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Transpulmonary

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https://www.readbyqxmd.com/read/29324568/effects-of-pressure-support-ventilation-on-ventilator-induced-lung-injury-in-mild-acute-respiratory-distress-syndrome-depend-on-level-of-positive-end-expiratory-pressure
#1
Paulo A F Magalhães, Gisele de A Padilha, Lillian Moraes, Cíntia L Santos, Ligia de A Maia, Cassia L Braga, Maria do Carmo M B Duarte, Lívia B Andrade, Alberto Schanaider, Vera L Capellozzi, Robert Huhle, Marcelo Gama de Abreu, Paolo Pelosi, Patricia R M Rocco, Pedro L Silva
BACKGROUND: Harmful effects of spontaneous breathing have been shown in experimental severe acute respiratory distress syndrome (ARDS). However, in the clinical setting, spontaneous respiration has been indicated only in mild ARDS. To date, no study has compared the effects of spontaneous assisted breathing with those of fully controlled mechanical ventilation at different levels of positive end-expiratory pressure (PEEP) on lung injury in ARDS. OBJECTIVE: To compare the effects of assisted pressure support ventilation (PSV) with pressure-controlled ventilation (PCV) on lung function, histology and biological markers at two different PEEP levels in mild ARDS in rats...
January 10, 2018: European Journal of Anaesthesiology
https://www.readbyqxmd.com/read/29323931/esophageal-manometry-and-regional-transpulmonary-pressure-in-lung-injury
#2
Takeshi Yoshida, Marcelo B P Amato, Domenico Luca Grieco, Lu Chen, Cristhiano A S Lima, Rollin Roldan, Caio C A Morais, Susimeire Gomes, Eduardo L V Costa, Paulo F G Cardoso, Emmanuel Charbonney, Jean-Christophe M Richard, Laurent Brochard, Brian P Kavanagh
RATIONALE: Esophageal manometry is the clinically available method to estimate pleural pressure, thus enabling calculation of the transpulmonary pressure (PL). However, many concerns make uncertain in which lung region esophageal manometry reflects local PL. OBJECTIVES: To determine the accuracy of esophageal pressure (Pes) and in which regions esophageal manometry reflects Ppl and PL; to assess whether lung stress in non-dependent regions can be estimated at end-inspiration from PL...
January 11, 2018: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/29305559/impact-of-surgery-on-presence-and-dimensions-of-anatomical-isthmuses-in-tetralogy-of-fallot
#3
Gijsbert F L Kapel, Sergio Laranjo, Nico A Blom, Mark G Hazekamp, Martin J Schalij, Margot M Bartelings, Monique R M Jongbloed, Katja Zeppenfeld
OBJECTIVE: In tetralogy of Fallot (TOF), the dominant ventricular tachycardia substrates are slow-conducting anatomical isthmuses. Surgical correction has evolved, which might have influenced isthmus presence and dimensions. METHODS: One hundred and forty-two postmortem TOF specimens (84/58 corrected/uncorrected) were studied for isthmus presence. Isthmus 1 is located between the tricuspid annulus and right ventricular (RV) outflow tract (RVOT) patch/RV incision, isthmus 2 between RVOT patch/RV incision and pulmonary valve, isthmus 3 between pulmonary valve and ventricular septal defect (patch), isthmus 4 between ventricular septal defect (patch) and tricuspid annulus...
January 5, 2018: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/29297365/regional-physiology-of-ards
#4
REVIEW
Luciano Gattinoni, Tommaso Tonetti, Michael Quintel
The acute respiratory distress (ARDS) lung is usually characterized by a high degree of inhomogeneity. Indeed, the same lung may show a wide spectrum of aeration alterations, ranging from completely gasless regions, up to hyperinflated areas. This inhomogeneity is normally caused by the presence of lung edema and/or anatomical variations, and is deeply influenced by the gravitational forces.For any given airway pressure generated by the ventilator, the pressure acting directly on the lung (i.e., the transpulmonary pressure or lung stress) is determined by two main factors: 1) the ratio between lung elastance and the total elastance of the respiratory system (which has been shown to vary widely in ARDS patients, between 0...
December 28, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29251543/express-the-transpulmonary-ratio-of-endothelin-1-is-elevated-in-patients-with-preserved-left-ventricular-ejection-fraction-and-combined-pre-and-post-capillary-pulmonary-hypertension
#5
David Frank Meoli, Yan Ru Su, Evan Brittain, Ivan Robbins, Anna Hemnes, Ken Monahan
No abstract text is available yet for this article.
January 1, 2017: Pulmonary Circulation
https://www.readbyqxmd.com/read/29246894/global-pulmonary-vascular-remodeling-in-pulmonary-hypertension-associated-with-heart-failure-and-preserved-or-reduced-ejection-fraction
#6
Ahmed U Fayyaz, William D Edwards, Joseph J Maleszewski, Ewa A Konik, Hilary M DuBrock, Barry A Borlaug, Robert P Frantz, Sarah M Jenkins, Margaret M Redfield
Background -We hypothesized that pulmonary venous hypertension in heart failure (HF) leads to predominate remodeling of pulmonary veins and that the severity of venous remodeling is associated with the severity of pulmonary hypertension (PH) in HF. Methods -Patients with HF (n=108; 53 preserved and 55 reduced ejection fraction) with PH (HF-PH; pulmonary artery systolic pressure (PASP) ≥ 40 mmHg) were compared to normal Controls (n=12) and patients with primary pulmonary veno-occlusive disease (PVOD; n=17)...
December 15, 2017: Circulation
https://www.readbyqxmd.com/read/29229263/the-hemodynamic-effects-of-different-pacing-modalities-after-cardiopulmonary-bypass-in-patients-with-reduced-left-ventricular-function
#7
R C W Gielgens, I H F Herold, A H M van Straten, B M van Gelder, F A Bracke, H H M Korsten, M A Soliman Hamad, R A Bouwman
OBJECTIVES: Patients with decreased left ventricular function undergoing cardiac surgery have a greater chance of difficult weaning from cardiopulmonary bypass and a poorer clinical outcome. Directly after weaning, interventricular dyssynchrony, paradoxical septal motion, and even temporary bundle-branch block might be observed. In this study, the authors measured arterial dP/dtmax, mean arterial pressure (MAP), and cardiac index using transpulmonary thermodilution, pulse contour analysis, and femoral artery catheter and compared the effects between right ventricular (A-RV) and biventricular (A-BiV) pacing on these parameters...
July 8, 2017: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29217236/accuracy-precision-and-trending-of-4-pulse-wave-analysis-techniques-in-the-postoperative-period
#8
Martin Geisen, Michael T Ganter, Sonja Hartnack, Omer Dzemali, Christoph K Hofer, Andreas Zollinger
OBJECTIVE: The aim of this study was to analyze the accuracy, precision, and trending ability of the following 4 pulse wave analysis devices to measure continuous cardiac output: PiCCO2 ([PCCO]; Pulsion Medical System, Munich, Germany); LiDCORapid ([LCCO]; LiDCO Ltd, London, UK); FloTrac/Vigileo ([FCCO]; Edwards Lifesciences, Irvine, CA); and Nexfin ([NCCO]; BMEYE, Amsterdam, The Netherlands). DESIGN: Prospective, observational clinical study. SETTING: Intensive care unit of a single-center, teaching hospital...
September 7, 2017: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29208025/change-in-cardiac-output-during-trendelenburg-maneuver-is-a-reliable-predictor-of-fluid-responsiveness-in-patients-with-acute-respiratory-distress-syndrome%C3%A2-in-the-prone-position-under-protective-ventilation
#9
Hodane Yonis, Laurent Bitker, Mylène Aublanc, Sophie Perinel Ragey, Zakaria Riad, Floriane Lissonde, Aurore Louf-Durier, Sophie Debord, Florent Gobert, Romain Tapponnier, Claude Guérin, Jean-Christophe Richard
BACKGROUND: Predicting fluid responsiveness may help to avoid unnecessary fluid administration during acute respiratory distress syndrome (ARDS). The aim of this study was to evaluate the diagnostic performance of the following methods to predict fluid responsiveness in ARDS patients under protective ventilation in the prone position: cardiac index variation during a Trendelenburg maneuver, cardiac index variation during an end-expiratory occlusion test, and both pulse pressure variation and change in pulse pressure variation from baseline during a tidal volume challenge by increasing tidal volume (VT) to 8 ml...
December 5, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29203299/evaluation-of-cardiac-index-and-extravascular-lung-water-after-single-lung-transplantation-using-the-transpulmonary-thermodilution-technique-by-the-picco2-device
#10
Alexy Tran-Dinh, Pascal Augustin, Guillaume Dufour, Sigismond Lasocki, Nicolas Allou, Gabriel Thabut, Yves Castier, Philippe Montravers, Mathieu Desmard
OBJECTIVES: First evaluation of the transpulmonary thermodilution technique by the PiCCO2 device to assess cardiac index and pulmonary edema during the postoperative course after single-lung transplantation. DESIGN: Prospective observational study. SETTINGS: Intensive care unit, university hospital (single center). PARTICIPANTS: Single-lung transplant patients. INTERVENTIONS: The authors compared cardiac index measured by PiCCO2 and pulmonary artery catheter and assessed pulmonary edema using extravascular lung water index and pulmonary vascular permeability index measured by PiCCO2...
December 1, 2017: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29189669/measurement-of-dead-space-fraction-upon-icu-admission-predicts-length-of-stay-and-clinical-outcomes-following-bidirectional-cavopulmonary-anastomosis
#11
Claire L Cigarroa, Sarah J van den Bosch, Xiaoqi Tang, Kimberlee Gauvreau, Christopher W Baird, James A DiNardo, John Nagi Kheir
OBJECTIVES: Increased alveolar dead space fraction has been associated with prolonged mechanical ventilation and increased mortality in pediatric patients with respiratory failure. The association of alveolar dead space fraction with clinical outcomes in patients undergoing bidirectional cavopulmonary anastomosis for single ventricle congenital heart disease has not been reported. We describe an association of alveolar dead space fraction with postoperative outcomes in patients undergoing bidirectional cavopulmonary anastomosis...
January 2018: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29174750/assessment-of-pulmonary-edema-principles-and-practice
#12
REVIEW
Sherif Assaad, Wolf B Kratzert, Benjamin Shelley, Malcolm B Friedman, Albert Perrino
Pulmonary edema increasingly is recognized as a perioperative complication affecting outcome. Several risk factors have been identified, including those of cardiogenic origin, such as heart failure or excessive fluid administration, and those related to increased pulmonary capillary permeability secondary to inflammatory mediators. Effective treatment requires prompt diagnosis and early intervention. Consequently, over the past 2 centuries a concentrated effort to develop clinical tools to rapidly diagnose pulmonary edema and track response to treatment has occurred...
August 19, 2017: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29148140/haemodynamic-effects-of-an-acute-vasodilator-challenge-in-heart-failure-patients-with-reduced-ejection-fraction-and-different-forms-of-post-capillary-pulmonary-hypertension
#13
Stefano Ghio, Gabriele Crimi, Pier Luigi Temporelli, Egidio Traversi, Maria Teresa La Rovere, Antonia Cannito, Dario Vizza, Laura Scelsi, Claudia Raineri, Marco Guazzi, Luigi Oltrona Visconti
AIMS: The most recent European guidelines have proposed new definitions of pulmonary hypertension (PH) in left heart disease, to better approach the characteristics required to reflect the presence of pulmonary vascular disease. The purpose of this study was to assess whether different haemodynamic definitions of post-capillary PH imply a different reversibility of PH in response to acute vasodilator administration in heart failure patients with reduced ejection fraction and PH (HFrEF-PH)...
November 16, 2017: European Journal of Heart Failure
https://www.readbyqxmd.com/read/29141525/hyperacute-hemodynamic-effects-of-bipap-noninvasive-ventilation-in-patients-with-acute-heart-failure-and-left-ventricular-systolic-dysfunction-in-emergency-department
#14
Cinzia Moret Iurilli, Natale Daniele Brunetti, Paola Rita Di Corato, Giuseppe Salvemini, Matteo Di Biase, Marco Matteo Ciccone, Vito Procacci
BACKGROUND: Acute heart failure (AHF) is one of the leading causes of admission to emergency department (ED); severe hypoxemic AHF may be treated with noninvasive ventilation (NIV). Despite the demonstrated clinical efficacy of NIV in relieving symptoms of AHF, less is known about the hyperacute effects of bilevel positive airway pressure (BiPAP) ventilation on hemodynamics of patients admitted to ED for AHF. We therefore aimed to assess the effect of BiPAP ventilation on principal hemodynamic, respiratory, pulse oximetry, and microcirculation indexes in patients admitted to ED for AHF, needing NIV...
January 1, 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/29134245/esophageal-pressure-research-or-clinical-tool
#15
REVIEW
E Baedorf Kassis, S H Loring, D Talmor
Esophageal manometry has traditionally been utilized for respiratory physiology research, but clinicians have recently found numerous applications within the intensive care unit. Esophageal pressure (PEs) is a surrogate for pleural pressures (PPl), and the difference between airway pressure (PAO) and PEs provides a good estimate for the pressure across the lung also known as the transpulmonary pressure (PL). Differentiating the effects of mechanical ventilation and spontaneous breathing on the respiratory system, chest wall, and across the lung allows for improved personalization in clinical decision making...
November 13, 2017: Medizinische Klinik, Intensivmedizin und Notfallmedizin
https://www.readbyqxmd.com/read/29113716/plethysmography-variability-index-for-prediction-of-fluid-responsiveness-during-graded-haemorrhage-and-transfusion-in-sevoflurane-anaesthetized-mechanically-ventilated-dogs
#16
Yusuke Endo, Koudai Kawase, Taku Miyasho, Tadashi Sano, Kazuto Yamashita, William W Muir
OBJECTIVE: To examine the accuracy of plethysmography variability index (PVI) as a noninvasive indicator of fluid responsiveness in hypovolaemic dogs. STUDY DESIGN: Prospective experimental study. ANIMALS: Six adult healthy sevoflurane-anaesthetized Beagle dogs. METHODS: Dogs were anaesthetized with 1.3-fold their individual minimum alveolar concentration of sevoflurane. The lungs were mechanically ventilated after neuromuscular blockade with vecuronium bromide...
November 2017: Veterinary Anaesthesia and Analgesia
https://www.readbyqxmd.com/read/29090260/assessment-of-method-agreement-between-two-minimally-invasive-hemodynamic-measurements-in-septic-shock-patients-on-high-doses-of-vasopressor-drugs-a-preliminary-study
#17
Oana Antal, Mihai Mărginean, Natalia Hagău
BACKGROUND: Minimally invasive hemodynamic monitoring is still controversial among the methods used to assess the hemodynamic profile of the septic shock patient. The aim of this study was to test the level of agreement between two different devices. METHODS: We collected 385 data entries during 12-hour intervals from four critically ill patients with septic shock and high doses of vasoactive therapy using two minimally invasive methods at the same time: Vigileo™ device which uses the pulse contour principle, and EV1000™ monitoring platform which uses the transpulmonary thermodilution principle...
October 2017: Romanian Journal of Anaesthesia and Intensive Care
https://www.readbyqxmd.com/read/29089460/measurements-obtained-from-esophageal-balloon-catheters-are-affected-by-the-esophageal-balloon-filling-volume-in-children-with-ards
#18
Justin C Hotz, Cary T Sodetani, Jeffrey Van Steenbergen, Robinder G Khemani, Timothy W Deakers, Christopher J Newth
INTRODUCTION: Esophageal balloon inflation volume may affect the accuracy of transpulmonary pressure estimates in adults, but the effect is unknown in pediatrics. Using a combination bench and human study, we sought to determine a range of optimal filling volumes for esophageal balloon catheters and to derive a technique to inflate catheters to yield the most accurate estimates of pleural pressure. METHODS: In the laboratory study, we evaluated 4 pediatric and adult esophageal balloon catheters, a liquid-filled catheter, and a micro-tip catheter, both with and without a model esophagus...
October 31, 2017: Respiratory Care
https://www.readbyqxmd.com/read/29077613/pressure-waveform-analysis
#19
Mathieu Jozwiak, Xavier Monnet, Jean-Louis Teboul
Monitoring cardiac output is of special interest for detecting early hemodynamic impairment and for guiding its treatment. Among the techniques that are available to monitor cardiac output, pressure waveform analysis estimates cardiac output from the shape of the arterial pressure curve. It is based on the general principle that the amplitude of the systolic part of the arterial curve is proportional to cardiac output and arterial compliance. Such an estimation of cardiac output has the advantage of being continuous and in real time...
October 26, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29058315/atelectasis-is-inversely-proportional-to-transpulmonary-pressure-during-weaning-from-ventilator-support-in-a-large-animal-model
#20
M Gudmundsson, G Perchiazzi, M Pellegrini, A Vena, G Hedenstierna, C Rylander
BACKGROUND: In mechanically ventilated, lung injured, patients without spontaneous breathing effort, atelectasis with shunt and desaturation may appear suddenly when ventilator pressures are decreased. It is not known how such a formation of atelectasis is related to transpulmonary pressure (PL ) during weaning from mechanical ventilation when the spontaneous breathing effort is increased. If the relation between PL and atelectasis were known, monitoring of PL might help to avoid formation of atelectasis and cyclic collapse during weaning...
October 23, 2017: Acta Anaesthesiologica Scandinavica
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