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https://www.readbyqxmd.com/read/28545542/recognition-and-treatment-of-sleep-disordered-breathing-an-important-component-of-chronic-disease-management
#1
REVIEW
Peter C Farrell, Glenn Richards
Sleep-disordered breathing (SDB) is a highly prevalent condition, and is associated with many debilitating chronic diseases. The role of untreated obstructive sleep apnea (OSA) in arterial hypertension has been recognized in international guidelines. Treatment with continuous positive airway pressure (CPAP) is associated with clinically-relevant reductions in blood pressure. In heart failure (HF), SDB is associated with worse prognosis and increased mortality. Major HF guidelines recommend that patients should be treated for sleep apnea to improve their HF status...
May 25, 2017: Journal of Translational Medicine
https://www.readbyqxmd.com/read/28544108/elevated-intrathoracic-co2-pressure-during-thoracoscopic-surgery-decreases-regional-cerebral-oxygen-saturation-in-neonates-and-infants-a-pilot-study
#2
Felix Neunhoeffer, Steven W Warmann, Michael Hofbeck, Alisa Müller, Frank Fideler, Guido Seitz, Martin U Schuhmann, Hans-Joachim Kirschner, Matthias Kumpf, Jörg Fuchs
BACKGROUND: Intraoperative hypercapnia and acidosis are risk factors during thoracoscopy in neonates and infants. METHODS: In a prospective pilot study, we evaluated the effects of thoracoscopy in neonates and infants on cerebral microcirculation, oxygen saturation, and oxygen consumption. Regional cerebral oxygen saturation and blood flow were measured noninvasively using a new device combining laser Doppler flowmetry and white light spectrometry. Additionally, cerebral fractional tissue oxygen extraction and approximated oxygen consumption were calculated...
May 24, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/28537512/do-patients-with-a-baseline-clinical-condition-warranting-the-cautious-use-of-parenteral-nutrition-develop-subsequent-metabolic-complications
#3
Diana M Solomon, James M Hollands, Laura A Siemianowski, Colleen E Smith, Richard J Song, Angela L Bingham
BACKGROUND: The American Society for Parenteral and Enteral Nutrition Adult Nutrition Support Core Curriculum describes clinical conditions that warrant cautious use of parenteral nutrition (CCWCPN). The Core Curriculum authors acknowledge there is no evidence for specific criteria suggested for the clinical conditions. Consequently, the purpose of this study was to determine the impact of a baseline CCWCPN on the development of subsequent metabolic complications in patients receiving parenteral nutrition (PN)...
June 2017: Nutrition in Clinical Practice
https://www.readbyqxmd.com/read/28537106/vasoreactivity-in-cadasil-comparison-to-structural-mri-and-neuropsychology
#4
Fiona C Moreton, Breda Cullen, Christian Delles, Celestine Santosh, Rosario L Gonzalez, Krishna Dani, Keith W Muir
Impaired cerebrovascular reactivity precedes histological and clinical evidence of CADASIL in animal models. We aimed to more fully characterise peripheral and cerebral vascular function and reactivity in a cohort of adult CADASIL patients, and explore the associations of these with conventional clinical, imaging and neuropsychological measures. A total of 22 adults with CADASIL gave informed consent to participate in an exploratory study of vascular function in CADASIL. Clinical assessment, comprehensive vascular assessment, MRI and neuropsychological testing were conducted...
January 1, 2017: Journal of Cerebral Blood Flow and Metabolism
https://www.readbyqxmd.com/read/28533903/using-paco2-values-to-grade-obesity-hypoventilation-syndrome-severity-a-retrospective-study
#5
Mario Francesco Damiani, Vito Antonio Falcone, Pierluigi Carratù, Cristina Scoditti, Elioda Bega, Silvano Dragonieri, Alfredo Scoditti, Onofrio Resta
BACKGROUND: To date, an important aspect that has still not been clarified is the assessment of OHS severity. The purpose of this retrospective study was to evaluate whether grading OHS severity according to PaCO2 values may be useful in order to provide a more definite characterization and targeted management of patients. In this regard, baseline anthropometric and sleep polygraphic characteristics, treatment options, and follow up outcomes, were compared between OHS patients with different degree of severity (as assessed according to PaCO2 values)...
2017: Multidisciplinary Respiratory Medicine
https://www.readbyqxmd.com/read/28528348/effect-of-home-noninvasive-ventilation-with-oxygen-therapy-vs-oxygen-therapy-alone-on-hospital-readmission-or-death-after-an-acute-copd-exacerbation-a-randomized-clinical-trial
#6
Patrick B Murphy, Sunita Rehal, Gill Arbane, Stephen Bourke, Peter M A Calverley, Angela M Crook, Lee Dowson, Nicholas Duffy, G John Gibson, Philip D Hughes, John R Hurst, Keir E Lewis, Rahul Mukherjee, Annabel Nickol, Nicholas Oscroft, Maxime Patout, Justin Pepperell, Ian Smith, John R Stradling, Jadwiga A Wedzicha, Michael I Polkey, Mark W Elliott, Nicholas Hart
Importance: Outcomes after exacerbations of chronic obstructive pulmonary disease (COPD) requiring acute noninvasive ventilation (NIV) are poor and there are few treatments to prevent hospital readmission and death. Objective: To investigate the effect of home NIV plus oxygen on time to readmission or death in patients with persistent hypercapnia after an acute COPD exacerbation. Design, Setting, and Participants: A randomized clinical trial of patients with persistent hypercapnia (Paco2 >53 mm Hg) 2 weeks to 4 weeks after resolution of respiratory acidemia, who were recruited from 13 UK centers between 2010 and 2015...
May 21, 2017: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/28522835/reactivity-in-the-human-retinal-microvasculature-measured-during-acute-gas-breathing-provocations
#7
Angelina Duan, Phillip A Bedggood, Andrew B Metha, Bang V Bui
Although changes in vessel diameter following gas perturbation have been documented in retinal arterioles and venules, these responses have yet to be quantified in the smallest vessels of the human retina. Here, using in vivo adaptive optics, we imaged 3-25 µm diameter vessels of the human inner retinal circulation and monitored the effects of altered gas-breathing conditions. During isocapnic hyperoxia, definite constrictions were seen in 51% of vessel segments (mean ± SD for pre-capillary arterioles -9...
May 18, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28507099/carbon-dioxide-dependent-regulation-of-nf-%C3%AE%C2%BAb-family-members-relb-and-p100-gives-molecular-insight-into-co2-dependent-immune-regulation
#8
Ciara E Keogh, Carsten C Scholz, Javier Rodriguez, Andrew C Selfridge, Alexander von Kriegshiem, Eoin P Cummins
CO2 is a physiological gas normally produced in the body during aerobic respiration. Hypercapnia (elevated blood pCO2 > ≈ 50mmHg) is a feature of several lung pathologies e.g. chronic obstructive pulmonary disease (COPD). Hypercapnia is associated with increased susceptibility to bacterial infections and suppression of inflammatory signaling. The NF-κB pathway has been implicated in these effects, however, the molecular mechanisms underpinning cellular sensitivity of the NF-κB pathway to CO2 is not fully elucidated...
May 15, 2017: Journal of Biological Chemistry
https://www.readbyqxmd.com/read/28497180/performance-of-a-capnodynamic-method-estimating-effective-pulmonary-blood-flow-during-transient-and-sustained-hypercapnia
#9
Thorir Svavar Sigmundsson, Tomas Öhman, Magnus Hallbäck, Eider Redondo, Fernando Suarez Sipmann, Mats Wallin, Anders Oldner, Caroline Hällsjö Sander, Håkan Björne
The capnodynamic method is a minimally invasive method continuously calculating effective pulmonary blood flow (COEPBF), equivalent to cardiac output when intra pulmonary shunt flow is low. The capnodynamic equation joined with a ventilator pattern containing cyclic reoccurring expiratory holds, provides breath to breath hemodynamic monitoring in the anesthetized patient. Its performance however, might be affected by changes in the mixed venous content of carbon dioxide (CvCO2). The aim of the current study was to evaluate COEPBF during rapid measurable changes in mixed venous carbon dioxide partial pressure (PvCO2) following ischemia-reperfusion and during sustained hypercapnia in a porcine model...
May 11, 2017: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/28494170/why-high-intensity-nppv-is-favourable-to-low-intensity-nppv-clinical-and-physiological-reasons
#10
S B Schwarz, F S Magnet, W Windisch
High-intensity non-invasive positive pressure ventilation (NPPV) was originally described for chronic hypercapnic chronic obstructive pulmonary disease (COPD) patients in 2009, and refers to a specific ventilatory approach whereby NPPV settings are aimed at achieving the lowest arterial partial pressure of carbon dioxide (PaCO2) values possible. Thus, high-intensity NPPV requires ventilator settings to be increased in a stepwise approach to either an individually tolerated maximum, or to the levels necessary to achieve normocapnia...
May 11, 2017: COPD
https://www.readbyqxmd.com/read/28490871/home-noninvasive-positive-pressure-ventilation-with-built-in-software-in-stable-hypercapnic-copd-a-short-term-prospective-multicenter-randomized-controlled-trial
#11
Luqian Zhou, Xiaoying Li, Lili Guan, Jianhua Chen, Bingpeng Guo, Weiliang Wu, Yating Huo, Ziqing Zhou, Zhenyu Liang, Yuqi Zhou, Jie Tan, Xin Chen, Yuanlin Song, Rongchang Chen
BACKGROUND: The benefits of noninvasive positive pressure ventilation (NPPV) in patients with hypercapnic COPD are controversial. It is presumed that methodology and appropriate use of NIV ventilator might be crucial for the outcomes. With the new built-in software, the performance of NIV can be monitored at home, which can guarantee the compliance and appropriate use. This study investigated effects of home use of NIV in hypercapnia in COPD patients using the NIV ventilator with built-in software for monitoring...
2017: International Journal of Chronic Obstructive Pulmonary Disease
https://www.readbyqxmd.com/read/28488728/fatty-acid-amide-hydrolase-faah-regulates-hypercapnia-ischemia-induced-increases-in-n-acylethanolamines-in-mouse-brain
#12
Lin Lin, Adam H Metherel, Peter J Jones, Richard P Bazinet
N-acylethanolamines (NAEs) are endogenous lipid ligands for several receptors including cannabinoid receptors and peroxisome proliferator-activated receptor-alpha (PPAR-α), which regulate numerous physiological functions. Fatty acid amide hydrolase (FAAH) is, largely, responsible for the degradation of NAEs. However, at high concentrations of ethanolamines and unesterified fatty acids, FAAH can also catalyze the reverse reaction, producing NAEs. Several brain insults such as ischemia and hypoxia increase brain unesterified fatty acids...
May 10, 2017: Journal of Neurochemistry
https://www.readbyqxmd.com/read/28482421/-effect-of-home-noninvasive-positive-pressure-ventilation-on-patients-with-severe-stable-chronic-obstructive-pulmonary-disease-a-meta-analysis
#13
Y Liu, B Dai, J Su, Y Peng, W Tan, H W Zhao
Objective: To evaluate the effect of home noninvasive positive pressure ventilation (NPPV) on patients with severe stable chronic obstructive pulmonary disease(COPD) by meta-analysis. Methods: The data of this meta-analysis was retrieved from the PubMed, EMBASE, Cochrane library, Wanfang, Weipu and CNKI databases from January 1980 to January 2016. Randomized controlled trials (RCTs) on comparison of the effect of home NPPV in patients with severe stable COPD were enrolled. The enrolled data were divided into different subgroups in terms of the levels of inspiratory positive airway pressure(IPAP), different duration of ventilation per day, and different levels of baseline hypercapnia on change in PaCO(2)...
May 12, 2017: Chinese Journal of Tuberculosis and Respiratory Diseases
https://www.readbyqxmd.com/read/28482381/-nasal-continuous-positive-airway-pressure-ventilation-in-children-with-community-acquired-pneumonia-under-five-years-of-age-a-prospective-multi-center-clinical-study
#14
J Liu, Q Wang, S Y Qian, W M Xu, L L Li, L M Ning, X X Ren, F Lyu, Y B Cheng, L J Gao, C F Liu, W Xu, L Pei, G P Lu, W M Chen
Objective: To analyze the clinical characteristics of community-acquired pneumonia (CAP) in children under five years of age and analyze the safety and efficiency of nasal continuous positive airway pressure (NCPAP) ventilation for CAP in this population. Method: This was a prospective multicenter study. Children who were admitted to these six centers with CAP and met the NCPAP ventilation indications, aged from 29 d to 5 years, were continuously included during November 2013 to October 2015. The baseline data were collected and NCPAP ventilation were then followed up by operation standards, and the vital signs and arterial blood gas change at special time points were observed and recorded...
May 4, 2017: Zhonghua Er Ke za Zhi. Chinese Journal of Pediatrics
https://www.readbyqxmd.com/read/28476010/redox-signaling-in-acute-oxygen-sensing
#15
REVIEW
Lin Gao, Patricia González-Rodríguez, Patricia Ortega-Sáenz, José López-Barneo
Acute oxygen (O2) sensing is essential for individuals to survive under hypoxic conditions. The carotid body (CB) is the main peripheral chemoreceptor, which contains excitable and O2-sensitive glomus cells with O2-regulated ion channels. Upon exposure to acute hypoxia, inhibition of K(+) channels is the signal that triggers cell depolarization, transmitter release and activation of sensory fibers that stimulate the brainstem respiratory center to produce hyperventilation. The molecular mechanisms underlying O2 sensing by glomus cells have, however, remained elusive...
April 26, 2017: Redox Biology
https://www.readbyqxmd.com/read/28472700/partial-pressure-of-arterial-carbon-dioxide-and-survival-to-hospital-discharge-among-patients-requiring-acute-mechanical-ventilation-a-cohort-study
#16
Brian M Fuller, Nicholas M Mohr, Anne M Drewry, Ian T Ferguson, Stephen Trzeciak, Marin H Kollef, Brian W Roberts
PURPOSE: To describe the prevalence of hypocapnia and hypercapnia during the earliest period of mechanical ventilation, and determine the association between PaCO2 and mortality. MATERIALS AND METHODS: A cohort study using an emergency department registry of mechanically ventilated patients. PaCO2 was categorized: hypocapnia (<35mmHg), normocapnia (35-45mmHg), and hypercapnia (>45mmHg). The primary outcome was survival to hospital discharge. RESULTS: A total of 1,491 patients were included...
April 26, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28466149/potentially-modifiable-factors-contributing-to-sepsis-associated-encephalopathy
#17
Romain Sonneville, Etienne de Montmollin, Julien Poujade, Maïté Garrouste-Orgeas, Bertrand Souweine, Michael Darmon, Eric Mariotte, Laurent Argaud, François Barbier, Dany Goldgran-Toledano, Guillaume Marcotte, Anne-Sylvie Dumenil, Samir Jamali, Guillaume Lacave, Stéphane Ruckly, Bruno Mourvillier, Jean-François Timsit
PURPOSE: Identifying modifiable factors for sepsis-associated encephalopathy may help improve patient care and outcomes. METHODS: We conducted a retrospective analysis of a prospective multicenter database. Sepsis-associated encephalopathy (SAE) was defined by a score on the Glasgow coma scale (GCS) <15 or when features of delirium were noted. Potentially modifiable risk factors for SAE at ICU admission and its impact on mortality were investigated using multivariate logistic regression analysis and Cox proportional hazard modeling, respectively...
May 2, 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/28462858/neuromuscular-disorders-and-chronic-ventilation
#18
REVIEW
Stamatia Alexiou, Joseph Piccione
Morbidity and mortality have decreased in patients with neuromuscular disease due to implementation of therapies to augment cough and improve ventilation. Infants with progressive neuromuscular disease will eventually develop respiratory complications as a result of muscle weakness and their inability to compensate during periods of increased respiratory loads. The finding of nocturnal hypercapnia is often the trigger for initiating non-invasive ventilation and studies have shown that its use not only may improve sleep-disordered breathing, but also that it may have an effect on daytime function, symptoms related to hypercapnia, and partial pressure of CO2...
April 24, 2017: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/28461215/role-of-a5-noradrenergic-neurons-in-the-chemoreflex-control-of-respiratory-and-sympathetic-activities-in-unanesthetized-conditions
#19
Camila L Taxini, Thiago S Moreira, Ana C Takakura, Kênia C Bícego, Luciane H Gargaglioni, Daniel B Zoccal
The A5 area at the ventrolateral pons contains noradrenergic neurons connected with other medullary areas involved in the cardiorespiratory control. Its contribution to the cardiorespiratory regulation was previously evidenced in anesthetized conditions. In the present study, we investigated the involvement of the A5 noradrenergic neurons to the basal and chemoreflex control of the sympathetic and respiratory activities in unanesthetized conditions. A5 noradrenergic neurons were lesioned using microinjections of anti-dopamine β-hydroxylase saporin (anti-DβH-SAP)...
April 29, 2017: Neuroscience
https://www.readbyqxmd.com/read/28459322/fifty-years-of-research-in-ards-is-extracorporeal-circulation-the-future-of-acute-respiratory-distress-syndrome-management
#20
Alain Combes, Antonio Pesenti, V Marco Ranieri
Mechanical ventilation (MV) remains the cornerstone of acute respiratory distress syndrome (ARDS) management. It guarantees sufficient alveolar ventilation, high FiO2 concentration, and high positive end-expiratory pressure levels. However, experimental and clinical studies have accumulated, demonstrating that MV also contributes to the high mortality observed in patients with ARDS by creating ventilator-induced lung injury. Under these circumstances, extracorporeal lung support (ECLS) may be beneficial in two distinct clinical settings: to rescue patients from the high risk for death associated with severe hypoxemia, hypercapnia, or both not responding to maximized conventional MV, and to replace MV and minimize/abolish the harmful effects of ventilator-induced lung injury...
May 1, 2017: American Journal of Respiratory and Critical Care Medicine
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