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Lung protective mechanical ventilation

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https://www.readbyqxmd.com/read/27932671/coupling-of-eit-with-computational-lung-modeling-for-predicting-patient-specific-ventilatory-responses
#1
Christian J Roth, Tobias Becher, Inez Frerichs, Norbert Weiler, Wolfgang A Wall
Providing personalised optimal mechanical ventilation for patients with acute or chronic respiratory failure is still a challenge within a clinical setting for each case anew. In this article, we integrate electrical impedance tomography (EIT) monitoring into a powerful patient-specific computational lung model to create an approach for personalising protective ventilatory treatment. The underlying computational lung model is able to predict global quantities e.g., tracheal flow and tidal volume, as well as local tissue aeration and strains for any ventilation manoeuvre...
December 8, 2016: Journal of Applied Physiology
https://www.readbyqxmd.com/read/27925446/the-declined-levels-of-inflammatory-cytokines-related-with-weaning-rate-during-period-of-septic-patients-using-ventilators
#2
Jung-Lung Hsiao, Chao-Huei Yang, Mei-Hua Lu, Hui-Ming Chang, Wang-Sheng Ko, Ya-Ling Chiou
INTRODUCTION: Approximately 50% of patients with sepsis-induced acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) require mechanical ventilation. Patients with extended mechanical ventilator use routinely develop re-infections, which increases hospital stay, mortality, and health care cost. Some studies have pointed out inflammatory factors concentrations can affect ventilator weaning, but do not indicate changed inflammatory factors related to ventilator weaning during using ventilators...
December 7, 2016: Clinical Respiratory Journal
https://www.readbyqxmd.com/read/27925055/lung-protection-an-intervention-for-tidal-volume-reduction-in-a-teaching-intensive-care-unit
#3
Arturo Briva, Cristina Gaiero
Objective: To determine the effect of feedback and education regarding the use of predicted body weight to adjust tidal volume in a lung-protective mechanical ventilation strategy. Methods: The study was performed from October 2014 to November 2015 (12 months) in a single university polyvalent intensive care unit. We developed a combined intervention (education and feedback), placing particular attention on the importance of adjusting tidal volumes to predicted body weight bedside...
December 1, 2016: Revista Brasileira de Terapia Intensiva
https://www.readbyqxmd.com/read/27922742/the-diaphragm-acts-as-a-brake-during-expiration-to-prevent-lung-collapse
#4
Mariangela Pellegrini, Göran Hedenstierna, Agneta Roneus, Monica Segelsjö, Anders Larsson, Gaetano Perchiazzi
RATIONALE: The diaphragm is the major inspiratory muscle and is assumed to relax during expiration. However, electrical post-inspiratory activity has been observed. Whether or not there is an expiratory diaphragmatic contraction that preserves lung patency has yet to be explored. OBJECTIVE: We hypothesized the occurrence of an expiratory diaphragmatic contraction directed at stabilizing peripheral airways and preventing or reducing cyclic expiratory lung collapse...
December 6, 2016: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/27911872/p120-regulates-beta-catenin-nuclear-translocation-through-e-cadherin-endocytosis-in-ventilator-induced-lung-injury
#5
Changping Gu, Chenyang Dai, Yongtao Sun, Mengjie Liu, Yuelan Wang, Xinyi Wu
Mechanical stretch induces epithelial barrier dysfunction by altering the location and degradation of cellular junction proteins. p120-catenin (p120) is a cell-cell junction protein known to protect against ventilator-induced lung injury (VILI) that results from improper ventilation of patients. In this study, we sought to determine the role of p120 in VILI and its relationship with the cellular response to mechanical stretch. Mouse lung epithelial cells (MLE-12) transfected with p120 siRNA, p120 cDNA, or E-cadherin siRNA were subjected to 20% cyclic stretch for 2 or 4 hours...
November 30, 2016: Oncotarget
https://www.readbyqxmd.com/read/27900922/-extracorporeal-life-support-for-legionella-pneumonia
#6
W A C Koekkoek, C Savelkoul, P R Wijnandts, M Platenkamp, D W Donker, D H T Tjan
BACKGROUND: Legionella species cause 5% of all community acquired pneumonias. However, Legionella pneumonia results relatively often in admission to the intensive care unit (ICU). A significant complication is the development of acute respiratory distress syndrome (ARDS). The ICU mortality rate for Legionella pneumonia is > 30% with conventional treatments. CASE DESCRIPTION: A 64-year-old male was admitted to the ICU with respiratory failure due to Legionella pneumonia complicated by ARDS...
2016: Nederlands Tijdschrift Voor Geneeskunde
https://www.readbyqxmd.com/read/27898437/how-best-to-set-the-ventilator-on-extracorporeal-membrane-lung-oxygenation
#7
Luciano Gattinoni, Tommaso Tonetti, Michael Quintel
PURPOSE OF REVIEW: Extracorporeal respiratory support in patients with acute respiratory distress syndrome is applied either as rescue maneuver for life-threatening hypoxemia or as a tool to reduce the harm of mechanical ventilation. Depending on the blood and gas flow, extracorporeal support may completely substitute the natural lung as a gas exchanger (high-flow venovenous bypass) or reduce the need for mechanical ventilation, enabling the removal of a fraction of the metabolically produced CO2...
November 24, 2016: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/27894328/effect-of-driving-pressure-on-mortality-in-ards-patients-during-lung-protective-mechanical-ventilation%C3%A2-in-two-randomized-controlled-trials
#8
Claude Guérin, Laurent Papazian, Jean Reignier, Louis Ayzac, Anderson Loundou, Jean-Marie Forel
BACKGROUND: Driving pressure (ΔPrs) across the respiratory system is suggested as the strongest predictor of hospital mortality in patients with acute respiratory distress syndrome (ARDS). We wonder whether this result is related to the range of tidal volume (VT). Therefore, we investigated ΔPrs in two trials in which strict lung-protective mechanical ventilation was applied in ARDS. Our working hypothesis was that ΔPrs is a risk factor for mortality just like compliance (Crs) or plateau pressure (Pplat,rs) of the respiratory system...
November 29, 2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/27875409/extracorporeal-membrane-oxygenation-beyond-rescue-therapy-for-acute-respiratory-distress-syndrome
#9
Alain Combes, Nicolas Bréchot, Charles-Edouard Luyt, Matthieu Schmidt
PURPOSE OF REVIEW: This article summarizes the results of past and more recent series on venovenous extracorporeal membrane oxygenation (VV-ECMO) and discusses its potential indications beyond the rescue of patients with lung failure refractory to conventional mechanical ventilation. RECENT FINDINGS: Successful VV-ECMO treatment in patients with extremely severe influenza A(H1N1)-associated acute respiratory distress syndrome (ARDS) and positive results of the CESAR trial have led to an exponential use of the technology in recent years...
November 19, 2016: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/27865481/the-influence-of-tethering-and-gravity-on-the-stability-of-compliant-liquid-lined-airways
#10
Jeremy Whang, Chandler Faulman, Thomas A Itin, Donald P Gaver
This study revolves around two simple questions: 1) how does pulmonary airway recruitment/de-recruitment (RecDer) depend on the tethering support provided by surrounding airways and alveoli, and 2) does airway angle of inclination (θ) influence airway stability? These two questions are critical to understanding the existence and prevention of atelectrauma, which may contribute to ventilator-induced lung injury (VILI). To address these questions, we develop PDMS 2mm ID compliant tubes that mimic pulmonary airways...
November 11, 2016: Journal of Biomechanics
https://www.readbyqxmd.com/read/27861175/transient-receptor-potential-vanilloid-4-and-serum-glucocorticoid-regulated-kinase-1-are-critical-mediators-of-lung-injury-in-overventilated-mice-in-vivo
#11
Laura Michalick, Lasti Erfinanda, Ulrike Weichelt, Markus van der Giet, Wolfgang Liedtke, Wolfgang M Kuebler
BACKGROUND: Mechanical ventilation can cause lung endothelial barrier failure and inflammation cumulating in ventilator-induced lung injury. Yet, underlying mechanotransduction mechanisms remain unclear. Here, the authors tested the hypothesis that activation of the mechanosensitive Ca channel transient receptor potential vanilloid (TRPV4) by serum glucocorticoid-regulated kinase (SGK) 1 may drive the development of ventilator-induced lung injury. METHODS: Mice (total n = 54) were ventilated for 2 h with low (7 ml/kg) or high (20 ml/kg) tidal volumes and assessed for signs of ventilator-induced lung injury...
November 18, 2016: Anesthesiology
https://www.readbyqxmd.com/read/27856731/airway-delivery-of-interferon-%C3%AE-overexpressing-macrophages-confers-resistance-to-mycobacterium-avium-infection-in-scid-mice
#12
Rajamouli Pasula, Bradley E Britigan, Banurekha Kesavalu, Maher Y Abdalla, William J Martin
Mycobacterium avium (M. avium) causes significant pulmonary infection, especially in immunocompromised hosts. Alveolar macrophages (AMs) represent the first line of host defense against infection in the lung. Interferon gamma (IFN-γ) activation of AMs enhances in vitro killing of pathogens such as M. avium We hypothesized that airway delivery of AMs into the lungs of immunodeficient mice infected with M. avium will inhibit M. avium growth in the lung and that this macrophage function is in part IFN-γ dependent...
November 2016: Physiological Reports
https://www.readbyqxmd.com/read/27842750/ventilatory-management-of-the-noninjured-lung
#13
REVIEW
David L Bowton, Louis Keith Scott
This article reviews aspects of mechanical ventilation in patients without lung injury, patients in the perioperative period, and those with neurologic injury or disease including spinal cord injury. Specific emphasis is placed on ventilator strategies, including timing and indications for tracheostomy. Lung protective ventilation, using low tidal volumes and modest levels of positive end-expiratory pressure, should be the default consideration in all patients requiring mechanical ventilatory support. The exception may be the patient with high cervical spinal cord injuries who requires mechanical ventilatory support...
December 2016: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/27842744/ventilator-induced-lung-injury
#14
REVIEW
Jeremy R Beitler, Atul Malhotra, B Taylor Thompson
Prevention of ventilator-induced lung injury (VILI) can attenuate multiorgan failure and improve survival in at-risk patients. Clinically significant VILI occurs from volutrauma, barotrauma, atelectrauma, biotrauma, and shear strain. Differences in regional mechanics are important in VILI pathogenesis. Several interventions are available to protect against VILI. However, most patients at risk of lung injury do not develop VILI. VILI occurs most readily in patients with concomitant physiologic insults. VILI prevention strategies must balance risk of lung injury with untoward side effects from the preventive effort, and may be most effective when targeted to subsets of patients at increased risk...
December 2016: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/27842743/assessing-respiratory-system-mechanical-function
#15
REVIEW
Ruben D Restrepo, Diana M Serrato, Rodrigo Adasme
The main goals of assessing respiratory system mechanical function are to evaluate the lung function through a variety of methods and to detect early signs of abnormalities that could affect the patient's outcomes. In ventilated patients, it has become increasingly important to recognize whether respiratory function has improved or deteriorated, whether the ventilator settings match the patient's demand, and whether the selection of ventilator parameters follows a lung-protective strategy. Ventilator graphics, esophageal pressure, intra-abdominal pressure, and electric impedance tomography are some of the best-known monitoring tools to obtain measurements and adequately evaluate the respiratory system mechanical function...
December 2016: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/27818334/neuromuscular-blockade-in-the-21-st-century-management-of-the-critically-ill-patient
#16
REVIEW
Julian deBacker, Nicholas Hart, Eddy Fan
Neuromuscular blockings agents (NMBAs) have a controversial role in the ventilatory and medical management of critical illness. The clinical concern surrounding NMBA-induced complications stems from evidence presented in the 2002 clinical practice guidelines, but new evidence from subsequent randomized trials and studies provides a more optimistic outlook about the application of NMBAs in the intensive care unit (ICU). Furthermore, changes in the delivery of critical care such as protocolized care pathways, minimizing or interrupting sedation, increased monitoring techniques, and overall improvements in reducing immobility have created a modern, 21st century ICU environment whereby NMBAs may be administered safely...
November 3, 2016: Chest
https://www.readbyqxmd.com/read/27811142/loss-of-epithelial-gq-and-g11-signaling-inhibits-tgf%C3%AE-production-but-promotes-il-33-mediated-macrophage-polarization-and-emphysema
#17
Alison E John, Michael R Wilson, Anthony Habgood, Joanne Porte, Amanda L Tatler, Anastasios Stavrou, Gino Miele, Lisa Jolly, Alan J Knox, Masao Takata, Stefan Offermanns, R Gisli Jenkins
Heterotrimeric guanine nucleotide-binding protein (G protein) signaling links hundreds of G protein-coupled receptors with four G protein signaling pathways. Two of these, one mediated by Gq and G11 (Gq/11) and the other by G12 and G13 (G12/13), are implicated in the force-dependent activation of transforming growth factor-β (TGFβ) in lung epithelial cells. Reduced TGFβ activation in alveolar cells leads to emphysema, whereas enhanced TGFβ activation promotes acute lung injury and idiopathic pulmonary fibrosis...
October 25, 2016: Science Signaling
https://www.readbyqxmd.com/read/27809884/diffuse-persistent-pulmonary-interstitial-emphysema-secondary-to-mechanical-ventilation-in-bronchiolitis
#18
Blanca Toledo Del Castillo, Isabel Gordillo, Elena Rubio García, Sarah Nicole Fernández Lafever, Rafael Gonzalez Cortés, Javier Urbano Villaescusa, Jorge López González, María José Solana García, Jesús López-Herce Cid
BACKGROUND: Persistent interstitial pulmonary emphysema (PIE) is a rare disease and it is even more uncommon in full-term infants, like our patient. When conservative management is not successful, surgical treatment should be considered. In our case, ECMO support was iniciated to keep the patient ventilated in order to allow the lung to heal using lung protection strategies. CASE PRESENTATION: We report an 18-day-old male infant with bronchiolitis that required mechanical ventilation with high positive airway pressures due to severe respiratory insufficiency...
November 3, 2016: BMC Pulmonary Medicine
https://www.readbyqxmd.com/read/27799180/high-peep-in-acute-respiratory-distress-syndrome-quantitative-evaluation-between-improved-arterial-oxygenation-and-decreased-oxygen-delivery
#19
M Chikhani, A Das, M Haque, W Wang, D G Bates, J G Hardman
BACKGROUND: Positive end-expiratory pressure (PEEP) is widely used to improve oxygenation and prevent alveolar collapse in mechanically ventilated patients with the acute respiratory distress syndrome (ARDS). Although PEEP improves arterial oxygenation predictably, high-PEEP strategies have demonstrated equivocal improvements in ARDS-related mortality. The effect of PEEP on tissue oxygen delivery is poorly understood and is difficult to quantify or investigate in the clinical environment...
November 2016: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/27790273/clinical-practice-guideline-of-acute-respiratory-distress-syndrome
#20
REVIEW
Young-Jae Cho, Jae Young Moon, Ein-Soon Shin, Je Hyeong Kim, Hoon Jung, So Young Park, Ho Cheol Kim, Yun Su Sim, Chin Kook Rhee, Jaemin Lim, Seok Jeong Lee, Won-Yeon Lee, Hyun Jeong Lee, Sang Hyun Kwak, Eun Kyeong Kang, Kyung Soo Chung, Won-Il Choi
There is no well-stated practical guideline for mechanically ventilated patients with or without acute respiratory distress syndrome (ARDS). We generate strong (1) and weak (2) grade of recommendations based on high (A), moderate (B) and low (C) grade in the quality of evidence. In patients with ARDS, we recommend low tidal volume ventilation (1A) and prone position if it is not contraindicated (1B) to reduce their mortality. However, we did not support high-frequency oscillatory ventilation (1B) and inhaled nitric oxide (1A) as a standard treatment...
October 2016: Tuberculosis and Respiratory Diseases
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