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https://www.readbyqxmd.com/read/28941533/pathophysiology-and-management-of-acute-respiratory-distress-syndrome-in-children
#1
REVIEW
Sabrina M Heidemann, Alison Nair, Yonca Bulut, Anil Sapru
Acute respiratory distress syndrome (ARDS) is a syndrome of noncardiogenic pulmonary edema and hypoxia that accompanies up to 30% of deaths in pediatric intensive care units. Pediatric ARDS (PARDS) is diagnosed by the presence of hypoxia, defined by oxygenation index or Pao2/Fio2 ratio cutoffs, and new chest infiltrate occurring within 7 days of a known insult. Hallmarks of ARDS include hypoxemia and decreased lung compliance, increased work of breathing, and impaired gas exchange. Mortality is often accompanied by multiple organ failure...
October 2017: Pediatric Clinics of North America
https://www.readbyqxmd.com/read/28939268/wave-reflection-correlates-with-pulmonary-vascular-wall-thickening-in-rats-with-pulmonary-arterial-hypertension
#2
Masafumi Fukumitsu, Toru Kawada, Shuji Shimizu, Michael J Turner, Kazunori Uemura, Masaru Sugimachi
BACKGROUND: Wave reflection is enhanced in patients with pulmonary arterial hypertension (PAH), which may be derived from a mismatch of pulmonary artery (PA) impedance between proximal and distal sites of arteries. Whether enhanced wave reflection correlates with histological remodeling remains unknown, partly because lung biopsy is not clinically recommended for PAH patients due to substantial risks of mortality and morbidity. METHODS: Pulmonary hypertension was induced by SU5416 injection and 3-week hypoxic exposure (SuHx-PH) in rats, and hemodynamic and histological examinations were performed at 4weeks (SuHx-PH4W) and 8weeks (SuHx-PH8W) after SU5416 injection (n=7 each)...
September 14, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28938958/pulmonary-hemodynamics-in-heart-failure-patients-with-reduced-or-preserved-ejection-fraction-and-pulmonary-hypertension-similarities-and-disparities
#3
Yochai Adir, Marco Guazzi, Amir Offer, Pier Luigi Temporelli, Antonia Cannito, Stefano Ghio
OBJECTIVE: The current understanding of pulmonary hypertension (PH) due to left ventricular diseases does not distinguish heart failure (HF) with reduced ejection fraction (HFrEF) from HF and preserved ejection fraction (HFpEF), in terms of pulmonary hemodynamics. The value of pulmonary vascular compliance (PCa) and diastolic pulmonary gradient (DPG) as predictors of survival in either HF syndrome is controversial. The aims of our study were to compare the pulmonary hemodynamics in the two HF phenotypes, given similar values of pulmonary artery wedge pressure (PAWP), and to evaluate the impact of PCa and DPG on survival...
October 2017: American Heart Journal
https://www.readbyqxmd.com/read/28936967/-effect-of-sedation-on-respiratory-function-of-patients-undergoing-mechanical-ventilation
#4
Jie Yang, Yan Kang
Sedation and analgesia for ventilated patients is an important treatment in intensive care unit (ICU). Patients receiving mechanical ventilation therapy comfortably and safely can improve patient-ventilator synchrony, reduce ventilation-related lung injury (VILI), improve compliance, decrease oxygen consumption and stress, prevent accidents, and reduce the incidence of complications and mortality in critical patients. Although sedation may protect lung function, it also has a greater impact on respiratory function...
September 2017: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/28936695/early-application-of-airway-pressure-release-ventilation-may-reduce-the-duration-of-mechanical-ventilation-in-acute-respiratory-distress-syndrome
#5
Yongfang Zhou, Xiaodong Jin, Yinxia Lv, Peng Wang, Yunqing Yang, Guopeng Liang, Bo Wang, Yan Kang
PURPOSE: Experimental animal models of acute respiratory distress syndrome (ARDS) have shown that the updated airway pressure release ventilation (APRV) methodologies may significantly improve oxygenation, maximize lung recruitment, and attenuate lung injury, without circulatory depression. This led us to hypothesize that early application of APRV in patients with ARDS would allow pulmonary function to recover faster and would reduce the duration of mechanical ventilation as compared with low tidal volume lung protective ventilation (LTV)...
September 22, 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/28912380/exposure-of-neonatal-mice-to-bromine-impairs-their-alveolar-development-and-lung-function
#6
Tamas Jilling, Changchun Ren, Aaron Jefthy Yee, Saurabh Aggarwal, Brian Halloran, Namasivayam Ambalavanan, Sadis Matalon
The halogen bromine (Br2) is used extensively in industry and stored and transported in large quantities. Its accidental or malicious release into the atmosphere has resulted in significant casualties. The pathophysiology of Br2-induced lung injury has been studied in adult animals, but the consequences of Br2 exposure to the developing lung are completely unknown. We exposed neonatal mouse littermates on postnatal day 3 (P3) to either Br2 at 400 ppm for 30 minutes (400/30), to Br2 at 600 ppm for 30 minutes (600/30), or to room air, then returned them to their dams and observed until P14...
September 14, 2017: American Journal of Physiology. Lung Cellular and Molecular Physiology
https://www.readbyqxmd.com/read/28912263/hemodynamic-phenotyping-of-pulmonary-hypertension-in-left-heart-failure
#7
REVIEW
Robert Naeije, Mario Gerges, Jean-Luc Vachiery, Sergio Caravita, Christian Gerges, Irene M Lang
Increased pulmonary venous pressure secondary to left heart disease is the most common cause of pulmonary hypertension (PH). The diagnosis of PH due to left heart disease relies on a clinical probability assessment followed by the invasive measurements of a mean pulmonary artery pressure (PAP) ≥25 mm Hg and mean wedged PAP (PAWP) >15 mm Hg. A combination of mean PAP and mean PAWP defines postcapillary PH. Postcapillary PH is generally associated with a diastolic pulmonary pressure gradient (diastolic PAP minus mean PAWP) <7 mm Hg, a transpulmonary pressure gradient (mean PAP minus mean PAWP) <12 mm Hg, and pulmonary vascular resistance ≤3 Wood units (WU)...
September 2017: Circulation. Heart Failure
https://www.readbyqxmd.com/read/28910340/successful-1-1-proportion-ventilation-with-a-unique-device-for-independent-lung-ventilation-using-a-double-lumen-tube-without-complications-in-the-supine-and-lateral-decubitus-positions-a-pilot-study
#8
Michał Kowalczyk, Sławomir Sawulski, Wojciech Dąbrowski, Luiza Grzycka-Kowalczyk, Edyta Kotlińska-Hasiec, Agnieszka Wrońska-Sewruk, Artur Florek, Rafał Rutyna
INTRODUCTION: Adequate blood oxygenation and ventilation/perfusion matching should be main goal of anaesthetic and intensive care management. At present, one of the methods of improving gas exchange restricted by ventilation/perfusion mismatching is independent ventilation with two ventilators. Recently, however, a unique device has been developed, enabling ventilation of independent lungs in 1:1, 2:1, 3:1, and 5:1 proportions. The main goal of the study was to evaluate the device's utility, precision and impact on pulmonary mechanics...
2017: PloS One
https://www.readbyqxmd.com/read/28904482/mathematics-of-ventilator-induced-lung-injury
#9
REVIEW
Ubaidur Rahaman
Ventilator-induced lung injury (VILI) results from mechanical disruption of blood-gas barrier and consequent edema and releases of inflammatory mediators. A transpulmonary pressure (PL) of 17 cmH2O increases baby lung volume to its anatomical limit, predisposing to VILI. Viscoelastic property of lung makes pulmonary mechanics time dependent so that stress (PL) increases with respiratory rate. Alveolar inhomogeneity in acute respiratory distress syndrome acts as a stress riser, multiplying global stress at regional level experienced by baby lung...
August 2017: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/28900890/high-level-of-venous-thromboembolism-in-critically-ill-trauma-patients-despite-early-and-well-driven-thromboprophylaxis-protocol
#10
S R Hamada, C Espina, T Guedj, R Buaron, A Harrois, S Figueiredo, J Duranteau
BACKGROUND: Venous thromboembolism (VTE) is one of the most common preventable causes of in-hospital death in trauma patients surviving their injuries. We assessed the prevalence, incidence and risk factors for deep venous thrombosis (DVT) and pulmonary embolism (PE) in critically ill trauma patients, in the setting of a mature and early mechanical and pharmacological thromboprophylaxis protocol. METHODS: This was a prospective observational study on a cohort of patients from a surgical intensive care unit of a university level 1 trauma centre...
September 12, 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/28893516/interleukin-6-is-independently-associated-with-right-ventricular-function-in-pulmonary-arterial-hypertension
#11
Kurt W Prins, Stephen L Archer, Marc Pritzker, Lauren Rose, E Kenneth Weir, Alok Sharma, Thenappan Thenappan
BACKGROUND: An elevated serum level of interleukin-6 (IL-6) in pulmonary arterial hypertension (PAH) patients results in a greater symptom burden and increased mortality; however, the mechanisms underlying these observations remain unclear. Because both pre-clinical and clinical data associate elevated IL-6 levels with impaired cardiac function, we hypothesized that the adverse effects of IL-6 in PAH result, in part, from right ventricular (RV) dysfunction. METHODS: We analyzed the relationship between IL-6 and RV function in 40 patients with PAH identified in our institutional PAH registry...
September 1, 2017: Journal of Heart and Lung Transplantation
https://www.readbyqxmd.com/read/28891198/targeted-medical-nutrition-for-cachexia-in-chronic-obstructive-pulmonary-disease-a-randomized-controlled-trial
#12
Philip C Calder, Alessandro Laviano, Fredrik Lonnqvist, Maurizio Muscaritoli, Maria Öhlander, Annemie Schols
BACKGROUND: Cachectic patients with chronic obstructive pulmonary disease (COPD) may benefit from nutritional support. This double-blind, randomized, controlled trial evaluated the safety and efficacy of targeted medical nutrition (TMN) vs. an isocaloric comparator in pre-cachectic and cachectic patients with COPD. METHODS: Patients aged ≥50 years with moderate-to-severe COPD and involuntary weight loss or low body mass index (16-18 kg/m(2) ) were randomized 1:1 to receive TMN (~230 kcal; 2 g omega-3 fatty acids; 10 μg 25-hydroxy-vitamin D3) or isocaloric comparator twice daily for 12 weeks (ClinicalTrials...
September 10, 2017: Journal of Cachexia, Sarcopenia and Muscle
https://www.readbyqxmd.com/read/28888803/effects-of-pneumoperitoneum-and-of-an-alveolar-recruitment-maneuver-followed-by-positive-end-expiratory-pressure-on-cardiopulmonary-function-in-sheep-anesthetized-with-isoflurane-fentanyl
#13
Jéssica C Rodrigues, Francisco J Teixeira-Neto, Sofia A Cerejo, Nathalia Celeita-Rodríguez, Natache A Garofalo, Juliany G Quitzan, Thalita L A Rocha
OBJECTIVE: To investigate the effects of pneumoperitoneum alone or combined with an alveolar recruitment maneuver (ARM) followed by positive end-expiratory pressure (PEEP) on cardiopulmonary function in sheep. STUDY DESIGN: Prospective, randomized, crossover study. ANIMALS: A total of nine adult sheep (36-52 kg). METHODS: Sheep were administered three treatments (≥10-day intervals) during isoflurane-fentanyl anesthesia and volume-controlled ventilation (tidal volume: 12 mL kg(-1)) with oxygen: CONTROL (no intervention); PNEUMO (120 minutes of CO2 pneumoperitoneum); PNEUMOARM/PEEP (PNEUMO protocol with an ARM instituted after 60 minutes of pneumoperitoneum)...
June 7, 2017: Veterinary Anaesthesia and Analgesia
https://www.readbyqxmd.com/read/28883720/effect-of-a-rehabilitation-based-chronic-disease-management-program-targeting-severe-copd-exacerbations-on-readmission-patterns
#14
C Lalmolda, R Coll-Fernández, N Martínez, M Baré, M Teixidó Colet, F Epelde, E Monsó
BACKGROUND: Pulmonary rehabilitation (PR) is recommended after a severe COPD exacerbation, but its short- and long-term effects on health care utilization have not been fully established. AIMS: The aims of this study were to evaluate patient compliance with a chronic disease management (CDM) program incorporating home-based exercise training as the main component after a severe COPD exacerbation and to determine its effects on health care utilization in the following year...
2017: International Journal of Chronic Obstructive Pulmonary Disease
https://www.readbyqxmd.com/read/28882231/hemodynamic-response-to-nitroprusside-in-patients-with-low-gradient-severe-aortic-stenosis-and-preserved-ejection-fraction
#15
COMPARATIVE STUDY
James W Lloyd, Rick A Nishimura, Barry A Borlaug, Mackram F Eleid
BACKGROUND: Low-gradient severe aortic stenosis (LGSAS) with preserved ejection fraction (EF) is incompletely understood. The influence of arterial afterload and diastolic dysfunction on the hemodynamic presentation of LGSAS remains unknown. OBJECTIVES: The authors sought to determine the acute hemodynamic response to sodium nitroprusside in LGSAS with preserved EF. METHODS: Symptomatic patients with LGSAS and preserved EF underwent cardiac catheterization with comparison of hemodynamic measurements before and after nitroprusside...
September 12, 2017: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/28872540/effects-on-pulmonary-vascular-mechanics-of-two-different-lung-protective-ventilation-strategies-in-an-experimental-model-of-acute-respiratory-distress-syndrome
#16
Arnoldo Santos, Eva Gomez-Peñalver, M Ignacio Monge-Garcia, Jaime Retamal, João Batista Borges, Gerardo Tusman, Goran Hedenstierna, Anders Larsson, Fernando Suarez-Sipmann
OBJECTIVES: To compare the effects of two lung-protective ventilation strategies on pulmonary vascular mechanics in early acute respiratory distress syndrome. DESIGN: Experimental study. SETTING: University animal research laboratory. SUBJECTS: Twelve pigs (30.8 ± 2.5 kg). INTERVENTIONS: Acute respiratory distress syndrome was induced by repeated lung lavages and injurious mechanical ventilation...
September 1, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28869934/typical-hemodialysis-in-india-a-case-report
#17
Georgi Abraham, Madhusudan Vijayan, Milly Mathew
We report here a typical case of a patient on hemodialysis (HD) for end-stage renal disease (ESRD) in India that highlights some of the management issues encountered in a country with an enormous burden of ESRD and major challenges of underdialysis and management of comorbidities. The patient, a 42-year-old multiparous woman with chronic kidney disease (CKD) stage V, type 2 diabetes mellitus, and hypertension is a homemaker from a middle-class family, living in a large city, with no family history of CKD. From May 2013 to December 2016, she has been receiving twice-weekly maintenance HD for 4 h (intermittent HD); access was via an internal jugular line initially and then via a left brachiocephalic arteriovenous fistula (AVF) from late June 2013...
2017: Blood Purification
https://www.readbyqxmd.com/read/28866134/wnt-%C3%AE-catenin-signaling-links-embryonic-lung-development-and-asthmatic-airway-remodeling
#18
REVIEW
Musaddique Hussain, Chengyun Xu, Meiping Lu, Xiling Wu, Lanfang Tang, Ximei Wu
Embryonic lung development requires reciprocal endodermal-mesodermal interactions; mediated by various signaling proteins. Wnt/β-catenin is a signaling protein that exhibits the pivotal role in lung development, injury and repair while aberrant expression of Wnt/β-catenin signaling leads to asthmatic airway remodeling: characterized by hyperplasia and hypertrophy of airway smooth muscle cells, alveolar and vascular damage goblet cells metaplasia, and deposition of extracellular matrix; resulting in decreased lung compliance and increased airway resistance...
August 30, 2017: Biochimica et Biophysica Acta
https://www.readbyqxmd.com/read/28860142/novel-therapeutic-roles-for-surfactant-inositols-and-phosphatidylglycerols-in-a-neonatal-piglet-ards-model-a-translational-study
#19
Dietmar Spengler, Supandi Winoto-Morbach, Sarah Kupsch, Christina Vock, Katharina Blöchle, Susanna Frank, Nele Rintz, Marie Diekötter, Harshavardhan Janga, Markus Weckmann, Sabine Fuchs, Andra B Schromm, Heinz Fehrenbach, Stefan Schütze, Martin F Krause
The biological and immune-protective properties of surfactant-derived phospholipids and phospholipid-subfractions in the context of neonatal inflammatory lung disease are widely unknown. Using a porcine neonatal triple-hit ARDS model (repeated airway lavage, overventilation, LPS instillation into airways), we assessed whether the supplementation of surfactant (poractant alfa, S) with inositol-derivatives (inositol-1,2,6-trisphosphate, IP3; phosphatidylinositol-3,5-bisphosphate, PIP2) or phosphatidylglycerol-subfractions (16:0/18:1-POPG; 18:1/18:1-DOPG) would result in improved clinical parameters, and sought to characterize changes in key inflammatory pathways behind these improvements...
August 31, 2017: American Journal of Physiology. Lung Cellular and Molecular Physiology
https://www.readbyqxmd.com/read/28857356/different-predictivity-of-fluid-responsiveness-by-pulse-pressure-variation-in-children-after-surgical-repair-of-ventricular-septal-defect-or-tetralogy-of-fallot
#20
Ding Han, Shoudong Pan, Xiaonan Wang, Qingyan Jia, Yi Luo, Jia Li, Chuan Ou-Yang
BACKGROUND: Pulse pressure variation derived from the varied pulse contour method is based on heart-lung interaction during mechanical ventilation. It has been shown that pulse pressure variation is predictive of fluid responsiveness in children undergoing surgical repair of ventricular septal defect. Right ventricle compliance and pulmonary vascular capacitance in children with tetralogy of Fallot are underdeveloped as compared to those in ventricular septal defect. We hypothesized that the difference in the right ventricle-pulmonary circulation in the two groups of children would affect the heart-lung interaction and therefore pulse pressure variation predictivity of fluid responsiveness following cardiac surgery...
August 31, 2017: Paediatric Anaesthesia
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