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Ventilatory drive

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https://www.readbyqxmd.com/read/29667182/breathing-regulation-and-blood-gas-homeostasis-after-near-complete-lesions-of-the-retrotrapezoid-nucleus-in-adult-rats
#1
George M P R Souza, Roy Kanbar, Daniel S Stornetta, Stephen B G Abbott, Ruth L Stornetta, Patrice G Guyenet
The retrotrapezoid nucleus (RTN) is one of several CNS nuclei that contribute, in various capacities (e.g. CO2 detection, neuronal modulation) to the central respiratory chemoreflex (CRC). Here we test how important the RTN is to PCO2 homeostasis and breathing during sleep or wake. RTN Nmb positive neurons were killed with targeted microinjections of substance-P-saporin conjugate in adult rats. Under normoxia, rats with large RTN lesions (92 ± 4 % cell loss) had normal blood pressure (BP) and arterial pH but were hypoxic (-8 mmHg PaO2 ) and hypercapnic (+10 mmHg PaCO2 )...
April 18, 2018: Journal of Physiology
https://www.readbyqxmd.com/read/29575957/ventilator-induced-lung-injury-during-controlled-ventilation-in-patients-with-acute-respiratory-distress-syndrome-less-is-probably-better
#2
Fernanda Ferreira Cruz, Lorenzo Ball, Patricia Rieken Macedo Rocco, Paolo Pelosi
Mechanical ventilation is required to support respiratory function in the acute respiratory distress syndrome (ARDS), but it may promote lung damage, a phenomenon known as ventilator-induced lung injury (VILI). Areas covered: Several mechanisms of VILI have been described, such as: inspiratory and/or expiratory stress inducing overdistension (volutrauma); interfaces between collapsed or edema-filled alveoli with surrounding open alveoli, acting as stress raisers; alveoli that repetitively open and close during tidal breathing (atelectrauma); and peripheral airway dynamics...
March 26, 2018: Expert Review of Respiratory Medicine
https://www.readbyqxmd.com/read/29566734/acute-exacerbation-of-idiopathic-pulmonary-fibrosis-lessons-learned-from-acute-respiratory-distress-syndrome
#3
REVIEW
Alessandro Marchioni, Roberto Tonelli, Lorenzo Ball, Riccardo Fantini, Ivana Castaniere, Stefania Cerri, Fabrizio Luppi, Mario Malerba, Paolo Pelosi, Enrico Clini
Idiopathic pulmonary fibrosis (IPF) is a fibrotic lung disease characterized by progressive loss of lung function and poor prognosis. The so-called acute exacerbation of IPF (AE-IPF) may lead to severe hypoxemia requiring mechanical ventilation in the intensive care unit (ICU). AE-IPF shares several pathophysiological features with acute respiratory distress syndrome (ARDS), a very severe condition commonly treated in this setting.A review of the literature has been conducted to underline similarities and differences in the management of patients with AE-IPF and ARDS...
March 23, 2018: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29564726/potentially-modifiable-respiratory-variables-contributing-to-outcome-in-icu-patients-without-ards-a-secondary-analysis-of-provent
#4
Fabienne D Simonis, Carmen S V Barbas, Antonio Artigas-Raventós, Jaume Canet, Rogier M Determann, James Anstey, Goran Hedenstierna, Sabrine N T Hemmes, Greet Hermans, Michael Hiesmayr, Markus W Hollmann, Samir Jaber, Ignacio Martin-Loeches, Gary H Mills, Rupert M Pearse, Christian Putensen, Werner Schmid, Paolo Severgnini, Roger Smith, Tanja A Treschan, Edda M Tschernko, Marcos F Vidal Melo, Hermann Wrigge, Marcelo Gama de Abreu, Paolo Pelosi, Marcus J Schultz, Ary Serpa Neto
BACKGROUND: The majority of critically ill patients do not suffer from acute respiratory distress syndrome (ARDS). To improve the treatment of these patients, we aimed to identify potentially modifiable factors associated with outcome of these patients. METHODS: The PRoVENT was an international, multicenter, prospective cohort study of consecutive patients under invasive mechanical ventilatory support. A predefined secondary analysis was to examine factors associated with mortality...
March 21, 2018: Annals of Intensive Care
https://www.readbyqxmd.com/read/29528526/minocycline-alters-expression-of-inflammatory-markers-in-autonomic-brain-areas-and-ventilatory-responses-induced-by-acute-hypoxia
#5
Talita M Silva, Laiali J Chaar, Reinaldo C Silva, Ana C Takakura, Niels O Câmara, Vagner R Antunes, Thiago S Moreira
NEW FINDINGS: What is the central question of this study? Microglia are presumably the source of inflammatory mediators, which contribute to hypoxia-induced neuroinflammation. However, the relationship between microglia activity during hypoxia and inflammatory responses in specific autonomic brain regions is not well understood. Therefore, we hypothesize that acute hypoxia (AH) initiates an immune response in the central nervous system elicited by an increased expression of inflammatory mediators in specific brain areas related to autonomic control...
March 12, 2018: Experimental Physiology
https://www.readbyqxmd.com/read/29487747/extranodal-non-b-non-t-cell-lymphoma-with-bilateral-tympanic-bulla-involvement-in-a-cat
#6
Austin T Kerns, Kelsey A Brakel, Christopher Premanandan, Ashlie Saffire, Sarah A Moore
Case summary: A 9-year-old spayed female domestic shorthair cat with clinical signs suggestive of chronic recurrent otitis media and recent seizures was presented with multifocal nervous system disease, including bilateral central and/or peripheral vestibular, cerebellar and forebrain deficits. Prior to presentation, there was inadequate improvement after 6 weeks of treatment for bilateral middle ear effusion from which a highly susceptible Staphylococcus species was cultured. This was followed by the development of seizures...
January 2018: JFMS Open Reports
https://www.readbyqxmd.com/read/29474404/role-of-acid-sensing-ion-channels-in-hypoxia-and-hypercapnia-induced-ventilatory-responses
#7
Neil D Detweiler, Kenneth G Vigil, Thomas C Resta, Benjimen R Walker, Nikki L Jernigan
Previous reports indicate roles for acid-sensing ion channels (ASICs) in both peripheral and central chemoreception, but the contributions of ASICs to ventilatory drive in conscious, unrestrained animals remain largely unknown. We tested the hypotheses that ASICs contribute to hypoxic- and hypercapnic-ventilatory responses. Blood samples taken from conscious, unrestrained mice chronically instrumented with femoral artery catheters were used to assess arterial O2, CO2, and pH levels during exposure to inspired gas mixtures designed to cause isocapnic hypoxemia or hypercapnia...
2018: PloS One
https://www.readbyqxmd.com/read/29357505/chemoreflex-mediated-arrhythmia-during-apnea-at-5-050-m-in-low-but-not-high-altitude-natives
#8
Stephen A Busch, Hannah Davies, Sean van Diepen, Lydia L Simpson, Frances Sobierajski, Laurel Riske, Mike Stembridge, Philip N Ainslie, Christopher K Willie, Ryan Hoiland, Jonathan P Moore, Craig D Steinback
Peripheral chemoreflex mediated increases in both parasympathetic and sympathetic drive under chronic hypoxia may evoke bradyarrhythmias during apneic periods. We determined whether 1) voluntary apnea unmasks arrhythmia at low (344 m) and high (5,050 m) altitude, 2) high-altitude natives (Nepalese Sherpa) exhibit similar cardiovagal responses at altitude, and 3) bradyarrhythmias at altitude are partially chemoreflex mediated. Participants were grouped as Lowlanders ( n = 14; age = 27 ± 6 yr) and Nepalese Sherpa ( n = 8; age = 32 ± 11 yr)...
April 1, 2018: Journal of Applied Physiology
https://www.readbyqxmd.com/read/29327943/phenotyping-pharyngeal-pathophysiology-using-polysomnography-in-patients-with-obstructive-sleep-apnea
#9
Scott A Sands, Bradley A Edwards, Philip I Terrill, Luigi Taranto-Montemurro, Ali Azarbarzin, Melania Marques, Lauren Hess, David P White, Andrew Wellman
RATIONALE: Therapies for obstructive sleep apnea (OSA) could be administered based on a patient's own phenotypic causes ("traits") if a clinically-applicable approach were available. Here we present a novel approach to quantify two key contributors to OSA-pharyngeal collapsibility and compensatory muscle responsiveness-that is applicable to diagnostic polysomnography. METHODS: Based on physiological definitions, pharyngeal collapsibility determines the ventilation at normal (eupneic) ventilatory drive during sleep, and pharyngeal compensation determines the rise in ventilation accompanying a rising ventilatory drive...
January 12, 2018: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/29228393/quantifying-the-arousal-threshold-using-polysomnography-in-obstructive-sleep-apnea
#10
Scott A Sands, Philip I Terrill, Bradley A Edwards, Luigi Taranto Montemurro, Ali Azarbarzin, Melania Marques, Camila M de Melo, Stephen H Loring, James P Butler, David P White, Andrew Wellman
Study Objectives: Precision medicine for obstructive sleep apnea (OSA) requires noninvasive estimates of each patient's pathophysiological "traits." Here, we provide the first automated technique to quantify the respiratory arousal threshold-defined as the level of ventilatory drive triggering arousal from sleep-using diagnostic polysomnographic signals in patients with OSA. Methods: Ventilatory drive preceding clinically scored arousals was estimated from polysomnographic studies by fitting a respiratory control model (Terrill et al...
January 1, 2018: Sleep
https://www.readbyqxmd.com/read/29184292/cardiopulmonary-rehabilitation-program-impact-on-prognostic-markers-in-selected-patients-with-resting-and-exercise-induced-ventilatory-inefficiency-a-clinical-trial
#11
Sherin Hassan M Mehani, Heba Ahmed A Abdeen
[Purpose] Ventilatory limitation is a common problem in patients with chronic heart failure and pulmonary hypertension. Excess ventilation may arise from augmented ventilatory drive, over activity of chemoreceptors and muscle ergoreceptors, or premature onset of lactic acidosis. Exertional dyspnea can cause limitations in the activities of daily living and as a result, reduced quality of life for these patients. The aim of the present study was to evaluate the effect of cardiopulmonary rehabilitation program on ventilatory efficiency for these patients...
October 2017: Journal of Physical Therapy Science
https://www.readbyqxmd.com/read/29150452/a-metabolic-hypothesis-for-the-evolution-of-temperature-effects-on-the-arterial-p-co-2-and-ph-of-vertebrate-ectotherms
#12
Stanley S Hillman, Michael S Hedrick
Body temperature increases in ectothermic vertebrates characteristically lead to both increases in arterial P CO2  ( P aCO2 ) and declines in resting arterial pH (pHa) of about 0.017 pH units per 1°C increase in temperature. This 'alphastat' pH pattern has previously been interpreted as being evolutionarily driven by the maintenance of a constant protonation state on the imidazole moiety of histidine protein residues, hence stabilizing protein structure-function. Analysis of the existing data for interclass responses of ectothermic vertebrates shows different degrees of P aCO2  increases and pH declines with temperature between the classes, with reptiles>amphibians>fish...
January 4, 2018: Journal of Experimental Biology
https://www.readbyqxmd.com/read/29135500/association-of-driving-pressure-with-mortality-among-ventilated-patients-with-acute-respiratory-distress-syndrome-a-systematic-review-and-meta-analysis
#13
Hiroko Aoyama, Tommaso Pettenuzzo, Kazuyoshi Aoyama, Ruxandra Pinto, Marina Englesakis, Eddy Fan
OBJECTIVES: A recent post hoc analysis suggested that driving pressure may be more important than traditional ventilatory variables in determining outcome in mechanically ventilated patients with acute respiratory distress syndrome. We conducted a systematic review and meta-analysis to summarize the risk of mortality for higher versus lower driving pressure. DATA SOURCES: MEDLINE, EMBASE, PubMed, CINAHL, and Cochrane CENTRAL from inception to February 10, 2017. STUDY SELECTION: Studies including mechanically ventilated adult patients with acute respiratory distress syndrome, reporting driving pressure and mortality...
February 2018: Critical Care Medicine
https://www.readbyqxmd.com/read/29114876/translating-carotid-body-function-into-clinical-medicine
#14
Rodrigo Iturriaga
The carotid body (CB) is considered the main O2 chemoreceptor, which contributes to the cardiorespiratory homeostasis and ventilatory acclimatization. In clinical medicine, the most common pathology associated with the CB are tumours. However, a growing body of evidences supports the novel idea that an enhanced CB chemosensory discharge contributes to the autonomic dysfunction and pathological consequences in obstructive sleep apnoea (OSA), hypertension, systolic heart failure (HF) and cardiometabolic diseases...
November 8, 2017: Journal of Physiology
https://www.readbyqxmd.com/read/29097629/increased-respiratory-neural-drive-and-work-of-breathing-in-exercise-induced-laryngeal-obstruction
#15
Emil S Walsted, Azmy Faisal, Caroline J Jolley, Laura L Swanton, Matthew J Pavitt, Yuan-Ming Luo, Vibeke Backer, Michael I Polkey, James H Hull
Exercise-induced laryngeal obstruction (EILO), a phenomenon in which the larynx closes inappropriately during physical activity, is a prevalent cause of exertional dyspnea in young individuals. The physiological ventilatory impact of EILO and its relationship to dyspnea are poorly understood. The objective of this study was to evaluate exercise-related changes in laryngeal aperture on ventilation, pulmonary mechanics, and respiratory neural drive. We prospectively evaluated 12 subjects (6 with EILO and 6 healthy age- and gender-matched controls)...
February 1, 2018: Journal of Applied Physiology
https://www.readbyqxmd.com/read/29060280/an-ic-based-controllable-stimulator-for-respiratory-muscle-stimulation-investigations
#16
Jonathan Castelli, Florian Kolbl, Ricardo Siu, Gilles N'Kaoua, Yannick Bornat, Ashwin Mangalore, Brian Hillen, James J Abbas, Sylvie Renaud, Ranu Jung, Noelle Lewis
Functional Electrical Stimulation can be used to restore motor functions loss consecutive to spinal cord injury, such as respiratory deficiency due to paralysis of ventilatory muscles. This paper presents a fully configurable IC-centered stimulator designed to investigate muscle stimulation paradigms. It provides 8 current stimulation channels with high-voltage compliance and real-time operation capabilities, to enable a wide range of FES applications. The stimulator can be used in a standalone mode, or within a closed-loop setup...
July 2017: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
https://www.readbyqxmd.com/read/29059880/evaluation-of-indirect-measures-of-neural-inspiratory-time-from-invasive-and-noninvasive-recordings-of-respiratory-activity
#17
Daniel Garcia-Castellote, Abel Torres, Luis Estrada, Leonardo Sarlabous, Raimon Jane
Measuring diaphragmatic electromyography (EMGdi) provides an indirect quantification of neural respiratory drive and allows the delimitation of diaphragm neural activation and deactivation during inspiration. EMGdi recordings have been incorporated in novel modes of assisted mechanical ventilation, such as neurally adjusted ventilatory assist (NAVA), to trigger and cycle-off the ventilator. The EMGdi signal improves the assistance delivered by more conventional ventilatory modes, in which the ventilator is synchronized with the patient employing a pneumatic triggering...
July 2017: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
https://www.readbyqxmd.com/read/29037528/driving-pressure-and-hospital-mortality-in-patients-without-ards-a-cohort-study
#18
Marcello F S Schmidt, Andre C K B Amaral, Eddy Fan, Gordon D Rubenfeld
BACKGROUND: Driving pressure (ΔP) is associated with mortality in patients with ARDS and with pulmonary complications in patients undergoing general anesthesia. Whether ΔP is associated with outcomes of patients without ARDS who undergo ventilation in the ICU is unknown. Our objective was to determine the independent association between ΔP and outcomes in mechanically ventilated patients without ARDS on day 1 of mechanical ventilation. METHODS: This was a retrospective analysis of a cohort of 622 mechanically ventilated adult patients without ARDS on day 1 of mechanical ventilation from five ICUs in a tertiary center in the United States...
January 2018: Chest
https://www.readbyqxmd.com/read/28966145/how-important-is-the-co2-chemoreflex-for-the-control-of-breathing-environmental-and-evolutionary-considerations
#19
REVIEW
Joseph M Santin
Haldane and Priestley (1905) discovered that the ventilatory control system is highly sensitive to CO2. This "CO2 chemoreflex" has been interpreted to dominate control of resting arterial PCO2/pH (PaCO2/pHa) by monitoring PaCO2/pHa and altering ventilation through negative feedback. However, PaCO2/pHa varies little in mammals as ventilation tightly couples to metabolic demands, which may minimize chemoreflex control of PaCO2. The purpose of this synthesis is to (1) interpret data from experimental models with meager CO2 chemoreflexes to infer their role in ventilatory control of steady-state PaCO2, and (2) identify physiological causes of respiratory acidosis occurring normally across vertebrate classes...
September 29, 2017: Comparative Biochemistry and Physiology. Part A, Molecular & Integrative Physiology
https://www.readbyqxmd.com/read/28877974/exertional-dyspnoea-in-pulmonary-arterial-hypertension
#20
Daniel Dumitrescu, Olivier Sitbon, Jason Weatherald, Luke S Howard
Dyspnoea is a principal presenting symptom in pulmonary arterial hypertension (PAH), and often the most distressing. The pathophysiology of PAH is relatively well understood, with the primary abnormality of pulmonary vascular disease resulting in a combination of impaired cardiac output on exercise and abnormal gas exchange, both contributing to increased ventilatory drive. However, increased ventilatory drive is not the sole explanation for the complex neurophysiological and neuropsychological symptom of dyspnoea, with other significant contributions from skeletal muscle reflexes, respiratory muscle function, and psychological and emotional status...
September 30, 2017: European Respiratory Review: An Official Journal of the European Respiratory Society
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