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Lung protective ventilation

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https://www.readbyqxmd.com/read/28725223/gas-exchange-disturbances-regulate-alveolar-fluid-clearance-during-acute-lung-injury
#1
REVIEW
István Vadász, Jacob I Sznajder
Disruption of the alveolar-capillary barrier and accumulation of pulmonary edema, if not resolved, result in poor alveolar gas exchange leading to hypoxia and hypercapnia, which are hallmarks of acute lung injury and the acute respiratory distress syndrome (ARDS). Alveolar fluid clearance (AFC) is a major function of the alveolar epithelium and is mediated by the concerted action of apically-located Na(+) channels [epithelial Na(+) channel (ENaC)] and the basolateral Na,K-ATPase driving vectorial Na(+) transport...
2017: Frontiers in Immunology
https://www.readbyqxmd.com/read/28722695/cardiac-cycle-efficiency-and-dicrotic-pressure-variations-new-parameters-for-fluid-therapy-a-pilot-observational-study
#2
Antonio Messina, Salvatore M Romano, Eleonora Bonicolini, Davide Colombo, Gianmaria Cammarota, Marco Chiostri, Francesco Della Corte, Paolo Navalesi, Didier Payen, Stefano Romagnoli
BACKGROUND: During a fluid challenge, the changes in cardiac performance and peripheral circulatory tone are closely related to the position of the ventricle on the Frank-Starling curve. Some patients have a good haemodynamic response to a fluid challenge, others hardly any response. The early haemodynamic effects of a fluid challenge could predict the final response before the entire fluid volume has been administered. OBJECTIVE: To assess whether a multivariate logistic regression model, including pulse pressure variation (PPV), cardiac cycle efficiency (CCE), arterial elastance and the difference between the dicrotic pressure and both systolic and mean arterial pressure (SAP - Pdic and MAP - Pdic) can predict cardiac responsiveness early during a fluid challenge in comparison with the standard procedure described elsewhere...
June 19, 2017: European Journal of Anaesthesiology
https://www.readbyqxmd.com/read/28714270/resistive-breathing-and-respiratory-muscle-fatigue-a-load-of-concern-just-expired
#3
Ken D O'Halloran
Pulmonary ventilation is a cyclical process of inhalation and exhalation of air providing dynamic tidal exchange between alveolar gas-exchanging units of the lungs and the external environment. This article is protected by copyright. All rights reserved.
July 17, 2017: Experimental Physiology
https://www.readbyqxmd.com/read/28707030/-update-acute-hypercapnic-respiratory-failure
#4
REVIEW
F Seiler, F C Trudzinski, M Kredel, C Lotz, P M Lepper, R M Muellenbach
BACKGROUND: Hypercapnic respiratory failure is a frequent problem in critical care and mainly affects patients with acute exacerbation of COPD (AECOPD) and acute respiratory distress syndrome (ARDS). In recent years, the usage of extracorporeal CO2 removal (ECCO2R) has been increasing. OBJECTIVE: Summarizing the state of the art in the management of hypercapnic respiratory failure with special regard to the role of ECCO2R. METHODS: Review based on a selective literature search and the clinical and scientific experience of the authors...
July 13, 2017: Medizinische Klinik, Intensivmedizin und Notfallmedizin
https://www.readbyqxmd.com/read/28701843/incidence-proportion-of-acute-cor-pulmonale-in-patients-with-acute-respiratory-distress-syndrome-subjected-to-lung-protective-ventilation-a-systematic-review-and-meta-analysis
#5
Saurabh Kumar Das, Nang Sujali Choupoo, Priyam Saikia, Amitabh Lahkar
INTRODUCTION: Reported incidence of acute cor pulmonale (ACP) in patients with acute respiratory distress syndrome (ARDS) varies from 10% to 84%, despite being subjected to lung protective ventilation according to the current guidelines. The objective of this review is to find pooled cumulative incidence of ACP in patients with ARDS undergoing lung protective ventilation. MATERIALS AND METHODS: We searched MEDLINE, EMBASE, Cochrane Library, KoreaMed, LILACS, and WHO Clinical Trial Registry...
June 2017: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/28697635/the-perpetuation-of-the-misconception-that-rats-receive-a-3-5-times-lower-lung-tissue-dose-than-humans-at-the-same-ozone-concentration
#6
Darrell McCant, Sabine Lange, Joseph Haney, Michael Honeycutt
This paper highlights the pervasive misconception concerning 1994 findings from Hatch et al. about ozone (O3) tissue dose in humans versus rats. That study exposed humans to 0.4 ppm and rats to 2 ppm (18)O-labeled O3 and found comparable incorporation of (18)O into bronchoalveolar lavage constituents. However, during O3 exposure humans were exercising, which increased their ventilation rate five-fold, while rats were at rest. This resulted in similar O3 tissue doses between the two species, and predominantly explained the comparable (18)O incorporation at five-fold different concentrations...
July 12, 2017: Inhalation Toxicology
https://www.readbyqxmd.com/read/28696966/defining-a-ventilation-strategy-for-flexible-bronchoscopy-on-mechanically-ventilated-patients-in-the-medical-intensive-care-unit
#7
Yonatan Y Greenstein, Eric Shakespeare, Peter Doelken, Paul H Mayo
BACKGROUND: Flexible bronchoscopy (FB) in intubated patients on mechanical ventilation increases airway resistance. During FB, two ventilatory strategies are possible: maintaining tidal volume (VT) while maintaining baseline CO2 or allowing reduction of VT. The former strategy carries risk of hyperinflation due to expiratory flow limitation with FB. The aim of the authors was too study end expiratory lung volume (EELV) during FB of intubated subjects while limiting VT. METHODS: We studied 16 subjects who were intubated on mechanical ventilation and required FB...
July 2017: Journal of Bronchology & Interventional Pulmonology
https://www.readbyqxmd.com/read/28695586/intra-operative-protective-mechanical-ventilation-in-lung-transplantation-a-randomised-controlled-trial
#8
G L Verbeek, P S Myles, G P Westall, E Lin, S L Hastings, S F Marasco, J Jaffar, A C Meehan
Primary graft dysfunction occurs in up to 25% of patients after lung transplantation. Contributing factors include ventilator-induced lung injury, cardiopulmonary bypass, ischaemia-reperfusion injury and excessive fluid administration. We evaluated the feasibility, safety and efficacy of an open-lung protective ventilation strategy aimed at reducing ventilator-induced lung injury. We enrolled adult patients scheduled to undergo bilateral sequential lung transplantation, and randomly assigned them to either a control group (volume-controlled ventilation with 5 cmH2 O, positive end-expiratory pressure, low tidal volumes (two-lung ventilation 6 ml...
August 2017: Anaesthesia
https://www.readbyqxmd.com/read/28695576/mechanical-ventilation-and-extracorporeal-membrane-oxygenation-as-a-bridging-strategy-to-lung-transplantation-significant-gains-in-survival
#9
Awori J Hayanga, Angela L Du, Kyla Joubert, Tuft Marie, Rachel Baird, Joseph Pilewski, Mathew Morrell, Jonathan D'Cunha, Norihisa Shigemura
Mechanical ventilation (MV) and extracorporeal membrane oxygenation (ECMO) are increasingly used to bridge patients to lung transplantation. We investigated the impact of using MV, with or without ECMO, prior to lung transplantation on survival after transplantation by performing a retrospective analysis of 826 patients who underwent transplantation at our high-volume center. Recipient characteristics and posttransplant outcomes were analyzed. Most lung transplant recipients (729 patients) did not require bridging; 194 of these patients were propensity matched with patients who were bridged using MV alone (48 patients) or MV and ECMO (49 patients)...
July 11, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28685722/can-dexmedetomidine-improve-arterial-oxygenation-and-intrapulmonary-shunt-during-one-lung-ventilation-in-adults-undergoing-thoracic-surgery-a-meta-analysis-of-randomized-placebo-controlled-trials
#10
Su-Qin Huang, Jian Zhang, Xiong-Xin Zhang, Lu Liu, Yang Yu, Xian-Hui Kang, Xiao-Min Wu, Sheng-Mei Zhu
BACKGROUND: One-lung ventilation (OLV) is a common ventilation technology during thoracic surgery that can cause serious clinical problems. We aimed to conduct a meta-analysis to compare oxygenation and intrapulmonary shunt during OLV in adults undergoing thoracic surgery with dexmedetomidine (Dex) versus placebo to assess the influence and safety of using Dex. METHODS: Randomized controlled trials comparing lung protection in patients who underwent thoracic surgery with Dex or a placebo were retrieved from PubMed, EMBASE, MEDLINE, Cochrane Library, and China CNKI database...
July 20, 2017: Chinese Medical Journal
https://www.readbyqxmd.com/read/28684287/high-frequency-oscillatory-ventilation-in-adults-with-ards-past-present-and-future
#11
REVIEW
Michael C Sklar, Eddy Fan, Ewan C Goligher
High-frequency oscillatory ventilation (HFOV) is a unique mode of mechanical ventilation that utilizes non-conventional gas exchange mechanisms to deliver ventilation at very low tidal volumes and high frequencies. The properties of HFOV make it a potentially ideal mode to prevent ventilator-induced lung injury in patients with acute respiratory distress syndrome. Despite a compelling physiological basis and promising experimental data, large randomized controlled trials have not detected an improvement in survival with the use of HFOV; the use of HFOV as an early lung-protective strategy in patients with ARDS may be harmful...
July 3, 2017: Chest
https://www.readbyqxmd.com/read/28677276/research-on-the-cause-of-death-for-severe-stroke-patients
#12
Mei-Zhen Yuan, Feng Li, Qin Fang, Wei Wang, Jing-Jing Peng, De-Yu Qin, Xue-Feng Wang, Guang-Wei Liu
AIMS AND OBJECTIVES: This study aimed to explore the characteristics of mortality among severe stroke patients, analyze their causes of death, and provide evidence for improving the survival rate of stroke patients. BACKGROUND: Stroke is an important fatal and disabling disease that poses a large burden on its patients, and its high death rates have caused substantial concern to the World Health Organization. DESIGN: A retrospective case-control study...
July 5, 2017: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/28677019/-acute-respiratory-distress-syndrome-basic-principles-and-treatment
#13
P M Spieth, A Güldner, M Gama de Abreu
Even after many years of intensive research acute respiratory distress syndrome (ARDS) is still associated with a high mortality. Epidemiologically, ARDS represents a central challenge for modern intensive care treatment. The multifactorial etiology of ARDS complicates the clear identification and evaluation of new therapeutic interventions. Lung protective mechanical ventilation and adjuvant therapies, such as the prone position and targeted extracorporeal lung support are of particular importance in the treatment of ARDS, depending on the severity of the disease...
July 2017: Der Anaesthesist
https://www.readbyqxmd.com/read/28673010/rhubarb-vs-glycerin-enema-for-treatment-of-critically-ill-patients-with-intra-abdominal-hypertension
#14
Bing Wan, Hao Zhang, Jiangtao Yin, Haiyan Fu, Yikun Chen, Liping Yang, Dadong Liu, Tangfeng Lv, Yong Song
Rhubarb has been used as an evacuant for thousands of years. However, recent research has indicated that rhubarb inhibits inflammation and protects organ function. In the current study, the use of rhubarb was investigated in patients with intra-abdominal hypertension (IAH). Specifically, its dual role in attenuating lung and bowel injury by catharsis and inhibiting inflammation was evaluated. Patients in the glycerin group (n=56) received 110 ml of glycerin enema by coloclysis once daily for 7 to 9 days. Patients in the rhubarb group (n=56) were treated with a mixture of 0...
July 2017: Experimental and Therapeutic Medicine
https://www.readbyqxmd.com/read/28671879/feasibility-of-protective-ventilation-during-elective-supratentorial-neurosurgery-a-randomized-crossover-clinical-trial
#15
Francesco Ruggieri, Luigi Beretta, Laura Corno, Valentina Testa, Enrico A Martino, Marco Gemma
BACKGROUND: Traditional ventilation approaches, providing high tidal volumes (Vt), produce excessive alveolar distention and lung injury. Protective ventilation, employing lower Vt and positive end-expiratory pressure (PEEP), is an attractive alternative also for neuroanesthesia, when prolonged mechanical ventilation is needed. Nevertheless, protective ventilation during intracranial surgery may exert dangerous effects on intracranial pressure (ICP). We tested the feasibility of a protective ventilation strategy in neurosurgery...
June 30, 2017: Journal of Neurosurgical Anesthesiology
https://www.readbyqxmd.com/read/28665929/effect-of-frequency-on-pressure-cost-of-ventilation-and-gas-exchange-in-newborns-receiving-high-frequency-oscillatory-hfov
#16
Emanuela Zannin, Raffaele L Dellaca', Giulia Dognini, Lara Marconi, Martina Perego, Jane J Pillow, Paolo E Tagliabue, Maria Luisa Ventura
BACKGROUND: We hypothesized that ventilating at the resonant frequency of the respiratory system optimizes gas exchange while limiting the mechanical stress to the lung in newborns receiving HFOV. We characterized the frequency dependence of oscillatory mechanics, gas exchange and pressure transmission during HFOV. METHODS: We studied 13 newborn infants with a median (IQR) gestational age of 29.3(26.4-30.4) weeks and body weight of 1.00(0.84-1.43) kg. Different frequencies (5, 8, 10, 12, 15 Hz) were tested, keeping carbon dioxide diffusion coefficient (DCO2) constant...
June 30, 2017: Pediatric Research
https://www.readbyqxmd.com/read/28664851/clinical-trials-in-acute-respiratory-distress-syndrome-challenges-and-opportunities
#17
REVIEW
Michael A Matthay, Daniel F McAuley, Lorraine B Ware
This year is the 50th anniversary of the first description of acute respiratory distress syndrome (ARDS). Since then, much has been learned about the pathogenesis of lung injury in ARDS, with an emphasis on the mechanisms of injury to the lung endothelium and the alveolar epithelium. In terms of treatment, major progress has been made in reducing mortality from ARDS with lung-protective ventilation, using a tidal volume of 6 mL per kg of predicted bodyweight and a plateau airway pressure of less than 30 cm H2O...
June 2017: Lancet Respiratory Medicine
https://www.readbyqxmd.com/read/28662411/activating-transcription-factor-3-protects-mice-against-pseudomonas-aeruginosa-induced-acute-lung-injury-by-interacting-with-lipopolysaccharide-binding-protein
#18
Yunfeng Zhao, Xiulin Wu, Lanlan Qian, Liang Guo, Jiangrong Liao, Xueling Wu
Excessive inflammatory response is critical event in the pathogenesis of acute lung injury (ALI). Previous study has shown that activating transcription factor 3 (ATF3) plays a role in downregulate inflammatory responses including ventilation-induced ALI. We hypothesized that ATF3 have a protective effect in ALI induced by pseudomonas aeruginosa. PA was intra-tracheally administrated to ATF3 knock-out (KO) mice to establish ALI model. Inflammatory factors, BALF protein, lung wet to dry ratio, lung injury score and mortality were determined...
June 26, 2017: Molecular Immunology
https://www.readbyqxmd.com/read/28656353/effect-of-low-tidal-volume-with-peep-on-respiratory-function-in-infants-undergoing-one-lung-ventilation
#19
Jing Liu, Xinfang Liao, Yongle Li, Hui Luo, Weijian Huang, Lingli Peng, Qin Fang, Zurong Hu
BACKGROUND: An increasing number of studies have shown that low tidal volume (TV) with positive end-expiratory pressure (PEEP) offers lung protection during one-lung ventilation (OLV). Considering the unique physiological characteristics of infants, we aimed to determine the feasibility and effect of low TV with PEEP in infants undergoing OLV during thoracoscopy. PATIENTS AND METHODS: We randomized 60 infants to a conventional group (group I: TV, 8-10 ml/kg; RR, 23-45 bpm; PEEP, 0 cmH2O) or a low TV with PEEP group (group II: TV, 5-7 ml/kg; RR, 23-45 bpm; PEEP, 4-6 cmH2O)...
June 27, 2017: Der Anaesthesist
https://www.readbyqxmd.com/read/28638160/low-flow-extracorporeal-carbon-dioxide-removal-using-the-hemolung-respiratory-dialysis-system-%C3%A2-to-facilitate-lung-protective-mechanical-ventilation-in-acute-respiratory-distress-syndrome
#20
Bindu Akkanti, Keshava Rajagopal, Kirti P Patel, Sangeeta Aravind, Emmanuel Nunez-Centanu, Rahat Hussain, Farshad Raissi Shabari, Wayne L Hofstetter, Ara A Vaporciyan, Igor S Banjac, Biswajit Kar, Igor D Gregoric, Pranav Loyalka
Extracorporeal carbon dioxide removal (ECCO2R) permits reductions in alveolar ventilation requirements that the lungs would otherwise have to provide. This concept was applied to a case of hypercapnia refractory to high-level invasive mechanical ventilator support. We present a case of an 18-year-old man who developed post-pneumonectomy acute respiratory distress syndrome (ARDS) after resection of a mediastinal germ cell tumor involving the left lung hilum. Hypercapnia and hypoxemia persisted despite ventilator support even at traumatic levels...
June 2017: Journal of Extra-corporeal Technology
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