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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
#1
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
#2
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
#3
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...
December 5, 2017: 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
#4
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
#5
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...
March 29, 2018: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/29596015/continuous-negative-abdominal-pressure-mechanism-of-action-and-comparison-with-prone-position
#6
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
#7
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
#8
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...
March 26, 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
#9
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
#10
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
https://www.readbyqxmd.com/read/29557101/immersion-pulmonary-oedema-in-a-healthy-diver-not-exposed-to-cold-or-strenuous-exercise
#11
Olivier Castagna, Sébastien de Maistre, Bruno Schmid, Delphine Caudal, Jacques Regnard
In healthy divers, the occurrence of immersion pulmonary oedema (IPE) is commonly caused by contributory factors including strenuous exercise, cold water and negative-pressure breathing. Contrary to this established paradigm, this case reports on a 26-year-old, well-trained combat swimmer who succumbed to acute IPE during static immersion in temperate (21°C) water, while using a front-mounted counterlung rebreather. The incident occurred during repeated depth-controlled ascent practice at the French military diving school...
March 31, 2018: Diving and Hyperbaric Medicine: the Journal of the South Pacific Underwater Medicine Society
https://www.readbyqxmd.com/read/29553050/molecular-mechanisms-of-ventilator-induced-lung-injury
#12
REVIEW
Lin Chen, Hai-Fa Xia, You Shang, Shang-Long Yao
Objective: Mechanical ventilation (MV) has long been used as a life-sustaining approach for several decades. However, researchers realized that MV not only brings benefits to patients but also cause lung injury if used improperly, which is termed as ventilator-induced lung injury (VILI). This review aimed to discuss the pathogenesis of VILI and the underlying molecular mechanisms. Data Sources: This review was based on articles in the PubMed database up to December 2017 using the following keywords: "ventilator-induced lung injury", "pathogenesis", "mechanism", and "biotrauma"...
March 19, 2018: Chinese Medical Journal
https://www.readbyqxmd.com/read/29541759/association-between-hemodynamic-markers-of-pulmonary-hypertension-and-outcomes-in-heart-failure-with-preserved-ejection-fraction
#13
Rebecca R Vanderpool, Melissa Saul, Mehdi Nouraie, Mark T Gladwin, Marc A Simon
Importance: Heart failure with preserved ejection fraction (HFpEF) is highly prevalent, yet there are no specific therapies, possibly due to phenotypic heterogeneity. The development of pulmonary hypertension (PH) in patients with HFpEF is considered a high-risk phenotype in need of targeted therapies, but there have been limited hemodynamic and outcomes data. Objective: To identify the hemodynamic characteristics and outcomes of PH-HFpEF. Design, Setting, and Participants: Cohort study of participants who had a right heart catheterization from January 2005 to September 2012 (median [interquartile range] follow-up time, 1578 [554-2513] days) were analyzed...
March 14, 2018: JAMA Cardiology
https://www.readbyqxmd.com/read/29538440/impact-of-large-volume-paracentesis-on-respiratory-parameters-including-transpulmonary-pressure-and-on-transpulmonary-thermodilution-derived-hemodynamics-a-prospective-study
#14
Ulrich Mayr, Eugen Karsten, Tobias Lahmer, Sebastian Rasch, Philipp Thies, Benedikt Henschel, Gerrit Fischer, Roland M Schmid, Wolfgang Huber
INTRODUCTION: Appropriate mechanical ventilation and prevention of alveolar collaps is mainly dependent on transpulmonary pressure TPP. TPP is assessed by measurement of esophageal pressure EP, largely influenced by pleural and intraabdominal pressure IAP. Consecutively, TPP-guided ventilation might be particularly useful in patients with high IAP. This study investigates the impact of large volume paracentesis LVP on TPP, EP, IAP as well as on hemodynamic and respiratory function in patients with liver cirrhosis and tense ascites...
2018: PloS One
https://www.readbyqxmd.com/read/29521672/effects-of-prone-positioning-on-transpulmonary-pressures-and-end-expiratory-volumes-in-patients-without-lung-disease
#15
Abirami Kumaresan, Robert Gerber, Ariel Mueller, Stephen H Loring, Daniel Talmor
BACKGROUND: The effects of prone positioning on esophageal pressures have not been investigated in mechanically ventilated patients. Our objective was to characterize effects of prone positioning on esophageal pressures, transpulmonary pressure, and lung volume, thereby assessing the potential utility of esophageal pressure measurements in setting positive end-expiratory pressure (PEEP) in prone patients. METHODS: We studied 16 patients undergoing spine surgery during general anesthesia and neuromuscular blockade...
March 9, 2018: Anesthesiology
https://www.readbyqxmd.com/read/29519291/-esophageal-pressure-and-transpulmonary-pressure-monitoring
#16
Xiumei Sun, Jianxin Zhou
Esophageal pressure monitoring provides a minimally invasive method to assess the pleural pressure, which can be used to differentiate the lung and chest wall mechanics. The information of transpulmonary pressure, work of breathing, intrinsic positive end-expiratory pressure and respiratory muscle performance can facilitate the proper setting of mechanical ventilation. Esophageal pressure monitoring is still not routinely used in the clinical setting because of difficulty in esophageal balloon catheter placement and data interpretation due to esophageal pressure monitoring has certain technical requirements, and the measurement results are influenced by many factors such as airbag volume, location, esophageal wall elasticity and mediastinal organ weight...
March 2018: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/29509430/transpulmonary-pressure-based-mechanical-ventilation-in-ards-from-theory-to-practice
#17
Salvatore Grasso, Tania Stripoli
No abstract text is available yet for this article.
March 6, 2018: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/29489470/biologic-impact-of-mechanical-power-at-high-and-low-tidal-volumes-in-experimental-mild-acute-respiratory-distress-syndrome
#18
Raquel S Santos, Ligia de A Maia, Milena V Oliveira, Cíntia L Santos, Lillian Moraes, Eliete F Pinto, Cynthia Dos S Samary, Joana A Machado, Anna Carolinna Carvalho, Marcos Vinícius de S Fernandes, Vanessa Martins, Vera L Capelozzi, Marcelo M Morales, Thea Koch, Marcelo Gama de Abreu, Paolo Pelosi, Pedro L Silva, Patricia R M Rocco
BACKGROUND: The authors hypothesized that low tidal volume (VT) would minimize ventilator-induced lung injury regardless of the degree of mechanical power. The authors investigated the impact of power, obtained by different combinations of VT and respiratory rate (RR), on ventilator-induced lung injury in experimental mild acute respiratory distress syndrome (ARDS). METHODS: Forty Wistar rats received Escherichia coli lipopolysaccharide intratracheally. After 24 h, 32 rats were randomly assigned to be mechanically ventilated (2 h) with a combination of different VT (6 ml/kg and 11 ml/kg) and RR that resulted in low and high power...
February 28, 2018: Anesthesiology
https://www.readbyqxmd.com/read/29465201/-pulse-wave-transit-time-one-more-attempt-of-non-invasive-cardiac-output-measurement
#19
B A Akselrod, L A Tolstova, T A Pshenichniy, S V Fedulova
BACKGROUND: Estimated continuous cardiac output (esCCOTM) based on pulse wave transit time is one of alternative non-invasive CO measurement techniques. METHODS: Randomized study included 23 scheduled patients operated upon due to cardiovascular diseases. Cardiac index (CI) was measured Comparative analyses of esCCO and others CO measurement methods used intraoperative was carried out. In the first group (n = 9) esCCO was compared with transpulmonary thermodilution (PiCCO-plus); in the second group (n = 8) - with pulmonary artery thermodilution; in the third group (n = 6) - with transoesophageal echocardiography (velocity-time integral)...
September 2017: Anesteziologiia i Reanimatologiia
https://www.readbyqxmd.com/read/29426051/-respiratory-failure-innovations-in-diagnostics-and-therapy
#20
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
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