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https://www.readbyqxmd.com/read/29426051/-respiratory-failure-innovations-in-diagnostics-and-therapy
#1
Gunther Hempel, Philipp Simon, Peter Salz, Hermann Wrigge
Acute and chronic respiratory failures require immediate diagnosis and preferably individualized ventilation therapy. If possible, non-invasive ventilation should be considered to avoid complications of invasive mechanical ventilation. Especially in patients with ARDS and moderate to severe cases, non-invasive ventilation may not be suitable and should not be used uncritically.Invasive mechanical ventilation parameters should be adjusted individually. In the future, additional parameters such as transpulmonary pressure, monitoring of regional ventilation using electrical impedance tomography could help to individualize ventilator settings...
February 2018: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
https://www.readbyqxmd.com/read/29400308/a-misclassification-of-pulmonary-stenosis-using-conventional-echocardiographic-methods
#2
Tuğba Kemaloğlu Öz, Mehmet Eren, Tayfun Gürol, Özer Soylu, Bahadır Dağdeviren
BACKGROUND: The classification of pulmonary stenosis (PS) severity based on the transpulmonary pressure gradient, which is affected by flow rate. CASE REPORT: We report the first case of a pregnant patient with atrial septal defect (ASD) and pulmonary stenosis that was misclassified by conventional echocardiographic methods. Most importantly, three-dimensional transoesophageal echocardiographic assessment of pulmonary stenosis changed the entire treatment strategy...
January 20, 2018: Balkan Medical Journal
https://www.readbyqxmd.com/read/29380189/respiratory-changes-in-subclavian-vein-diameters-predicts-fluid-responsiveness-in-intensive-care-patients-a-pilot-study
#3
Raphaël Giraud, Paul S Abraham, Pauline Brindel, Nils Siegenthaler, Karim Bendjelid
The present pilot study investigated whether respiratory variation in subclavian vein (SCV) diameters correlates with fluid responsiveness in mechanically ventilated patients. Monocentric, prospective clinical study on fluid responsiveness in adult sedated, mechanically ventilated ICU patient, monitored with the PiCCO™ system (Pulsion Medical System, Germany), and requiring a fluid challenge (FC). A 10-min fluid bolus of 500 mL of 0.9% saline was administered. Cardiac output (CO) and dynamic parameters [stroke volume variation (SVV) and pulse pressure variation (PPV)] measured by transpulmonary thermodilution and pulse contour analysis (PiCCO™) as well as classical hemodynamic parameters were recorded at baseline and after FC...
January 29, 2018: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/29377300/effects-of-6-tetrastarch-and-lactated-ringer-s-solution-on-extravascular-lung-water-and-markers-of-acute-renal-injury-in-hemorrhaged-isoflurane-anesthetized-healthy-dogs
#4
M S Diniz, F J Teixeira-Neto, N Celeita-Rodríguez, C H Girotto, M W Fonseca, A C Oliveira-Garcia, B López-Castañeda
BACKGROUND: Tetrastarch can cause acute kidney injury (AKI) in humans with sepsis, but less likely to result in tissue edema than lactated Ringer's solution (LRS). OBJECTIVES: Compare effects of volume replacement (VR) with LRS and 6% tetrastarch solution (TS) on extravascular lung water (EVLW) and markers of AKI in hemorrhaged dogs. ANIMALS: Six healthy English Pointer dogs (19.7-35.3 kg). METHODS: Prospective crossover study...
January 28, 2018: Journal of Veterinary Internal Medicine
https://www.readbyqxmd.com/read/29377061/individualized-lung-recruitment-maneuver-guided-by-pulse-oximetry-in-anesthetized-patients-undergoing-laparoscopy-a-feasibility-study
#5
C Ferrando, G Tusman, F Suarez-Sipmann, I León, N Pozo, J Carbonell, J Puig, E Pastor, E Gracia, A Gutiérrez, G Aguilar, F J Belda, M Soro
BACKGROUND: We conducted this study to test whether pulse-oximetry hemoglobin saturation (SpO2 ) can personalize the implementation of an open-lung approach during laparoscopy. Thirty patients with SpO2  ≥ 97% on room-air before anesthesia were studied. After anesthesia and capnoperitoneum the FIO2 was reduced to 0.21. Those patients whose SpO2 decreased below 97% - an indication of shunt related to atelectasis - completed the following phases: (1) First recruitment maneuver (RM), until reaching lung's opening pressure, defined as the inspiratory pressure level yielding a SpO2 ≥ 97%; (2) decremental positive end-expiratory (PEEP) titration trial until reaching lung's closing pressure defined as the PEEP level yielding a SpO2  < 97%; (3) second RM and, (4) ongoing ventilation with PEEP adjusted above the detected closing pressure...
January 29, 2018: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/29368799/the-influence-of-pulmonary-vascular-pressures-on-lung-diffusing-capacity-during-incremental-exercise-in-healthy-aging
#6
Kirsten E Coffman, Timothy B Curry, Niki M Dietz, Steven C Chase, Alex R Carlson, Briana L Ziegler, Bruce D Johnson
Alveolar-capillary surface area for pulmonary gas exchange falls with aging, causing a reduction in lung diffusing capacity for carbon monoxide (DLCO). However, during exercise additional factors may influence DLCO, including pulmonary blood flow and pulmonary vascular pressures. First, we sought to determine the age-dependent effect of incremental exercise on pulmonary vascular pressures and DLCO. We also aimed to investigate the dependence of DLCO on pulmonary vascular pressures during exercise via sildenafil administration to reduce pulmonary smooth muscle tone...
January 2018: Physiological Reports
https://www.readbyqxmd.com/read/29363638/effect-of-systolic-cardiac-function-on-passive-leg-raising-for-predicting-fluid-responsiveness-a-prospective-observational-study
#7
Xiang Si, Dai-Yin Cao, Juan Chen, Jian-Feng Wu, Zi-Meng Liu, Hai-Lin Xu, Min-Ying Chen, Yong-Jun Liu, Xiang-Dong Guan
BACKGROUND: Passive leg raising (PLR) represents a "self-volume expansion (VE)" that could predict fluid responsiveness, but the influence of systolic cardiac function on PLR has seldom been reported. This study aimed to investigate whether systolic cardiac function, estimated by the global ejection fraction (GEF) from transpulmonary-thermodilution, could influence the diagnostic value of PLR. METHODS: This prospective, observational study was carried out in the surgical Intensive Care Unit of the First Affiliated Hospital of Sun Yat-sen University from December 2013 to July 2015...
February 5, 2018: Chinese Medical Journal
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
#8
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
#9
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/29297365/regional-physiology-of-ards
#10
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/29246894/global-pulmonary-vascular-remodeling-in-pulmonary-hypertension-associated-with-heart-failure-and-preserved-or-reduced-ejection-fraction
#11
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
#12
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/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
#13
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/29148140/haemodynamic-effects-of-an-acute-vasodilator-challenge-in-heart-failure-patients-with-reduced-ejection-fraction-and-different-forms-of-post-capillary-pulmonary-hypertension
#14
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
#15
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...
February 2018: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/29134245/esophageal-pressure-research-or-clinical-tool
#16
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
#17
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
#18
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
#19
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
#20
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
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