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Intrathoracic pressure

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https://www.readbyqxmd.com/read/29642696/periprocedural-and-perioperatory-management-of-patients-with-tricuspid-valve-disease
#1
Fabrizio Monaco, Ambra L DI Prima, Monica DE Luca, Gaia Barucco, Alberto Zangrillo
Tricuspid regurgitation (TR) is a common valvular lesion which may affect morbidity and mortality. It can be related to an intrinsic abnormality of the tricuspid valve leaflets (organic) or secondary to annular dilatation (functional). Often organic and functional TR coexist in the same patient. A long standing TR is associated with ascites, congestive hepatopathy, peripheral edema, renal failure, and abdominal fullness which significantly affect the outcome. In particular, the perioperative course may be complicated due to both the presence of comorbidities and the development of a severe postoperative right ventricle (RV) dysfunction...
April 11, 2018: Minerva Cardioangiologica
https://www.readbyqxmd.com/read/29617746/thoracoabdominal-pressure-gradient-and-gastroesophageal-reflux-insights-from-lung-transplant-candidates
#2
T Masuda, S K Mittal, B Kovacs, M Smith, R Walia, J Huang, R M Bremner
Advanced lung disease is associated with gastroesophageal reflux disease (GERD). The thoracoabdominal pressure gradient (TAPG) facilitates gastroesophageal reflux, but the effects of TAPG on gastroesophageal reflux in patients with pulmonary disease have not been well defined. Patients diagnosed with end-stage lung disease are expected to have the most extreme derangement in respiratory mechanics. The aim of this study is to explore the relationship between TAPG and reflux in lung transplant (LTx) candidates...
March 31, 2018: Diseases of the Esophagus: Official Journal of the International Society for Diseases of the Esophagus
https://www.readbyqxmd.com/read/29605197/airway-obstruction-and-lung-hyperinflation-in-copd-are-linked-to-an-impaired-left-ventricular-diastolic-filling
#3
Peter Alter, Henrik Watz, Kathrin Kahnert, Michael Pfeifer, Winfried J Randerath, Stefan Andreas, Benjamin Waschki, Björn E Kleibrink, Tobias Welte, Robert Bals, Holger Schulz, Frank Biertz, David Young, Claus F Vogelmeier, Rudolf A Jörres
AIMS: Chronic obstructive pulmonary disease (COPD) and cardiovascular diseases are thought to be linked through various factors. We aimed to assess the relationship between airway obstruction, lung hyperinflation and diastolic filling in COPD. METHODS: The study population was a subset of the COPD cohort COSYCONET. Echocardiographic parameters included the left atrial diameter (LA), early (E) and late (A) transmitral flow, mitral annulus velocity (e'), E wave deceleration time (E[dt]), and isovolumic relaxation time (IVRT)...
April 2018: Respiratory Medicine
https://www.readbyqxmd.com/read/29559613/clavicle-kirschner-wire-migration-into-left-lung-a-case-report
#4
Érica Lofrano Reghine, Caio César Inaco Cirino, André Amate Neto, Fabiana Rossi Varallo, Paulo Roberto Barbosa Évora, Tales Rubens de Nadai
BACKGROUND Kirschner wires are often used to perform osteosynthesis. Migration through tissue of these wires is a rare but well-known occurrence. CASE REPORT A 65-year-old female presented with light intensity pain complaints in the upper left chest area; personal history included left clavicle fracture 20 years ago that was treated surgically with fixation using a K-wire. Chest radiography showed the presence of metallic foreign body in the left pulmonary apex. An exploratory axillary thoracotomy was performed, and the foreign body was extracted by a pneumotomy...
March 21, 2018: American Journal of Case Reports
https://www.readbyqxmd.com/read/29541763/associations-of-obstructive-sleep-apnea-with-atrial-fibrillation-and-continuous-positive-airway-pressure-treatment-a-review
#5
Dominik Linz, R Doug McEvoy, Martin R Cowie, Virend K Somers, Stanley Nattel, Patrick Lévy, Jonathan M Kalman, Prashanthan Sanders
Importance: Obstructive sleep apnea (OSA) is the most common clinically significant breathing abnormality during sleep. It is highly prevalent among patients with atrial fibrillation (AF), and it promotes arrhythmogenesis and impairs treatment efficacy. Observations: The prevalence of OSA ranges from 3% to 49% in population-based studies and from 21% to 74% in patients with AF. Diagnosis and treatment of OSA in patients with AF requires a close interdisciplinary collaboration between electrophysiologists, cardiologists, and sleep specialists...
March 14, 2018: JAMA Cardiology
https://www.readbyqxmd.com/read/29536209/right-trisectionectomy-and-caval-reconstruction-with-peritoneal-patch-under-short-total-vascular-exclusion-for-hepatocellular-carcinoma-with-tumoral-thrombus-in-suprahepatic-vena-cava
#6
Safi Dokmak, Béatrice Aussilhou, Tiziana Marchese, Nizar Kardoun, François Cauchy, Anne Sophie Schneck, Olivier Soubrane
BACKGROUND: Hepatocellular carcinoma (HCC) can be complicated by major vascular invasion, and resection can be beneficial in some patients.1 Some of these patients are traditionally operated under total vascular exclusion (TVE), refrigeration, extracorporeal circulatory bypass, and cardiac surgery, with high morbidity and mortality.2 However, HCC thrombi are not adherent to the venous wall, and with advances in surgical techniques, resection can be simplified and performed during short-duration TVE alone...
March 13, 2018: Annals of Surgical Oncology
https://www.readbyqxmd.com/read/29519280/-variability-of-peripheral-arterial-peak-velocity-predicts-fluid-responsiveness-in-patients-with-septic-shock
#7
Nianfang Lu, Li Jiang, Bo Zhu, Wenyong Han, Yingqi Zhao, Yuntao Shi, Fashuang Guo, Xiuming Xi
OBJECTIVE: To explore the accuracy of fluid responsiveness assessment by variability of peripheral arterial peak velocity and variability of inferior vena cava diameter (ΔIVC) in patients with septic shock. METHODS: A prospective study was conducted. The patients with septic shock undergoing mechanical ventilation (MV) admitted to intensive care unit (ICU) of Beijing Electric Power Hospital from January 2016 to December 2017 were enrolled. According to sepsis bundles of septic shock, volume expansion (VE) was conducted...
March 2018: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/29507790/hyperthermic-intrathoracic-chemotherapy-after-extended-pleurectomy-and-decortication-for-malignant-pleura-mesothelioma-an-observational-study-on-outcome-and-microcirculatory-changes
#8
Luca Luzzi, Federico Franchi, Annarita Dapoto, Marco Ghisalberti, Roberto Corzani, Daniele Marrelli, Luca Marchetti, Piero Paladini, Sabino Scolletta
Background: In the treatment of malignant pleural mesothelioma the Hyperthermic Intra THOracic Chemotherapy (HITHOC) can improve the efficacy of pleurectomy and decortication with a local cytotoxic effect. However its biological impact in patient's hemodynamic and microcirculatory changes were rarely investigated. Aim of this study is to describe our experience with HITHOC after pleurectomy and decortication evaluating the role of sublingual video-microscopy in assessing the microcirculatory changes in the perioperative period...
January 2018: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/29501267/paradoxical-cerebral-embolism-after-gastrointestinal-endoscopy-in-a-patient-with-crohn-s-disease
#9
Hajime Ikenouchi, Naoto Sugeno, Takaaki Nakamura, Junpei Kobayashi, Ryuji Oshima, Hiroshi Kuroda, Masashi Aoki
Development of paradoxical cerebral embolism requires both unstable venous thrombosis and right-to-left shunt (RLS). Gastrointestinal endoscopy (GE) has the potential to affect intrathoracic and abdominal venous thrombi and to enhance RLS because the procedure alters intrathoracic and abdominal pressure. We describe a patient with Crohn's disease who developed paradoxical cerebral embolism after GE. Both an unstable venous thrombus in the superior vena cava and RLS through patent foramen ovale were thought to be responsible for the stroke...
February 28, 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/29500508/-single-port-vats-assisted-internal-fixation-of-serial-rib-fractures
#10
REVIEW
M T Berninger, F Kellermann, A Woltmann, V Bühren, M Lang
This article describes the operative stabilization of a flail chest due to traumatic serial rib fractures with extensive chest wall deformation and respiratory insufficiency. Initial conservative treatment including systemic and regional pain management and non-invasive positive pressure ventilation did not improve the pain or ventilation. Therefore, a single-port video-assisted thoracoscopic surgery (VATS) assisted internal fixation of the ribs was performed. The thoracoscopy enabled easy repositioning of the ribs and additionally an estimation of intrathoracic injuries...
April 2018: Der Unfallchirurg
https://www.readbyqxmd.com/read/29494288/respiratory-pump-maintains-cardiac-stroke-volume-during-hypovolemia-in-young-healthy-volunteers
#11
Maria Skytioti, Signe Søvik, Maja Elstad
Spontaneous breathing has beneficial effects on the circulation, since negative intrathoracic pressure enhances venous return and increases cardiac stroke volume. We quantified the contribution of the respiratory pump to preserve stroke volume during hypovolemia in awake, young, healthy subjects. Non-invasive stroke volume, cardiac output, heart rate and mean arterial pressure (Finometer) were recorded in 31 volunteers (19 females), 19-30 years old, during normovolemia and hypovolemia (approximating 450-500 ml reduction in central blood volume) induced by lower body negative pressure...
March 1, 2018: Journal of Applied Physiology
https://www.readbyqxmd.com/read/29445529/cardiorespiratory-interaction-with-continuous-positive-airway-pressure
#12
REVIEW
Martino F Pengo, Sara Bonafini, Cristiano Fava, Joerg Steier
The treatment of choice for obstructive sleep apnoea (OSA) is continuous positive airway pressure therapy (CPAP). Since its introduction in clinical practice, CPAP has been used in various clinical conditions with variable and heterogeneous outcomes. In addition to the well-known effects on the upper airway CPAP impacts on intrathoracic pressures, haemodynamics and blood pressure (BP) control. However, short- and long-term effects of CPAP therapy depend on multiple variables which include symptoms, underlying condition, pressure used, treatment acceptance, compliance and usage...
January 2018: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/29445526/intermittent-hypoxia-cardiovascular-disease-and-obstructive-sleep-apnoea
#13
REVIEW
Chris D Turnbull
Obstructive sleep apnoea (OSA) is a common disorder and is associated with cardiovascular disease. Continuous positive airway pressure (CPAP), whilst reducing blood pressure, has not been shown to reduce cardiovascular events when used as a treatment solely for this purpose in patients with previous cardiovascular disease. Developing a better understanding of the mechanisms underlying cardiovascular disease in OSA is important to develop new treatments. Potential causative mechanisms for cardiovascular disease in OSA include arousal induced sympathetic activation, large intrathoracic pressure swings leading to shear stress on the heart and great vessels, and intermittent hypoxia (IH)...
January 2018: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/29445057/utility-of-fluid-assessment-based-on-the-intrathoracic-impedance-monitoring-in-a-peripartum-woman-with-heart-disease
#14
Atsushi Daimon, Chizuko A Kamiya, Masami Sawada, Yusuke Ueda, Chinami Horiuchi, Takekazu Miyoshi, Mitsuhiro Tsuritani, Naoko Iwanaga, Reiko Neki, Hideo Okamura, Shingo Kusano, Jun Yoshimatsu
Recently, implantable cardioverter-defibrillators (ICD) have become capable of monitoring intrathoracic impedance to detect an increased fluid volume and heart failure. Pregnancy is a well-known cause of an increased body fluid volume; however, it is not clear whether the measurement of intrathoracic impedance by ICD is clinically useful for precisely detecting heart failure in pregnant women. We herein report the case of a 39-year-old woman with an ICD that had been implanted after an event of ventricular fibrillation due to severe aortic regurgitation with a bicuspid aortic valve...
February 14, 2018: International Heart Journal
https://www.readbyqxmd.com/read/29424007/inspiratory-muscle-training-improves-exercise-capacity-with-thoracic-load-carriage
#15
Ren-Jay Shei, Robert F Chapman, Allison H Gruber, Timothy D Mickleborough
Thoracic load carriage (LC) exercise impairs exercise performance compared to unloaded exercise, partially due to impaired respiratory mechanics. We investigated the effects of LC on exercise and diaphragmatic fatigue in a constant-load exercise task; and whether inspiratory muscle training (IMT) improved exercise capacity and diaphragmatic fatigue with LC. Twelve recreationally active males completed three separate running trials to exhaustion (Tlim ) at a fixed speed eliciting 70% of their V˙O2max . The first two trials were completed either unloaded (UL) or while carrying a 10 kg backpack (LC)...
February 2018: Physiological Reports
https://www.readbyqxmd.com/read/29377377/the-hemodynamic-response-to-incremental-increases-in-negative-intrathoracic-pressure-in-healthy-humans
#16
William S Cheyne, Jinelle C Gelinas, Neil D Eves
Negative intrathoracic pressure (nITP) generally augments venous return and left ventricular (LV) stroke volume (LVSV), though large increases in nITP, commonly seen in respiratory disease, attenuate LVSV. Despite this consistent finding, the degree of nITP required to reduce LVSV and the contributions of series and direct ventricular interaction (DVI) in mediating this response remain unclear. We hypothesized that nITP ≤-15 cmH2 0 would augment LVSV, while nITP ≥-20 cmH2 o would reduce LVSV via DVI and increased afterload...
January 27, 2018: Experimental Physiology
https://www.readbyqxmd.com/read/29374723/low-dose-pressurized-intrathoracic-aerosol-chemotherapy-pitac-as-an-alternative-therapy-for-pleuropulmonary-involvement-in-pseudomyxoma-peritonei
#17
Manuela Robella, Marco Vaira, Alice Borsano, Claudio Mossetti, Michele DE Simone
BACKGROUND/AIM: Pseudomyxoma peritonei (PMP) is a rare disease characterized by mucinous ascites and widespread peritoneal implants. It usually originates from the rupture of an adenoma/adenocarcinoma of the appendix. Although this tumor is only superficially invasive and does not metastasize, it could be a fatal disease. Extra-abdominal spread of PMP is an unusual occurrence with few reports in medical literature. CASE REPORT: A 50-year-old man was diagnosed with PMP according to the findings of thorax and abdomen CT scan and cytologic and histological examinations...
February 2018: Anticancer Research
https://www.readbyqxmd.com/read/29368315/intraoperative-valsalva-maneuver-a-narrative-review
#18
Chandra Mohan Kumar, André A J Van Zundert
The Valsalva maneuver (VM) involves expiratory effort against a closed mouth and/or glottis in the sitting or supine position with the increased intraoral and intrathoracic pressure raised to 40 mmHg for 15-20 sec after which the pressure is suddenly released and the breathing restored to normal. Complex cardiovascular and other physiologic changes occur during the VM. The VM has been used for diagnostic and therapeutic reasons as well as intraoperatively during specific surgical procedures. Although the VM is usually safe, rare complications have been reported...
January 24, 2018: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
https://www.readbyqxmd.com/read/29364998/usefulness-of-radiological-signs-of-pulmonary-congestion-in-predicting-failed-spontaneous-breathing-trials
#19
Ana Carolina Peçanha Antonio, Cassiano Teixeira, Priscylla Souza Castro, Ana Paula Zanardo, Marcelo Basso Gazzana, Marli Knorst
Inspiratory fall in intrathoracic pressure during a spontaneous breathing trial (SBT) may precipitate cardiac dysfunction and acute pulmonary edema. We aimed to determine the relationship between radiological signs of pulmonary congestion prior to an SBT and weaning outcomes. This was a post hoc analysis of a prospective cohort study involving patients in an adult medical-surgical ICU. All enrolled individuals met the eligibility criteria for liberation from mechanical ventilation. Tracheostomized subjects were excluded...
July 2017: Jornal Brasileiro de Pneumologia: Publicaça̋o Oficial da Sociedade Brasileira de Pneumologia e Tisilogia
https://www.readbyqxmd.com/read/29344963/refractory-pulmonary-edema-and-upper-body-hypoxemia-during-veno-arterial-extracorporeal-membrane-oxygenation-a-case-for-atrial-septostomy
#20
Amit Prasad, Ali Ghodsizad, Christoph Brehm, Mark Kozak, Michael Körner, Aly El Banayosy, Kai Singbartl
Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) provides mechanical circulatory support for patients with advanced cardiogenic shock, facilitating myocardial recovery and limiting multi-organ failure. In patients with severely limited left ventricular ejection, peripheral VA-ECMO can further increase left ventricular and left atrial pressures (LAP). Failure to decompress the left heart under these circumstances can result in pulmonary edema and upper body hypoxemia, that is, myocardial and cerebral ischemia...
January 18, 2018: Artificial Organs
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