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https://www.readbyqxmd.com/read/29435738/alveolar-tidal-recruitment-derecruitment-and-overdistension-during-four-levels-of-end-expiratory-pressure-with-protective-tidal-volume-during-anesthesia-in-a-murine-lung-healthy-model
#1
Joao Henrique Neves Soares, Alysson Roncally Carvalho, Bruno Curty Bergamini, Maria Alice Kuster Gress, Frederico Caetano Jandre, Walter Araujo Zin, Antonio Giannella-Neto
PURPOSE: We compared respiratory mechanics between the positive end-expiratory pressure of minimal respiratory system elastance (PEEP minErs ) and three levels of PEEP during low-tidal-volume (6 mL/kg) ventilation in rats. METHODS: Twenty-four rats were anesthetized, paralyzed, and mechanically ventilated. Airway pressure (P aw ), flow (F), and volume (V) were fitted by a linear single compartment model (LSCM) P aw (t) = E rs × V(t) + R rs × F(t) + PEEP or a volume- and flow-dependent SCM (VFDSCM) P aw (t) = (E 1 + E 2 × V(t)) × V(t) + (K 1 + K 2 × |F(t)|) × F(t) + PEEP, where E rs and R rs are respiratory system elastance and resistance, respectively; E 1 and E 2 × V are volume-independent and volume-dependent E rs , respectively; and K 1 and K 2 × F are flow-independent and flow-dependent R rs , respectively...
February 12, 2018: Lung
https://www.readbyqxmd.com/read/29432712/expiratory-flow-limitation-during-mechanical-ventilation
#2
REVIEW
Detajin Junhasavasdikul, Irene Telias, Domenico Luca Grieco, Lu Chen, Cinta Millan Gutierrez, Thomas Piraino, Laurent Brochard
Expiratory flow limitation (EFL) is present when the flow cannot rise despite an increase of the expiratory driving pressure. The mechanisms of EFL are debated but are thought to be related to the collapsibility of small airways. In mechanically ventilated patients, EFL can exist during tidal ventilation, representing an extreme situation where lung volume cannot decrease whatever the expiratory driving forces. It is a key factor for the generation of auto- or intrinsic positive end-expiratory pressure (auto-PEEP or PEEPi) and requires specific management such as positioning and adjustment of external PEEP...
February 9, 2018: Chest
https://www.readbyqxmd.com/read/29431700/influence-of-tidal-volume-and-positive-end-expiratory-pressure-on-ventilation-distribution-and-oxygenation-during-one-lung-ventilation
#3
Zhanqi Zhao, Wei Wang, Zuojing Zhang, Meiying Xu, Inez Frerichs, Jing-Xiang Wu, Knut Moeller
The aim of the study was to explore the feasibility of titrating tidal volume (VT) and positive end-expiratory pressure (PEEP) during one-lung ventilation (OLV) based on ventilation distribution and oxygenation. Approach: Twenty four consecutive patients requiring intubation with a double-lumen tube and subsequent OLV for thoracic surgical procedures were examined prospectively in lateral posture. Electrical impedance tomography (EIT), blood gases, respiratory mechanics were successfully measured in 21 patients at various combinations of VT (4 ml/kg, 6 ml/kg, 8 ml/kg body weight) and PEEP (0 cmH2O, 4 cmH2O, 8 cmH2O) during OLV...
February 12, 2018: Physiological Measurement
https://www.readbyqxmd.com/read/29430442/effects-of-peep-on-lung-injury-pulmonary-function-systemic-circulation-and-mortality-in-animals-with-uninjured-lungs-a-systematic-review
#4
REVIEW
Anna Geke Algera, Luigi Pisani, Renato Carneiro de Freitas Chaves, Thiago Chaves Amorim, Thomas Cherpanath, Rogier Determann, Dave A Dongelmans, Frederique Paulus, Pieter Roel Tuinman, Paolo Pelosi, Marcelo Gama de Abreu, Marcus J Schultz, Ary Serpa Neto
It is well-known that positive end-expiratory pressure (PEEP) can prevent ventilator-induced lung injury (VILI) and improve pulmonary physiology in animals with injured lungs. It's uncertain whether PEEP has similar effects in animals with uninjured lungs. A systematic review of randomized controlled trials (RCTs) comparing different PEEP levels in animals with uninjured lungs was performed. Trials in animals with injured lungs were excluded, as were trials that compared ventilation strategies that also differed with respect to other ventilation settings, e...
January 2018: Annals of Translational Medicine
https://www.readbyqxmd.com/read/29420904/unstable-inflation-causing-injury-insight-from-prone-position-and-paired-ct-scans
#5
Yi Xin, Maurizio Cereda, Hooman Hamedani, Mehrdad Pourfathi, Sarmad Siddiqui, Natalie Meeder, Stephen Kadlecek, Ian Duncan, Harrilla Profka, Jennia Rajaei, Nicholas J Tustison, James C Gee, Brian P Kavanagh, Rahim R Rizi
BACKGROUND: It remains unclear how prone positioning improves survival in acute respiratory distress syndrome (ARDS). Using serial computed tomography (CT), we previously reported that 'unstable' inflation, i.e. partial aeration with large tidal density swings (indicating increased local strain) is associated with injury progression. We prospectively tested whether prone position contains the early propagation of experimental lung injury by stabilizing inflation. METHODS: Injury was induced by tracheal hydrochloric acid (HCl) in rats; after randomization to supine or prone position, injurious ventilation was commenced using high tidal volume and low PEEP...
February 8, 2018: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/29411336/central-sleep-apnea-with-cheyne-stokes-breathing-in-heart-failure-from-research-to-clinical-practice-and-beyond
#6
K Terziyski, A Draganova
Characterized by periodic crescendo-decrescendo pattern of breathing alternating with central apneas, Central sleep apnea (CSA) with Cheyne-Stokes Breathing represents a highly prevalent, yet underdiagnosed comorbidity in chronic heart failure (CHF). A diverse body of evidence demonstrates increased morbidity and mortality in the presence of CSB. CSB has been described in both CHF patients with preserved and reduced ejection fraction, regardless of drug treatment. Risk factors for CSB are older age, male gender, high BMI, atrial fibrillation and hypocapnia...
February 7, 2018: Advances in Experimental Medicine and Biology
https://www.readbyqxmd.com/read/29408490/gender-aspects-in-cardiopulmonary-resuscitation-by-schoolchildren-a-systematic-review
#7
REVIEW
Simon-Richard Finke, Daniel C Schroeder, Hannes Ecker, Sabine Wingen, Jochen Hinkelbein, Wolfgang A Wetsch, Daniela Köhler, Bernd W Böttiger
AIM: Bystander CPR-rates are embarrassingly low in some European countries. To increase bystander CPR-rates, many different approaches are used; one of them is training of schoolchildren in CPR. Multiple authors investigated practical and theoretical CPR performance and demonstrated gender differences related to schoolchildren CPR. The objective was to elaborate gender aspects in practical and theoretical CPR-performance from the current literature to better address female and male students...
February 3, 2018: Resuscitation
https://www.readbyqxmd.com/read/29371130/individualised-perioperative-open-lung-approach-versus-standard-protective-ventilation-in-abdominal-surgery-iprove-a-randomised-controlled-trial
#8
Carlos Ferrando, Marina Soro, Carmen Unzueta, Fernando Suarez-Sipmann, Jaume Canet, Julián Librero, Natividad Pozo, Salvador Peiró, Alicia Llombart, Irene León, Inmaculada India, Cesar Aldecoa, Oscar Díaz-Cambronero, David Pestaña, Francisco J Redondo, Ignacio Garutti, Jaume Balust, Jose I García, Maite Ibáñez, Manuel Granell, Aurelio Rodríguez, Lucía Gallego, Manuel de la Matta, Rafael Gonzalez, Andrea Brunelli, Javier García, Lucas Rovira, Francisco Barrios, Vicente Torres, Samuel Hernández, Estefanía Gracia, Marta Giné, María García, Nuria García, Lisset Miguel, Sergio Sánchez, Patricia Piñeiro, Roger Pujol, Santiago García-Del-Valle, José Valdivia, María J Hernández, Oto Padrón, Ana Colás, Jaume Puig, Gonzalo Azparren, Gerardo Tusman, Jesús Villar, Javier Belda
BACKGROUND: The effects of individualised perioperative lung-protective ventilation (based on the open-lung approach [OLA]) on postoperative complications is unknown. We aimed to investigate the effects of intraoperative and postoperative ventilatory management in patients scheduled for abdominal surgery, compared with standard protective ventilation. METHODS: We did this prospective, multicentre, randomised controlled trial in 21 teaching hospitals in Spain. We enrolled patients who were aged 18 years or older, were scheduled to have abdominal surgery with an expected time of longer than 2 h, had intermediate-to-high-risk of developing postoperative pulmonary complications, and who had a body-mass index less than 35 kg/m2...
January 19, 2018: Lancet Respiratory Medicine
https://www.readbyqxmd.com/read/29370755/associations-between-intraoperative-ventilator-settings-during-one-lung-ventilation-and-postoperative-pulmonary-complications-a-prospective-observational-study
#9
Shuji Okahara, Kazuyoshi Shimizu, Satoshi Suzuki, Kenzo Ishii, Hiroshi Morimatsu
BACKGROUND: The interest in perioperative lung protective ventilation has been increasing. However, optimal management during one-lung ventilation (OLV) remains undetermined, which not only includes tidal volume (V T ) and positive end-expiratory pressure (PEEP) but also inspired oxygen fraction (F I O 2 ). We aimed to investigate current practice of intraoperative ventilation during OLV, and analyze whether the intraoperative ventilator settings are associated with postoperative pulmonary complications (PPCs) after thoracic surgery...
January 25, 2018: BMC Anesthesiology
https://www.readbyqxmd.com/read/29369819/comparison-of-flow-and-gas-washout-characteristics-between-pressure-control-and-high-frequency-percussive-ventilation-using-a-test-lung
#10
Rabijit Dutta, Tao Xing, Craig Swanson, Jeff Heltborg, Gordon K Murdoch
A comparison between flow and gas washout data for High Frequency Percussive Ventilation (HFPV) and pressure control ventilation (PCV) under similar conditions is currently not available. This bench study aims to compare and describe the flow and gas washout behavior of HFPV and PCV in a newly designed experimental setup and establish a framework for future clinical and animal studies. Approach: We studied gas washout behavior using a newly designed experimental setup that is motivated by the multi-breath nitrogen washout measurements...
January 25, 2018: Physiological Measurement
https://www.readbyqxmd.com/read/29367411/ards-challenges-in-patient-care-and-frontiers-in-research
#11
Lieuwe D Bos, Ignacio Martin-Loeches, Marcus J Schultz
This review discusses the clinical challenges associated with ventilatory support and pharmacological interventions in patients with acute respiratory distress syndrome (ARDS). In addition, it discusses current scientific challenges facing researchers when planning and performing trials of ventilatory support or pharmacological interventions in these patients.Noninvasive mechanical ventilation is used in some patients with ARDS. When intubated and mechanically ventilated, ARDS patients should be ventilated with low tidal volumes...
March 31, 2018: European Respiratory Review: An Official Journal of the European Respiratory Society
https://www.readbyqxmd.com/read/29354672/impact-of-heated-humidified-high-flow-air-via-nasal-cannula-on-respiratory-effort-in-patients-with-chronic-obstructive-pulmonary-disease
#12
Charles W Atwood, Sharon Camhi, Kathryn C Little, Colleen Paul, Hobart Schweikert, Nicholas J Macmillan, Thomas L Miller
Background: High flow nasal cannula therapy (HFNC) has been widely adopted for respiratory distress, and evidence suggests that purging dead space of the upper airway improves gas fractions in the lung. This study tests the hypothesis that HFNC with room air could be as effective as low flow oxygen in chronic obstructive pulmonary disease (COPD). Methods: Thirty-two COPD patients prescribed 1 - 2 L/min of oxygen were studied. The conditions tested consisted of a control (CTRL; no therapy), then in random order HFNC and prescribed low flow oxygen (LFO)...
August 15, 2017: Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation
https://www.readbyqxmd.com/read/29343171/prognosis-of-acute-respiratory-distress-syndrome-in-patients-with-hematological-malignancies
#13
Gil Myeong Seong, Yunkyoung Lee, Sang-Bum Hong, Chae-Man Lim, Younsuck Koh, Jin Won Huh
INTRODUCTION: The intensive care unit (ICU) admission of patients with hematologic malignancies is gradually increasing. Life-threatening events are common, and acute respiratory distress syndrome (ARDS) is one of the most critical conditions. The aim of this study was to investigate the clinical characteristics and outcomes of ARDS in patients with hematological malignancies admitted to the ICU. METHODS: A retrospective study was performed on all patients with ARDS with hematological malignancies in a single tertiary teaching hospital between 2008 and 2015...
January 1, 2018: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/29338821/factors-influencing-regional-cerebral-oxygen-saturation-during-one-lung-ventilation-in-thoracic-surgery
#14
Ya Hong Gong, Wei Jia Wang, Wei Wei, Yu Guang Huang
Objective To identify factors influencing regional cerebral oxygen saturation (rScO2) during one-lung ventilation (OLV) in thoracic surgery. Methods Totally 33 patients with an ASA physical status of 1-3 scheduled for elective thoracic surgery with one-lung ventilation under general anesthesia were recruited. After anesthesia was induced with propofol,fentanyl/sufentanil,and rocuronium. All patients received balanced anesthesia using sevoflurane. During OLV,volume-controlled ventilation was used with a tidal volume of 6-7 ml/kg and an inspiration:expiration ratio of 1:1...
December 20, 2017: Zhongguo Yi Xue Ke Xue Yuan Xue Bao. Acta Academiae Medicinae Sinicae
https://www.readbyqxmd.com/read/29297365/regional-physiology-of-ards
#15
REVIEW
Luciano Gattinoni, Tommaso Tonetti, Michael Quintel
The acute respiratory distress (ARDS) lung is usually characterized by a high degree of inhomogeneity. Indeed, the same lung may show a wide spectrum of aeration alterations, ranging from completely gasless regions, up to hyperinflated areas. This inhomogeneity is normally caused by the presence of lung edema and/or anatomical variations, and is deeply influenced by the gravitational forces.For any given airway pressure generated by the ventilator, the pressure acting directly on the lung (i.e., the transpulmonary pressure or lung stress) is determined by two main factors: 1) the ratio between lung elastance and the total elastance of the respiratory system (which has been shown to vary widely in ARDS patients, between 0...
December 28, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29260449/low-minute-ventilation-episodes-during-anesthesia-recovery-following-intraperitoneal-surgery-as-detected-by-a-non-invasive-respiratory-volume-monitor
#16
Alexandre N Cavalcante, Yvette N Martin, Juraj Sprung, Jasmin Imsirovic, Toby N Weingarten
An electrical impedance-based noninvasive respiratory volume monitor (RVM) accurately reports minute volume, tidal volume and respiratory rate. Here we used the RVM to quantify the occurrence of and evaluate the ability of clinical factors to predict respiratory depression in the post-anesthesia care unit (PACU). RVM generated respiratory data were collected from spontaneously breathing patients following intraperitoneal surgeries under general anesthesia admitted to the PACU. Respiratory depression was defined as low minute ventilation episode (LMVe, < 40% predicted minute ventilation for at least 2 min)...
December 20, 2017: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/29250319/patients-with-uninjured-lungs-may-also-benefit-from-lung-protective-ventilator-settings
#17
REVIEW
Roger Alencar, Vittorio D'Angelo, Rachel Carmona, Marcus J Schultz, Ary Serpa Neto
Although mechanical ventilation is a life-saving strategy in critically ill patients and an indispensable tool in patients under general anesthesia for surgery, it also acts as a double-edged sword. Indeed, ventilation is increasingly recognized as a potentially dangerous intrusion that has the potential to harm lungs, in a condition known as 'ventilator-induced lung injury' (VILI). So-called 'lung-protective' ventilator settings aiming at prevention of VILI have been shown to improve outcomes in patients with acute respiratory distress syndrome (ARDS), and, over the last few years, there has been increasing interest in possible benefit of lung-protective ventilation in patients under ventilation for reasons other than ARDS...
2017: F1000Research
https://www.readbyqxmd.com/read/29238880/in-vitro-performance-of-prefilled-co2-absorbers-with-the-zeus%C3%A2
#18
Mohab Omer, Jan F A Hendrickx, Simon De Ridder, Alexander De Houwer, Rik Carette, Sofie De Cooman, Andre M De Wolf
Low fresh gas flows (FGFs) decrease the use of anesthetic gases, but increase CO2 absorbent usage. CO2 absorbent usage remains poorly quantified. The goal of this study is to determine canister life of 8 commercially available CO2 absorbent prepacks with the Zeus®. Pre-packed CO2 canisters of 8 different brands were tested in vitro: Amsorb Plus, Spherasorb, LoFloSorb, LithoLyme, SpiraLith, SpheraSorb, Drägersorb 800+, Drägersorb Free, and CO2ntrol. CO2 (160 mL min- 1) flowed into the tip of a 2 L breathing bag that was ventilated with a tidal volume of 500 mL, a respiratory rate of 10/min, and an I:E ratio of 1:1 using the controlled mechanical ventilation mode of the Zeus® (Dräger, Lubeck, Germany)...
December 13, 2017: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/29225003/improving-patient-safety-during-procedural-sedation-via-respiratory-volume-monitoring-a-randomized-controlled-trial
#19
Donald M Mathews, Michael J Oberding, Eric L Simmons, Stephen E O'Donnell, Kevin R Abnet, Kathleen MacDonald
STUDY OBJECTIVE: Assess the utility of a respiratory volume monitor (RVM) to reduce the incidence of low minute ventilation events in procedural sedation. DESIGN: Randomized control trial SETTING: Endoscopy suite PATIENTS: Seventy-three total patients (ASA Physical Status 1-3) undergoing upper endoscopies were analyzed. INTERVENTION: Patients were randomized into two groups using a computer generated randomization table: Control (n=41): anesthesia provider was unable to see the screen of the RVM; RVM (n=32): anesthesia provider had access to RVM data to assist with management of the case...
December 7, 2017: Journal of Clinical Anesthesia
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
#20
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
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