods: Eleven hundred and sixty-six patients with esophageal cancer, who underwent McKeown MIE in our center from February 2006 to December 2016, were studied retrospectively. Seven hundred and five patients who underwent one lung ventilation with double lumen endotracheal tube (DLET) were assigned to DLET group...
March 2018: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/29702296/advances-in-management-of-esophageal-motility-disorders
#14
REVIEW
Peter J Kahrilas, Albert J Bredenoord, Dustin A Carlson, John E Pandolfino
The widespread adoption of high-resolution manometry (HRM) has led to a restructuring in the classification of esophageal motility disorder classification summarized in the Chicago Classification, currently in version 3.0. It has become apparent that the cardinal feature of achalasia, impaired lower esophageal sphincter relaxation, can occur in several disease phenotypes: without peristalsis, with premature (spastic) distal esophageal contractions, with panesophageal pressurization, or even with preserved peristalsis...
April 24, 2018: Clinical Gastroenterology and Hepatology
https://www.readbyqxmd.com/read/29698944/mucosally-expressed-cytokines-are-associated-with-the-esophageal-motility-function
#15
Keita Fukaura, Eikichi Ihara, Haruei Ogino, Yoichiro Iboshi, Kazumasa Muta, Bai Xiaopeng, Shohei Hamada, Yoshitaka Hata, Tsutomu Iwasa, Akira Aso, Kazuhiko Nakamura, Yoshihiro Ogawa
BACKGROUND AND AIM: Although basic research has shown that certain cytokines affect gastrointestinal motility, the clinical evidence is lacking. The objective of this study was to explore the association between mucosally expressed cytokines and the esophageal motility function in humans. METHODS: We enrolled a total of 57 patients with suspected esophageal motility disorders (EMDs) who underwent high-resolution manometry. RESULTS: The diagnoses of the patients were as follows: normal esophageal motility (n = 25), ineffective esophageal motility (n = 5), esophagogastric junction outflow obstruction (EGJOO; n = 10), distal esophageal spasm (n = 5), achalasia (n = 10), absent contractility (n = 1), and jackhammer esophagus (n = 1)...
April 26, 2018: Digestion
https://www.readbyqxmd.com/read/29688787/comparison-of-desflurane-and-propofol-at-equipotent-doses-in-combination-with-a-constant-rate-infusion-of-dexmedetomidine-on-global-and-peripheral-perfusion-and-oxygenation-in-horses
#16
Stephan Neudeck, Sabine B R Kästner, Liza Wittenberg-Voges, Karl Rohn, Klaus Hopster
OBJECTIVE To determine global and peripheral perfusion and oxygenation during anesthesia with equipotent doses of desflurane and propofol combined with a constant rate infusion of dexmedetomidine in horses. ANIMALS 6 warmblood horses. PROCEDURES Horses were premedicated with dexmedetomidine (3.5 μg•kg-1 , IV). Anesthesia was induced with propofol or ketamine and maintained with desflurane or propofol (complete crossover design) combined with a constant rate infusion of dexmedetomidine (7 μg•kg-1 •h-1 )...
May 2018: American Journal of Veterinary Research
https://www.readbyqxmd.com/read/29683923/effects-of-age-and-sex-on-inspiratory-muscle-activation-patterns-during-exercise
#17
Yannick Molgat-Seon, Paolo B Dominelli, Andrew H Ramsook, Michele R Schaeffer, Lee M Romer, Jeremy D Road, Jordan A Guenette, A William Sheel
PURPOSE: Characterize the effects of age, sex, and their interaction on inspiratory muscle activation patterns during exercise. METHODS: Twenty younger (20-30y, n=10 women) and twenty older (60-80y, n=10 women) subjects performed an incremental cycle exercise test. Electromyography of the scalene (EMGsca) and sternocleidomastoid (EMGscm) muscles were measured using skin surface electrodes, while diaphragm electromyography (EMGdi) and esophageal and transdiaphragmatic pressures were measured using an esophageal catheter...
April 21, 2018: Medicine and Science in Sports and Exercise
https://www.readbyqxmd.com/read/29679768/comparison-of-proaqt-pulsioflex%C3%A2-and-oesophageal-doppler-for-intraoperative-haemodynamic-monitoring-during-intermediate-risk-abdominal-surgery
#18
Grégoire Weil, Cyrus Motamed, Alexandre Eghiaian, Xavier Monnet, Stéphanie Suria
OBJECTIVE: To compare cardiac index (CI) between Proaqt/PulsioFlex® and esophageal Doppler (OD) and the ability of the PulsioFlex® to track CI changes induced by fluid challenge and secondly to assess the impact of the time interval between two auto-calibrations of PulsioFlex® on the accuracy of the measured CI. METHODS: In a single hospital, 49 intermediate-risk oncologic abdominal surgery patients were included in an observational study. We measured the cardiac Index (CI) provided by OD and by the Proaqt/PulsioFlex® before and after internal calibration, which were performed randomly at specific intervals after the initial one (30, 60, 90 and 120min)...
April 18, 2018: Anaesthesia, Critical Care & Pain Medicine
https://www.readbyqxmd.com/read/29679342/fundoplication-with-180-degree-wrap-during-esophagogastrostomy-after-robotic-proximal-gastrectomy-for-early-gastric-cancer
#19
Toshiyasu Ojima, Mikihito Nakamori, Masaki Nakamura, Keiji Hayata, Shimpei Maruoka, Hiroki Yamaue
BACKGROUND: Compared with total gastrectomy, proximal gastrectomy (PG) has potential advantages from a nutritional perspective, such as anemia and postoperative loss of body weight. However, PG is associated with some postoperative functional disorders, such as reflux esophagus (13-31%) and anastomotic stenosis (3-29%).1 We therefore developed a new procedure for fundoplication during esophago-gastrostomy after robotic PG (RPG). METHODS: We performed RPG for early gastric cancer localized in the upper third of the stomach using the da Vinci Surgical System (Intuitive, Sunnyvale, CA)...
April 20, 2018: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
https://www.readbyqxmd.com/read/29673610/low-exertional-inspiratory-capacity-is-not-related-to-dynamic-inspiratory-muscle-weakness-in-heart-failure
#20
Franciele Plachi, Fernanda Machado Balzan, Ricardo Gass, Rui Gustavo Dorneles, Reisi Zambiazi, Danton Pereira da Silva, Paulo R Sanches, Nadine Oliveira Clausell, Danilo C Berton
Reduction in inspiratory capacity (IC) during exercise has been reported in chronic heart failure (CHF). Since inspiratory muscle dysfunction may be present to a variable degree, the assumption that IC reduction during exercise represents an increase in end-expiratory lung volume must be made with caution. This interpretation is flawed if patients develop dynamic inspiratory muscle strength reduction, i.e., progressively lower esophageal (Pes) pressures as the IC maneuvers are repeated. Sixteen CHF patients and 9 age-matched controls performed an incremental exercise test with serial IC and respiratory pressure measurements...
April 16, 2018: Respiratory Physiology & Neurobiology
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