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https://www.readbyqxmd.com/read/28636403/applying-precision-medicine-to-trial-design-using-physiology-extracorporeal-co2-removal-for-ards
#1
Ewan C Goligher, Marcelo B P Amato, Arthur S Slutsky
In clinical trials of therapies for ARDS, the average treatment effect in the study population may be attenuated because individual patient responses vary widely. This inflates sample size requirements and increases the cost and difficulty of conducting successful clinical trials. One solution is to enrich the study population with patients most likely to benefit based on predicted patient response to treatment (predictive enrichment). In this perspective, we apply the precision medicine paradigm to the emerging use of extracorporeal CO2 removal (ECCO2R) for ultra-protective ventilation in ARDS...
June 21, 2017: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28633157/epidemiology-practice-of-ventilation-and-outcome-for-patients-at-increased-risk-of-postoperative-pulmonary-complications-an-observational-study-in-29-countries
#2
(no author information available yet)
BACKGROUND: Limited information exists about the epidemiology and outcome of surgical patients at increased risk of postoperative pulmonary complications (PPCs), and how intraoperative ventilation was managed in these patients. OBJECTIVES: To determine the incidence of surgical patients at increased risk of PPCs, and to compare the intraoperative ventilation management and postoperative outcomes with patients at low risk of PPCs. DESIGN: This was a prospective international 1-week observational study using the 'Assess Respiratory Risk in Surgical Patients in Catalonia risk score' (ARISCAT score) for PPC for risk stratification...
June 20, 2017: European Journal of Anaesthesiology
https://www.readbyqxmd.com/read/28632754/permissive-hypercapnia-for-severe-acute-respiratory-distress-syndrome-in-immunocompromised-children-a-single-center-experience
#3
Hans Fuchs, Nicola Rossmann, Manuel B Schmid, Manfred Hoenig, Ulrich Thome, Benjamin Mayer, Daniel Klotz, Helmut D Hummler
BACKGROUND: Controlled hypoventilation while accepting hypercapnia has been advocated to reduce ventilator-induced lung injury. The aim of the study was to analyze outcomes of a cohort of immunocompromised children with acute respiratory distress syndrome (ARDS) ventilated with a strategy of stepwise increasing PCO2 targets up to 140 mm Hg. METHODS: Retrospective analysis of outcomes of a cohort of children with oncologic disease or after stem cell transplantation and severe respiratory failure in comparison with a historical control cohort...
2017: PloS One
https://www.readbyqxmd.com/read/28632529/respiratory-system-mechanics-during-low-versus-high-positive-end-expiratory-pressure-in-open-abdominal-surgery-a-substudy-of-provhilo-randomized-controlled-trial
#4
Davide D'Antini, Robert Huhle, Jacob Herrmann, Demet S Sulemanji, Jun Oto, Pasquale Raimondo, Lucia Mirabella, Sabrine N T Hemmes, Marcus J Schultz, Paolo Pelosi, David W Kaczka, Marcos Francisco Vidal Melo, Marcelo Gama de Abreu, Gilda Cinnella
BACKGROUND: In the 2014 PROtective Ventilation using HIgh versus LOw positive end-expiratory pressure (PROVHILO) trial, intraoperative low tidal volume ventilation with high positive end-expiratory pressure (PEEP = 12 cm H2O) and lung recruitment maneuvers did not decrease postoperative pulmonary complications when compared to low PEEP (0-2 cm H2O) approach without recruitment breaths. However, effects of intraoperative PEEP on lung compliance remain poorly understood. We hypothesized that higher PEEP leads to a dominance of intratidal overdistension, whereas lower PEEP results in intratidal recruitment/derecruitment (R/D)...
June 19, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28629919/comparing-pulmonary-nodule-location-during-electromagnetic-bronchoscopy-with-predicted-location-based-on-two-virtual-airway-maps-at-different-phases-of-respiration
#5
Brian S Furukawa, Nicholas J Pastis, Nichole T Tanner, Alexander Chen, Gerard A Silvestri
BACKGROUND: Electromagnetic navigational bronchoscopy (ENB) is guided-bronchoscopy to pulmonary nodules (PN) which relies on a pre-procedural chest CT to create a 3-dimensional (3-D) virtual airway map. The CT is traditionally done at a full inspiratory breath hold (INSP) but the procedure is performed while the patient tidal breaths, where lung volumes are closer to functional residual capacity. Movement of a PN from INSP to expiration (EXP) has been shown to average 17.6 mm. Therefore, the hypothesis of this study is that pre-procedural virtual maps built off a CT closer to physiological lung volumes during bronchoscopy may better represent the actual 3-D location of a PN...
June 16, 2017: Chest
https://www.readbyqxmd.com/read/28627354/-principle-and-influence-factors-of-aerosolized-antibiotics-in-the-treatment-of-ventilator-associated-pneumonia
#6
Chang Liu, Yuting Zhang, Jianguo Li
Ventilator associated pneumonia (VAP) is a challenging complication of critical illness. Aerosolized antibiotic is an option for the management of VAP currently, as it is reported that it could increase levels of drug in alveolar without increasing systemic toxicity. The articles that focused on the aerosolized antibiotics in the treatment of VAP and its influence factors were reviewed, and it was found that to achieve maximum drug delivery efficiency and reduce the influence of nebulization method, some factors, such as ventilation modes, tidal volume, nebulizer type, should be adjusted and monitored during the treatment...
March 2017: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/28627346/-study-on-rac1-mapk-erk-pathway-mediated-mechanism-and-role-in-rats-with-ventilator-induced-lung-injury
#7
Guanghua Tao, Linghui Pan, Ren Jing, Fei Lin, Huijun Dai, Wanyun Ge
OBJECTIVE: To investigate the role of Ras-related C3 botulinum toxin substrate 1/mitogen-activated protein kinase/extracellular signal-regulated kinase (Rac1/MAPK/ERK) signal pathway in rats with ventilator induced lung injury (VILI) and its mechanism. METHODS: Thirty Sprague-Dawley (SD) rats were randomly divided into spontaneous respiration group, normal tidal volume (VT) group and high VT group with 10 rats in each group. The rats in spontaneous respiration group were kept their spontaneous breathing...
March 2017: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/28625243/-experimental-study-on-effect-of-airway-pressure-on-cardiopulmonary-resuscitation
#8
Dingyu Tan, Feng Sun, Yangyang Fu, Shihuan Shao, Yazhi Zhang, Yingying Hu, Jun Xu, Huadong Zhu, Xuezhong Yu
OBJECTIVE: To observe the effect of different airway pressure on ventilation, organ perfusion and return of spontaneous circulation (ROSC) of cardiac arrest (CA) pigs during cardiopulmonary resuscitation (CPR), and to explore the possible beneficial mechanism of positive airway pressure during CPR. METHODS: Twenty healthy landrace pigs of clean grade were divided into low airway pressure group (LP group, n = 10) and high airway pressure group (HP group, n = 10) with random number table...
June 2017: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/28624991/a-new-global-and-comprehensive-model-for-icu-ventilator-performances-evaluation
#9
Nicolas S Marjanovic, Agathe De Simone, Guillaume Jegou, Erwan L'Her
BACKGROUND: This study aimed to provide a new global and comprehensive evaluation of recent ICU ventilators taking into account both technical performances and ergonomics. METHODS: Six recent ICU ventilators were evaluated. Technical performances were assessed under two FIO2 levels (100%, 50%), three respiratory mechanics combinations (Normal: compliance [C] = 70 mL cmH2O(-1)/resistance [R] = 5 cmH2O L(-1) s(-1); Restrictive: C = 30/R = 10; Obstructive: C = 120/R = 20), four exponential levels of leaks (from 0 to 12...
December 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/28623500/contribution-of-the-nasal-passage-to-face-mask-ventilation-a-prospective-blinded-randomized-crossover-trial
#10
Tomoki Yamasaki, Nobuyasu Komasawa, Haruki Kido, Toshiaki Minami
BACKGROUND: Previous studies have shown that the nasal passage plays an important role in manual face mask ventilation, but this has yet to be quantitatively assessed. We conducted a prospective randomized crossover clinical trial to compare the change in pressure-controlled face mask tidal volume with and without nasal airway occlusion. METHOD: Female patients undergoing elective surgery under general anesthesia served as study subjects. Patients were randomly assigned to face mask ventilation beginning either with or without nasal passage occlusion (achieved with a swimmer's nose clip), followed by removal or application of the nose clip, respectively...
June 16, 2017: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
https://www.readbyqxmd.com/read/28618745/effects-of-a-closed-system-suction-connector-on-airway-resistance-in-ventilated-neonates
#11
Sezin Ünal, Ebru Ergenekon, Ebru Kazanci, Selma Aktaş, Ferit Kulali, İbrahim Murat Hirfanoğlu, Canan Türkyilmaz, Yıldız Atalay
BACKGROUND/AIM: Increased airway resistance reduces the effectiveness of ventilation treatment. Endotracheal tubes (ETTs) and connectors contribute to resistance. However, the effect of a closed system suction (CSS) connector is not well known. We compared the in vivo resistance occurring with a CSS connector with that of the standard connector. MATERIALS AND METHODS: This prospective study was conducted at Gazi University Hospital's neonatal intensive care unit...
June 12, 2017: Turkish Journal of Medical Sciences
https://www.readbyqxmd.com/read/28616282/pressure-controlled-versus-volume-controlled-ventilation-during-one-lung-ventilation-for-video-assisted-thoracoscopic-lobectomy
#12
Yi-Qi Zhu, Fang Fang, Xiao-Min Ling, Jian Huang, Jing Cang
BACKGROUND: It is controversial as to which ventilation mode is better during one-lung ventilation (OLV). This study was designed to figure out whether there was any difference between volume controlled ventilation (VCV) and pressure controlled ventilation (PCV) on oxygenation and postoperative complications under the condition of protective ventilation (PV). METHODS: Sixty-five patients undergoing video-assisted thoracoscopic lobectomy were randomized into two groups...
May 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28606851/cardiorespiratory-action-of-opioid-tachykinin-agonist-peptide-hybrid-in-anaesthetized-rats-transduction-pathways
#13
Piotr Wojciechowski, Małgorzata Szereda-Przestaszewska, Andrzej Wojciech Lipkowski
AWL3106 composed of opioid (dermorphin) and tachykinin (substance P7-11) pharmacophores is a new compound with high analgesic potency and markedly reduced ability to induce tolerance and dependence. The present study aimed to determine the respiratory and cardiovascular responses evoked by this peptide in urethane-chloralose anaesthetized, spontaneously breathing rats in the presence or absence of vagal connection. Intravenous injection of AWL3106 at a dose of 0.3μmol/kg in intact rats resulted in apnoea lasting 5...
June 9, 2017: European Journal of Pharmacology
https://www.readbyqxmd.com/read/28606716/the-relation-between-given-volume-and-heart-rate-during-newborn-resuscitation
#14
J E Linde, J Schulz, J M Perlman, K Øymar, L Blacy, H Kidanto, H L Ersdal
BACKGROUND: During delivery room resuscitation of depressed newborns, provision of appropriate tidal volume (TV) with establishment of functional residual capacity (FRC) is essential for circulatory recovery. Effective positive pressure ventilation (PPV) is associated with a rapid increase in heart rate (HR). The relationship between delivery of TV and HR responses remains unclear. OBJECTIVES: The study objectives were to determine (1) the relationship between a given TV during initial PPV and HR responses of depressed newborns, and (2) the optimal delivered TV associated with a rapid increase in HR...
June 9, 2017: Resuscitation
https://www.readbyqxmd.com/read/28605206/the-effect-of-a-holistic-self-management-plan-on-asthma-control
#15
Eirini Grammatopoulou, Emmanouil K Skordilis, Aikaterini Haniotou, Zarotis John, Spyros Athanasopoulos
The holistic self-management plan includes lifelong actions that enable patients to cope with their disease. The present study was designed to evaluate the effect of a holistic self-management plan on asthma control. A 12-month controlled study was conducted. Adult patients with mild-to-moderate asthma (n = 24) who attended the emergency asthma department were randomized to two groups: One group followed four educational sessions and three personal home sessions (n = 12), while a second group received a short manual with asthma information (n = 12)...
June 12, 2017: Physiotherapy Theory and Practice
https://www.readbyqxmd.com/read/28604996/one-lung-ventilation-for-thoracic-surgery-current-perspectives
#16
Filippo Bernasconi, Federico Piccioni
One-lung ventilation (OLV) is an anesthesiological technique that is increasingly being used beyond thoracic surgery. This requires specific skills and knowledge about airway management, maintenance of gas exchange and prevention of acute lung injury. Sometimes maintaining adequate gas exchange and minimizing acute lung injury may be opposing processes. Parameters validated for OLV titration still have not been found, but a multimodal approach based on low tidal volume, end-expiratory pressure application and alveolar recruitment maneuvers is considered the best way to ensure protective ventilation and reduce lung damage...
June 7, 2017: Tumori
https://www.readbyqxmd.com/read/28599888/cardiopulmonary-effects-of-pleural-insufflation-with-co2-during-two-lung-ventilation-in-dorsally-recumbent-anesthetized-horses
#17
Kaylee S Bohaychuk-Preuss, M Valentina Carrozzo, Tanya Duke-Novakovski
OBJECTIVE: To record the cardiopulmonary effects of pleural CO2 positive pressure insufflation in anesthetized horses. STUDY DESIGN: Prospective study. ANIMALS: Seven horses (mean ± standard deviation, 530.9 ± 68.1 kg) undergoing terminal surgery. METHODS: Horses were sedated with xylazine. Anesthesia was induced with ketamine-propofol and maintained with isoflurane, positive pressure ventilation, detomidine infusion, and butorphanol with the horses in dorsal recumbency...
January 10, 2017: Veterinary Anaesthesia and Analgesia
https://www.readbyqxmd.com/read/28598916/protective-lung-ventilation-and-morbidity-after-pulmonary-resection-a-propensity-score-matched-analysis
#18
David Amar, Hao Zhang, Alessia Pedoto, Dawn P Desiderio, Weiji Shi, Kay See Tan
BACKGROUND: Protective lung ventilation (PLV) during one-lung ventilation (OLV) for thoracic surgery is frequently recommended to reduce pulmonary complications. However, limited outcome data exist on whether PLV use during OLV is associated with less clinically relevant pulmonary morbidity after lung resection. METHODS: Intraoperative data were prospectively collected in 1080 patients undergoing pulmonary resection with OLV, intentional crystalloid restriction, and mechanical ventilation to maintain inspiratory peak airway pressure <30 cm H2O...
July 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28598909/cardiorespiratory-reference-data-in-older-adults-the-generation-100-study
#19
Dorthe Stensvold, Silvana Bucher Sandbakk, Hallgeir Viken, Nina Zisko, Line Skarsem Reitlo, Javaid Nauman, Svein Erik Gaustad, Erlend Hassel, Marcel Moufack, Eivind Brønstad, Nils Petter Aspvik, Vegard Malmo, Sigurd Loe Steinshamn, Asbjørn Støylen, Sigmund Alfred Anderssen, Jorunn L Helbostad, Øivind Rognmo, Ulrik Wisløff
PURPOSE: Cardiorespiratory fitness (CRF) is regarded a clinical vital sign, and accurate reference values for all age groups are essential. Little data exist on CRF and cardiorespiratory function in older adults. The aim of this study was to provide normative values for CRF and cardiorespiratory function in older adults, including people with history of cardiovascular diseases. METHODS: In total, 1537 (769 women) participants aged 70-77 underwent clinical examinations and cardiopulmonary exercise tests...
June 9, 2017: Medicine and Science in Sports and Exercise
https://www.readbyqxmd.com/read/28598023/nintedanib-reduces-ventilation-augmented-bleomycin-induced-epithelial-mesenchymal-transition-and-lung-fibrosis-through-suppression-of-the-src-pathway
#20
Li-Fu Li, Kuo-Chin Kao, Yung-Yang Liu, Chang-Wei Lin, Ning-Hung Chen, Chung-Shu Lee, Chih-Wei Wang, Cheng-Ta Yang
Mechanical ventilation (MV) used in patients with acute respiratory distress syndrome (ARDS) can increase lung inflammation and pulmonary fibrogenesis. Src is crucial in mediating the transforming growth factor (TGF)-β1-induced epithelial-mesenchymal transition (EMT) during the fibroproliferative phase of ARDS. Nintedanib, a multitargeted tyrosine kinase inhibitor that directly blocks Src, has been approved for the treatment of idiopathic pulmonary fibrosis. The mechanisms regulating interactions among MV, EMT and Src remain unclear...
June 9, 2017: Journal of Cellular and Molecular Medicine
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