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Ventilatory drive

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https://www.readbyqxmd.com/read/29228393/quantifying-the-arousal-threshold-using-polysomnography-in-obstructive-sleep-apnea
#1
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 White, Andrew Wellman
Objectives: Precision medicine for obstructive sleep apnea (OSA) requires non-invasive 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 P et al...
November 9, 2017: 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
#2
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-pco2-and-ph-of-vertebrate-ectotherms
#3
Stanley S Hillman, Michael S Hedrick
Body temperature increases in ectothermic vertebrates characteristically lead to both increases in arterial PCO2 (PaCO2) and declines in resting arterial pH (pHa) of about 0.017 pH units/°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 show different degrees of PaCO2 increases and pH declines with temperature between the classes with reptiles>amphibians>fish...
November 17, 2017: 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
#4
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...
November 10, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/29114876/translating-carotid-body-function-into-clinical-medicine
#5
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
#6
Emil Schwarz Walsted, Azmy Faisal, Caroline J Jolley, Laura L Swanton, Matthew J Pavitt, Yuan-Ming Luo, Vibeke Backer, Michael I Polkey, James H Hull
Rationale: 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. Objectives: To evaluate exercise related changes in laryngeal aperture on ventilation, pulmonary mechanics and respiratory neural drive. Methods: We prospectively evaluated 12 subjects (six with EILO and six healthy age- and gender-matched controls)...
November 2, 2017: Journal of Applied Physiology
https://www.readbyqxmd.com/read/29060280/an-ic-based-controllable-stimulator-for-respiratory-muscle-stimulation-investigations
#7
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
#8
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
#9
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...
October 14, 2017: Chest
https://www.readbyqxmd.com/read/28966145/how-important-is-the-co2-chemoreflex-for-the-control-of-breathing-environmental-and-evolutionary-considerations
#10
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
#11
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
https://www.readbyqxmd.com/read/28828362/tidal-volume-in-acute-respiratory-distress-syndrome-how-best-to-select-it
#12
REVIEW
Michele Umbrello, Antonella Marino, Davide Chiumello
Mechanical ventilation is the type of organ support most widely provided in the intensive care unit. However, this form of support does not constitute a cure for acute respiratory distress syndrome (ARDS), as it mainly works by buying time for the lungs to heal while contributing to the maintenance of vital gas exchange. Moreover, it can further damage the lung, leading to the development of a particular form of lung injury named ventilator-induced lung injury (VILI). Experimental evidence accumulated over the last 30 years highlighted the factors associated with an injurious form of mechanical ventilation...
July 2017: Annals of Translational Medicine
https://www.readbyqxmd.com/read/28808320/carotid-body-mediated-chemoreflex-drive-in-the-setting-of-low-and-high-output-heart-failure
#13
Rodrigo Del Rio, David C Andrade, Camilo Toledo, Hugo S Diaz, Claudia Lucero, Alexis Arce-Alvarez, Noah J Marcus, Harold D Schultz
Enhanced carotid body (CB) chemoreflex function is strongly related to cardiorespiratory disorders and disease progression in heart failure (HF). The mechanisms underlying CB sensitization during HF are not fully understood, however previous work indicates blood flow per se can affect CB function. Then, we hypothesized that the CB-mediated chemoreflex drive will be enhanced only in low output HF but not in high output HF. Myocardial infarcted rats and aorto-caval fistulated rats were used as a low output HF model (MI-CHF) and as a high output HF model (AV-CHF), respectively...
August 14, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28774953/cerebrovascular-and-ventilatory-responses-to-acute-normobaric-hypoxia-in-girls-and-women
#14
Laura E Morris, Daniela Flück, Philip N Ainslie, Ali M McManus
Physiological responses to hypoxia in children are incompletely understood. We aimed to characterize cerebrovascular and ventilatory responses to normobaric hypoxia in girls and women. Ten healthy girls (9.9 ± 1.7 years; mean ± SD; Tanner stage 1 and 2) and their mothers (43.9 ± 3.5 years) participated. Internal carotid (ICA) and vertebral artery (VA) velocity, diameter and flow (Duplex ultrasound) was recorded pre- and post-1 h of hypoxic exposure (FIO2 = 0.126;~4000 m) in a normobaric chamber...
August 2017: Physiological Reports
https://www.readbyqxmd.com/read/28757365/assessing-chemoreflexes-and-oxygenation-in-the-context-of-acute-hypoxia-implications-for-field-studies
#15
Jamie R Pfoh, Craig D Steinback, Emily R Vanden Berg, Christina D Bruce, Trevor A Day
Carotid chemoreceptors detect changes in PO2 and elicit a peripheral respiratory chemoreflex (PCR). The PCR can be tested through a transient hypoxic ventilatory response test (TT-HVR), which may not be safe nor feasible at altitude. We characterized a transient hyperoxic ventilatory withdrawal test in the setting of steady-state normobaric hypoxia (13.5-14% FIO2) and compared it to a TT-HVR and a steady-state poikilocapnic hypoxia test, within-individuals. No PCR test magnitude was correlated with any other test, nor was any test magnitude correlated with oxygenation while in steady-state hypoxia...
December 2017: Respiratory Physiology & Neurobiology
https://www.readbyqxmd.com/read/28750686/carbon-dioxide-narcosis-due-to-inappropriate-oxygen-delivery-a-case-report
#16
Thomas Herren, Eva Achermann, Thomas Hegi, Adrian Reber, Max Stäubli
BACKGROUND: Oxygen delivery to patients with chronic obstructive pulmonary disease may be challenging because of their potential hypoxic ventilatory drive. However, some oxygen delivery systems such as non-rebreathing face masks with an oxygen reservoir bag require high oxygen flow for adequate oxygenation and to avoid carbon dioxide rebreathing. CASE PRESENTATION: A 72-year-old Caucasian man with severe chronic obstructive pulmonary disease was admitted to the emergency department because of worsening dyspnea and an oxygen saturation of 81% measured by pulse oximetry...
July 28, 2017: Journal of Medical Case Reports
https://www.readbyqxmd.com/read/28730724/dynamic-loop-gain-increases-upon-adopting-the-supine-body-position-during-sleep-in-patients-with-obstructive-sleep-apnoea
#17
Simon A Joosten, Shane A Landry, Scott A Sands, Philip I Terrill, Dwayne Mann, Christopher Andara, Elizabeth Skuza, Anthony Turton, Philip Berger, Garun S Hamilton, Bradley A Edwards
BACKGROUND AND OBJECTIVE: Obstructive sleep apnoea (OSA) is typically worse in the supine versus lateral sleeping position. One potential factor driving this observation is a decrease in lung volume in the supine position which is expected by theory to increase a key OSA pathogenic factor: dynamic ventilatory control instability (i.e. loop gain). We aimed to quantify dynamic loop gain in OSA patients in the lateral and supine positions, and to explore the relationship between change in dynamic loop gain and change in lung volume with position...
November 2017: Respirology: Official Journal of the Asian Pacific Society of Respirology
https://www.readbyqxmd.com/read/28687484/participation-of-locus-coeruleus-in-breathing-control-in-female-rats
#18
Débora de Carvalho, Luis Gustavo A Patrone, Danuzia A Marques, Mariane C Vicente, Raphael E Szawka, Janete A Anselmo-Franci, Kênia C Bícego, Luciane H Gargaglioni
Several evidences indicate that the locus coeruleus (LC) is involved in central chemoreception responding to CO2/pH and displaying a high percentage of chemosensitive neurons (>80%). However, there are no studies about the LC-mediated hypercapnic ventilation performed in females. Therefore, we assessed the role of noradrenergic LC neurons in non-ovariectomized (NOVX), ovariectomized (OVX) and estradiol (E2)-treated ovariectomized (OVX+E2) rats in respiratory response to hypercapnia, using a 6-hydroxydopamine (6-OHDA) - lesion model...
July 4, 2017: Respiratory Physiology & Neurobiology
https://www.readbyqxmd.com/read/28683763/new-setting-of-neurally-adjusted-ventilatory-assist-for-noninvasive-ventilation-by-facial-mask-a-physiologic-study
#19
Federico Longhini, Chun Pan, Jianfeng Xie, Gianmaria Cammarota, Andrea Bruni, Eugenio Garofalo, Yi Yang, Paolo Navalesi, Haibo Qiu
BACKGROUND: Noninvasive ventilation (NIV) is generally delivered using pneumatically-triggered and cycled-off pressure support (PSP) through a mask. Neurally adjusted ventilatory assist (NAVA) is the only ventilatory mode that uses a non-pneumatic signal, i.e., diaphragm electrical activity (EAdi), to trigger and drive ventilator assistance. A specific setting to generate neurally controlled pressure support (PSN) was recently proposed for delivering NIV by helmet. We compared PSN with PSP and NAVA during NIV using a facial mask, with respect to patient comfort, gas exchange, and patient-ventilator interaction and synchrony...
July 7, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/28673877/remifentanil-effects-on-respiratory-drive-and-timing-during-pressure-support-ventilation-and-neurally-adjusted-ventilatory-assist
#20
Roberta Costa, Paolo Navalesi, Gianmaria Cammarota, Federico Longhini, Giorgia Spinazzola, Flora Cipriani, Giuliano Ferrone, Olimpia Festa, Massimo Antonelli, Giorgio Conti
We assessed the effects of varying doses of remifentanil on respiratory drive and timing in patients receiving Pressure Support Ventilation (PSV) and Neurally Adjusted Ventilatory Assist (NAVA). Four incrementing remifentanil doses were randomly administered to thirteen intubated patients (0.03, 0.05, 0.08, and 0.1μg·Kg(-1)·min(-)1) during both PSV and NAVA. We measured the patient's (Ti/Ttotneu) and ventilator (Ti/Ttotmec) duty cycle, the Electrical Activity of the Diaphragm (EAdi), the inspiratory (Delaytrinsp) and expiratory (Delaytrexp) trigger delays and the Asynchrony Index (AI)...
July 1, 2017: Respiratory Physiology & Neurobiology
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