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https://www.readbyqxmd.com/read/28636403/applying-precision-medicine-to-trial-design-using-physiology-extracorporeal-co2-removal-for-ards
#1
Ewan C Goligher, Marcelo B P Amato, Arthur S Slutsky
In clinical trials of therapies for ARDS, the average treatment effect in the study population may be attenuated because individual patient responses vary widely. This inflates sample size requirements and increases the cost and difficulty of conducting successful clinical trials. One solution is to enrich the study population with patients most likely to benefit based on predicted patient response to treatment (predictive enrichment). In this perspective, we apply the precision medicine paradigm to the emerging use of extracorporeal CO2 removal (ECCO2R) for ultra-protective ventilation in ARDS...
June 21, 2017: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28634220/tidal-changes-on-ct-and-progression-of-ards
#2
Maurizio Cereda, Yi Xin, Hooman Hamedani, Giacomo Bellani, Stephen Kadlecek, Justin Clapp, Luca Guerra, Natalie Meeder, Jennia Rajaei, Nicholas J Tustison, James C Gee, Brian P Kavanagh, Rahim R Rizi
BACKGROUND: Uncertain prediction of outcome in acute respiratory distress syndrome (ARDS) impedes individual patient management and clinical trial design. OBJECTIVES: To develop a radiological metric of injurious inflation derived from matched inspiratory and expiratory CT scans, calibrate it in a model of experimental lung injury, and test it in patients with ARDS. METHODS: 73 anaesthetised rats (acid aspiration model) were ventilated (protective or non-protective) for up to 4 hours to generate a spectrum of lung injury...
June 20, 2017: Thorax
https://www.readbyqxmd.com/read/28632529/respiratory-system-mechanics-during-low-versus-high-positive-end-expiratory-pressure-in-open-abdominal-surgery-a-substudy-of-provhilo-randomized-controlled-trial
#3
Davide D'Antini, Robert Huhle, Jacob Herrmann, Demet S Sulemanji, Jun Oto, Pasquale Raimondo, Lucia Mirabella, Sabrine N T Hemmes, Marcus J Schultz, Paolo Pelosi, David W Kaczka, Marcos Francisco Vidal Melo, Marcelo Gama de Abreu, Gilda Cinnella
BACKGROUND: In the 2014 PROtective Ventilation using HIgh versus LOw positive end-expiratory pressure (PROVHILO) trial, intraoperative low tidal volume ventilation with high positive end-expiratory pressure (PEEP = 12 cm H2O) and lung recruitment maneuvers did not decrease postoperative pulmonary complications when compared to low PEEP (0-2 cm H2O) approach without recruitment breaths. However, effects of intraoperative PEEP on lung compliance remain poorly understood. We hypothesized that higher PEEP leads to a dominance of intratidal overdistension, whereas lower PEEP results in intratidal recruitment/derecruitment (R/D)...
June 19, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28632138/monitoring-lung-contusion-in-a-porcine-polytrauma-model-using-eit-an-application-study
#4
Susana Aguiar Santos, Carlos Castelar Wembers, Klemens Horst, Roman Pfeifer, Tim-Philipp Simon, Hans-Christoph Pape, Frank Hildebrand, Michael Czaplik, Steffen Leonhardt, Daniel Teichmann
Lung contusion is the most common lung injury following blunt chest trauma which, in turn, is associated with high mortality rates (Gavelli et al., 2002). Lung contusion is characterized by hemorrhage and edema with consecutively reduced compliance. In this study, unilateral lung contusion and other traumata were induced in 12 pigs by using a bolt gun machine. To investigate the pathophysiological consequences of lung contusion, information on clinical parameters was collected and monitored regularly while animals were additionally monitored with electrical impedance tomography (EIT) before trauma, and at 4, 24, 48 and 72 h after polytrauma...
June 20, 2017: Physiological Measurement
https://www.readbyqxmd.com/read/28629872/sevoflurane-relieves-lung-function-deterioration-after-cardiopulmonary-bypass
#5
Adam L Balogh, Ferenc Peták, Gergely H Fodor, Roberta Sudy, Barna Babik
OBJECTIVE: To investigate sevoflurane's potential to alleviate the detrimental pulmonary changes after cardiopulmonary bypass (CPB). DESIGN: Prospective, randomized clinical investigation. SETTING: University hospital. PARTICIPANTS: One hundred ninety patients undergoing elective cardiac surgery. INTERVENTIONS: Ninety-nine patients under intravenous anesthesia were administered 1 minimal alveolar concentration of sevoflurane for 5 minutes after being weaned from CPB (group SEV); intravenous anesthesia was maintained in the other 91 patients (group CTRL)...
February 24, 2017: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/28629359/forced-expiration-measurements-in-mouse-models-of-obstructive-and-restrictive-lung-diseases
#6
Fien C Devos, André Maaske, Annette Robichaud, Lore Pollaris, Sven Seys, Carolina Aznar Lopez, Erik Verbeken, Matthias Tenbusch, Rik Lories, Benoit Nemery, Peter Hm Hoet, Jeroen Aj Vanoirbeek
BACKGROUND: Pulmonary function measurements are important when studying respiratory disease models. Both resistance and compliance have been used to assess lung function in mice. Yet, it is not always clear how these parameters relate to forced expiration (FE)-related parameters, most commonly used in humans. We aimed to characterize FE measurements in four well-established mouse models of lung diseases. METHOD: Detailed respiratory mechanics and FE measurements were assessed concurrently in Balb/c mice, using the forced oscillation and negative pressure-driven forced expiration techniques, respectively...
June 19, 2017: Respiratory Research
https://www.readbyqxmd.com/read/28625640/association-between-intensity-modulated-radiotherapy-and-survival-in-patients-with-stage-iii-non-small-cell-lung-cancer-treated-with-chemoradiotherapy
#7
Matthew Koshy, Renuka Malik, Michael Spiotto, Usama Mahmood, Chad G Rusthoven, David J Sher
PURPOSE: To determine the effect of radiotherapy (RT) technique on treatment compliance and overall survival (OS) in patients with stage III non-small lung cancer (NSCLC) treated with definitive chemoradiotherapy (CRT). METHODS AND MATERIALS: This study included patients with stage III NSCLC in the National Cancer Database treated between 2003 and 2011 with definitive CRT to 60-63 Gray (Gy). Radiation treatment interruption (RTI) was defined as a break of ≥4 days...
June 2017: Lung Cancer: Journal of the International Association for the Study of Lung Cancer
https://www.readbyqxmd.com/read/28624991/a-new-global-and-comprehensive-model-for-icu-ventilator-performances-evaluation
#8
Nicolas S Marjanovic, Agathe De Simone, Guillaume Jegou, Erwan L'Her
BACKGROUND: This study aimed to provide a new global and comprehensive evaluation of recent ICU ventilators taking into account both technical performances and ergonomics. METHODS: Six recent ICU ventilators were evaluated. Technical performances were assessed under two FIO2 levels (100%, 50%), three respiratory mechanics combinations (Normal: compliance [C] = 70 mL cmH2O(-1)/resistance [R] = 5 cmH2O L(-1) s(-1); Restrictive: C = 30/R = 10; Obstructive: C = 120/R = 20), four exponential levels of leaks (from 0 to 12...
December 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/28621244/-evaluation-of-physians-patients-relatives-and-society-of-opinions-on-the-told-lung-cancer-diagnosis
#9
Utku Datlı, Pınar Çelik, Yavuz Havlucu, Tuğba Göktalay, Ayşın Şakar Coşkun, Ayşe Arzu Yorgancıoğlu
Introduction: In our country, this is usually done by patient relatives. In this study, we aimed to investigate the thought of doctors who done the diagnosis, doctors who arrange the treatment, first degree relatives of patients with lung cancer, and population as a control. Materials and Methods: 310 subjects (100 doctors, 110 first degree realtives of patients, and 100 subjects as a control) were included to the study. The mean age was 39.77 ± 11.44 years and there was 170 females...
March 2017: Tüberküloz Ve Toraks
https://www.readbyqxmd.com/read/28619778/in-patients-with-severe-uncontrolled-asthma-does-knowledge-of-adherence-and-inhaler-technique-using-electronic-monitoring-improve-clinical-decision-making-a-protocol-for-a-randomised-controlled-trial
#10
Matshediso C Mokoka, Lorna Lombard, Elaine M MacHale, Joanne Walsh, Breda Cushen, Imran Sulaiman, Damien Mc Carthy, Fiona Boland, Frank Doyle, Eoin Hunt, Desmond M Murphy, John Faul, Marcus Butler, Kathy Hetherington, J Mark FitzGerald, Job Fm van Boven, Liam G Heaney, Richard B Reilly, Richard W Costello
INTRODUCTION: Many patients with asthma remain poorly controlled despite the use of inhaled corticosteroids and long-acting beta agonists. Poor control may arise from inadequate adherence, incorrect inhaler technique or because the condition is refractory. Without having an objective assessment of adherence, clinicians may inadvertently add extra medication instead of addressing adherence. This study aims to assess if incorporating objectively recorded adherence from the Inhaler Compliance Assessment (INCA) device and lung function into clinical decision making provides more cost-effective prescribing and improves outcomes...
June 15, 2017: BMJ Open
https://www.readbyqxmd.com/read/28614627/a-randomized-phase-ii-feasibility-trial-of-a-multimodal-intervention-for-the-management-of-cachexia-in-lung-and-pancreatic-cancer
#11
Tora S Solheim, Barry J A Laird, Trude Rakel Balstad, Guro B Stene, Asta Bye, Neil Johns, Caroline H Pettersen, Marie Fallon, Peter Fayers, Kenneth Fearon, Stein Kaasa
BACKGROUND: Cancer cachexia is a syndrome of weight loss (including muscle and fat), anorexia, and decreased physical function. It has been suggested that the optimal treatment for cachexia should be a multimodal intervention. The primary aim of this study was to examine the feasibility and safety of a multimodal intervention (n-3 polyunsaturated fatty acid nutritional supplements, exercise, and anti-inflammatory medication: celecoxib) for cancer cachexia in patients with incurable lung or pancreatic cancer, undergoing chemotherapy...
June 14, 2017: Journal of Cachexia, Sarcopenia and Muscle
https://www.readbyqxmd.com/read/28608650/comparison-of-different-dosing-strategies-of-intratracheally-instilled-budesonide-on-meconium-injured-piglet-lungs
#12
Chih-Hsueh Lin, Mei-Jy Jeng, Yi-Chiang Yang, Yu-Hsuan Hsiao, Yu Ru Kou
BACKGROUND: Severe inflammation plays a vital role in the pathogenesis of meconium aspiration syndrome (MAS). Intratracheal (IT) instillation of corticosteroids may be beneficial for MAS in optimizing local effect and reducing systemic adverse effects, but the optimum dosing course remains open to question. METHODS: Thirty meconium-injured newborn piglets were enrolled into six study groups. The first four groups consisted of the IT instillation of 0.25/0.5 mg/kg using either one (IT-B251/IT-B501) or two (IT-B252/IT-B502) doses of budesonide, while the other two groups were the intravenous (IV) dexamethasone (0...
July 2017: Pediatric Pulmonology
https://www.readbyqxmd.com/read/28606649/accuracy-of-lung-ultrasound-in-patients-with-acute-dyspnea-the-influence-of-age-multimorbidity-and-cognitive-and-motor-impairment
#13
Luca Vizioli, Paola Forti, Elena Bartoli, Marco Giovagnoli, Guerino Recinella, Davide Bernucci, Marco Masetti, Elena Martino, Gian Luca Pirazzoli, Marco Zoli, Giampaolo Bianchi
Discriminating between causes of dyspnea may be difficult, particularly in the elderly. The aim of this retrospective study of 83 inpatients with acute dyspnea was to assess the influence of age, multimorbidity and cognitive or motor impairment on the diagnostic accuracy of lung ultrasound (LUS) in discriminating acute heart failure (AHF) from noncardiogenic dyspnea (NCD). Univariate analysis indicates that LUS misdiagnosis was associated with the following parameters: history of stroke (p = 0.037), lower activity of daily living (p = 0...
June 9, 2017: Ultrasound in Medicine & Biology
https://www.readbyqxmd.com/read/28606589/regulatory-effects-of-interleukin-il-15-on-allergen-induced-airway-obstruction
#14
Sathisha Upparahalli Venkateshaiah, Xiang Zhu, Priya Rajavelu, Rituraj Niranjan, Murli Manohar, Alok K Verma, Joseph A Lasky, Anil Mishra
BACKGROUND: Airway obstruction is a physiologic feature of asthma and IL-15 may have an important role in the pathogenesis of asthma. OBJECTIVE: We tested the hypothesis that regulation of IL-15 is critical for the preservation of allergen-induced airway hyperresponsiveness (AHR), airway resistance and compliance in response to methacholine. METHODS: Airway inflammation, AHR, resistance and compliance were assessed in IL-15- gene deficient mice and IL-15 overexpressing mice in an allergen-induced murine model of asthma...
June 9, 2017: Journal of Allergy and Clinical Immunology
https://www.readbyqxmd.com/read/28605525/infectious-diseases-team-for-the-early-management-of-severe-sepsis-and-septic-shock-in-the-emergency-department
#15
Pierluigi Viale, Sara Tedeschi, Luigia Scudeller, Luciano Attard, Lorenzo Badia, Michele Bartoletti, Alessandra Cascavilla, Francesco Cristini, Nicola Dentale, Giovanni Fasulo, Giorgio Legnani, Filippo Trapani, Fabio Tumietto, Gabriella Verucchi, Giulio Virgili, Andrea Berlingeri, Simone Ambretti, Chiara De Molo, Mara Brizi, Mario Cavazza, Maddalena Giannella
Background.: To assess the impact on all-cause 14-day survival of the implementation of an infectious disease (ID) team for the early management of severe sepsis/septic shock (SS/SS) in the Emergency Department (ED). Methods.: A quasi-experimental pre-post study was carried-out at the general ED of our 1,420-bed teaching hospital. During the pre phase (June 2013-July 2014) all consecutive adult patients with SS/SS were managed according to standard-of-care and data were prospectively collected...
June 12, 2017: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
https://www.readbyqxmd.com/read/28596273/novel-analysis-of-4dct-imaging-quantifies-progressive-increases-in-anatomic-dead-space-during-mechanical-ventilation-in-mice
#16
Elizabeth H Kim, Melissa Preissner, Richard Carnibella, Chaminda R Samarage, Ellen Bennett, Andreas Fouras, Graeme R Zosky, Heather Dale Jones
PURPOSE: Increased dead space is an important prognostic marker in early acute respiratory distress syndrome (ARDS) that correlates with mortality. The cause of increased dead space in ARDS has largely been attributed to increased alveolar dead space due to ventilation/perfusion mismatching and shunt. We sought to determine if anatomic dead space also increases in response to mechanical ventilation. METHODS: Mice received intratracheal lipopolysaccharide (LPS) or saline and mechanical ventilation (MV)...
June 8, 2017: Journal of Applied Physiology
https://www.readbyqxmd.com/read/28588116/high-oxygen-concentrations-adversely-affect-the-performance-of-pulmonary-surfactant
#17
Craig D Smallwood, Parnian Boloori-Zadeh, Maricris R Silva, Andrew Gouldstone
BACKGROUND: Although effective in the neonatal population, exogenous pulmonary surfactant has not demonstrated a benefit in pediatric and adult subjects with hypoxic lung injury despite a sound physiologic rationale. Importantly, neonatal surfactant replacement therapy is administered in conjunction with low fractional FIO2 while pediatric/adult therapy is administered with high FIO2 . We suspected a connection between FIO2 and surfactant performance. Therefore, we sought to assess a possible mechanism by which the activity of pulmonary surfactant is adversely affected by direct oxygen exposure in in vitro experiments...
June 6, 2017: Respiratory Care
https://www.readbyqxmd.com/read/28587802/cytokine-filtration-modulates-pulmonary-metabolism-and-edema-formation-during-ex-vivo-lung-perfusion
#18
Ilker Iskender, Tugba Cosgun, Stephan Arni, Michael Trinkwitz, Stefan Fehlings, Yoshito Yamada, Nikola Cesarovic, Keke Yu, Thomas Frauenfelder, Wolfgang Jungraithmayr, Walter Weder, Ilhan Inci
BACKGROUND: Ex vivo lung perfusion (EVLP) has improved the process of donor lung management. Cytokine accumulation during EVLP has been shown to correlate with worse outcome after lung transplantation. Our objective in this study was to test the safety and efficacy of cytokine filtration during EVLP in a large animal model. METHODS: Pig donor lungs were preserved for 24 hours at 4°C, followed by 12 hours of EVLP, according to the Toronto protocol. The perfusate was continuously run through an absorbent device (CytoSorb) via a veno-venous shunt from the reservoir in the filter group...
May 20, 2017: Journal of Heart and Lung Transplantation
https://www.readbyqxmd.com/read/28584436/titration-of-ideal-positive-end-expiratory-pressure-in-acute-respiratory-distress-syndrome-comparison-between-lower-inflection-point-and-esophageal-pressure-method-using-volumetric-capnography
#19
Nandakishore Baikunje, Inderpaul Singh Sehgal, Sahajal Dhooria, Kuruswamy Thurai Prasad, Ritesh Agarwal
The tenets of mechanical ventilation in acute respiratory distress syndrome (ARDS) include the utilization of low tidal volume and optimal application of positive end-expiratory pressure (PEEP). Optimal PEEP in ARDS is characterized by reduction in alveolar dead space along with improvement in the lung compliance and resultant betterment in oxygenation. There are various methods of setting PEEP in ARDS. Herein, we report a patient of ARDS, wherein we employed measurement of dead space using volumetric capnography to compare two different PEEP strategies, namely, the lower inflection point and transpulmonary pressure monitoring...
May 2017: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/28584212/variations-of-postresuscitation-lung-function-after-thrombolysis-therapy-in-a-cardiac-arrest-porcine-model-caused-by-pulmonary-thromboembolism
#20
Jun Yang, Lian-Xing Zhao, Chun-Sheng Li, Nan Tong, Hong-Li Xiao, Le An
BACKGROUND: Study of lung function in survivor from cardiac arrest (CA) caused by pulmonary thromboembolism (PTE) was rare. The aim of this study was to investigate the variations of postresuscitation lung function after thrombolysis treatment in a CA porcine model caused by PTE. METHODS: After 2 min of untreated CA, pigs of 10-12 weeks with a weight of 30 ± 2 kg (n = 24) were treated with recombinant human tissue plasminogen activator (50 mg). Cardiopulmonary resuscitation (CPR) and ventilation were initiated after drug administration...
June 20, 2017: Chinese Medical Journal
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