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Transpulmonary pressure

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https://www.readbyqxmd.com/read/29025576/the-prevalence-correlates-and-impact%C3%A2-on%C3%A2-cardiac-mortality-of-right%C3%A2-ventricular-dysfunction-in-nonischemic%C3%A2-cardiomyopathy
#1
Andreas Pueschner, Pairoj Chattranukulchai, John F Heitner, Dipan J Shah, Brenda Hayes, Wolfgang Rehwald, Michele A Parker, Han W Kim, Robert M Judd, Raymond J Kim, Igor Klem
OBJECTIVES: This study sought to determine the prevalence, correlates, and impact on cardiac mortality of right ventricular (RV) dysfunction in nonischemic cardiomyopathy. BACKGROUND: Current heart failure guidelines place little emphasis on RV assessment due to limited available data on determinants of RV function, mechanisms leading to its failure, and relation to outcomes. METHODS: We prospectively studied 423 patients with cardiac magnetic resonance (CMR)...
October 2017: JACC. Cardiovascular Imaging
https://www.readbyqxmd.com/read/29019966/transthoracic-balloon-pulmonary-valvuloplasty-for-treatment-of-congenial-pulmonary-atresia-patients-with-intact-ventricular-septum
#2
Zhi-Qin Lin, Qiang Chen, Hua Cao, Liang-Wan Chen, Gui-Can Zhang, Dao-Zhong Chen, Qin-Min Wang, Han-Fan Qiu, Dong-Shan Liao, Feng Lin
BACKGROUND To summarize our clinical experience in performing transthoracic balloon pulmonary valvuloplasty for the treatment of patients suffering from congenial pulmonary atresia with intact ventricular septum (PA/IVS). MATERIAL AND METHODS Between April 2009 and April 2016, 38 patients with PA/IVS underwent transthoracic balloon pulmonary valvuloplasty in our hospital. All of them were combined with patent ductus arteriosus, tricuspid insufficiency, and atrial septal defect or patent foramen ovale. The valvuloplasty was performed from the right ventricular outflow tract through a median sternotomy incision under TEE guidance for all cases...
October 11, 2017: Medical Science Monitor: International Medical Journal of Experimental and Clinical Research
https://www.readbyqxmd.com/read/28986852/effect-of-inspiratory-synchronization-during-pressure-controlled-ventilation-on-lung-distension-and-inspiratory-effort
#3
Nuttapol Rittayamai, François Beloncle, Ewan C Goligher, Lu Chen, Jordi Mancebo, Jean-Christophe M Richard, Laurent Brochard
BACKGROUND: In pressure-controlled (PC) ventilation, tidal volume (V T) and transpulmonary pressure (P L ) result from the addition of ventilator pressure and the patient's inspiratory effort. PC modes can be classified into fully, partially, and non-synchronized modes, and the degree of synchronization may result in different V T and P L despite identical ventilator settings. This study assessed the effects of three PC modes on V T, P L , inspiratory effort (esophageal pressure-time product, PTPes), and airway occlusion pressure, P 0...
October 6, 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/28930639/50-years-of-research-in-ards-tidal-volume-selection-in-the-acute-respiratory-distress-syndrome
#4
Sarina K Sahetya, Jordi Mancebo, Roy G Brower
Mechanical ventilation (MV) is critical in the management of many patients with the acute respiratory distress syndrome (ARDS). However, MV can also cause ventilator-induced lung injury (VILI). The selection of an appropriate tidal volume is an essential part of a lung-protective MV strategy. Since the publication of a large randomized clinical trial demonstrating the benefit of lower tidal volumes, the use of tidal volumes of 6 mL/kg predicted body weight (PBW, based on sex and height) has been recommended in clinical practice guidelines...
September 20, 2017: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28912263/hemodynamic-phenotyping-of-pulmonary-hypertension-in-left-heart-failure
#5
REVIEW
Robert Naeije, Mario Gerges, Jean-Luc Vachiery, Sergio Caravita, Christian Gerges, Irene M Lang
Increased pulmonary venous pressure secondary to left heart disease is the most common cause of pulmonary hypertension (PH). The diagnosis of PH due to left heart disease relies on a clinical probability assessment followed by the invasive measurements of a mean pulmonary artery pressure (PAP) ≥25 mm Hg and mean wedged PAP (PAWP) >15 mm Hg. A combination of mean PAP and mean PAWP defines postcapillary PH. Postcapillary PH is generally associated with a diastolic pulmonary pressure gradient (diastolic PAP minus mean PAWP) <7 mm Hg, a transpulmonary pressure gradient (mean PAP minus mean PAWP) <12 mm Hg, and pulmonary vascular resistance ≤3 Wood units (WU)...
September 2017: Circulation. Heart Failure
https://www.readbyqxmd.com/read/28904482/mathematics-of-ventilator-induced-lung-injury
#6
REVIEW
Ubaidur Rahaman
Ventilator-induced lung injury (VILI) results from mechanical disruption of blood-gas barrier and consequent edema and releases of inflammatory mediators. A transpulmonary pressure (PL) of 17 cmH2O increases baby lung volume to its anatomical limit, predisposing to VILI. Viscoelastic property of lung makes pulmonary mechanics time dependent so that stress (PL) increases with respiratory rate. Alveolar inhomogeneity in acute respiratory distress syndrome acts as a stress riser, multiplying global stress at regional level experienced by baby lung...
August 2017: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/28875324/-extreme-obesity-particular-aspect-of-invasive-and-noninvasive-ventilation
#7
REVIEW
M Deppe, P Lebiedz
The obesity rate is increasing worldwide and the percentage of obese patients in the intensive care unit (ICU) is rising concomitantly. Ventilatory support strategies in obese patients must take into account the altered pathophysiological conditions. Unfortunately, prospective randomized multicenter trials on this subject are lacking. Therefore, current strategies are based on the individual experiences of ICU physicians and single-center studies. Noninvasive ventilation (NIV) in critically ill patients with acute respiratory failure and obesity hypoventilation syndrome (OHS) is an efficient treatment option and should be provided as early as possible is an effort to avoid intubation...
September 5, 2017: Medizinische Klinik, Intensivmedizin und Notfallmedizin
https://www.readbyqxmd.com/read/28855727/noninvasive-oscillometric-cardiac-output-determination-in-the-intensive-care-unit-comparison-with-invasive-transpulmonary-thermodilution
#8
Alexander Reshetnik, Friederike Compton, Anna Schölzel, Markus Tölle, Walter Zidek, Markus van der Giet
Assessment of the cardiac output (CO) is usually performed with invasive techniques requiring specialized equipment in the intensive care unit (ICU). With TEL-O-GRAPH (TG), CO can be derived from the oscillometrically obtained brachial pulse wave during the measurement of brachial blood pressure. CO and stroke volume (SV) determinations with TG were compared with transpulmonary thermodilution measurements with the PICCO system (PICCO) in 38 haemodynamically unstable ICU patients with a total of 84 comparison measurements performed...
August 30, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28831765/validation-of-transpulmonary-thermodilution-variables-in-hemodynamically-stable-patients-with-heart-diseases
#9
Matthias Peter Hilty, Daniel Peter Franzen, Christophe Wyss, Patric Biaggi, Marco Maggiorini
BACKGROUND: Transpulmonary thermodilution is recommended in the treatment of critically ill patients presenting with complex shock. However, so far it has not been validated in hemodynamically stable patients with heart disease. METHODS: We assessed the validity of cardiac output, global end-diastolic volume index (GEDVI), an established marker of preload thought to reflect the volume of all four heart chambers, global ejection fraction (GEF) and cardiac function index (CFI) as variables of cardiac function, and extravascular lung water index (EVLWI) as indicator of pulmonary edema in 29 patients undergoing elective left and right heart catheterization including left ventricular angiography with stable coronary heart disease and normal cardiac function (controls, n = 11), moderate-to-severe aortic valve stenosis (AS, n = 10), or dilated cardiomyopathy (DCM, n = 8)...
August 22, 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/28828367/spontaneous-breathing-a-double-edged-sword-to-handle-with-care
#10
REVIEW
Tommaso Mauri, Barbara Cambiaghi, Elena Spinelli, Thomas Langer, Giacomo Grasselli
In acute hypoxemic respiratory failure (AHRF) and acute respiratory distress syndrome (ARDS) patients, spontaneous breathing is associated with multiple physiologic benefits: it prevents muscles atrophy, avoids paralysis, decreases sedation needs and is associated with improved hemodynamics. On the other hand, in the presence of uncontrolled inspiratory effort, severe lung injury and asynchronies, spontaneous ventilation might also worsen lung edema, induce diaphragm dysfunction and lead to muscles exhaustion and prolonged weaning...
July 2017: Annals of Translational Medicine
https://www.readbyqxmd.com/read/28828365/recruitment-maneuvers-in-acute-respiratory-distress-syndrome
#11
REVIEW
Jean-Michel Constantin, Thomas Godet, Matthieu Jabaudon, Jean-Etienne Bazin, Emmanuel Futier
The rationale for the use of recruitment maneuvers (RMs) in acute respiratory distress syndrome (ARDS) is to promote alveolar recruitment, leading to an increased end-expiratory lung volume and thus decreased ventilator-induced lung injury (VILI). RMs consists of a transient increase in transpulmonary pressure that can re-open previously collapsed alveoli. RMs represents a physiological response to lung aggression in different conditions by re-opening the collapsed part of the lung and decreasing lung oedema...
July 2017: Annals of Translational Medicine
https://www.readbyqxmd.com/read/28828360/transpulmonary-pressure-importance-and-limits
#12
REVIEW
Domenico Luca Grieco, Lu Chen, Laurent Brochard
Transpulmonary pressure (PL) is computed as the difference between airway pressure and pleural pressure and separates the pressure delivered to the lung from the one acting on chest wall and abdomen. Pleural pressure is measured as esophageal pressure (PES) through dedicated catheters provided with esophageal balloons. We discuss the role of PL in assessing the effects of mechanical ventilation in patients with acute respiratory distress syndrome (ARDS). In the supine position, directly measured PL represents the pressure acting on the alveoli and airways...
July 2017: Annals of Translational Medicine
https://www.readbyqxmd.com/read/28798197/corp-measurement-of-lung-function-in-small-animals
#13
Jason H T Bates
The measurement of lung function in mice and rats is crucial for understanding how well small animal models of pulmonary disease recapitulate human clinical pathology, but brings with it the challenge of making accurate measurements in animals as small as a mouse. Overcoming these challenges can be achieved in a number of ways, each based on a model idealization of how the lung works as a mechanical system. Accordingly, it is important to understand the theoretical basis on which an assessment of lung function rests in order to interpret experimental measurements appropriately...
August 10, 2017: Journal of Applied Physiology
https://www.readbyqxmd.com/read/28775071/the-acute-effects-of-long-acting-bronchodilators-on-small-airways-detected-in-copd-patients-by-single-breath-n2-test-and-lung-p-v-curve
#14
Matteo M Pecchiari, Pierachille Santus, Dejan Radovanovic, Edgardo Giacomo D'Angelo
Small airways represent the key factor of chronic obstructive pulmonary disease (COPD) pathophysiology. The effect of different classes of bronchodilators on small airways is still poorly understood and difficult to assess. Hence, the acute effects of tiotropium (18 µg) and indacaterol (150 µg) on closing volume (CV) and ventilation inhomogeneity were investigated and compared in 51 stable patients (mean age (SD): 70±7 years; 82% males) with moderate to very severe COPD. Patients underwent body-plethysmography, arterial blood gas-analysis, tidal expiratory flow limitation (EFL), dyspnea assessment, and simultaneous recording of single breath nitrogen test (SBN) and transpulmonary pressure-volume curve (PL-V), before and one hour after drug administration...
August 3, 2017: Journal of Applied Physiology
https://www.readbyqxmd.com/read/28742775/estimation-of-stroke-volume-and-stroke-volume-changes-by-electrical-impedance-tomography
#15
Fernando José da Silva Ramos, André Hovnanian, Rogério Souza, Luciano C P Azevedo, Marcelo B P Amato, Eduardo L V Costa
BACKGROUND: Electrical impedance tomography (EIT) is a noninvasive imaging method that identifies changes in air and blood volume based on thoracic impedance changes. Recently, there has been growing interest in EIT to measure stroke volume (SV). The objectives of this study are as follows: (1) to evaluate the ability of systolic impedance variations (ΔZsys) to track changes in SV in relation to a baseline condition; (2) to assess the relationship of ΔZsys and SV in experimental subjects; and (3) to identify the influence of body dimensions on the relationship between ΔZsys and SV...
July 24, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28708679/transpulmonary-pressure-describes-lung-morphology-during-decremental-positive-end-expiratory-pressure-trials-in-obesity
#16
Jacopo Fumagalli, Lorenzo Berra, Changsheng Zhang, Massimiliano Pirrone, Roberta R De Santis Santiago, Susimeire Gomes, Federico Magni, Glaucia A B Dos Santos, Desmond Bennett, Vinicius Torsani, Daniel Fisher, Caio Morais, Marcelo B P Amato, Robert M Kacmarek
OBJECTIVES: Atelectasis develops in critically ill obese patients when undergoing mechanical ventilation due to increased pleural pressure. The current study aimed to determine the relationship between transpulmonary pressure, lung mechanics, and lung morphology and to quantify the benefits of a decremental positive end-expiratory pressure trial preceded by a recruitment maneuver. DESIGN: Prospective, crossover, nonrandomized interventional study. SETTING: Medical and Surgical Intensive Care Units at Massachusetts General Hospital (Boston, MA) and University Animal Research Laboratory (São Paulo, Brazil)...
August 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28707173/intraoperative-ventilation-of-morbidly-obese-patients-guided-by-transpulmonary-pressure
#17
Lars Eichler, Katarzyna Truskowska, A Dupree, P Busch, Alwin E Goetz, Christian Zöllner
BACKGROUND: Bariatric surgery has proven a successful approach in the treatment of morbid obesity and its concomitant diseases such as diabetes mellitus and arterial hypertension. Aiming for optimal management of this challenging patient cohort, tailored concepts directly guided by individual patient physiology may outperform standardized care. Implying esophageal pressure measurement and electrical impedance tomography-increasingly applied monitoring approaches to individually adjust mechanical ventilation in challenging circumstances like acute respiratory distress syndrome (ARDS) and intraabdominal hypertension-we compared our institutions standard ventilator regimen with an individually adjusted positive end expiratory pressure (PEEP) level aiming for a positive transpulmonary pressure (P L) throughout the respiratory cycle...
July 14, 2017: Obesity Surgery
https://www.readbyqxmd.com/read/28701178/the-future-of-mechanical-ventilation-lessons-from-the-present-and-the-past
#18
REVIEW
Luciano Gattinoni, John J Marini, Francesca Collino, Giorgia Maiolo, Francesca Rapetti, Tommaso Tonetti, Francesco Vasques, Michael Quintel
The adverse effects of mechanical ventilation in acute respiratory distress syndrome (ARDS) arise from two main causes: unphysiological increases of transpulmonary pressure and unphysiological increases/decreases of pleural pressure during positive or negative pressure ventilation. The transpulmonary pressure-related side effects primarily account for ventilator-induced lung injury (VILI) while the pleural pressure-related side effects primarily account for hemodynamic alterations. The changes of transpulmonary pressure and pleural pressure resulting from a given applied driving pressure depend on the relative elastances of the lung and chest wall...
July 12, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/28690287/stroke-volume-variation-svv-and-pulse-pressure-variation-ppv-as-indicators-of-fluid-responsiveness-in-sevoflurane-anesthetized-mechanically-ventilated-euvolemic-dogs
#19
Yusuke Endo, Jun Tamura, Tomohito Ishizuka, Takaharu Itami, Kiwamu Hanazono, Kenjiro Miyoshi, Tadashi Sano, Kazuto Yamashita, William W Muir
Changes in stroke volume variation (SVV) and pulse pressure variation (PPV) in response to fluid infusion were experimentally evaluated during vecuronium infusion and sevoflurane anesthesia in 5 adult, mechanically ventilated, euvolemic, beagle dogs. Sequential increases in central venous pressure (CVP; 3-7[baseline], 8-12, 13-17, 18-22 and 23-27 mmHg) were produced by infusing lactated Ringer's solution and 6% hydroxyethyl starch solution. Heart rate (beats/min), right atrial pressure (RAP, mmHg), pulmonary arterial pressure (PAP, mmHg), pulmonary capillary wedge pressure (PCWP, mmHg), transpulmonary thermodilution cardiac output (TPTDCO, l/min), stroke volume (SV, ml/beat), arterial blood pressure (ABP, mmHg), extravascular lung water (EVLW, ml), pulmonary vascular permeability index (PVPI, calculated), SVV (%), PPV (%) and systemic vascular resistance (SVR, dynes/sec/cm(5)) were determined at each predetermined CVP range...
August 18, 2017: Journal of Veterinary Medical Science
https://www.readbyqxmd.com/read/28679201/physiological-effects-of-the-open-lung-approach-during-laparoscopic-cholecystectomy-focus-on-driving-pressure
#20
Davide D'Antini, Michela Rauseo, Salvatore Grasso, Lucia Mirabella, Luigi Camporota, Antonella Cotoia, Savino Spadaro, Alberto Fersini, Rocco Petta, Rosaria Menga, Alberto Sciusco, Michele Dambrosio, Gilda Cinnella
BACKGROUND: During laparoscopy, respiratory mechanics and gas exchange are impaired because of pneumoperitoneum and atelectasis formation. We applied an open lung approach (OLA) consisting in lung recruitment followed by a decremental positive-end expiratory pressure (PEEP) trial to identify the level of PEEP corresponding to the highest compliance of the respiratory system (best PEEP). Our hypothesis was that this approach would improve both lung mechanics and oxygenation without hemodynamic impairment...
July 5, 2017: Minerva Anestesiologica
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