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Lung protective mechanical ventilation

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https://www.readbyqxmd.com/read/29221302/the-society-for-translational-medicine-clinical-practice-guidelines-for-mechanical-ventilation-management-for-patients-undergoing-lobectomy
#1
REVIEW
Shugeng Gao, Zhongheng Zhang, Alessandro Brunelli, Chang Chen, Chun Chen, Gang Chen, Haiquan Chen, Jin-Shing Chen, Stephen Cassivi, Ying Chai, John B Downs, Wentao Fang, Xiangning Fu, Martínez I Garutti, Jianxing He, Jie He, Jian Hu, Yunchao Huang, Gening Jiang, Hongjing Jiang, Zhongmin Jiang, Danqing Li, Gaofeng Li, Hui Li, Qiang Li, Xiaofei Li, Yin Li, Zhijun Li, Chia-Chuan Liu, Deruo Liu, Lunxu Liu, Yongyi Liu, Haitao Ma, Weimin Mao, Yousheng Mao, Juwei Mou, Calvin Sze Hang Ng, René H Petersen, Guibin Qiao, Gaetano Rocco, Erico Ruffini, Lijie Tan, Qunyou Tan, Tang Tong, Haidong Wang, Qun Wang, Ruwen Wang, Shumin Wang, Deyao Xie, Qi Xue, Tao Xue, Lin Xu, Shidong Xu, Songtao Xu, Tiansheng Yan, Fenglei Yu, Zhentao Yu, Chunfang Zhang, Lanjun Zhang, Tao Zhang, Xun Zhang, Xiaojing Zhao, Xuewei Zhao, Xiuyi Zhi, Qinghua Zhou
Patients undergoing lobectomy are at significantly increased risk of lung injury. One-lung ventilation is the most commonly used technique to maintain ventilation and oxygenation during the operation. It is a challenge to choose an appropriate mechanical ventilation strategy to minimize the lung injury and other adverse clinical outcomes. In order to understand the available evidence, a systematic review was conducted including the following topics: (I) protective ventilation (PV); (II) mode of mechanical ventilation [e...
September 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/29216437/epha2-modulation-associates-with-protective-effect-of-prone-position-in-ventilator-induced-lung-injury
#2
Byung Hoon Park, Mi Hwa Shin, Ivor S Douglas, Kyung Soo Chung, Joo Han Song, Song Yee Kim, Eun Young Kim, Ji Ye Jung, Young Ae Kang, Joon Chang, Young Sam Kim, Moo Suk Park
The erythropoietin-producing hepatoma receptor tyrosine kinase A2 (EphA2) and its ligand ephrinA1 play a pivotal role in inflammation and tissue injury by modulating the epithelial and endothelial barrier integrity. Therefore, EphA2 receptor may be a potential therapeutic target for modulating ventilator-induced lung injury (VILI). To support this hypothesis, here we analyzed EphA2/ephrinA1 signaling in the process of VILI and determined the role of EphA2/ephrinA1 signaling in the protective mechanism of prone positioning in a VILI model...
December 7, 2017: American Journal of Respiratory Cell and Molecular Biology
https://www.readbyqxmd.com/read/29215365/physiologic-evaluation-of-ventilation-perfusion-mismatch-and-respiratory-mechanics-at-different-positive-end-expiratory-pressure-in-patients-undergoing-protective-one-lung-ventilation
#3
Savino Spadaro, Salvatore Grasso, Dan Stieper Karbing, Alberto Fogagnolo, Marco Contoli, Giacomo Bollini, Riccardo Ragazzi, Gilda Cinnella, Marco Verri, Narciso Giorgio Cavallesco, Stephen Edward Rees, Carlo Alberto Volta
BACKGROUND: Arterial oxygenation is often impaired during one-lung ventilation, due to both pulmonary shunt and atelectasis. The use of low tidal volume (VT) (5 ml/kg predicted body weight) in the context of a lung-protective approach exacerbates atelectasis. This study sought to determine the combined physiologic effects of positive end-expiratory pressure and low VT during one-lung ventilation. METHODS: Data from 41 patients studied during general anesthesia for thoracic surgery were collected and analyzed...
December 6, 2017: Anesthesiology
https://www.readbyqxmd.com/read/29207907/implementation-of-a-goal-directed-mechanical-ventilation-order-set-driven-by-respiratory-therapists-improves-compliance-with-best-practices-for-mechanical-ventilation
#4
Misty A Radosevich, Brendan T Wanta, Todd J Meyer, Verlin W Weber, Daniel R Brown, Nathan J Smischney, Daniel A Diedrich
PURPOSE: Data regarding best practices for ventilator management strategies that improve outcomes in acute respiratory distress syndrome (ARDS) are readily available. However, little is known regarding processes to ensure compliance with these strategies. We developed a goal-directed mechanical ventilation order set that included physician-specified lung-protective ventilation and oxygenation goals to be implemented by respiratory therapists (RTs). We sought as a primary outcome to determine whether an RT-driven order set with predefined oxygenation and ventilation goals could be implemented and associated with improved adherence with best practice...
January 1, 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/29206492/intravenous-controlled-release-hydrogen-sulfide-protects-against-ventilator-induced-lung-injury
#5
Lifeng Wang, Hao Yu, Yana Zhang, Caiyu Dong, Bo Liu
BACKGROUND: Despite its critical utility in providing life support to patients with impaired respiratory functions, prolonged mechanical ventilation has been found to cause a series of pathological changes in the lung that are collectively referred to as ventilator-induced lung injury (VILI). This study aims to investigate the therapeutic effects of mesoporous silica nanoparticles (DATS-MSN), which is capable of releasing H2S in a slow and controlled manner, on VILI. METHODS: A murine VILI model was generated...
December 5, 2017: Experimental Lung Research
https://www.readbyqxmd.com/read/29194916/the-impact-of-obesity-in-cirrhotic-patients-with-septic-shock-a-retrospective-cohort-study
#6
Beverley Kok, Constantine J Karvellas, Juan G Abraldes, Rajiv Jalan, Vinay Sundaram, David Gurka, Sean Keenan, Aseem Kumar, Greg Martinka, Brian Bookatz, Gordon Wood, Anand Kumar
BACKGROUND & AIMS: The prevalence of obesity in cirrhosis is rising. The impact of obesity in the critically-ill cirrhotic patient with sepsis/septic shock has not been evaluated. This study aimed to examine the relationship between obesity and mortality in cirrhotic patients admitted to the intensive care unit with septic shock. METHODS: A retrospective cohort study of all cirrhotic patients with septic shock (n=362) and a recorded body mass index (BMI) from an international, multicenter (CATTS) database (1996-2015) was performed...
December 1, 2017: Liver International: Official Journal of the International Association for the Study of the Liver
https://www.readbyqxmd.com/read/29179681/low-flow-extracorporeal-co2-removal-in-ards-patients-a-prospective-short-term-crossover-pilot-study
#7
Harlinde Peperstraete, Sunny Eloot, Pieter Depuydt, Filip De Somer, Carl Roosens, Eric Hoste
BACKGROUND: Lung protective mechanical ventilation (MV) is the corner stone of therapy for ARDS. However, its use may be limited by respiratory acidosis. This study explored feasibility of, effectiveness and safety of low flow extracorporeal CO2 removal (ECCO2R). METHODS: This was a prospective pilot study, using the Abylcap® (Bellco) ECCO2R, with crossover off-on-off design (2-h blocks) under stable MV settings, and follow up till end of ECCO2R. Primary endpoint for effectiveness was a 20% reduction of PaCO2 after the first 2-h...
November 28, 2017: BMC Anesthesiology
https://www.readbyqxmd.com/read/29173777/surgical-excision-is-the-treatment-of-choice-for-cervical-lymphatic-malformations-with-mediastinal-expansion
#8
Nader Ghaffarpour, Carmen Mesas Burgos, Tomas Wester
BACKGROUND: Lymphatic malformations (LMs) in the mediastinum are uncommon. However, cervical LMs may expand into the mediastinum. The aim of this study was to review our experience with the management of patients with LMs involving the mediastinum and to propose a treatment algorithm to guide the management of these rare malformations. MATERIAL AND METHODS: This was a descriptive retrospective chart review of all patients with LMs involving the mediastinum treated at our Institution between 2009 and 2015...
October 16, 2017: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/29172232/review-demonstrates-that-less-invasive-surfactant-administration-in-preterm-neonates-leads-to-fewer-complications
#9
REVIEW
Ludwig Gortner, Simone S Schüller, Egbert Herting
Surfactant treatment of neonatal respiratory distress syndrome (RDS) was introduced into Europe during the 1990s. Meta-analyses have indicated that using less invasive surfactant administration (LISA) techniques on preterm neonates receiving continuous positive airway pressure (CPAP) results in improved survival rates without bronchopulmonary dysplasia. Surfactant should be administered early and ventilator settings adapted to changing oxygen requirements and lung mechanics. Side effects including initial bradycardia, oxygen desaturation, tube obstruction and isolated cases of pulmonary haemorrhage have been reported CONCLUSION: Less invasive surfactant therapy improves pulmonary outcomes in preterm neonates with RDS and should ideally be administered in combination with CPAP...
November 24, 2017: Acta Paediatrica
https://www.readbyqxmd.com/read/29162728/evaluating-the-value-of-the-respiratory-therapist-where-is-the-evidence-focus-on-the-barnes-jewish-hospital-experience
#10
Marin H Kollef
Currently, >20 million people in the United States have asthma, and approximately 15 million adults have been diagnosed with COPD, with approximately the same number not yet having been diagnosed with this condition. Moreover, the overall burden of respiratory diseases is still increasing, in part due to environmental factors, such as air pollution. At the same time, the number of patients requiring hospitalization as well as the number of individuals admitted to ICUs from emergency departments has been on the rise over the last decade...
December 2017: Respiratory Care
https://www.readbyqxmd.com/read/29138816/protective-effects-of-fucoidan-against-hyperoxic-lung-injury-via-the-erk-signaling-pathway
#11
Minghao Nie, Yan Wang, Yanhong Lu, Ying Yuan, Yingying Liu, Xiurong Li
High oxygen mechanical ventilation is widely used to treat various lung diseases; however, it may result in hyperoxia, which induces inflammation and lung injury. Fucoidan is an extract of the seaweed Fucus vesiculosus, which has previously been reported to exert effects against diabetic nephropathy. The present study is the first, to the best of our knowledge, to investigate the protective effects of fucoidan against hyperoxic lung injury. Balb/c mice were ventilated with 100% oxygen, with or without the atomization inhalation of fucoidan, for 36 h...
November 10, 2017: Molecular Medicine Reports
https://www.readbyqxmd.com/read/29134246/does-high-peep-prevent-alveolar-cycling
#12
REVIEW
M Cressoni, C Chiurazzi, D Chiumello, L Gattinoni
Acute respiratory distress syndrome (ARDS) patients need mechanical ventilation to sustain gas exchange. Animal experiments showed that mechanical ventilation with high volume/plateau pressure and no positive end-expiratory pressure (PEEP) damages healthy lungs, while low tidal volumes and the application of higher PEEP levels are protective. PEEP makes the lung homogeneous, reducing the pressure multiplication at the interface between lung units with different inflation statuses and keeps the lung open through the whole respiratory cycle, avoiding intratidal opening and closing...
November 13, 2017: Medizinische Klinik, Intensivmedizin und Notfallmedizin
https://www.readbyqxmd.com/read/29118026/carbon-monoxide-in-lung-cell-physiology-and-disease
#13
Stefan W Ryter, Kevin C Ma, Augustine M K Choi
Carbon monoxide (CO) is an endogenously produced gas that has gained recognition as a biological signal transduction effector with properties similar, but not identical, to that of nitric oxide (NO). CO, which binds primarily to heme iron, may activate the hemoprotein guanylate cyclase (sGC), although with lower potency than NO. Furthermore, CO can modulate the activities of several cellular signaling molecules such as p38 MAPK, ERK1/2, JNK, AKT, NF-κB, and others. Emerging studies suggest that mitochondria, the energy-generating organelle of cells, represent a key target of CO action in eukaryotes...
November 8, 2017: American Journal of Physiology. Cell Physiology
https://www.readbyqxmd.com/read/29112971/effects-of-positive-end-expiratory-pressure-and-recruitment-maneuvers-in-a-ventilator-induced-injury-mouse-model
#14
Laura A Cagle, Lisa M Franzi, Angela L Linderholm, Jerold A Last, Jason Y Adams, Richart W Harper, Nicholas J Kenyon
BACKGROUND: Positive-pressure mechanical ventilation is an essential therapeutic intervention, yet it causes the clinical syndrome known as ventilator-induced lung injury. Various lung protective mechanical ventilation strategies have attempted to reduce or prevent ventilator-induced lung injury but few modalities have proven effective. A model that isolates the contribution of mechanical ventilation on the development of acute lung injury is needed to better understand biologic mechanisms that lead to ventilator-induced lung injury...
2017: PloS One
https://www.readbyqxmd.com/read/29099451/the-quest-for-the-holy-grail-of-optimizing-mechanical-ventilation-and-protecting-the-lung-in-mechanically-ventilated-infants-and-children
#15
Shekhar T Venkataraman
No abstract text is available yet for this article.
November 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29096562/alpha-1-antitrypsin-ameliorates-ventilator-induced-lung-injury-in-rats-by-inhibiting-inflammatory-responses-and-apoptosis
#16
He Zhu, Jianshuai He, Jia Liu, Xin Zhang, Fengyun Yang, Pingting Liu, Shilei Wang
Mechanical ventilation is extensively used to treat patients with lung injury but may result in ventilator-induced lung injury (VILI). The present study investigated the protective effect of alpha 1-antitrypsin (AAT) on VILI. Adult male rats were subjected to sham, ventilation + saline, or ventilation + AAT treatment and lung injuries were evaluated. Peripheral blood and bronchoalveolar lavage fluid (BALF) were obtained to assess systemic and local inflammatory responses, respectively. Mechanical ventilation resulted in lung injury, as evidenced by histological abnormalities as well as elevations in PaO2/FiO2 ratio, the wet-to-dry weight ratio, and the BALF level of proteins...
January 1, 2017: Experimental Biology and Medicine
https://www.readbyqxmd.com/read/29089468/protective-effect-of-htk-solution-on-postoperative-pulmonary-function-in-infants-with-chd-and-pah
#17
Jindong Li, Yanhong Wu, Xudong Tian, Jiantang Wang, Mingfeng Dong, Anbiao Wang
Objective In this study, we aimed to investigate the effect of pulmonary arterial perfusion (PAP) with HTK on lung protection in infants with congenital heart disease (CHD) and pulmonary arterial hypertension (PAH) after cardiopulmonary bypass (CPB). Methods Fifty infant patients with CHD and PAH at our hospital from January 2016 to February 2017 were randomly divided into control group and HTK group. The level of IL-6, MDA and ET-1 in serum were detected using ELISA Kit. Oxygen index (OI) and respiratory index (RI) were calculated at each time point...
October 31, 2017: Bioscience Reports
https://www.readbyqxmd.com/read/29078905/sphingosine-rescues-aged-mice-from-pulmonary-pseudomonas-infection
#18
Teresa C Rice, Amanda M Pugh, Aaron P Seitz, Erich Gulbins, Vanessa Nomellini, Charles C Caldwell
BACKGROUND: Bacterial lung infection is a leading cause of death for those 65 y or older, often requiring intensive care unit admission and mechanical ventilation, which consumes considerable health care resources. Although administration of antibiotics is the standard of care for bacterial pneumonia, its overuse has led to the emergence of multidrug resistant organisms. Therefore, alternative strategies to help minimize the effects of bacterial pneumonia in the elderly are necessary...
November 2017: Journal of Surgical Research
https://www.readbyqxmd.com/read/29078756/effects-of-lung-protective-mechanical-ventilation-associated-with-permissive-respiratory-acidosis-on-regional-extra-pulmonary-blood-flow-in-experimental-ards
#19
Rudolf Hering, Stefan Kreyer, Christian Putensen
BACKGROUND: Lung protective mechanical ventilation with limited peak inspiratory pressure has been shown to affect cardiac output in patients with ARDS. However, little is known about the impact of lung protective mechanical ventilation on regional perfusion, especially when associated with moderate permissive respiratory acidosis. We hypothesized that lung protective mechanical ventilation with limited peak inspiratory pressure and moderate respiratory acidosis results in an increased cardiac output but unequal distribution of blood flow to the different organs of pigs with oleic-acid induced ARDS...
October 27, 2017: BMC Anesthesiology
https://www.readbyqxmd.com/read/29068269/prone-position-for-acute-respiratory-distress-syndrome-a-systematic-review-and-meta-analysis
#20
Laveena Munshi, Lorenzo Del Sorbo, Neill K J Adhikari, Carol L Hodgson, Hannah Wunsch, Maureen O Meade, Elizabeth Uleryk, Jordi Mancebo, Antonio Pesenti, V Marco Ranieri, Eddy Fan
RATIONALE: The application of prone positioning for acute respiratory distress syndrome (ARDS) has evolved, with recent trials focusing on patients with more severe ARDS, and applying prone ventilation for more prolonged periods. OBJECTIVES: This review evaluates the effect of prone positioning on 28-day mortality (primary outcome) compared with conventional mechanical ventilation in the supine position for adults with ARDS. METHODS: We updated the literature search from a systematic review published in 2010, searching MEDLINE, EMBASE, and CENTRAL (through to August 2016)...
October 2017: Annals of the American Thoracic Society
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