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Thomas Günther Lesser, Carsten Boltze, Harald Schubert, Frank Wolfram
Background: In recent years, high intensity focused ultrasound (HIFU) has gained increasing clinical interest as a non-invasive method for local therapy of liver malignancies. HIFU treatment of tumours and metastases in the liver dome is limited due to the adjacent ultrasound blocking lung. One-lung flooding (OLF) enables complete sonography of lung and adjoining organs including liver. HIFU liver ablation passing through the flooded lung could enable a direct intercostal beam path and thus improve dose deposition in liver...
2016: International Journal of Medical Sciences
Matthias Hansen
Advanced hemodynamic monitoring is necessary for adequate management of high-risk patients or patients with derangement of circulation. Studies demonstrate a benefit of early goal directed therapy in unstable cardiopulmonary situations. In these days we have different possibilities of minimally invasive or invasive hemodynamic monitoring. Minimally invasive measurements like pulse conture analysis or pulse wave analysis being less accurate under some circumstances, however only an artery catheter is needed for cardiac output monitoring...
October 2016: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
Gisele de A Padilha, Lucas F B Horta, Lillian Moraes, Cassia L Braga, Milena V Oliveira, Cíntia L Santos, Isalira P Ramos, Marcelo M Morales, Vera Luiza Capelozzi, Regina C S Goldenberg, Marcelo Gama de Abreu, Paolo Pelosi, Pedro L Silva, Patricia R M Rocco
BACKGROUND: In patients with emphysema, invasive mechanical ventilation settings should be adjusted to minimize hyperinflation while reducing respiratory effort and providing adequate gas exchange. We evaluated the impact of pressure-controlled ventilation (PCV) and pressure support ventilation (PSV) on pulmonary and diaphragmatic damage, as well as cardiac function, in experimental emphysema. METHODS: Emphysema was induced by intratracheal instillation of porcine pancreatic elastase in Wistar rats, once weekly for 4 weeks...
December 2016: Intensive Care Medicine Experimental
Jonne Doorduin, Joeke L Nollet, Lisanne H Roesthuis, Hieronymus W H van Hees, Laurent J Brochard, Christer A Sinderby, Johannes G van der Hoeven, Leo M A Heunks
RATIONALE: Controlled mechanical ventilation is used to deliver lung-protective ventilation in patients with acute respiratory distress syndrome. Despite recognized benefits, such as preserved diaphragm activity, partial support ventilation modes may be incompatible with lung-protective ventilation due to high tidal volume and high transpulmonary pressure. As an alternative to high dose sedatives and controlled mechanical ventilation, pharmacologically induced neuromechanical uncoupling of the diaphragm should facilitate lung-protective ventilation under partial support modes...
October 17, 2016: American Journal of Respiratory and Critical Care Medicine
P M Kapoor, Vandana Bhardwaj, Amita Sharma, Usha Kiran
A reliable estimation of cardiac preload is helpful in the management of severe circulatory dysfunction. The estimation of cardiac preload has evolved from nuclear angiography, pulmonary artery catheterization to echocardiography, and transpulmonary thermodilution (TPTD). Global end-diastolic volume (GEDV) is the combined end-diastolic volumes of all the four cardiac chambers. GEDV has been demonstrated to be a reliable preload marker in comparison with traditionally used pulmonary artery catheter-derived pressure preload parameters...
October 2016: Annals of Cardiac Anaesthesia
Bernd Saugel, Wolfgang Huber, Axel Nierhaus, Stefan Kluge, Daniel A Reuter, Julia Y Wagner
In patients with sepsis and septic shock, the hemodynamic management in both early and later phases of these "organ dysfunction syndromes" is a key therapeutic component. It needs, however, to be differentiated between "early goal-directed therapy" (EGDT) as proposed for the first 6 hours of emergency department treatment by Rivers et al. in 2001 and "hemodynamic management" using advanced hemodynamic monitoring in the intensive care unit (ICU). Recent large trials demonstrated that nowadays protocolized EGDT does not seem to be superior to "usual care" in terms of a reduction in mortality in emergency department patients with early identified septic shock who promptly receive antibiotic therapy and fluid resuscitation...
2016: BioMed Research International
Xiaowei Gong, Haiyan Wang, Yadong Yuan
The present study aimed to investigate the factors affecting the first therapeutic-target-achieving (TTA) time of warfarin therapy in patients with acute pulmonary embolism (PTE). Between January 2008 and June 2013, patients with PTE confirmed by transpulmonary arterial enhanced computed tomographic pulmonary angiography or pulmonary ventilation perfusion scanning were included in the present study. Data collected included demographic information, history of tobacco and alcohol intake, basic diseases (stable and unstable hypertension, diabetes, heart failure, cancer/cerebral infarction, old myocardial infarction and atrial fibrillation), liver and kidney function, the haemoglobin and platelet count of the blood, international normalized ratio monitoring, warfarin dosage adjustment and medication combinations...
October 2016: Experimental and Therapeutic Medicine
Grace Hofmann, Lutana Haan, Jeff Anderson
Esophageal balloons are used in the respiratory monitoring of critical care patients. After the esophageal pressure is measured, the corresponding pleural pressure in the thorax can be projected, enabling lung-thorax compliance to be partitioned into chest-wall compliance and lung compliance. The esophageal balloon allows determination of transpulmonary pressures and a correspondingly individually tailored approach to respiratory care, such as patient-specific titration of positive end-expiratory pressure for patients with extrapulmonary acute respiratory distress syndrome...
October 2016: Critical Care Nurse
Carine Pavy, Olivier Ghez
The association of complete atrial ventricular septal defect (cAVSD) with tetralogy of Fallot remains a complex malformation that involves both inlet and outlet components of the ventricles. The surgical treatment used to be, in the 1980s, a staged repair strategy due to the high mortality rate of first primary repairs (PRs). However, nowadays, PRs have better outcomes. Although double-patch procedures are widely performed, this article describes the single-patch approach for cAVSD repair with transatrial-transpulmonary repair of the Fallot component with preservation of the pulmonary valve...
2016: Multimedia Manual of Cardiothoracic Surgery: MMCTS
Bertrand Prunet, Pierre-Yves Cordier, Nicolas Prat, Sophie DE Bourmont, David Couret, Dominique Lambert, Pierre Michelet
OBJECTIVES: This study aimed to assess the short-term respiratory tolerance and haemodynamic efficiency of low-volume resuscitation with hypertonic saline and hydroxyethylstarch (HS/HES) in a pig model of lung contusion and controlled haemorrhagic shock. We hypothesised that a low-volume of HS/HES after haemorrhagic shock didn't impact contused lungs in terms of extravascular lung water 3hours after trauma. METHODS: A lung contusion resulting from blunt chest trauma was induced in 28 anaesthetised female pigs with five bolt shots to the right thoracic cage, followed by haemorrhagic shock and fluid resuscitation...
September 19, 2016: Anaesthesia, Critical Care & Pain Medicine
Per Persson, Stefan Lundin, Ola Stenqvist
BACKGROUND: We have shown in acute lung injury patients that lung elastance can be determined by a positive end-expiratory pressure (PEEP) step procedure and proposed that this is explained by the spring-out force of the rib cage off-loading the chest wall from the lung at end-expiration. The aim of this study was to investigate the effect of the expanding chest wall on pleural pressure during PEEP inflation by building a model with an elastic recoiling lung and an expanding chest wall complex...
December 2016: Intensive Care Medicine Experimental
Philippe Ariès, Thomas Leclerc
No abstract text is available yet for this article.
September 16, 2016: Anesthesia and Analgesia
Laurent Brochard, Arthur Slutsky, Antonio Pesenti
Mechanical Ventilation (MV) is used to sustain life in patients with acute respiratory failure. A major concern in mechanically ventilated patients is the risk of Ventilator-Induced Lung Injury (VILI), which is partially prevented by lung protective ventilation. Spontaneously breathing, non-intubated, patients with acute respiratory failure may have a high respiratory drive and breathe with large tidal volumes and potentially injurious transpulmonary pressure swings. In patients with existing lung injury, regional forces generated by the respiratory muscles may lead to injurious effects on a regional level...
September 14, 2016: American Journal of Respiratory and Critical Care Medicine
Sabri Soussi, Benjamin Deniau, Axelle Ferry, Charlotte Levé, Mourad Benyamina, Véronique Maurel, Maïté Chaussard, Brigitte Le Cam, Alice Blet, Maurice Mimoun, Jêrome Lambert, Marc Chaouat, Alexandre Mebazaa, Matthieu Legrand
BACKGROUND: Impact of early systemic hemodynamic alterations and fluid resuscitation on outcome in the modern burn care remains controversial. We investigate the association between acute-phase systemic hemodynamics, timing of fluid resuscitation and outcome in critically ill burn patients. METHODS: Retrospective, single-center cohort study was conducted in a university hospital. Forty critically ill burn patients with total body surface area (TBSA) burn-injured >20 % with invasive blood pressure and cardiac output monitoring (transpulmonary thermodilution technique) within 8 h from trauma were included...
December 2016: Annals of Intensive Care
M Cressoni, Davide Chiumello
No abstract text is available yet for this article.
December 2016: Annals of Intensive Care
Matteo Pecchiari, Dejan Radovanovic, Pierachille Santus, Edgardo D'Angelo
PURPOSE: To determine whether the analysis of the slow expiratory transpulmonary pressure-volume (PL-V) curve provides an alternative to the single-breath nitrogen test (SBN) for the assessment of the closing volume (CV). METHODS: SBN test and slow deflation PL-V curve were simultaneously recorded in 40 healthy subjects and 43 COPD patients. Onset of phase IV identified CV in SBN test (CVSBN), whereas in the PL-V curve CV was identified by: a) deviation from the exponential fit (CVexp), and b) inflection point of the interpolating sigmoid function (CVsig)...
September 6, 2016: Respiratory Physiology & Neurobiology
Sonia Ferretto, Elvin Tafciu, Immacolata Giuliani, Giuseppe Feltrin, Tomaso Bottio, Antonio Gambino, Angela Fraiese, Sabino Iliceto, Gino Gerosa, Loira Leoni
BACKGROUND: Causes and significance of interventricular conduction disorders (IVCDs) after orthotopic heart transplantation (OHT) are still unknown. METHODS: We retrospectively researched the presence of IVCDs in 240 patients who underwent bicaval OHT in three time periods: at day 1, after 1 year, and after 3 years from OHT. To evaluate the impact of the surgical technique, a control population treated with biatrial anastomosis was used. RESULTS: The most common IVCD was right bundle branch block (RBBB)...
September 9, 2016: Annals of Noninvasive Electrocardiology
Stephen H Loring, George P Topulos, Rolf D Hubmayr
Recent studies applying the principles of respiratory mechanics to respiratory disease have used inconsistent and mutually exclusive definitions of the term "transpulmonary pressure." By the traditional definition, transpulmonary pressure is the pressure across the whole lung including the intrapulmonary airways, i.e., the pressure difference between the opening to the pulmonary airway and the pleural surface. However more recently, transpulmonary pressure has also been defined as the pressure across only the lung tissue, i...
September 8, 2016: American Journal of Respiratory and Critical Care Medicine
Julia Mascherbauer, Ekkehard Grünig, Michael Halank, Wolfgang Hohenforst-Schmidt, Andreas A Kammerlander, Ingrid Pretsch, Regina Steringer-Mascherbauer, Silvia Ulrich, Irene M Lang, Manfred Wargenau, Reiner Frey, Diana Bonderman
BACKGROUND: The presence of pulmonary hypertension (PH) severely aggravates the clinical course of heart failure with preserved ejection fraction (HFPEF) resulting in substantial morbidity and mortality. So far, neither established heart failure therapies nor pulmonary vasodilators have proven to be effective for this condition. Riociguat (Adempas®, BAY 63-2521), a stimulator of soluble guanylate cyclase, is a novel pulmonary and systemic vasodilator that has been approved for the treatment of precapillary forms of PH...
September 2, 2016: Wiener Klinische Wochenschrift
M Louis Handoko, Frances S De Man, Frank P T Oosterveer, Harm-Jan Bogaard, Anton Vonk-Noordegraaf, Nico Westerhof
Pulmonary hypertension (PH) resulting from left heart failure is an increasingly recognized clinical entity. To distinguish isolated postcapillary PH from combined post- and precapillary PH, the use of a diastolic pressure gradient (DPG = diastolic Pulmonary Artery Pressure - Pulmonary Arterial Wedge Pressure, dPAP - PAWP) has been advocated over the transpulmonary pressure gradient (TPG = mean Pulmonary Artery Pressure - PAWP, mPAP - PAWP) since DPG was suggested to be independent of cardiac output (CO) and only slightly related to PAWP, while TPG depends on both...
September 2016: Physiological Reports
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