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https://www.readbyqxmd.com/read/29896798/renal-effects-of-norepinephrine-induced-variations-in-mean-arterial-pressure-after-liver-transplantation-a-randomized-cross-over-trial
#1
J Skytte Larsson, G Bragadottir, B Redfors, S-E Ricksten
BACKGROUND: Acute kidney injury is commonly seen after liver transplantation. The optimal perioperative target mean arterial pressure (MAP) for renal filtration, perfusion and oxygenation in liver recipients is not known. The effects of norepinephrine-induced changes in MAP on renal blood flow (RBF), oxygen delivery (RDO2 ), glomerular filtration rate (GFR) and renal oxygenation (=renal oxygen extraction, RO2 Ex) were therefore studied early after liver transplantation. METHODS: Ten patients with an intra- and post-operative vasopressor-dependent systemic vasodilation were studied early after liver transplantation during sedation and mechanical ventilation...
June 12, 2018: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/29880507/abnormal-ventilation-perfusion-scan-is-associated-with-pulmonary-hypertension-in-sickle-cell-adults
#2
Alem Mehari, Norris Igbineweka, Darlene Allen, Jim Nichols, Swee Lay Thein, Nargues A Weir
Pulmonary hypertension (PH) in adults with sickle cell disease (SCD) is associated with early mortality. Chronic thromboembolic pulmonary hypertension (CTEPH) is an important complication and contributor to PH in SCD, but likely underappreciated. Guidelines recommend ventilation-perfusion scintigraphy (V/Q) as imaging modality of choice to exclude CTEPH. Data on V/Q are limited in SCD. Objective: To compare the performance of V/Q with computed tomography pulmonary angiography (CTPA) and to report clinical outcomes associated with abnormal V/Q...
June 7, 2018: Journal of Nuclear Medicine: Official Publication, Society of Nuclear Medicine
https://www.readbyqxmd.com/read/29845759/pressure-decay-testing-of-pleural-air-leaks-in-intact-murine-lungs-evidence-for-peripheral-airway-regulation
#3
Andrew B Servais, Cristian D Valenzuela, Alexandra B Ysasi, Willi L Wagner, Arne Kienzle, Stephen H Loring, Akira Tsuda, Maximilian Ackermann, Steven J Mentzer
The critical care management of pleural air leaks can be challenging in all patients, but particularly in patients on mechanical ventilation. To investigate the effect of central airway pressure and pleural pressure on pulmonary air leaks, we studied orotracheally intubated mice with pleural injuries. We used clinically relevant variables - namely, airway pressure and pleural pressure - to investigate flow through peripheral air leaks. The model studied the pleural injuries using a pressure-decay maneuver. The pressure-decay maneuver involved a 3 sec ramp to 30 cmH2 0 followed by a 3 sec breath hold...
May 2018: Physiological Reports
https://www.readbyqxmd.com/read/29793604/influence-of-xenon-on-pulmonary-mechanics-and-lung-aeration-in-patients-with-healthy-lungs
#4
M S Schaefer, T A Treschan, J Gauch, M Neukirchen, P Kienbaum
BACKGROUND: The anaesthetic xenon shows potent organ-protective properties. Due to high density and dynamic viscosity, peak inspiratory pressure (Pmax ) increases during xenon application. Thus, barotrauma may counteract organ protection. Accordingly, we investigated the influence of xenon on lung mechanics and lung aeration in patients with normal and reduced thoracic wall compliance. METHODS: After registration and ethical approval, 20 patients free of pulmonary disease undergoing routine xenon-based anaesthesia were mechanically ventilated...
June 2018: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29785232/effects-of-fasudil-on-patients-with-pulmonary-hypertension-associated-with-left-ventricular-heart-failure-with-preserved-ejection-fraction-a-prospective-intervention-study
#5
Xiang Zhang, Xueming Zhang, Saihua Wang, Jun Luo, Zhihong Zhao, Changzhu Zheng, Jieyan Shen
Background: Pulmonary hypertension due to left ventricular heart failure with preserved ejection fraction (PH-HFpEF) is an increasingly medical problem. The aim of the study was to evaluate the clinical efficacy of fasudil on PH-HFpEF elderly patients and to figure out the subtype of PH-HFpEF which may be the therapeutic object of fasudil. Method: 58 PH-HFpEF elderly patients were enrolled. Patients were diagnosed with passive pulmonary hypertension (PPH) or reactive pulmonary hypertension (RPH) by right heart catheterization and all receiving Rho kinase inhibitor fasudil for 2 weeks...
2018: Canadian Respiratory Journal: Journal of the Canadian Thoracic Society
https://www.readbyqxmd.com/read/29756414/arterial-to-end-tidal-carbon-dioxide-tension-difference-co-2-gap-as-a-prognostic-marker-for-adverse-outcomes-in-emergency-department-patients-presenting-with-suspected-sepsis
#6
Amith Shetty, Sebastian Sparenberg, Kristian Adams, Selwyn Selvedran, Benjamin Tang, Kim Hanna, Jonathan Iredell
OBJECTIVE: The arterial to end-tidal carbon dioxide tension difference (CO2 gap) correlates with physiologic dead space. The prognostic value of increased CO2 gap in trauma and respiratory distress patients is documented. Transpulmonary arteriovenous shunting is identified as a predictor of mortality in non-pulmonary sepsis. We set out to investigate the prognostic value of the CO2 gap in a pilot study of patients with suspected sepsis from non-respiratory causes. METHODS: Patients presenting to tertiary Australian ED with suspected sepsis (n = 215) underwent near-simultaneous end-tidal carbon dioxide and partial pressure of carbon dioxide measurements...
May 13, 2018: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/29743121/high-frequency-oscillatory-ventilation-guided-by-transpulmonary-pressure-in-acute-respiratory-syndrome-an-experimental-study-in-pigs
#7
Philipp Klapsing, Onnen Moerer, Christoph Wende, Peter Herrmann, Michael Quintel, Annalen Bleckmann, Jan Florian Heuer
BACKGROUND: Recent clinical studies have not shown an overall benefit of high-frequency oscillatory ventilation (HFOV), possibly due to injurious or non-individualized HFOV settings. We compared conventional HFOV (HFOVcon ) settings with HFOV settings based on mean transpulmonary pressures (PLmean ) in an animal model of experimental acute respiratory distress syndrome (ARDS). METHODS: ARDS was induced in eight pigs by intrabronchial installation of hydrochloric acid (0...
May 9, 2018: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29718770/endothelial-nitric-oxide-synthase-genotype-is-associated-with-pulmonary-hypertension-severity-in-left-heart-failure-patients
#8
Julio D Duarte, Mayank Kansal, Ankit A Desai, Katherine Riden, Meghan J Arwood, Alex A Yacob, Thomas D Stamos, Larisa H Cavallari, Roham T Zamanian, Sanjiv J Shah, Roberto F Machado
The biological mechanisms behind the development of pulmonary hypertension in the setting of left heart failure (HF-PH), including combined pre- and post-capillary pulmonary hypertension (Cpc-PH), remains unclear. This study aimed to use candidate polymorphisms in nitric oxide synthase (NOS) genes to explore the role of NOS in HF-PH. DNA samples from 118 patients with HF-PH were genotyped for the NOS3 rs1799983 and NOS2 rs3730017 polymorphisms. A multiple regression model was used to compare hemodynamic measurements between genotype groups...
April 2018: Pulmonary Circulation
https://www.readbyqxmd.com/read/29708892/continuous-negative-abdominal-pressure-reduces-ventilator-induced-lung-injury-in-a-porcine-model
#9
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...
July 2018: Anesthesiology
https://www.readbyqxmd.com/read/29698719/serum-chloride-levels-track-with-survival-in-patients-with-pulmonary-arterial-hypertension
#10
Tawfeq Naal, Batool Abuhalimeh, Ghaleb Khirfan, Raed A Dweik, W H Wilson Tang, Adriano R Tonelli
BACKGROUND: Serum chloride is an important homeostatic biomarker in left heart failure, with significant prognostic implications. The impact of serum chloride in the long-term survival of patients with pulmonary arterial hypertension (PAH) is unknown. We tested whether serum chloride levels are associated with long-term survival in patients with PAH. METHODS: We included patients with idiopathic or heritable PAH who had a basic metabolic panel performed at the time of their diagnostic right heart catheterization...
April 24, 2018: Chest
https://www.readbyqxmd.com/read/29681957/mechanical-circulatory-support-is-effective-to-treat-pulmonary-hypertension-in-heart-transplant-candidates-disqualified-due-to-unacceptable-pulmonary-vascular-resistance
#11
Michał Zakliczyński, Jerzy Pacholewicz, Izabela Copik, Marcin Maruszewski, Tomasz Hrapkowicz, Roman Przybylski, Marian Zembala
Introduction: High pulmonary vascular resistance (PVR) in orthotopic heart transplantation (OHT) candidates is a risk factor of right ventricle failure after the procedure. However, the increase of PVR may be a consequence of the life-threatening deterioration of the left ventricle function. The use of mechanical circulatory support (MCS) seems to be the best solution, but it is reimbursed only in active OHT candidates. Aim: We performed a retrospective analysis of MCS effectiveness in maintaining PVR at values accepted for OHT...
March 2018: Kardiochirurgia i Torakochirurgia Polska, Polish Journal of Cardio-Thoracic Surgery
https://www.readbyqxmd.com/read/29670537/impact-of-different-tidal-volume-levels-at-low-mechanical-power-on-ventilator-induced-lung-injury-in-rats
#12
Lillian Moraes, Pedro L Silva, Alessandra Thompson, Cintia L Santos, Raquel S Santos, Marcos V S Fernandes, Marcelo M Morales, Vanessa Martins, Vera L Capelozzi, Marcelo G de Abreu, Paolo Pelosi, Patricia R M Rocco
Tidal volume (VT ) has been considered the main determinant of ventilator-induced lung injury (VILI). Recently, experimental studies have suggested that mechanical power transferred from the ventilator to the lungs is the promoter of VILI. We hypothesized that, as long as mechanical power is kept below a safe threshold, high VT should not be injurious. The present study aimed to investigate the impact of different VT levels and respiratory rates (RR) on lung function, diffuse alveolar damage (DAD), alveolar ultrastructure, and expression of genes related to inflammation [interleukin (IL)-6], alveolar stretch (amphiregulin), epithelial [club cell secretory protein (CC)16] and endothelial [intercellular adhesion molecule (ICAM)-1] cell injury, and extracellular matrix damage [syndecan-1, decorin, and metalloproteinase (MMP)-9] in experimental acute respiratory distress syndrome (ARDS) under low-power mechanical ventilation...
2018: Frontiers in Physiology
https://www.readbyqxmd.com/read/29655977/dexmedetomidine-or-fentanyl-cardiovascular-stability-and-analgesia-during-propofol-ketamine-total-intravenous-anaesthesia-in-experimental-pigs
#13
Andreas Lervik, Joanna Raszplewicz, Birgit Ranheim, Susanna Solbak, Simen F Toverud, Henning A Haga
OBJECTIVE: To compare cardiovascular function and response to nociception during total intravenous anaesthesia in pigs with propofol, ketamine and either dexmedetomidine or fentanyl administered as a continuous infusion. STUDY DESIGN: Blinded, randomized, balanced, crossover study ANIMALS: Eight immunocastrated male, mixed breed pigs with a mean ± standard deviation body weight of 26.4 ± 1.9 kg for dexmedetomidine and 27.5 ± 3.8 kg for fentanyl treatment...
May 2018: Veterinary Anaesthesia and Analgesia
https://www.readbyqxmd.com/read/29652273/assessment-of-the-effect-of-two-regimens-of-milrinone-infusion-in-pediatric-patients-undergoing-fontan-procedure-a-randomized-study
#14
Rabie Soliman, Adel Ragheb
Objective: The aim of the study was to compare the effect of two different regimens of milrinone on hemodynamics and oxygen saturation in pediatric patients undergoing Fontan procedure. Design: This was a randomized study. Setting: Cardiac centers. Patients: This study included 116 patients undergoing Fontan procedure. Material and Methods: Group E: Milrinone was started as infusion 0.5 μg/kg/min without a loading dose at the beginning of cardiopulmonary bypass (CPB) followed by infusion 0...
April 2018: Annals of Cardiac Anaesthesia
https://www.readbyqxmd.com/read/29601320/esophageal-pressure-monitoring-why-when-and-how
#15
Takeshi Yoshida, Laurent Brochard
PURPOSE OF REVIEW: Esophageal manometry has shown its usefulness to estimate transpulmonary pressure, that is lung stress, and the intensity of spontaneous effort in patients with acute respiratory distress syndrome. However, clinical uptake of esophageal manometry in ICU is still low. Thus, the purpose of review is to describe technical tips to adequately measure esophageal pressure at the bedside, and then update the most important clinical applications of esophageal manometry in ICU...
June 2018: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/29596015/continuous-negative-abdominal-pressure-mechanism-of-action-and-comparison-with-prone-position
#16
Takeshi Yoshida, Doreen Engelberts, Gail Otulakowski, Bhushan Katira, Niall D Ferguson, Laurent Brochard, Marcelo B P Amato, Brian P Kavanagh
We recently reported that continuous negative abdominal pressure (CNAP) could recruit dorsal atelectasis in experimental lung injury, and that oxygenation improved at different transpulmonary pressure values compared with increases in airway pressure (31). The mechanism of recruitment with CNAP is uncertain; and, its impact compared with a commonly proposed alternative approach to recruitment -prone positioning- is not known. We hypothesized that CNAP recruits lung by decreasing the vertical Ppl gradient (i...
March 29, 2018: Journal of Applied Physiology
https://www.readbyqxmd.com/read/29576127/evaluation-of-lung-and-chest-wall-mechanics-during-anaesthesia-using-the-peep-step-method
#17
P Persson, O Stenqvist, S Lundin
BACKGROUND: Postoperative pulmonary complications are common. Between patients there are differences in lung and chest wall mechanics. Individualised mechanical ventilation based on measurement of transpulmonary pressures would be a step forward. A previously described method evaluates lung and chest wall mechanics from a change of ΔPEEP and calculation of change in end-expiratory lung volume (ΔEELV). The aim of the present study was to validate this PEEP-step method (PSM) during general anaesthesia by comparing it with the conventional method using oesophageal pressure (PES) measurements...
April 2018: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29575957/ventilator-induced-lung-injury-during-controlled-ventilation-in-patients-with-acute-respiratory-distress-syndrome-less-is-probably-better
#18
Fernanda Ferreira Cruz, Lorenzo Ball, Patricia Rieken Macedo Rocco, Paolo Pelosi
Mechanical ventilation is required to support respiratory function in the acute respiratory distress syndrome (ARDS), but it may promote lung damage, a phenomenon known as ventilator-induced lung injury (VILI). Areas covered: Several mechanisms of VILI have been described, such as: inspiratory and/or expiratory stress inducing overdistension (volutrauma); interfaces between collapsed or edema-filled alveoli with surrounding open alveoli, acting as stress raisers; alveoli that repetitively open and close during tidal breathing (atelectrauma); and peripheral airway dynamics...
May 2018: Expert Review of Respiratory Medicine
https://www.readbyqxmd.com/read/29573567/comparison-of-continuous-flow-ventricular-assist-device-therapy-with-intensive-medical-therapy-in-fixed-pulmonary-hypertension-secondary-to-advanced-left-heart-failure
#19
Gayathri Kumarasinghe, Pankaj Jain, Andrew Jabbour, Jacqueline Lai, Anne M Keogh, Eugene Kotlyar, Paul Jansz, Peter S Macdonald, Christopher S Hayward
AIMS: Both ventricular assist device (VAD) and pulmonary vasodilator therapy have been shown in uncontrolled studies to improve pulmonary hypertension secondary to advanced left heart failure (Group 2 PH). This study aimed to compare haemodynamic benefits and survival in patients with fixed Group 2 PH treated with continuous-flow VAD to intensive medical therapy. METHODS AND RESULTS: Ninety-five patients listed for heart transplantation with sequential right heart catheters were studied, 24 patients having fixed Group 2 PH (as defined by cardiac index < 2...
March 24, 2018: ESC Heart Failure
https://www.readbyqxmd.com/read/29564137/regional-overdistension-during-prone-positioning-in-a-patient-with-acute-respiratory-failure-who-was-ventilated-with-a-low-tidal-volume-a-case-report
#20
Toru Kotani, Masanori Hanaoka, Shinya Hirahara, Hisashi Yamanaka, Eckhard Teschner, Atsuko Shono
Background: Prone positioning may provide a uniform distribution of transpulmonary pressure and contribute to prevent ventilator-induced lung injury. However, despite moderate positive end-expiratory pressure and low tidal volumes, there is still a risk of regional overdistension. Case presentation: A man with refractory hypoxemia was mechanically ventilated with prone positioning. Although prone positioning with a plateau pressure of 18 cmH2 O and a positive end-expiratory pressure of 8 cmH2 O promptly improved oxygenation, regional ventilation monitoring using electrical impedance tomography initially detected decreased distribution in the dorsal region but increased in the ventral, suggesting overdistension...
2018: Journal of Intensive Care
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