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Lung-protective ventilation

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https://www.readbyqxmd.com/read/28346529/human-amnion-epithelial-cells-modulate-the-inflammatory-response-to-ventilation-in-preterm-lambs
#1
Jacqueline M Melville, Courtney A McDonald, Robert J Bischof, Graeme R Polglase, Rebecca Lim, Euan M Wallace, Graham Jenkin, Timothy J Moss
Ventilation of preterm neonates causes pulmonary inflammation that can contribute to lung injury, propagate systemically and result in long-term disease. Modulation of this initial response may reduce lung injury and its sequelae. We aimed to determine the effect of human amnion epithelial cells (hAECs) on immune activation and lung injury in preterm neonatal lambs. Preterm lambs received intratracheal hAECs (90x106) or vehicle, prior to 2 h of mechanical ventilation. Within 5 min of ventilation onset, lambs also received intravenous hAECs (90x106) or vehicle...
2017: PloS One
https://www.readbyqxmd.com/read/28342045/effects-of-an-alveolar-recruitment-maneuver-on-subdural-pressure-brain-swelling-and-mean-arterial-pressure-in-patients-undergoing-supratentorial-tumour-resection-a-randomized-crossover-study
#2
Alana M Flexman, Peter A Gooderham, Donald E Griesdale, Ruth Argue, Brian Toyota
PURPOSE: Although recruitment maneuvers have been advocated as part of a lung protective ventilation strategy, their effects on cerebral physiology during elective neurosurgery are unknown. Our objectives were to determine the effects of an alveolar recruitment maneuver on subdural pressure (SDP), brain relaxation score (BRS), and cerebral perfusion pressure among patients undergoing supratentorial tumour resection. METHODS: In this prospective crossover study, patients scheduled for resection of a supratentorial brain tumour were randomized to undergo either a recruitment maneuver (30 cm of water for 30 sec) or a "sham" maneuver (5 cm of water for 30 sec), followed by the alternative intervention after a 90-sec equilibration period...
March 24, 2017: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
https://www.readbyqxmd.com/read/28339394/global-and-regional-assessment-of-sustained-inflation-pressure-volume-curves-in-patients-with-acute-respiratory-distress-syndrome
#3
Tobias Becher, Philipp Rostalski, Matthias Kott, Andy Adler, Dirk Schadler, Norbert Weiler, Inez Frerichs
Static or quasi-static pressure-volume (P-V) curves can be used to determine the lung mechanical properties of patients suffering from acute respiratory distress syndrome (ARDS). According to the traditional interpretation, lung recruitment occurs mainly below the lower point of maximum curvature (LPMC) of the inflation P-V curve. Although some studies have questioned this assumption, setting of positive end-expiratory pressure 2 cmH2O above the LPMC was part of a "lung-protective" ventilation strategy successfully applied in several clinical trials...
March 24, 2017: Physiological Measurement
https://www.readbyqxmd.com/read/28338504/ventilation-with-high-or-low-tidal-volume-with-peep-does-not-influence-lung-function-after-spinal-surgery-in-prone-position-a-randomized-controlled-trial
#4
Sarah Soh, Jae-Kwang Shim, Yoon Ha, Young-Sam Kim, Hyelin Lee, Young-Lan Kwak
BACKGROUND: Spinal surgery in the prone position is accompanied by increased intrathoracic pressure and decreased respiratory compliance. This study investigated whether intraoperative lung protective mechanical ventilation improved lung function evaluated with pulmonary function tests in patients at risk of postoperative pulmonary complications (PPCs) after major spinal surgery in the prone position. METHODS: Seventy-eight patients at potential risk of PPCs were randomly assigned to the protective group (tidal volume; 6 mL/kg predicted body weight, 6 cm H2O positive end-expiratory pressure with recruitment maneuvers) or the conventional group (10 mL/kg predicted body weight, no positive end-expiratory pressure)...
March 23, 2017: Journal of Neurosurgical Anesthesiology
https://www.readbyqxmd.com/read/28330410/outcome-and-management-of-refractory-respiratory-failure-with-timely-extracorporeal-membrane-oxygenationsingle-center-experience-with-legionella-pneumonia
#5
Roberto Roncon-Albuquerque, Rodrigo Vilares-Morgado, Gert-Jan van der Heijden, João Ferreira-Coimbra, Paulo Mergulhão, José Artur Paiva
OBJECTIVE: To analyze the management and outcome of patients with refractory respiratory failure complicating severe Legionella pneumonia rescued with extracorporeal membrane oxygenation (ECMO) in our Center. DESIGN AND SETTING: Observational study of patients with refractory respiratory failure treated with ECMO in Hospital S.João (Porto, Portugal), between November 2009 and September 2016. PARTICIPANTS: A total of 112 patients rescued with ECMO, of which 14 had Legionella pneumonia...
January 1, 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/28323670/prevention-of-respiratory-complications-of-the-surgical-patient-actionable-plan-for-continued-process-improvement
#6
Katarina J Ruscic, Stephanie D Grabitz, Maíra I Rudolph, Matthias Eikermann
PURPOSE OF REVIEW: Postoperative respiratory complications (PRCs) increase hospitalization time, 30-day mortality and costs by up to $35 000. These outcomes measures have gained prominence as bundled payments have become more common. RECENT FINDINGS: Results of recent quantitative effectiveness studies and clinical trials provide a framework that helps develop center-specific treatment guidelines, tailored to minimize the risk of PRCs. The implementation of those protocols should be guided by a local, respected, and visible facilitator who leads proper implementation while inviting center-specific input from surgeons, anesthesiologists, and other perioperative stakeholders...
March 20, 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/28322416/effect-of-intensive-vs-moderate-alveolar-recruitment-strategies-added-to-lung-protective-ventilation-on-postoperative-pulmonary-complications-a-randomized-clinical-trial
#7
Alcino Costa Leme, Ludhmila Abrahao Hajjar, Marcia S Volpe, Julia Tizue Fukushima, Roberta Ribeiro De Santis Santiago, Eduardo A Osawa, Juliano Pinheiro de Almeida, Aline Muller Gerent, Rafael Alves Franco, Maria Ignez Zanetti Feltrim, Emília Nozawa, Vera Regina de Moraes Coimbra, Rafael de Moraes Ianotti, Clarice Shiguemi Hashizume, Roberto Kalil Filho, Jose Otavio Costa Auler, Fabio Biscegli Jatene, Filomena Regina Barbosa Gomes Galas, Marcelo Britto Passos Amato
Importance: Perioperative lung-protective ventilation has been recommended to reduce pulmonary complications after cardiac surgery. The protective role of a small tidal volume (VT) has been established, whereas the added protection afforded by alveolar recruiting strategies remains controversial. Objective: To determine whether an intensive alveolar recruitment strategy could reduce postoperative pulmonary complications, when added to a protective ventilation with small VT...
March 21, 2017: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/28314081/delirium-after-lung-transplantation-association-with-recipient-characteristics-hospital-resource-utilization-and-mortality
#8
Yelizaveta Sher, Joshua Mooney, Gundeep Dhillon, Roy Lee, José R Maldonado
BACKGROUND: Delirium is associated with increased morbidity and mortality. The factors associated with post-lung transplant delirium and its impact on outcomes are under characterized. METHODS: The medical records of 163 consecutive adult lung transplant recipients were reviewed for delirium within 5 days (early-onset) and 30 hospital days (ever-onset) post-transplantation. A multivariable logistic regression model assessed factors associated with delirium. Multivariable negative binomial regression and Cox proportional hazards models assessed the association of delirium with ventilator duration, intensive care unit (ICU) length of stay (LOS), hospital LOS and one-year mortality...
March 17, 2017: Clinical Transplantation
https://www.readbyqxmd.com/read/28306327/fifty-years-of-research-in-ards-respiratory-mechanics-in-acute-respiratory-distress-syndrome
#9
William R Henderson, Lu Chen, Marcelo B P Amato, Laurent J Brochard
Acute respiratory distress syndrome is a multifactorial lung injury that continues to be associated with high levels of morbidity and mortality. Mechanical ventilation, while lifesaving, is associated with new iatrogenic injury. Current best practice involves the use of small tidal volumes, low plateau and driving pressures, and high levels of positive end expiratory pressure. Collectively, these interventions are termed "lung protective ventilation". Recent investigations suggest that individualized measurements of pulmonary mechanical variables rather than population based ventilation prescriptions may be used to set the ventilator with the potential to improve outcomes beyond those achieved with standard lung protective ventilation...
March 17, 2017: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28296181/-white-out-after-lung-transplantation-a-multicentre-cohort-description-of-late-acute-graft-failure
#10
Stijn E Verleden, Jens Gottlieb, Adriana Dubbeldam, Geert M Verleden, Hendrik Suhling, Tobias Welte, Robin Vos, Mark Greer
Graft failure represents a leading cause of mortality following organ transplantation. Acute late-onset graft failure has not been widely reported. This paper describes the demographics, CT imaging pathology findings and treatment of patients presenting with the latter. A retrospective review of lung transplant recipients at 2 large-volume centres was performed. Acute late-onset graft failure was defined as sudden onset of bilateral infiltrates with an oxygenation index <200 without identifiable cause or concurrent extra-pulmonary organ failure...
March 12, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28294285/evaluation-of-a-flexible-bronchoscope-prototype-designed-for-bronchoscopy-during-mechanical-ventilation-a-proof-of-concept-study
#11
M-A Nay, A Auvet, J Mankikian, V Herve, P-F Dequin, A Guillon
Bronchoscopy during mechanical ventilation of patients' lungs significantly affects ventilation because of partial obstruction of the tracheal tube, and may thus be omitted in the most severely ill patients. It has not previously been possible to reduce the external diameter of the bronchoscope without reducing the diameter of the suction channel, thus reducing the suctioning capacity of the device. We believed that a better-designed bronchoscope could improve the safety of bronchoscopy in patients whose lungs were ventilated...
March 14, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28284294/optimal-strategies-for-severe-acute-respiratory-distress-syndrome
#12
REVIEW
Jeremy W Cannon, Jacob T Gutsche, Daniel Brodie
Acute respiratory distress syndrome (ARDS) occurs in more than 10% of intensive care unit admissions and in nearly 25% of ventilated patients. Mortality remains high at 40%, and, for patients who survive, recovery continues for months or even years. Early recognition and minimizing further lung injury remain essential to successful management of severe ARDS. Advanced treatment strategies, which complement lung protective ventilation, include short-term neuromuscular blockade, prone positioning, and extracorporeal membrane oxygenation...
April 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/28277322/utilizing-forced-vital-capacity-to-predict-low-lung-compliance-and-select-intraoperative-tidal-volume-during-thoracic-surgery
#13
Nir Hoftman, Eric Eikermann, John Shin, Jack Buckley, Kaveh Navab, Fereidoun Abtin, Tristan Grogan, Maxime Cannesson, Aman Mahajan
BACKGROUND: Tidal volume selection during mechanical ventilation utilizes dogmatic formulas that only consider a patient's predicted body weight (PBW). In this study, we investigate whether forced vital capacity (FVC) (1) correlates better to total lung capacity (TLC) than PBW, (2) predicts low pulmonary compliance, and (3) provides an alternative method for tidal volume selection. METHODS: One hundred thirty thoracic surgery patients had their preoperative TLC calculated via 2 methods: (1) pulmonary function test (PFT; TLCPFT) and (2) computed tomography 3D reconstruction (TLCCT)...
March 8, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28276077/quantifying-the-reproducibility-of-lung-ventilation-images-between-4-dimensional-cone-beam-ct-and-4-dimensional-ct
#14
Henry C Woodruff, Chun-Chien Shieh, Fiona Hegi-Johnson, Paul J Keall, John Kipritidis
PURPOSE: Deformable image registration (DIR) based computed tomography ventilation imaging derived from four-dimensional cone-beam CT (CTVI(4)(DCBCT) ) can complement existing 4DCT-based methods (CTVI(4)(DCT) ) to track lung function changes over a course of lung cancer radiation therapy. However the accuracy of CTVI(4)(DCBCT) needs to be assessed since anatomic 4DCBCT has demonstrably poor image quality and small field of view (FOV) compared to treatment planning 4DCT. We perform a direct comparison between short interval CTVI(4)(DCBCT) and CTVI(4)(DCT) pairs to understand the patient specific image quality factors affecting the intermodality CTVI reproducibility in the clinic...
March 9, 2017: Medical Physics
https://www.readbyqxmd.com/read/28275225/low-flow-veno-venous-extracorporeal-co2-removal-for-acute-hypercapnic-respiratory-failure
#15
Matthias P Hilty, Thomas Riva, Silvia R Cottini, Eva-Maria Kleinert, Alessandra Maggiorini, Marco Maggiorini
BACKGROUND: Ventilation with low tidal volume and airway pressure results in a survival benefit in ARDS patients. Previous research suggests that avoiding mechanical ventilation altogether may be beneficial in some cases of respiratory failure. Our hypothesis was that low flow veno-venous extracorporeal CO2 removal (ECCO2R) enables maintenance of a lung protective ventilation strategy or awake spontaneous ventilation despite severe hypercapnic respiratory failure (HRF). METHODS: Twenty patients with HRF were investigated while mechanically ventilated (n=14) or breathing spontaneously close to respiratory exhaustion (n=6)...
March 8, 2017: Minerva Anestesiologica
https://www.readbyqxmd.com/read/28268159/protective-lung-strategies-a-cross-sectional-survey-of-nurses-knowledge-and-use-in-the-emergency-department
#16
Sarah Cornish, Rochelle Wynne, Sharon Klim, Anne-Maree Kelly
BACKGROUND: Mechanical ventilation (MV) is commonly used in emergency departments (EDs). Protective lung strategies (PLS), comprising of low tidal volume (6mL/kg), control of oxygen and plateau pressures, and administration of positive end expiratory pressure (PEEP) has been shown to reduces the risks associated with MV but there is little evidence exists about nurses' knowledge or application of PLS. Our aim was to explore nurses knowledge and application of PLS in Australian EDs. METHODS: Descriptive, exploratory design utilising an online questionnaire...
March 3, 2017: Australasian Emergency Nursing Journal: AENJ
https://www.readbyqxmd.com/read/28261612/increased-circulating-endothelial-microparticles-associated-with-pak4-play-a-key-role-in-ventilation-induced-lung-injury-process
#17
Shuming Pan, Aihua Fei, Lihong Jing, Xiangyu Zhang, Chengjin Gao
Inappropriate mechanical ventilation (MV) can result in ventilator-induced lung injury (VILI). Probing mechanisms of VILI and searching for effective methods are current areas of research focus on VILI. The present study aimed to probe into mechanisms of endothelial microparticles (EMPs) in VILI and the protective effects of Tetramethylpyrazine (TMP) against VILI. In this study, C57BL/6 and TLR4KO mouse MV models were used to explore the function of EMPs associated with p21 activated kinases-4 (PAK-4) in VILI...
2017: BioMed Research International
https://www.readbyqxmd.com/read/28261294/influence-of-intraoperative-positive-end-expiratory-pressure-level-on-pulmonary-complications-in-emergency-major-trauma-surgery
#18
Thomas Stueber, Jan Karsten, Nikolas Voigt, Michaela Wilhelmi
INTRODUCTION: Pulmonary complications have a major impact on the morbidity and mortality of critically ill patients with multiple trauma. Intraoperative protective ventilation with low tidal volume may prevent lung injury and infection, whereas the role of positive end-expiratory pressure (PEEP) levels is unclear. The aim of this study was to evaluate the influence of different intraoperative PEEP levels on incidence of pulmonary complications after emergency trauma surgery. MATERIAL AND METHODS: We retrospectively analysed data of multiple trauma patients who underwent emergency surgery within 24 h after injury in our level I trauma centre (n = 86)...
March 1, 2017: Archives of Medical Science: AMS
https://www.readbyqxmd.com/read/28259481/lung-protective-ventilation-initiated-in-the-emergency-department-lov-ed-a%C3%A2-quasi-experimental-before-after-trial
#19
Brian M Fuller, Ian T Ferguson, Nicholas M Mohr, Anne M Drewry, Christopher Palmer, Brian T Wessman, Enyo Ablordeppey, Jacob Keeperman, Robert J Stephens, Cristopher C Briscoe, Angelina A Kolomiets, Richard S Hotchkiss, Marin H Kollef
STUDY OBJECTIVE: We evaluated the efficacy of an emergency department (ED)-based lung-protective mechanical ventilation protocol for the prevention of pulmonary complications. METHODS: This was a quasi-experimental, before-after study that consisted of a preintervention period, a run-in period of approximately 6 months, and a prospective intervention period. The intervention was a multifaceted ED-based mechanical ventilator protocol targeting lung-protective tidal volume, appropriate setting of positive end-expiratory pressure, rapid oxygen weaning, and head-of-bed elevation...
March 1, 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/28259372/-gas-tamponade-following-intraoperative-pneumothorax-on-a-single-lung-a-case-study
#20
S D El Jaouhari, O Mamane Nassirou, M Meziane, M Bensghir, C Haimeur
Intraoperative pneumothorax is a rare complication with a high risk of cardiorespiratory arrest by gas tamponade especially on a single lung. We report the case of a female patient aged 53 years who benefited from a left pneumonectomy on pulmonary tuberculosis sequelae. The patient presented early postoperative anemia with a left hemothorax requiring an emergency thoracotomy. In perioperative, the patient had a gas tamponade following a pneumothorax of the remaining lung, and the fate has been avoided by an exsufflation...
March 1, 2017: Revue de Pneumologie Clinique
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