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https://www.readbyqxmd.com/read/29907273/extracorporeal-gas-exchange
#1
REVIEW
Onnen Moerer, Francesco Vasques, Eleonora Duscio, Francesco Cipulli, Federica Romitti, Luciano Gattinoni, Michael Quintel
Extracorporeal gas exchange is increasingly used for various indications. Among these are refractory acute respiratory failure, including the acute respiratory distress syndrome (ARDS), and the avoidance of ventilator-induced lung injury (VILI) by enabling lung-protective ventilation. Additionally, extracorporeal gas exchange allows the treatment of hypercapnic respiratory failure while helping to unload the respiratory muscles and avoid intubation and invasive ventilation, as well as facilitating weaning from the ventilator...
July 2018: Critical Care Clinics
https://www.readbyqxmd.com/read/29907082/paravertebral-dexmedetomidine-as-an-adjuvant-to-ropivacaine-protects-against-independent-lung-injury-during-one-lung-ventilation-a-preliminary-randomized-clinical-trial
#2
Wei Zhang, Shanfeng Zhang, Bing Li, Mingyang Sun, Jiaqiang Zhang
BACKGROUND: To investigate the effect of paravertebral dexmedetomidine as an adjuvant to ropivacaine on independent lung injury during one-lung ventilation. METHODS: In total, 120 patients who underwent elective radical resection of pulmonary carcinoma were randomly assigned to one of six groups (n = 20): normal saline (C group), ropivacaine (R group), intravenous dexmedetomidine (Div group), 0.5 μg/kg paravertebral dexmedetomidine as an adjuvant to ropivacaine (RD0...
June 15, 2018: BMC Anesthesiology
https://www.readbyqxmd.com/read/29902538/a-multicentre-observational-study-on-management-of-general-anaesthesia-in-elderly-patients-at-high-risk-of-postoperative-adverse-outcomes
#3
Serge Molliex, Sylvie Passot, Jerome Morel, Emmanuel Futier, Jean Yves Lefrant, Jean Michel Constantin, Yannick Le Manach, Bruno Pereira
INTRODUCTION: in elderly patients, goal directed haemodynamic therapy (GDHT), depth of anaesthesia monitoring and lung-protective ventilation have been shown to improve postoperative outcomes. The aim of this study was to evaluate current practices concerning strategies of anaesthesia optimisation in patients aged ≥ 75 years. PATIENTS AND METHODS: a multicentre observational study was performed from February to May 2015 in 23 French academic centres. On 30 consecutive days in each centre, patients ≥ 75 years with at least one major co-morbidity undergoing elective or emergency procedures (femoral-neck fractures surgery, intraperitoneal abdominal surgery or vascular surgery) were included...
June 11, 2018: Anaesthesia, Critical Care & Pain Medicine
https://www.readbyqxmd.com/read/29901798/the-use-of-extracorporeal-membrane-oxygenation-for-acute-respiratory-distress-syndrome-in-severe-burns-without-inhalation-injury
#4
Juliet J Ray, Richard J Straker, Valerie J Hart, Jonathan P Meizoso, Carl I Schulman, Matthias Loebe, Ali Ghodsizad
Burn injury results in a severe systemic inflammatory response which is associated with the development of acute respiratory distress syndrome (ARDS), even without associated inhalation injury. Venous-venous extracorporeal membrane oxygenation (VV-ECMO) has been implemented in various cases of ARDS to provide support and allow for protective lung ventilation strategies. We report the case of a 27-year-old man presenting with a 60% total body surface area partial thickness burn who developed refractory ARDS with Murray Score of 3...
June 13, 2018: Journal of Burn Care & Research: Official Publication of the American Burn Association
https://www.readbyqxmd.com/read/29898436/endotracheal-intubation-and-in-hospital-mortality-after-intracerebral-hemorrhage
#5
Vasileios-Arsenios Lioutas, Sarah Marchina, Louis R Caplan, Magdy Selim, Joseph Tarsia, Luciana Catanese, Jonathan Edlow, Sandeep Kumar
BACKGROUND: Many patients with acute intracerebral hemorrhages (ICHs) undergo endotracheal intubation with subsequent mechanical ventilation (MV) for "airway protection" with the intent to prevent aspiration, pneumonias, and its related mortality. Conversely, these procedures may independently promote pneumonia, laryngeal trauma, dysphagia, and adversely affect patient outcomes. The net benefit of intubation and MV in this patient cohort has not been systematically investigated...
June 13, 2018: Cerebrovascular Diseases
https://www.readbyqxmd.com/read/29862257/alternative-and-natural-therapies-for-acute-lung-injury-and-acute-respiratory-distress-syndrome
#6
REVIEW
Vipul J Patel, Sreeja Biswas Roy, Hiren J Mehta, Myungsoo Joo, Ruxana T Sadikot
Introduction: Acute respiratory distress syndrome (ARDS) is a complex clinical syndrome characterized by acute inflammation, microvascular damage, and increased pulmonary vascular and epithelial permeability, frequently resulting in acute respiratory failure and death. Current best practice for ARDS involves "lung-protective ventilation," which entails low tidal volumes and limiting the plateau pressures in mechanically ventilated patients. Although considerable progress has been made in understanding the pathogenesis of ARDS, little progress has been made in the development of specific therapies to combat injury and inflammation...
2018: BioMed Research International
https://www.readbyqxmd.com/read/29847990/pregnancy-preserves-pulmonary-function-following-influenza-virus-infection-in-c57bl-6-mice
#7
Meghan S Vermillion, Andrew Nelson, Landon G Vom Steeg, Jeffrey Martin Loube, Wayne Mitzner, Sabra L Klein
Pregnancy is associated with significant anatomic and functional changes to the cardiopulmonary system. Using pregnant C57BL/6 mice, we characterized changes in pulmonary structure and function during pregnancy in healthy animals and following infection with influenza A virus (IAV). We hypothesized that pregnancy-associated alterations in pulmonary physiology would contribute to the more severe outcome of IAV infection. Nonpregnant and pregnant females (at embryonic day 10.5) were either mock-infected or infected with 2009 H1N1 IAV for assessment of pulmonary function, structure, and inflammation at 8 days post-inoculation...
May 31, 2018: American Journal of Physiology. Lung Cellular and Molecular Physiology
https://www.readbyqxmd.com/read/29807393/design-and-development-of-a-non-rigid-phantom-for-the-quantitative-evaluation-of-dir-based-mapping-of-simulated-pulmonary-ventilation
#8
Shin Miyakawa, Hidenobu Tachibana, Shunsuke Moriya, Tomoyuki Kurosawa, Teiji Nishio, Masanori Sato
PURPOSE: The validation of deformable image registration (DIR)-based pulmonary ventilation mapping is time-consuming and prone to inaccuracies and is also affected by deformation parameters. In this study, we developed a non-rigid phantom as a quality assurance (QA) tool that simulates ventilation to evaluate DIR-based images quantitatively. METHODS: The phantom consists of an acrylic cylinder filled with polyurethane foam designed to simulate pulmonic alveoli. A polyurethane membrane is attached to the inferior end of the phantom to simulate the diaphragm...
May 28, 2018: Medical Physics
https://www.readbyqxmd.com/read/29793604/influence-of-xenon-on-pulmonary-mechanics-and-lung-aeration-in-patients-with-healthy-lungs
#9
M S Schaefer, T A Treschan, J Gauch, M Neukirchen, P Kienbaum
BACKGROUND: The anaesthetic xenon shows potent organ-protective properties. Due to high density and dynamic viscosity, peak inspiratory pressure (Pmax ) increases during xenon application. Thus, barotrauma may counteract organ protection. Accordingly, we investigated the influence of xenon on lung mechanics and lung aeration in patients with normal and reduced thoracic wall compliance. METHODS: After registration and ethical approval, 20 patients free of pulmonary disease undergoing routine xenon-based anaesthesia were mechanically ventilated...
June 2018: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29790144/-prone-position-and-nursing-care
#10
Shu-Ju Lu, Shiao-Pei Wang
Acute respiratory distress syndrome (ARDS) is a life-threatening disease, as acute inflammation in the lungs typically leads to hypoxia and symptoms of dyspnea. The treatment modalities of ARDS include mechanical ventilation, corticosteroid, extracorporeal membranous oxygenation, inhaled nitrogen oxide, and the prone position. Among these, the prone position is supported by evidence showing significantly reduced mortality in patients that adopt this modality. Lying in the prone position reduces atelectatic lung volumes by recruitment of dependent parts and facilitates normal regulation of alveolar ventilation, giving better-matched ventilation perfusion and, thus, improved oxygenation...
June 2018: Hu Li za Zhi the Journal of Nursing
https://www.readbyqxmd.com/read/29787413/halving-the-volume-of-anaconda-evaluation-of-a-new-small-volume-anesthetic-reflector-in-a-test-lung-model
#11
Hagen Bomberg, Franziska Meiser, Philipp Daume, Martin Bellgardt, Thomas Volk, Daniel I Sessler, Heinrich V Groesdonk, Andreas Meiser
BACKGROUND: Volatile anesthetics are increasingly used for sedation in intensive care units. The most common administration system is AnaConDa-100 mL (ACD-100; Sedana Medical, Uppsala, Sweden), which reflects volatile anesthetics in open ventilation circuits. AnaConDa-50 mL (ACD-50) is a new device with half the volumetric dead space. Carbon dioxide (CO2) can be retained with both devices. We therefore compared the CO2 elimination and isoflurane reflection efficiency of both devices. METHODS: A test lung constantly insufflated with CO2 was ventilated with a tidal volume of 500 mL at 10 breaths/min...
May 21, 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29787304/deterioration-of-regional-lung-strain-and-inflammation-during-early-lung-injury
#12
Gabriel C Motta-Ribeiro, Soshi Hashimoto, Tilo Winkler, Rebecca M Baron, Kira Grogg, Luís F S C Paula, Arnoldo Santos, Congli Zeng, Kathryn Hibbert, Robert S Harris, Ednan Bajwa, Marcos F Vidal Melo
RATIONALE: The contribution of aeration heterogeneity to lung injury during early mechanical ventilation of uninjured lungs is unknown. OBJECTIVE: Test the hypotheses that a strategy consistent with clinical practice does not protect from worsening in lung strains during the first 24h of ventilation of initially normal lungs exposed to mild systemic endotoxemia in supine versus prone position, and that local neutrophilic inflammation is associated with local strain and blood volume at global strains below a proposed injurious threshold...
May 22, 2018: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/29776982/variable-effectiveness-of-stepwise-implementation-of-nudge-type-interventions-to-improve-provider-compliance-with-intraoperative-low-tidal-volume-ventilation
#13
Vikas N O'Reilly-Shah, George S Easton, Craig S Jabaley, Grant C Lynde
BACKGROUND: Identifying mechanisms to improve provider compliance with quality metrics is a common goal across medical disciplines. Nudge interventions are minimally invasive strategies that can influence behavioural changes and are increasingly used within healthcare settings. We hypothesised that nudge interventions may improve provider compliance with lung-protective ventilation (LPV) strategies during general anaesthesia. METHODS: We developed an audit and feedback dashboard that included information on both provider-level and department-level compliance with LPV strategies in two academic hospitals, two non-academic hospitals and two academic surgery centres affiliated with a single healthcare system...
May 18, 2018: BMJ Quality & Safety
https://www.readbyqxmd.com/read/29764547/-comparison-of-lung-protection-for-hydrochloric-acid-or-oleic-acid-induced-rat-acute-respiratory-distress-syndrome-models-pretreated-with-penehyclidine
#14
Yumei Cheng, Zhou Yang, Feng Shen, Bo Liu, Yahui Wang, Yanqi Wu, Ling Yao, Yuqing Liu
OBJECTIVE: To compare the lung protection roles of intraperitoneal pre-injection with penehyclidine for two kinds of rat models with pulmonary and extrapulmonary acute respiratory distress syndrome (ARDSp and ARDSexp). METHODS: Forty healthy adult Sprague-Dawley (SD) rats were randomly divided into five groups (each n = 8): the rats in sham group received only tracheotomy; the ARDS rat models were reproduced by intratracheal inhalation of 0.1 mol/L hydrochloric acid (HCl) 2 mL/kg to simulate ARDSexp (HCl group) and 0...
May 2018: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/29754942/dead-space-analysis-at-different-levels-of-positive-end-expiratory-pressure-in-acute-respiratory-distress-syndrome-patients
#15
Emiliano Gogniat, Marcela Ducrey, José Dianti, Matías Madorno, Nicolás Roux, Alejandro Midley, Julio Raffo, Sergio Giannasi, Eduardo San Roman, Fernando Suarez-Sipmann, Gerardo Tusman
PURPOSE: To analyze the effects of positive end-expiratory pressure (PEEP) on Bohr's dead space (VDBohr /VT) in patients with acute respiratory distress syndrome (ARDS). MATERIAL AND METHODS: Fourteen ARDS patients under lung protective ventilation settings were submitted to 4 different levels of PEEP (0, 6, 10, 16 cmH2 O). Respiratory mechanics, hemodynamics and volumetric capnography were recorded at each protocol step. RESULTS: Two groups of patients responded differently to PEEP when comparing baseline with 16-PEEP: those in which driving pressure increased > 15% (∆P˃15% , n = 7, p = ...
June 2018: Journal of Critical Care
https://www.readbyqxmd.com/read/29754418/comprehensive-outcomes-after-lung-retransplantation-a-single-center-review
#16
Kieran Halloran, Meghan Aversa, Kathryn Tinckam, Tereza Martinu, Matthew Binnie, Cecilia Chaparro, Chung-Wai Chow, Tom Waddell, Karen McRae, Andrew Pierre, Marc de Perrot, Kazuhiro Yasufuku, Marcelo Cypel, Shaf Keshavjee, Lianne G Singer
INTRODUCTION: Lung retransplantation is an important therapy for a growing population of lung transplant recipients with graft failure, but detailed outcome data are lacking. METHODS: We conducted a retrospective cohort study of adult lung retransplant in the Toronto Lung Transplant Program from 2001 to 2013 (n=38). We analyzed the post-operative course, graft function, renal function, microbiology, donor specific antibodies (DSA), quality of life and survival compared to a control cohort of primary transplant recipients matched for age and era...
May 13, 2018: Clinical Transplantation
https://www.readbyqxmd.com/read/29750051/angiotensin-ii-type-2-receptor-agonist-compound-21-attenuates-pulmonary-inflammation-in-a-model-of-acute-lung-injury
#17
Mario Menk, Jan Adriaan Graw, Clarissa von Haefen, Hendrik Steinkraus, Burkhard Lachmann, Claudia D Spies, David Schwaiberger
Purpose: Although the role of the angiotensin II type 2 (AT2) receptor in acute lung injury is not yet completely understood, a protective role of this receptor subtype has been suggested. We hypothesized that, in a rodent model of acute lung injury, stimulation of the AT2 receptor with the direct agonist Compound 21 (C21) might have a beneficial effect on pulmonary inflammation and might improve pulmonary gas exchange. Materials and methods: Male adult rats were divided into a treatment group that received pulmonary lavage followed by mechanical ventilation (LAV, n=9), a group receiving pulmonary lavage, mechanical ventilation, and direct stimulation of the AT2 receptor with C21 (LAV+C21, n=9), and a control group that received mechanical ventilation only (control, n=9)...
2018: Journal of Inflammation Research
https://www.readbyqxmd.com/read/29743094/feasibility-and-safety-of-low-flow-extracorporeal-co-2-removal-managed-with-a-renal-replacement-platform-to-enhance-lung-protective-ventilation-of-patients-with-mild-to-moderate-ards
#18
Matthieu Schmidt, Samir Jaber, Elie Zogheib, Thomas Godet, Gilles Capellier, Alain Combes
BACKGROUND: Extracorporeal carbon-dioxide removal (ECCO2 R) might allow ultraprotective mechanical ventilation with lower tidal volume (VT) (< 6 ml/kg predicted body weight), plateau pressure (Pplat ) (< 30 cmH2 O), and driving pressure to limit ventilator-induced lung injury. This study was undertaken to assess the feasibility and safety of ECCO2 R managed with a renal replacement therapy (RRT) platform to enable very low tidal volume ventilation of patients with mild-to-moderate acute respiratory distress syndrome (ARDS)...
May 10, 2018: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29734208/improved-lung-recruitment-and-oxygenation-during-mandatory-ventilation-with-a-new-expiratory-ventilation-assistance-device-a-controlled-interventional-trial-in-healthy-pigs
#19
Johannes Schmidt, Christin Wenzel, Marlene Mahn, Sashko Spassov, Heidi Cristina Schmitz, Silke Borgmann, Ziwei Lin, Jörg Haberstroh, Stephan Meckel, Sebastian Eiden, Steffen Wirth, Hartmut Buerkle, Stefan Schumann
BACKGROUND: In contrast to conventional mandatory ventilation, a new ventilation mode, expiratory ventilation assistance (EVA), linearises the expiratory tracheal pressure decline. OBJECTIVE: We hypothesised that due to a recruiting effect, linearised expiration oxygenates better than volume controlled ventilation (VCV). We compared the EVA with VCV mode with regard to gas exchange, ventilation volumes and pressures and lung aeration in a model of peri-operative mandatory ventilation in healthy pigs...
May 4, 2018: European Journal of Anaesthesiology
https://www.readbyqxmd.com/read/29732188/weaning-from-veno-venous-extracorporeal-membrane-oxygenation-how-i-do-it
#20
REVIEW
Lars M Broman, Maximilian V Malfertheiner, Andrea Montisci, Federico Pappalardo
Veno-venous extracorporeal membrane oxygenation (VV ECMO) is a rescue treatment for acute respiratory distress syndrome (ARDS) failing protective mechanical ventilation. It temporarily provides proper gas exchange: hypoxia is treated by adjusting the blood flow rate and fraction in spired oxygen over the ventilator (FiO2 ) on the extracorporeal membrane oxygenation (ECMO) circuit while CO2 removal is regulated by the ECMO fresh gas flow. Therefore, ventilator settings can be gradually reduced allowing the lungs to rest and recover...
March 2018: Journal of Thoracic Disease
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