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https://www.readbyqxmd.com/read/29045567/individualized-positive-end-expiratory-pressure-in-obese-patients-during-general-anaesthesia-a-randomized-controlled-clinical-trial-using-electrical-impedance-tomography
#1
C Nestler, P Simon, D Petroff, S Hammermüller, D Kamrath, S Wolf, A Dietrich, L M Camilo, A Beda, A R Carvalho, A Giannella-Neto, A W Reske, H Wrigge
Background: General anaesthesia leads to atelectasis, reduced end-expiratory lung volume (EELV), and diminished arterial oxygenation in obese patients. We hypothesized that a combination of a recruitment manoeuvre (RM) and individualized positive end-expiratory pressure (PEEP) can avoid these effects. Methods: Patients with a BMI ≥35 kg m-2 undergoing elective laparoscopic surgery were randomly allocated to mechanical ventilation with a tidal volume of 8 ml kg-1 predicted body weight and (i) an RM followed by individualized PEEP titrated using electrical impedance tomography (PEEPIND) or (ii) no RM and PEEP of 5 cm H2O (PEEP5)...
October 16, 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29045280/sedation-practice-in-extracorporeal-membrane-oxygenation-treated-patients-with-acute-respiratory-distress-syndrome-a-retrospective-study
#2
Julian deBacker, Erik Tamberg, Laveena Munshi, Lisa Burry, Eddy Fan, Sangeeta Mehta
Our objective was to characterize sedation management in adult patients with severe respiratory distress syndrome (ARDS) treated with venovenous extracorporeal membrane oxygenation (VV-ECMO). We conducted a retrospective chart review of these patients treated at Toronto General Hospital between January 2012 and October 2015. Medications administered (sedative, analgesic, paralytic, and antipsychotic), sedation depth (Sedation Agitation Scale [SAS] score) delirium assessments, and mobilization were recorded daily...
October 18, 2017: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/29043834/higher-peep-versus-lower-peep-strategies-for-patients-with-acute-respiratory-distress-syndrome-a-systematic-review-and-meta-analysis
#3
Allan J Walkey, Lorenzo Del Sorbo, Carol Hodgson, Neill Kj Adhikari, Hannah Wunsch, Maureen O Meade, Elizabeth Uleryk, Dean Hess, Daniel S Talmor, B Taylor Thompson, Roy G Brower, Eddy Fan
RATIONALE: Higher positive end-expiratory pressure (PEEP) levels may reduce atelectrauma but increase over-distention lung injury. Whether higher PEEP improves clinical outcomes among patients with acute respiratory distress syndrome (ARDS) is unclear. OBJECTIVE: To compare clinical outcomes of mechanical ventilation strategies using higher PEEP levels versus lower PEEP strategies in patients with ARDS. METHODS: We performed a systematic review and meta-analysis of clinical trials investigating mechanical ventilation strategies using higher versus lower PEEP levels...
October 18, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/29042484/accuracy-of-oxygen-flow-delivered-by-compressed-gas-cylinders-in-hospital-and-prehospital-emergency-care
#4
Frédéric Duprez, Jean Bernard Michotte, Gregory Cuvelier, Alexandre Legrand, Sharam Mashayekhi, Gregory Reychler
BACKGROUND: Oxygen cylinders are widely used both in hospital and prehospital care. Excessive or inappropriate FIO2 may be critical for patients with hypercapnia or hypoxia. Moreover, over-oxygenation could be deleterious in ischemic disorders. Supplemental oxygen from oxygen cylinder should therefore be delivered accurately. The aim of this study was to assess the accuracy of oxygen flows for oxygen cylinder in hospital and prehospital care. METHODS: A prospective trial was conducted to evaluate accuracy of delivered oxygen flows (2, 4, 6, 9 and 12 L/min) for different oxygen cylinder ready for use in different hospital departments...
October 17, 2017: Respiratory Care
https://www.readbyqxmd.com/read/29041920/intraoperative-continuous-cerebral-microcirculation-measurement-in-patients-with-aneurysmal-subarachnoid-hemorrhage-preliminary-data-on-the-early-administration-of-magnesium-sulfate
#5
Bjoern Sommer, Cornelia S Weidinger, Dennis Wolf, Michael Buchfelder, Hubert Schmitt
BACKGROUND: In patients with subarachnoid hemorrhage (SAH), vasospasm remains one of the major complications. The application of intravenous magnesium sulfate (MgSO4) has been under discussion to prevent cerebral ischemia. Our aim was to examine the impact of early MgSO4 administration on local cerebral microcirculation during microsurgical clipping of SAH-related aneurysms. METHODS: The non-invasive laser-Doppler spectrophotometry system "Oxygen-to-See (O2C)" was used in 14 consecutive patients (11 female, 3 male, median age 56...
October 17, 2017: BMC Anesthesiology
https://www.readbyqxmd.com/read/29038619/alteration-of-inflammatory-mediators-in-the-upper-and-lower-airways-under-chronic-intermittent-hypoxia-preliminary-animal-study
#6
Eun Jung Lee, Woon Heo, Joo Young Kim, Hyungchul Kim, Min Jung Kang, Bo Ra Kim, Ji Hyun Kim, Do Yang Park, Chang-Hoon Kim, Joo-Heon Yoon, Hyung-Ju Cho
PURPOSE: We hypothesized that CIH may affect the upper airway immune system and aimed to verify whether CIH can induce airway inflammation in a murine obstructive sleep apnea (OSA) model. METHODS: C57BL6 male mice were exposed to intermittent hypoxia (CIH group; 5 ~ 21% FiO2, 120 sec cycles, 12 h/d, n = 6) or room air (Sham group, n = 6) for up to 4 weeks in identical chambers. Nasal and lung tissues and lavage fluid were collected and analyzed by multiplex assay...
2017: Mediators of Inflammation
https://www.readbyqxmd.com/read/29038412/-effects-of-high-frequency-jet-ventilation-on-respiratory-failure-after-total-arch-replacement-due-to-acute-aortic-dissection-with-morbid-obesity-report-of-a-case
#7
Motoyuki Kumagai, Junichiro Nishizawa, Kazuhiro Takatoku, Takashi Ohba
A 55-year-old morbidly obese woman [body mass index (BMI) 51.2] developed acute type A aortic dissection, and she also presented with significant hypoxemia and hypercapnia. She underwent a successful emergency total arch replacement, but severe hypoxemia persisted and Pao2/Fio2 lowered to 71.9 mmHg. We therefore applied high frequency jet ventilation (HFJV), which soon improved the hypoxemia without hemodynamic compromise. HFJV was discontinued three days later, when her Pao2/Fio2 improved to 170.0 mmHg. Weaning from the respirator was initiated on postoperative day 13...
October 2017: Kyobu Geka. the Japanese Journal of Thoracic Surgery
https://www.readbyqxmd.com/read/29037528/driving-pressure-and-hospital-mortality-in-patients-without-ards-a-cohort-study
#8
Marcello F S Schmidt, Andre C K B Amaral, Eddy Fan, Gordon D Rubenfeld
BACKGROUND: Driving pressure is associated with mortality in patients with Acute Respiratory Distress Syndrome (ARDS) and with pulmonary complications in patients undergoing general anesthesia. Whether driving pressure is associated with outcomes of patients without ARDS ventilated in the intensive care unit is unknown. Our objective was to determine the independent association between driving pressure and outcomes in mechanically ventilated patients without ARDS on day 1 of mechanical ventilation...
October 13, 2017: Chest
https://www.readbyqxmd.com/read/29037221/high-flow-oxygen-via-nasal-cannulae-in-patients-with-acute-hypoxemic-respiratory-failure-a-systematic-review-and-meta-analysis
#9
Murdoch Leeies, Eric Flynn, Alexis F Turgeon, Bojan Paunovic, Hal Loewen, Rasheda Rabbani, Ahmed M Abou-Setta, Niall D Ferguson, Ryan Zarychanski
BACKGROUND: We performed a systematic review and meta-analysis to evaluate the efficacy and safety of high-flow oxygen via nasal cannulae (HFNC) compared to non-invasive ventilation (NIV) and/or standard oxygen in patients with acute, hypoxemic respiratory failure. METHODS: We reviewed randomized controlled trials from CENTRAL, EMBASE, MEDLINE, Scopus and the International Clinical Trials Registry Platform (inception to February 2016), conference proceedings, and relevant article reference lists...
October 16, 2017: Systematic Reviews
https://www.readbyqxmd.com/read/29033043/in%C3%A2-vivo-lung-perfusion-rehabilitates-sepsis-induced-lung-injury
#10
J Hunter Mehaffey, Eric J Charles, Sarah Schubert, Morgan Salmon, Ashish K Sharma, Dustin Money, Mark H Stoler, Victor E Laubach, Curtis G Tribble, Mark E Roeser, Irving L Kron
BACKGROUND: Sepsis is the leading cause of lung injury in adults and can lead to acute respiratory distress syndrome (ARDS). Using a novel technique of isolated in vivo lung perfusion (IVLP), we hypothesized that normothermic IVLP will improve oxygenation and compliance in a porcine model of sepsis-induced lung injury. METHODS: Mature adult swine (n = 8) were administered lipopolysaccharide (LPS; 50 μg/kg over 2 hours) via the external jugular vein, followed by sternotomy and central extracorporeal membrane oxygenation (ECMO) cannulation (right atrium to ascending aorta)...
September 14, 2017: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/29032960/correlation-between-oxyhaemoglobin-saturation-by-pulse-oximetry-and-partial-pressure-of-oxygen-in-patients-with-acute-respiratory-failure
#11
C Cinesi-Gómez, P García-García, I López-Pelayo, J I Giménez, L M González-Torres, E Bernal-Morell
OBJECTIVES: To ascertain the correlation between the partial pressure of oxygen (PaO2) and oxyhaemoglobin saturation by pulse oximetry (SpO2) in patients who were admitted to the emergency department with suspected acute respiratory failure. MATERIAL AND METHODS: A prospective, observational multicentre study was conducted in the emergency departments of 3 Spanish hospitals. RESULTS: The study included 166 patients who presented mean±standard deviation PaO2, SpO2 and fraction of inspired oxygen (FiO2) values of 61...
October 12, 2017: Revista Clínica Española
https://www.readbyqxmd.com/read/29030751/effects-of-regional-perfusion-block-in-healthy-and-injured-lungs
#12
Barbara Cambiaghi, Francesco Vasques, Onnen Mörer, Christian Ritter, Tommaso Mauri, Nils Kunze-Szikszay, Karin Holke, Francesca Collino, Giorgia Maiolo, Francesca Rapetti, Elias Schulze-Kalthoff, Tommaso Tonetti, Günter Hahn, Michael Quintel, Luciano Gattinoni
BACKGROUND: Severe hypoperfusion can cause lung damage. We studied the effects of regional perfusion block in normal lungs and in the lungs that had been conditioned by lavage with 500 ml saline and high V T (20 ml kg(-1)) ventilation. METHODS: Nineteen pigs (61.2 ± 2.5 kg) were randomized to five groups: controls (n = 3), the right lower lobe block alone (n = 3), lavage and high V T (n = 4), lung lavage, and high V T plus perfusion block of the right (n = 5) or left (n = 4) lower lobe...
October 13, 2017: Intensive Care Medicine Experimental
https://www.readbyqxmd.com/read/29028763/effects-of-hyperoxia-during-resuscitation-from-hemorrhagic-shock-in-swine-with-preexisting-coronary-artery-disease
#13
Clair Hartmann, Maurizio Loconte, Elena Antonucci, Michael Holzhauser, Tobias Hölle, David Katzsch, Tamara Merz, Oscar McCook, Ulrich Wachter, Josef A Vogt, Andrea Hoffmann, Martin Wepler, Michael Gröger, Martin Matejovic, Enrico Calzia, Michael Georgieff, Pierre Asfar, Peter Radermacher, Benedikt L Nussbaum
OBJECTIVES: Investigation of the effects of hyperoxia during resuscitation from hemorrhagic shock in swine with preexisting coronary artery disease. DESIGN: Prospective, controlled, randomized trial. SETTING: University animal research laboratory. SUBJECTS: Nineteen hypercholesterolemic pigs with preexisting coronary artery disease. INTERVENTIONS: Anesthetized, mechanically ventilated, and surgically instrumented pigs underwent 3 hours of hemorrhagic shock (removal of 30% of the calculated blood volume and subsequent titration of mean arterial blood pressure ≈40 mm Hg)...
October 12, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/29023857/preceding-haemorrhagic-shock-as-a-detrimental-risk-factor-for-respiratory-distress-after-excessive-allogeneic-blood-transfusion
#14
R Masuda, T Iijima, R Kondo, Y Itoda, M Matsuhashi, S Hashimoto, T Kohira, N Kobayashi, H Okazaki
BACKGROUND AND OBJECTIVES: Whether transfusion-associated circulatory overload arises as a simple result of over-transfusion or requires another trigger remains unclear. Here, we examined whether respiratory distress could be reproduced by massive transfusion alone in an animal model. MATERIALS AND METHODS: A total of 20 anaesthetized swine were equipped with monitors. Allogeneic blood was obtained from 10 donor swine. A 4-stage loading protocol with each stage equivalent to 25% of the blood volume (BV) in the recipient swine was then used to infuse crystalloid (CR), hydroxyethyl starch (HES) or allogeneic blood (TR) (n = 5 each)...
October 11, 2017: Vox Sanguinis
https://www.readbyqxmd.com/read/29023738/klf2-mediates-enhanced-chemoreflex-sensitivity-disordered-breathing-and-autonomic-dysregulation-in-heart-failure
#15
Noah J Marcus, Rodrigo Del Rio, Yanfeng Ding, Harold D Schultz
KEY POINTS: Enhanced carotid body chemoreflex activity contributes to development of disordered breathing patterns, autonomic dysregulation and increases in incidence of arrhythmia in animal models of reduced ejection fraction heart failure. Chronic reductions in carotid artery blood flow are associated with increased carotid body chemoreceptor activity. Krüppel-like Factor 2 (KLF2) is a shear stress-sensitive transcription factor that regulates the expression of enzymes which have previously been shown to play a role in increased chemoreflex sensitivity...
September 6, 2017: Journal of Physiology
https://www.readbyqxmd.com/read/29019530/efficacy-of-prone-position-in-acute-respiratory-distress-syndrome-overview-of-systematic-reviews
#16
Michel Marcos Dalmedico, Dafne Salas, Andrey Maciel de Oliveira, Fátima Denise Padilha Baran, Jéssica Tereza Meardi, Michelle Caroline Santos
OBJECTIVE: To identify and integrate the available scientific evidence related to the use of the prone position in patients with acute respiratory distress syndrome for the reduction of the outcome variable of mortality compared to the dorsal decubitus position. METHOD: Overview of systematic reviews or meta-analyzes of randomized clinical trials. It included studies that evaluated the use of prone positioning in patients with acute respiratory distress syndrome published between 2014 and 2016...
October 9, 2017: Revista da Escola de Enfermagem da U S P
https://www.readbyqxmd.com/read/28992392/norepinephrine-infusion-improves-hemodynamics-in-the-preterm-infants-during-septic-shock
#17
M Y Rizk, A Lapointe, F Lefebvre, K J Barrington
AIM: This study evaluated the clinical and hemodynamic effects of norepinephrine infusion in preterm infants. METHODS: The effects of norepinephrine therapy for refractory hypotension were evaluated in preterm infants between April 2009 and April 2011 at the neonatal intensive care unit of Sainte-Justine Hospital, Montreal, Quebec. Changes in hemodynamics and clinical parameters were analyzed eight hours before and eight hours after the start of norepinephrine infusion, and eight hours after its cessation...
October 9, 2017: Acta Paediatrica
https://www.readbyqxmd.com/read/28988158/outcomes-of-oxygen-saturation-targeting-during-delivery-room-stabilisation-of-preterm-infants
#18
Ju Lee Oei, Neil N Finer, Ola Didrik Saugstad, Ian M Wright, Yacov Rabi, William Tarnow-Mordi, Wade Rich, Vishal Kapadia, Denise Rook, John P Smyth, Kei Lui, Maximo Vento
OBJECTIVE: To determine the association between SpO2 at 5 min and preterm infant outcomes. DESIGN: Data from 768 infants <32 weeks gestation from 8 randomised controlled trials (RCTs) of lower (≤0.3) versus higher (≥0.6) initial inspiratory fractions of oxygen (FiO2) for resuscitation, were examined. SETTING: Individual patient analysis of 8 RCTs INTERVENTIONS: Lower (≤0.3) versus higher (≥0.6) oxygen resuscitation strategies targeted to specific predefined SpO2 before 10 min of age...
October 7, 2017: Archives of Disease in Childhood. Fetal and Neonatal Edition
https://www.readbyqxmd.com/read/28985608/the-role-of-neutrophil-gelatinase-associated-lipocalin-ngal-in-the-detection-of-blast-lung-injury-in-a-military-population
#19
Andrew Lumley, Erik Osborn, Adrian Mellor, Elise LaCroix, George Johnson, Mary Wallace, Mike Stacey, Jason E Smith, David Woods
PURPOSE: To study the relationship between serum neutrophil gelatinase-associated lipocalin (NGAL) and military blast and gunshot wound (GSW) to establish whether potential exists for NGAL as a biomarker for blast lung injury (BLI). METHOD: Patients from the intensive care unit (ICU) of the Role 3 Medical Treatment Facility at Camp Bastion, Helmand Province, Afghanistan were studied over a five month period commencing in 2012. Age, mechanism, trauma injury severity score (TRISS) and serum NGAL were recorded on ICU admission (NGAL1)...
September 1, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28984373/pulmonary-ultrasound-scoring-system-for-intubated-critically-ill-patients-and-its-association-with-clinical-metrics-and-mortality-a-prospective-cohort-study
#20
David M Tierney, Lori L Boland, Josh D Overgaard, Joshua S Huelster, Ann Jorgenson, James P Normington, Roman R Melamed
PURPOSE: Pulmonary ultrasound (PU) examination at the point-of-care can rapidly identify the etiology of acute respiratory failure (ARF) and assess treatment response. The often-subjective classification of PU abnormalities makes it difficult to document change over time and communicate findings across providers. The study goal was to develop a simple, PU scoring system that would allow for standardized documentation, have high interprovider agreement, and correlate with clinical metrics...
October 6, 2017: Journal of Clinical Ultrasound: JCU
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