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Protective ventilation

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https://www.readbyqxmd.com/read/27922742/the-diaphragm-acts-as-a-brake-during-expiration-to-prevent-lung-collapse
#1
Mariangela Pellegrini, Göran Hedenstierna, Agneta Roneus, Monica Segelsjö, Anders Larsson, Gaetano Perchiazzi
RATIONALE: The diaphragm is the major inspiratory muscle and is assumed to relax during expiration. However, electrical post-inspiratory activity has been observed. Whether or not there is an expiratory diaphragmatic contraction that preserves lung patency has yet to be explored. OBJECTIVE: We hypothesized the occurrence of an expiratory diaphragmatic contraction directed at stabilizing peripheral airways and preventing or reducing cyclic expiratory lung collapse...
December 6, 2016: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/27917545/measured-performance-of-filtration-and-ventilation-systems-for-fine-and-ultrafine-particles-and-ozone-in-an-unoccupied-modern-california-house
#2
Brett C Singer, William W Delp, Douglas R Black, Iain S Walker
This study evaluated nine ventilation and filtration systems in an unoccupied 2006 house located 250m downwind of the I-80 freeway in Sacramento, California. Systems were evaluated for reducing indoor concentrations of outdoor particles in summer and fall/winter, ozone in summer, and particles from stir-fry cooking. Air exchange rate was measured continuously. Energy use was estimated for year-round operation in California. Exhaust ventilation without enhanced filtration produced indoor PM2.5 that was 70% lower than outdoors...
December 5, 2016: Indoor Air
https://www.readbyqxmd.com/read/27916341/hospital-influenza-pandemic-stockpiling-needs-a-computer-simulation
#3
Mark N Abramovich, John C Hershey, Byron Callies, Amesh A Adalja, Pritish K Tosh, Eric S Toner
BACKGROUND: A severe influenza pandemic could overwhelm hospitals but planning guidance that accounts for the dynamic interrelationships between planning elements is lacking. We developed a methodology to calculate pandemic supply needs based on operational considerations in hospitals and then tested the methodology at Mayo Clinic in Rochester, MN. METHODS: We upgraded a previously designed computer modeling tool and input carefully researched resource data from the hospital to run 10,000 Monte Carlo simulations using various combinations of variables to determine resource needs across a spectrum of scenarios...
December 2, 2016: American Journal of Infection Control
https://www.readbyqxmd.com/read/27911872/p120-regulates-beta-catenin-nuclear-translocation-through-e-cadherin-endocytosis-in-ventilator-induced-lung-injury
#4
Changping Gu, Chenyang Dai, Yongtao Sun, Mengjie Liu, Yuelan Wang, Xinyi Wu
Mechanical stretch induces epithelial barrier dysfunction by altering the location and degradation of cellular junction proteins. p120-catenin (p120) is a cell-cell junction protein known to protect against ventilator-induced lung injury (VILI) that results from improper ventilation of patients. In this study, we sought to determine the role of p120 in VILI and its relationship with the cellular response to mechanical stretch. Mouse lung epithelial cells (MLE-12) transfected with p120 siRNA, p120 cDNA, or E-cadherin siRNA were subjected to 20% cyclic stretch for 2 or 4 hours...
November 30, 2016: Oncotarget
https://www.readbyqxmd.com/read/27907083/effects-of-acute-systemic-hypoxia-and-hypercapnia-on-brain-damage-in-a-rat-model-of-hypoxia-ischemia
#5
Wanchao Yang, Xuezhong Zhang, Nan Wang, Jing Tan, Xianhai Fang, Qi Wang, Tao Tao, Wenzhi Li
Therapeutic hypercapnia has the potential for neuroprotection after global cerebral ischemia. Here we further investigated the effects of different degrees of acute systemic hypoxia in combination with hypercapnia on brain damage in a rat model of hypoxia and ischemia. Adult wistar rats underwent unilateral common carotid artery (CCA) ligation for 60 min followed by ventilation with normoxic or systemic hypoxic gas containing 11%O2,13%O2,15%O2 and 18%O2 (targeted to PaO2 30-39 mmHg, 40-49 mmHg, 50-59 mmHg, and 60-69 mmHg, respectively) or systemic hypoxic gas containing 8% carbon dioxide (targeted to PaCO2 60-80 mmHg) for 180 min...
2016: PloS One
https://www.readbyqxmd.com/read/27903471/bovine-pericardium-as-new-technical-option-for-in-situ-reconstruction-of-aortic-graft-infection
#6
Brigitta Lutz, Christian Reeps, Gabor Biro, Christoph Knappich, Alexander Zimmermann, Hans-Henning Eckstein
OBJECTIVE: Alloplastic aortic graft infection is a devastating complication following aortic surgery. It is associated with excessively high mortality and morbidity caused by anastomotic rupture or septicemia. Many authors consider in situ replacement after complete surgical graft removal as the method of choice. However, there is an ongoing debate about the most suitable material for reconstruction. We present our first experiences with replacing the descending and infra-renal aorta using custom-made bovine pericardium grafts...
November 26, 2016: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/27903339/-effect-of-goal-directed-haemodynamic-management-on-the-postoperative-outcome-in-elderly-patients-with-fragile-cardiac-function-undergoing-abdominal-surgery
#7
L S Zheng, E W Gu, X H Peng, L Zhang, Y Y Cao
Objective: To investigate the effect of goal-directed haemodynamic management based on stroke volume variation (SVV), cardiac index (CI) and mean arterial blood pressure (MAP) on the postoperative outcome in elderly patients with fragile cardiac function undergoing gastrointestinal surgery. Methods: Ninety patients with fragile cardiac function, aged 65-90 years old, ASAⅡ or Ⅲ, NYHA Ⅱor Ⅲ, scheduled for abdominal surgery were enrolled in this study.The patients were randomly assigned to two groups: Experience anesthesia group (group E, n=45) and goal-directed hemodynamic management group (G group, n=45)...
November 22, 2016: Zhonghua Yi Xue za Zhi [Chinese medical journal]
https://www.readbyqxmd.com/read/27903208/early-experience-of-a-new-extracorporeal-carbon-dioxide-removal-device-for-acute-hypercapnic-respiratory-failure
#8
Ravindranath Tiruvoipati, Hergen Buscher, James Winearls, Jeff Breeding, Debasish Ghosh, Shimonti Chaterjee, Gary Braun, Eldho Paul, John F Fraser, John Botha
BACKGROUND: Recent advances in the technology of extracorporeal respiratory assist systems have led to a renewed interest in extracorporeal carbon dioxide removal (ECCOR). The Hemolung is a new, low-flow, venovenous, minimally invasive, partial ECCOR device that has recently been introduced to clinical practice to aid in avoiding invasive ventilation or to facilitate lung-protective ventilation. OBJECTIVE: We report our early experience on use, efficacy and safety of the Hemolung in three Australian intensive care units...
December 2016: Critical Care and Resuscitation: Journal of the Australasian Academy of Critical Care Medicine
https://www.readbyqxmd.com/read/27903130/risk-factors-and-mortality-in-the-carbapenem-resistant-klebsiella-pneumoniae-infection-case-control-study
#9
Fethiye Akgul, Ilkay Bozkurt, Mustafa Sunbul, Saban Esen, Hakan Leblebicioglu
Carbapenem-resistant Klebsiella pneumoniae (CRKP) has been known as a nosocomial pathogen, both for the last 10 years in Turkey and for 20 years worldwide. Due to limited treatment options and high mortality rates, despite improvements in the field of medicine at the present time, CRKP is still a big threat for public health. This study was carried out between the dates of January 2010 and September 2014. Patients ≥18 who were hospitalized for at least 72 h and who also had CRKP growth were included in the study as a case group...
December 1, 2016: Pathogens and Global Health
https://www.readbyqxmd.com/read/27902842/vagal-denervation-inhibits-the-increase-in-pulmonary-blood-flow-during-partial-lung-aeration-at-birth
#10
Justin A R Lang, James T Pearson, Corinna Binder-Heschl, Megan J Wallace, Melissa L Siew, Marcus J Kitchen, Arjan B Te Pas, Robert A Lewis, Graeme R Polglase, Mikiyasu Shirai, Stuart B Hooper
Air entry into the lungs at birth triggers major cardiovascular changes, including a large increase in pulmonary blood flow (PBF) that is not spatially related to regional lung aeration. To investigate the possible underlying role of a vagally-mediated stimulus, we used simultaneous phase-contrast X-ray imaging and angiography in near-term (30 days of gestation) vagotomised (n = 15) or sham-operated (n = 15) rabbit kittens. Rabbits were imaged before ventilation, when one lung was ventilated (unilateral) with 100% nitrogen (N2 ), air or 100% oxygen (O2 ), before all kittens were switched to unilateral ventilation in air, then ventilation of both lungs using air...
November 30, 2016: Journal of Physiology
https://www.readbyqxmd.com/read/27900922/-extracorporeal-life-support-for-legionella-pneumonia
#11
W A C Koekkoek, C Savelkoul, P R Wijnandts, M Platenkamp, D W Donker, D H T Tjan
BACKGROUND: Legionella species cause 5% of all community acquired pneumonias. However, Legionella pneumonia results relatively often in admission to the intensive care unit (ICU). A significant complication is the development of acute respiratory distress syndrome (ARDS). The ICU mortality rate for Legionella pneumonia is > 30% with conventional treatments. CASE DESCRIPTION: A 64-year-old male was admitted to the ICU with respiratory failure due to Legionella pneumonia complicated by ARDS...
2016: Nederlands Tijdschrift Voor Geneeskunde
https://www.readbyqxmd.com/read/27898744/pre-exercise-hyperpnea-attenuates-exercise-induced-bronchoconstriction-without-affecting-performance
#12
Philipp A Eichenberger, Thomas A Scherer, Christina M Spengler
Whole-body warm-up exercises were shown to attenuate exercise-induced bronchoconstriction (EIB). Whether intense pre-exercise hyperpnea offers similar protection and whether this might negatively affect exercise performance is unknown. Nine subjects with EIB (25±5 yrs; forced expiratory volume in 1s [FEV1], 104±15% predicted) performed an exercise challenge (ECh) followed-after 30min-by a constant-load cycling test to exhaustion. The ECh was preceded by one of four conditions: by i) control warm-up (CON) or by 10min of normocapnic hyperpnea with partial rebreathing at either ii) 50% (WU50) or iii) variable intensity (8x 30s-80%/45s-30%; WU80/30), or at iv) 70% (WU70) of maximal voluntary ventilation...
2016: PloS One
https://www.readbyqxmd.com/read/27898437/how-best-to-set-the-ventilator-on-extracorporeal-membrane-lung-oxygenation
#13
Luciano Gattinoni, Tommaso Tonetti, Michael Quintel
PURPOSE OF REVIEW: Extracorporeal respiratory support in patients with acute respiratory distress syndrome is applied either as rescue maneuver for life-threatening hypoxemia or as a tool to reduce the harm of mechanical ventilation. Depending on the blood and gas flow, extracorporeal support may completely substitute the natural lung as a gas exchanger (high-flow venovenous bypass) or reduce the need for mechanical ventilation, enabling the removal of a fraction of the metabolically produced CO2...
November 24, 2016: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/27894328/effect-of-driving-pressure-on-mortality-in-ards-patients-during-lung-protective-mechanical-ventilation%C3%A2-in-two-randomized-controlled-trials
#14
Claude Guérin, Laurent Papazian, Jean Reignier, Louis Ayzac, Anderson Loundou, Jean-Marie Forel
BACKGROUND: Driving pressure (ΔPrs) across the respiratory system is suggested as the strongest predictor of hospital mortality in patients with acute respiratory distress syndrome (ARDS). We wonder whether this result is related to the range of tidal volume (VT). Therefore, we investigated ΔPrs in two trials in which strict lung-protective mechanical ventilation was applied in ARDS. Our working hypothesis was that ΔPrs is a risk factor for mortality just like compliance (Crs) or plateau pressure (Pplat,rs) of the respiratory system...
November 29, 2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/27891239/two-cases-of-methyl-alcohol-intoxication-by-sub-chronic-inhalation-and-dermal-exposure-during-aluminum-cnc-cutting-in-a-small-sized-subcontracted-factory
#15
Jia Ryu, Key Hwan Lim, Dong-Ryeol Ryu, Hyang Woon Lee, Ji Young Yun, Seoung-Wook Kim, Ji-Hoon Kim, Kyunghee Jung-Choi, Hyunjoo Kim
BACKGROUND: Methyl alcohol poisoning has been mainly reported in community. Two cases of methyl alcohol poisoning occurred in a small-sized subcontracted factory which manufactured smartphone parts in Korea. CASE PRESENTATION: One young female patient presented with dyspnea and visual disturbance. Another young male patient presented with visual disturbance and myalgia. They treated with sodium bicarbonate infusion and hemodialysis for metabolic acidosis. In addition, he received ethyl alcohol per oral treatment...
2016: Annals of Occupational and Environmental Medicine
https://www.readbyqxmd.com/read/27878830/clinical-assessment-of-histidine-tryptophan-ketoglutarate-solution-and-modified-st-thomas-solution-in-pediatric-cardiac-surgery-of-tetralogy-of-fallot
#16
Zhao-Hui Wang, Yong An, Ming-Cheng Du, Ting-Jiang Qin, Yin-Bei Liu, Hong-Zhen Xu, Li-Qun Yang
The objective of this study is to compare the myocardium protective effect of Bretschneider's histidine-tryptophan-ketoglutarate (HTK) solution versus Modified St. Thomas' (STH) solution in pediatric cardiac surgery of Tetralogy of Fallot (TOF). Seventy-seven pediatric patients of TOF who received the total surgical repair were reviewed, from January 2014 to October 2015. A horizontal comparison between HTK solution and modified STH solution has been made since the HTK solutions were started to be used in our hospital...
November 22, 2016: Artificial Organs
https://www.readbyqxmd.com/read/27876355/lung-protective-ventilatory-strategies-in-intubated-preterm-neonates-with-rds
#17
REVIEW
F Reiterer, B Schwaberger, T Freidl, G Schmölzer, G Pichler, B Urlesberger
This article provides a narrative review of lung-protective ventilatory strategies (LPVS) in intubated preterm infants with RDS. A description of strategies is followed by results on short-and long-term respiratory and neurodevelopmental outcomes. Strategies will include patient-triggered or synchronized ventilation, volume targeted ventilation, the technique of intubation, surfactant administration and rapid extubation to NCPAP (INSURE), the open lung concept, strategies of high-frequency ventilation, and permissive hypercapnia...
October 26, 2016: Paediatric Respiratory Reviews
https://www.readbyqxmd.com/read/27875409/extracorporeal-membrane-oxygenation-beyond-rescue-therapy-for-acute-respiratory-distress-syndrome
#18
Alain Combes, Nicolas Bréchot, Charles-Edouard Luyt, Matthieu Schmidt
PURPOSE OF REVIEW: This article summarizes the results of past and more recent series on venovenous extracorporeal membrane oxygenation (VV-ECMO) and discusses its potential indications beyond the rescue of patients with lung failure refractory to conventional mechanical ventilation. RECENT FINDINGS: Successful VV-ECMO treatment in patients with extremely severe influenza A(H1N1)-associated acute respiratory distress syndrome (ARDS) and positive results of the CESAR trial have led to an exponential use of the technology in recent years...
November 19, 2016: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/27865481/the-influence-of-tethering-and-gravity-on-the-stability-of-compliant-liquid-lined-airways
#19
Jeremy Whang, Chandler Faulman, Thomas A Itin, Donald P Gaver
This study revolves around two simple questions: 1) how does pulmonary airway recruitment/de-recruitment (RecDer) depend on the tethering support provided by surrounding airways and alveoli, and 2) does airway angle of inclination (θ) influence airway stability? These two questions are critical to understanding the existence and prevention of atelectrauma, which may contribute to ventilator-induced lung injury (VILI). To address these questions, we develop PDMS 2mm ID compliant tubes that mimic pulmonary airways...
November 11, 2016: Journal of Biomechanics
https://www.readbyqxmd.com/read/27861295/improving-national-results-in-liver-transplantation-using-grafts-from-donation-after-cardiac-death-donors
#20
Kristopher P Croome, David D Lee, Andrew P Keaveny, C Burcin Taner
BACKGROUND: Published reports describing the national experience with liver grafts from donation after cardiac death (DCD) donors have resulted in reservations with their widespread utilization. The present study aimed to investigate if temporal improvements in outcomes have been observed on a national level and to determine if donor and recipient selection have been modified in a fashion consistent with published data on DCD use in liver transplantation (LT). METHODS: Patients undergoing DCD LT between 2003 and 2014 were obtained from the United Network of Organ Sharing Standard Transplant Analysis and Research file and divided into 3 equal eras based on the date of DCD LT: era 1 (2003-2006), era 2 (2007-2010), and era 3 (2011-2014)...
December 2016: Transplantation
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