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Transpulmonary pressure

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
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
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
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
Christophe Guervilly, Jean-Marie Forel, Sami Hraiech, Antoine Roch, Daniel Talmor, Laurent Papazian
BACKGROUND: High-frequency oscillatory ventilation (HFOV) has not been shown to be beneficial in the management of moderate-to-severe acute respiratory distress syndrome (ARDS). There is uncertainty about the actual pressure applied into the lung during HFOV. We therefore performed a study to compare the transpulmonary pressure (P L) during conventional mechanical ventilation (CMV) and different levels of mean airway pressure (mPaw) during HFOV. METHODS: This is a prospective randomized crossover study in a university teaching hospital...
December 2016: Annals of Intensive Care
Aiping Liu, Timothy Hacker, Jens C Eickhoff, Naomi C Chesler
Pulmonary arterial hypertension (PAH) is caused by extensive pulmonary vascular remodeling that increases right ventricular (RV) afterload and leads to RV failure. PAH predominantly affects women; paradoxically, female PAH patients have better outcomes than men. The roles of estrogen in PAH remain controversial, which is referred to as "the estrogen paradox". Here, we sought to determine the role of estrogen in pulsatile pulmonary arterial hemodynamic changes and its impact on RV functional adaption to PAH...
August 24, 2016: Annals of Biomedical Engineering
Ole Broch, Jochen Renner, Patrick Meybohm, Martin Albrecht, Jan Höcker, Assad Haneya, Markus Steinfath, Berthold Bein, Matthias Gruenewald
OBJECTIVES: The reliability of dynamic and volumetric variables of fluid responsiveness in the presence of pericardial effusion is still elusive. The aim of the present study was to investigate their predictive power in a porcine model with hemodynamic relevant pericardial effusion. DESIGN: A single-center animal investigation. PARTICIPANTS: Twelve German domestic pigs. INTERVENTIONS: Pigs were studied before and during pericardial effusion...
October 2016: Journal of Cardiothoracic and Vascular Anesthesia
Huseyin Konur, Gulay Erdogan Kayhan, Huseyin Ilksen Toprak, Nizamettin Bucak, Mustafa Said Aydogan, Saim Yologlu, Mahmut Durmus, Sezai Yılmaz
Fluid management is challenging and still remains controversial in orthotopic liver transplantation (OLT). The pleth variability index (PVI) has been shown to be a reliable predictor of fluid responsiveness of perioperative and critically ill patients; however, it has not been evaluated in OLT. This study was designed to examine whether the PVI can reliably predict fluid responsiveness in OLT and to compare PVI with other hemodynamic indexes that are measured using the PiCCO2 monitoring system. Twenty-five patients were enrolled in this study...
July 2016: Kaohsiung Journal of Medical Sciences
P Formenti, M Umbrello, J Graf, A B Adams, D J Dries, J J Marini
The stress index (SI) is a parameter that characterizes the shape of the airway pressure-time profile (P/t). It indicates the slope progression of the curve, reflecting both lung and chest wall properties. The presence of pleural effusion alters the mechanical properties of the respiratory system decreasing transpulmonary pressure (Ptp). We investigated whether the SI computed using Ptp tracing would provide reliable insight into tidal recruitment/overdistention during the tidal cycle in the presence of unilateral effusion...
July 20, 2016: Journal of Clinical Monitoring and Computing
Hong Mei, Miao Chen, Xiaoyun Fu, Kang Li, Guoyue Liu, Song Qin
OBJECTIVE: To investigate the influence of continuous veno-venous hemofiltration (CVVH) on cardiac output (CO) value and parameters of hemodynamics monitored by transpulmonary thermodilution technique in critical patients. METHODS: A prospective cohort study was conduced. Sixty-two critical patients admitted to intensive care unit (ICU) of Zunyi Medical College Affiliated Hospital from January 2011 to October 2015 were enrolled. All of the patients received CVVH through femoral vein puncture catheter...
August 2016: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
Chun Pan, Lu Chen, Yun-Hang Zhang, Wei Liu, Rosario Urbino, V Marco Ranieri, Hai-Bo Qiu, Yi Yang
BACKGROUND: Stress index at post-recruitment maneuvers could be a method of positive end-expiratory pressure (PEEP) titration in acute respiratory distress syndrome (ARDS) patients. However, airway pressure (Paw) stress index may not reflect lung mechanics in the patients with high chest wall elastance. This study was to evaluate the Pawstress index on lung mechanics and the correlation between Pawstress index and transpulmonary pressure (PL) stress index in acute respiratory failure (ARF) patients...
July 20, 2016: Chinese Medical Journal
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