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Respiratory Mechanical Ventilation

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https://www.readbyqxmd.com/read/29444340/antipsychotics-delirium-and-acute-respiratory-distress-syndrome-what-is-the-link
#1
Heather Torbic, Abhijit Duggal
Acute respiratory distress syndrome (ARDS) is an acute inflammatory process that impairs the ability of the lungs to oxygenate and ultimately leads to respiratory failure. Patients who develop ARDS often have prolonged and complicated hospital courses putting them at risk for intensive care unit (ICU) delirium. Patients with ICU delirium often need chemical sedation, mechanical ventilation, prolonged duration of ICU and hospital stays, long-term cognitive impairment, and increased mortality. In a patient with ARDS, ICU delirium further complicates the hospital course and increases the risk of morbidly and mortality...
February 14, 2018: Pharmacotherapy
https://www.readbyqxmd.com/read/29442057/inguinal-hernia-repair-in-day-surgery-the-role-of-mac-monitored-anesthesia-care-with-remifentanil
#2
P Palumbo, S Usai, C Amatucci, B Perotti, L Ruggeri, G Illuminati, G Tellan
BACKGROUND: The extension of indications for procedures in a Day Surgery (DS) setting has led to changes in the anesthetic and surgical treatment of Inguinal Hernias (IH). According to the recommendations of the European Hernia Society, the treatment of IH in DS units should be performed under Monitored Anesthesia Care (MAC). PATIENTS AND METHODS: 960 patients underwent IH repairs over a period of 24 months. The patients were randomly divided into two groups: R (remifentanil) and F (fentanyl); the group F was considered as a control group...
November 2017: Il Giornale di Chirurgia
https://www.readbyqxmd.com/read/29439205/inhaled-nitric-oxide-in-extremely-premature-neonates-with-respiratory-distress-syndrome
#3
William A Carey, Amy L Weaver, Kristin C Mara, Reese H Clark
BACKGROUND: Inhaled nitric oxide (iNO) is increasingly prescribed to extremely premature neonates with respiratory distress syndrome (RDS). Most of this off-label use occurs during the first week of life. We studied this practice, hypothesizing that it would not be associated with improved survival. METHODS: We queried the Pediatrix Medical Group Clinical Data Warehouse to identify all neonates born at 22 to 29 weeks' gestation from 2004 to 2014. In our study sample, we included singletons who required mechanical ventilation for treatment of RDS and excluded those with anomalies...
February 9, 2018: Pediatrics
https://www.readbyqxmd.com/read/29438332/diaphragmatic-palsy
#4
REVIEW
Laxmi Kokatnur, Mohan Rudrappa
The diaphragm is the primary muscle of respiration, and its weakness can lead to respiratory failure. Diaphragmatic palsy can be caused by various causes. Injury to the phrenic nerve during thoracic surgeries is the most common cause for diaphragmatic palsy. Depending on the cause, the symptoms of diaphragmatic palsies vary from completely asymptomatic to disabling dyspnea requiring mechanical ventilation. On pulmonary function tests, there will be a decrease in the maximum respiratory muscle power. Spirometry shows reduced lung functions and a significant drop of lung function in supine position is typical of diaphragmatic palsy...
February 13, 2018: Diseases (Basel)
https://www.readbyqxmd.com/read/29437939/evolution-of-respiratory-function-in-duchenne-muscular-dystrophy-from-childhood-to-adulthood
#5
Antonella LoMauro, Marianna Romei, Sandra Gandossini, Riccardo Pascuzzo, Simone Vantini, Maria Grazia D'Angelo, Andrea Aliverti
In Duchenne muscular dystrophy (DMD), it is still to be determined if specific timepoints can be identified during the natural evolution of respiratory dysfunction from childhood to adulthood and if scoliosis, steroid therapy and nocturnal noninvasive mechanical ventilation (NIMV) have any effect on it.In a 7-year retrospective study performed on 115 DMD patients (6-24 years), evaluated once or twice per year, with 574 visits in total, evolution mean curves of spirometry, lung volumes, spontaneous breathing and thoraco-abdominal pattern (measured by optoelectronic plethysmography) parameters were obtained by nonlinear regression model analysis...
February 2018: European Respiratory Journal: Official Journal of the European Society for Clinical Respiratory Physiology
https://www.readbyqxmd.com/read/29437006/enteral-administration-of-tkis-report-of-a-response-to-ceritinib-in-an-alk-positive-nsclc-patient-and-literature-review
#6
Francesco Facchinetti, Paola Bordi, Paola Bini, Livia Bidin, Roberta Camisa, Marcello Tiseo
INTRODUCTION: Several reports attest the feasibility and the favorable outcomes of kinase inhibitors administration through feeding tubes or percutaneous endoscopic gastrostomies (PEG), mainly in non-small cell lung cancer (NSCLC) patients exposed to first-generation compounds. Here we present the case of an ALK-positive NSCLC patient who achieved cerebral and extra-cranial disease response with ceritinib (a novel ALK inhibitor) administered through a nasogastric tube (NGT). We moreover provide a review gathering clinical successes obtained with targeted agents intake through NGT or PEG...
February 12, 2018: Current Drug Targets
https://www.readbyqxmd.com/read/29436355/care-of-the-neonate-on-nasal-continuous-positive-airway-pressure-a-bedside-guide
#7
Jennifer M Guay, Dru Carvi, Deborah A Raines, Wendy A Luce
Respiratory distress continues to be a major cause of neonatal morbidity. Current neonatal practice recommends the use of nasal continuous positive airway pressure (nCPAP) in the immediate resuscitation and continued support of neonates of all gestations with clinical manifestations of respiratory distress. Despite the many short- and long-term benefits of nCPAP, many neonatal care units have met resistance in its routine use. Although there have been numerous recent publications investigating the use and outcomes of various modes of nCPAP delivery, surfactant administration, mechanical ventilation, and other forms of noninvasive respiratory support (high-flow nasal cannula, nasal intermittent positive pressure ventilation), there has been a relative lack of publications addressing the practical bedside care of infants managed on nCPAP...
January 1, 2018: Neonatal Network: NN
https://www.readbyqxmd.com/read/29435738/alveolar-tidal-recruitment-derecruitment-and-overdistension-during-four-levels-of-end-expiratory-pressure-with-protective-tidal-volume-during-anesthesia-in-a-murine-lung-healthy-model
#8
Joao Henrique Neves Soares, Alysson Roncally Carvalho, Bruno Curty Bergamini, Maria Alice Kuster Gress, Frederico Caetano Jandre, Walter Araujo Zin, Antonio Giannella-Neto
PURPOSE: We compared respiratory mechanics between the positive end-expiratory pressure of minimal respiratory system elastance (PEEP minErs ) and three levels of PEEP during low-tidal-volume (6 mL/kg) ventilation in rats. METHODS: Twenty-four rats were anesthetized, paralyzed, and mechanically ventilated. Airway pressure (P aw ), flow (F), and volume (V) were fitted by a linear single compartment model (LSCM) P aw (t) = E rs × V(t) + R rs × F(t) + PEEP or a volume- and flow-dependent SCM (VFDSCM) P aw (t) = (E 1 + E 2 × V(t)) × V(t) + (K 1 + K 2 × |F(t)|) × F(t) + PEEP, where E rs and R rs are respiratory system elastance and resistance, respectively; E 1 and E 2 × V are volume-independent and volume-dependent E rs , respectively; and K 1 and K 2 × F are flow-independent and flow-dependent R rs , respectively...
February 12, 2018: Lung
https://www.readbyqxmd.com/read/29434789/effects-of-pumpless-extracorporeal-lung-assist-on-hemodynamics-gas-exchange-and-inflammatory-cascade-response-during-experimental-lung-injury
#9
Zhihai Ju, Jinhui Ma, Chen Wang, Jie Yu, Yeru Qiao, Feilong Hei
Pumpless extracorporeal lung assist (pECLA) has been reported to efficiently remove the systemic CO 2 production and provide mild to moderate oxygenation, thereby allowing for ventilator settings and modes prioritizing oxygenation and lung protection. However, an adequate bypass flow, the capacity to provide respiratory support and the effect on the inflammatory cascade response and tissue perfusion require further study to be determined. After induction of acute lung injury (ALI) by oleic acid injection, pECLA was implemented in 12 anaesthetized and mechanically ventilated dogs for 48 h...
February 2018: Experimental and Therapeutic Medicine
https://www.readbyqxmd.com/read/29434764/pediatric-acute-respiratory-distress-syndrome-current-views
#10
Jinfeng Liu, Wei Wang, Fengli Liu, Zhenguang Li
Acute respiratory distress syndrome (ARDS) mainly involves acute respiratory failure. In addition to this affected patients feel progressive arterial hypoxemia, dyspnea, and a marked increase in the work of breathing. The only clinical solution for the above pathological state is ventilation. Mechanical ventilation is necessary to support life in ARDs but it itself worsen lung injury and the term is known clinically as 'ventilation induced lung injury' (VILI). At the cellular level, respiratory epithelial cells are subjected to cyclic stretch, i...
February 2018: Experimental and Therapeutic Medicine
https://www.readbyqxmd.com/read/29433792/clinical-characteristics-of-influenza-virus-induced-lower-respiratory-infection-during-the-2015-to-2016-season
#11
Kazuhiro Uda, Kensuke Shoji, Chitose Koyama-Wakai, Munehiro Furuichi, Noriyasu Iwase, Seiichiro Fujisaki, Shinji Watanabe, Isao Miyairi
BACKGROUND: Influenza A(H1N1)pdm09 virus infections often manifest severe respiratory symptoms, particularly in patients with a past history of allergic disease. Most of these findings were reported during the 2009 pandemic. The purpose of this study was to detail the clinical characteristics of influenza virus-induced lower respiratory infection (LRI) during the A(H1N1)pdm09-predominant 2015-2016 season. METHODS: We retrospectively reviewed the clinical characteristics of influenza-induced LRI cases in children admitted to a tertiary children's hospital...
February 9, 2018: Journal of Infection and Chemotherapy: Official Journal of the Japan Society of Chemotherapy
https://www.readbyqxmd.com/read/29432712/expiratory-flow-limitation-during-mechanical-ventilation
#12
REVIEW
Detajin Junhasavasdikul, Irene Telias, Domenico Luca Grieco, Lu Chen, Cinta Millan Gutierrez, Thomas Piraino, Laurent Brochard
Expiratory flow limitation (EFL) is present when the flow cannot rise despite an increase of the expiratory driving pressure. The mechanisms of EFL are debated but are thought to be related to the collapsibility of small airways. In mechanically ventilated patients, EFL can exist during tidal ventilation, representing an extreme situation where lung volume cannot decrease whatever the expiratory driving forces. It is a key factor for the generation of auto- or intrinsic positive end-expiratory pressure (auto-PEEP or PEEPi) and requires specific management such as positioning and adjustment of external PEEP...
February 9, 2018: Chest
https://www.readbyqxmd.com/read/29432350/an-exploratory-reanalysis-of-the-randomized-trial-on-efficacy-of-corticosteroids-as-rescue-therapy-for-the-late-phase-of-acute-respiratory-distress-syndrome
#13
G Umberto Meduri, Lisa Bridges, Reed A C Siemieniuk, Mehmet Kocak
OBJECTIVES: In the Acute Respiratory Distress Syndrome Network randomized controlled trial, methylprednisolone treatment was associated with increased return to mechanical ventilation with partial loss of early improvements. We hypothesize a causal relationship between protocol-driven rapid discontinuation of methylprednisolone post extubation and return to mechanical ventilation. To explore this possibility, we investigated the timing that events occurred in each treatment arm during active treatment intervention (efficacy) and after stopping therapy...
February 9, 2018: Critical Care Medicine
https://www.readbyqxmd.com/read/29431700/influence-of-tidal-volume-and-positive-end-expiratory-pressure-on-ventilation-distribution-and-oxygenation-during-one-lung-ventilation
#14
Zhanqi Zhao, Wei Wang, Zuojing Zhang, Meiying Xu, Inez Frerichs, Jing-Xiang Wu, Knut Moeller
The aim of the study was to explore the feasibility of titrating tidal volume (VT) and positive end-expiratory pressure (PEEP) during one-lung ventilation (OLV) based on ventilation distribution and oxygenation. Approach: Twenty four consecutive patients requiring intubation with a double-lumen tube and subsequent OLV for thoracic surgical procedures were examined prospectively in lateral posture. Electrical impedance tomography (EIT), blood gases, respiratory mechanics were successfully measured in 21 patients at various combinations of VT (4 ml/kg, 6 ml/kg, 8 ml/kg body weight) and PEEP (0 cmH2O, 4 cmH2O, 8 cmH2O) during OLV...
February 12, 2018: Physiological Measurement
https://www.readbyqxmd.com/read/29430454/effects-of-hypercapnia-in-acute-respiratory-distress-syndrome
#15
REVIEW
Nicolás Nin, Martín Angulo, Arturo Briva
In patients with acute respiratory distress syndrome (ARDS) hypercapnia is a marker of poor prognosis, however there is controversial information regarding the effect of hypercapnia on outcomes. Recently two studies in a large population of mechanical ventilation patients showed higher mortality associated independently to hypercapnia. Key roles responsible for the poor clinical outcomes observed in critically ill patients exposed to hypercapnia are not well known, two possible mechanisms involved are the effect of CO 2 on the muscle and the alveolar epithelium...
January 2018: Annals of Translational Medicine
https://www.readbyqxmd.com/read/29430451/micrornas-as-biomarkers-of-acute-lung-injury
#16
REVIEW
Antonio Ferruelo, Óscar Peñuelas, José A Lorente
Acute respiratory distress syndrome (ARDS) is a common and complex inflammatory lung diseases affecting critically ill patients requiring mechanical ventilation. MicroRNAs (miRNAs), a novel pathway of non-coding RNA molecules that regulate gene expression at the post-transcriptional level, have emerged as a novel class of gene expression, and can play important roles in inflammation or apoptosis, which are common manifestations of ARDS and diffuse alveolar damage (DAD). In the present review, we discuss the role of miRNAs as biomarkers of ARDS and DAD, and their potential use as therapeutic targets for this condition...
January 2018: Annals of Translational Medicine
https://www.readbyqxmd.com/read/29430448/extracorporeal-carbon-dioxide-removal-in-acute-exacerbations-of-chronic-obstructive-pulmonary-disease
#17
REVIEW
Tommaso Pettenuzzo, Eddy Fan, Lorenzo Del Sorbo
Extracorporeal carbon dioxide removal (ECCO 2 R) has been proposed as an adjunctive intervention to avoid worsening respiratory acidosis, thereby preventing or shortening the duration of invasive mechanical ventilation (IMV) in patients with exacerbation of chronic obstructive pulmonary disease (COPD). This review will present a comprehensive summary of the pathophysiological rationale and clinical evidence of ECCO 2 R in patients suffering from severe COPD exacerbations.
January 2018: Annals of Translational Medicine
https://www.readbyqxmd.com/read/29430447/mechanisms-involved-in-brain-dysfunction-in-mechanically-ventilated-critically-ill-patients-implications-and-therapeutics
#18
REVIEW
Marc Turon, Sol Fernández-Gonzalo, Candelaria de Haro, Rudys Magrans, Josefina López-Aguilar, Lluís Blanch
Critical illness may lead to significant long-term neurological morbidity and patients frequently develop neuropsychological disturbances including acute delirium or memory impairment after intensive care unit (ICU) discharge. Mechanical ventilation (MV) is a risk factor to the development of adverse neurocognitive outcomes. Patients undergoing MV for long periods present neurologic impairment with memory and cognitive alteration. Delirium is considered an acute form of brain dysfunction and its prevalence rises in mechanically ventilated patients...
January 2018: Annals of Translational Medicine
https://www.readbyqxmd.com/read/29430444/heart-lung-interactions-in-acute-respiratory-distress-syndrome-pathophysiology-detection-and-management-strategies
#19
REVIEW
Fernando Suarez Sipmann, Arnoldo Santos, Gerardo Tusman
Acute respiratory distress syndrome (ARDS) is the most severe form of acute respiratory failure characterized by diffuse alveolar and endothelial damage. The severe pathophysiological changes in lung parenchyma and pulmonary circulation together with the effects of positive pressure ventilation profoundly affect heart lung interactions in ARDS. The term pulmonary vascular dysfunction (PVD) refers to the specific involvement of the vascular compartment in ARDS and is expressed clinically by an increase in pulmonary arterial (PA) pressure and pulmonary vascular resistance both affecting right ventricular (RV) afterload...
January 2018: Annals of Translational Medicine
https://www.readbyqxmd.com/read/29430443/electrical-impedance-tomography
#20
REVIEW
Beatriz Lobo, Cecilia Hermosa, Ana Abella, Federico Gordo
Continuous assessment of respiratory status is one of the cornerstones of modern intensive care unit (ICU) monitoring systems. Electrical impedance tomography (EIT), although with some constraints, may play the lead as a new diagnostic and guiding tool for an adequate optimization of mechanical ventilation in critically ill patients. EIT may assist in defining mechanical ventilation settings, assess distribution of tidal volume and of end-expiratory lung volume (EELV) and contribute to titrate positive end-expiratory pressure (PEEP)/tidal volume combinations...
January 2018: Annals of Translational Medicine
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