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https://www.readbyqxmd.com/read/27694355/esophageal-pressure-measurements-in-patients-with-acute-respiratory-distress-syndrome
#1
Grace Hofmann, Lutana Haan, Jeff Anderson
Esophageal balloons are used in the respiratory monitoring of critical care patients. After the esophageal pressure is measured, the corresponding pleural pressure in the thorax can be projected, enabling lung-thorax compliance to be partitioned into chest-wall compliance and lung compliance. The esophageal balloon allows determination of transpulmonary pressures and a correspondingly individually tailored approach to respiratory care, such as patient-specific titration of positive end-expiratory pressure for patients with extrapulmonary acute respiratory distress syndrome...
October 2016: Critical Care Nurse
https://www.readbyqxmd.com/read/27577052/effect-of-high-frequency-oscillatory-ventilation-on-esophageal-and-transpulmonary-pressures-in-moderate-to-severe-acute-respiratory-distress-syndrome
#2
Christophe Guervilly, Jean-Marie Forel, Sami Hraiech, Antoine Roch, Daniel Talmor, Laurent Papazian
BACKGROUND: High-frequency oscillatory ventilation (HFOV) has not been shown to be beneficial in the management of moderate-to-severe acute respiratory distress syndrome (ARDS). There is uncertainty about the actual pressure applied into the lung during HFOV. We therefore performed a study to compare the transpulmonary pressure (P L) during conventional mechanical ventilation (CMV) and different levels of mean airway pressure (mPaw) during HFOV. METHODS: This is a prospective randomized crossover study in a university teaching hospital...
December 2016: Annals of Intensive Care
https://www.readbyqxmd.com/read/27390467/esophageal-pressure-guided-positive-end-expiratory-pressure-in-acute-respiratory-distress-syndrome-the-jury-is-still-out
#3
Animesh Ray, Ayush Gupta
No abstract text is available yet for this article.
June 2016: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/27318943/mortality-and-pulmonary-mechanics-in-relation-to-respiratory-system-and-transpulmonary-driving-pressures-in-ards
#4
Elias Baedorf Kassis, Stephen H Loring, Daniel Talmor
PURPOSE: The driving pressure of the respiratory system has been shown to strongly correlate with mortality in a recent large retrospective ARDSnet study. Respiratory system driving pressure [plateau pressure-positive end-expiratory pressure (PEEP)] does not account for variable chest wall compliance. Esophageal manometry can be utilized to determine transpulmonary driving pressure. We have examined the relationships between respiratory system and transpulmonary driving pressure, pulmonary mechanics and 28-day mortality...
August 2016: Intensive Care Medicine
https://www.readbyqxmd.com/read/27235320/should-peep-titration-be-based-on-chest-mechanics-in-patients-with-ards
#5
Richard H Kallet
Functional residual capacity (FRC) is essentially the alveolar volume and a determinant of both oxygenation and respiratory system compliance (CRS). ARDS decreases FRC, and sufficient PEEP restores FRC; thus, assessments of PEEP by its impact on oxygenation and CRS are intimately linked. PEEP also can ameliorate or aggravate ventilator-induced lung injury. Therefore, it can be argued that PEEP should be titrated primarily by its impact on CRS The pro position argues that the heterogeneous nature of lung injury and its unique presentation in individual patients results in an uncoupling between oxygenation and CRS Therefore, relying upon oxygenation alone may enhance lung injury and mortality risk, particularly in those with severe ARDS...
June 2016: Respiratory Care
https://www.readbyqxmd.com/read/27076736/acute-respiratory-distress-syndrome-pulmonary-and-extrapulmonary-not-so-similar
#6
Inderpaul Singh Sehgal, Sahajal Dhooria, Digambar Behera, Ritesh Agarwal
Acute respiratory distress syndrome (ARDS) is characterized by acute onset respiratory failure with bilateral pulmonary infiltrates and hypoxemia. Current evidence suggests different respiratory mechanics in pulmonary ARDS (ARDSp) and extrapulmonary ARDS (ARDSexp) with disproportionate decrease in lung compliance in the former and chest wall compliance in the latter. Herein, we report two patients of ARDS, one each with ARDSp and ARDSexp that were managed using real-time esophageal pressure monitoring using the AVEA ventilator to tailor the ventilatory strategy...
March 2016: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/26999639/control-of-respiratory-drive-and-effort-in-extracorporeal-membrane-oxygenation-patients-recovering-from-severe-acute-respiratory-distress-syndrome
#7
Tommaso Mauri, Giacomo Grasselli, Grazia Suriano, Nilde Eronia, Savino Spadaro, Cecilia Turrini, Nicolo' Patroniti, Giacomo Bellani, Antonio Pesenti
BACKGROUND: The amount of extracorporeal carbon dioxide removal may influence respiratory drive in acute respiratory distress syndrome (ARDS) patients undergoing extracorporeal membrane oxygenation (ECMO). The authors evaluated the effects of different levels of extracorporeal carbon dioxide removal in patients recovering from severe ARDS undergoing pressure support ventilation (PSV) and neurally adjusted ventilatory assist (NAVA). METHODS: The authors conducted a prospective, randomized, crossover study on eight spontaneously breathing ARDS patients undergoing venovenous ECMO since 28 ± 20 days...
July 2016: Anesthesiology
https://www.readbyqxmd.com/read/26847436/respiratory-mechanics-and-lung-stress-strain-in-children-with-acute-respiratory-distress-syndrome
#8
Davide Chiumello, Giovanna Chidini, Edoardo Calderini, Andrea Colombo, Francesco Crimella, Matteo Brioni
BACKGROUND: In sedated and paralyzed children with acute respiratory failure, the compliance of respiratory system and functional residual capacity were significantly reduced compared with healthy subjects. However, no major studies in children with ARDS have investigated the role of different levels of PEEP and tidal volume on the partitioned respiratory mechanic (lung and chest wall), stress (transpulmonary pressure) and strain (inflated volume above the functional residual capacity)...
December 2016: Annals of Intensive Care
https://www.readbyqxmd.com/read/26814111/-effect-of-transpulmonary-pressure-directed-mechanical-ventilation-on-respiration-in-severe-acute-pancreatitis-patient-with-intraabdominal-hypertension
#9
Xiaoyan Wu, Ruiqiang Zheng, Hua Lin, Zhiqing Zhuang, Min Zhang, Peixia Yan
OBJECTIVE: To assess the effect of mehanical ventilation (MV) guided by transpulmonary pressure (Ptp) on respiratory mechanics and gas exchange in severe acute pancreatitis patient with intraabdominal hypertension. METHODS: Twelve severe acute pancreatitis patient with intraabdominal hypertension and acute respiratory distress syndrome(ARDS) underwent mechanical ventilation were involved from Jan to Dec 2013. PEEP levels were set to achieve a Ptp of 0 to 10 cm of water at end expiration...
October 20, 2015: Zhonghua Yi Xue za Zhi
https://www.readbyqxmd.com/read/26627536/the-promises-and-problems-of-transpulmonary-pressure-measurements-in-acute-respiratory-distress-syndrome
#10
REVIEW
Sarina K Sahetya, Roy G Brower
PURPOSE OF REVIEW: The optimal strategy for assessing and preventing ventilator-induced lung injury in the acute respiratory distress syndrome (ARDS) is controversial. Recent investigative efforts have focused on personalizing ventilator settings to individual respiratory mechanics. This review examines the strengths and weaknesses of using transpulmonary pressure measurements to guide ventilator management in ARDS. RECENT FINDINGS: Recent clinical studies suggest that adjusting ventilator settings based on transpulmonary pressure measurements is feasible, may improve oxygenation, and reduce ventilator-induced lung injury...
February 2016: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/26595042/controversies-in-the-management-of-severe-ards-optimal-ventilator-management-and-use-of-rescue-therapies
#11
REVIEW
Brian O'Gara, Eddy Fan, Daniel S Talmor
Groundbreaking research into the pathophysiology of the adult acute respiratory distress syndrome (ARDS) and the prevention of ventilator-induced lung injury has led to dramatic improvements in survival. Investigations over the last two decades have revolved around the development of rescue therapies that can be used for patients with severe ARDS and refractory hypoxemia. To date, the techniques of using high levels of positive end-expiratory pressure (PEEP), prompt institution of neuromuscular blockade, and early prolonged prone positioning have been shown to reduce mortality in patients with severe ARDS...
December 2015: Seminars in Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/26457754/pulse-pressure-variation-adjusted-by-respiratory-changes-in-pleural-pressure-rather-than-by-tidal-volume-reliably-predicts-fluid-responsiveness-in-patients-with-acute-respiratory-distress-syndrome
#12
Yang Liu, Lu-qing Wei, Guo-qiang Li, Xin Yu, Guo-feng Li, Yu-ming Li
OBJECTIVES: 1) To evaluate the ability of pulse pressure variation adjusted by respiratory changes in pleural pressure to predict fluid responsiveness compared with pulse pressure variation alone. 2) To identify factors explaining the poor performance of pulse pressure variation in acute respiratory distress syndrome. DESIGN: Prospective study. SETTING: Forty-bed university hospital general ICU. PATIENTS: Ninety-six mechanically ventilated acute respiratory distress syndrome patients requiring fluid challenge...
February 2016: Critical Care Medicine
https://www.readbyqxmd.com/read/25695069/managing-hypercapnia-in-patients-with-severe-ards-and-low-respiratory-system-compliance-the-role-of-esophageal-pressure-monitoring-a-case-cohort-study
#13
Arie Soroksky, Julia Kheifets, Zehava Girsh Solomonovich, Emad Tayem, Balmor Gingy Ronen, Boris Rozhavsky
PURPOSE: Patients with severe acute respiratory distress syndrome (ARDS) and hypercapnia present a formidable treatment challenge. We examined the use of esophageal balloon for assessment of transpulmonary pressures to guide mechanical ventilation for successful management of severe hypercapnia. MATERIALS AND METHODS: Patients with severe ARDS and hypercapnia were studied. Esophageal balloon was inserted and mechanical ventilation was guided by assessment of transpulmonary pressures...
2015: BioMed Research International
https://www.readbyqxmd.com/read/25424169/non-invasive-assessment-of-lung-elastance-in-patients-with-acute-respiratory-distress-syndrome
#14
A Garnero, D Tuxen, L Ducros, D Demory, S Y Donati, J Durand-Gasselin, J Cooper, C Hodgson, J M Arnal
BACKGROUND: Chest wall mechanics can be abnormal in patients with acute respiratory disease syndrome (ARDS). Therefore, partitioning respiratory system between lungs and chest wall at the bedside is useful to optimize ventilator settings. A non-invasive method for assessing lung elastance (EL), called lung barometry, was previously described on an animal model. METHODS: This prospective study was designed to compare EL assessed by lung barometry (ELLB) versus esophageal pressure (ELPeso)...
October 2015: Minerva Anestesiologica
https://www.readbyqxmd.com/read/25287106/the-esophageal-pressure-guided-ventilation-2-epvent2-trial-protocol-a-multicentre-randomised-clinical-trial-of-mechanical-ventilation-guided-by-transpulmonary-pressure
#15
RANDOMIZED CONTROLLED TRIAL
Emily Fish, Victor Novack, Valerie M Banner-Goodspeed, Todd Sarge, Stephen Loring, Daniel Talmor
INTRODUCTION: Optimal ventilator management for patients with acute respiratory distress syndrome (ARDS) remains uncertain. Lower tidal volume ventilation appears to be beneficial, but optimal management of positive end-expiratory pressure (PEEP) remains unclear. The Esophageal Pressure-Guided Ventilation 2 Trial (EPVent2) aims to examine the impact of mechanical ventilation directed at maintaining a positive transpulmonary pressure (PTP) in patients with moderate-to-severe ARDS. METHODS AND ANALYSIS: EPVent2 is a multicentre, prospective, randomised, phase II clinical trial testing the hypothesis that the use of a PTP-guided ventilation strategy will lead to improvement in composite outcomes of mortality and time off the ventilator at 28 days as compared with a high-PEEP control...
2014: BMJ Open
https://www.readbyqxmd.com/read/25162475/higher-levels-of-spontaneous-breathing-reduce-lung-injury-in-experimental-moderate-acute-respiratory-distress-syndrome
#16
COMPARATIVE STUDY
Nadja C Carvalho, Andreas Güldner, Alessandro Beda, Ines Rentzsch, Christopher Uhlig, Susanne Dittrich, Peter M Spieth, Bärbel Wiedemann, Michael Kasper, Thea Koch, Torsten Richter, Patricia R Rocco, Paolo Pelosi, Marcelo Gama de Abreu
OBJECTIVES: To assess the effects of different levels of spontaneous breathing during biphasic positive airway pressure/airway pressure release ventilation on lung function and injury in an experimental model of moderate acute respiratory distress syndrome. DESIGN: Multiple-arm randomized experimental study. SETTING: University hospital research facility. SUBJECTS: Thirty-six juvenile pigs. INTERVENTIONS: Pigs were anesthetized, intubated, and mechanically ventilated...
November 2014: Critical Care Medicine
https://www.readbyqxmd.com/read/25120368/clinical-utility-of-the-neutrophil-elastase-inhibitor-sivelestat-for-the-treatment-of-acute-respiratory-distress-syndrome
#17
REVIEW
Naoki Aikawa, Yasushi Kawasaki
Acute respiratory distress syndrome is a serious condition that can arise following direct or indirect lung injury. It is heterogeneous and has a high mortality rate. Supportive care is the mainstay of treatment and there is no definitive pharmacological treatment as yet. Sivelestat is a neutrophil elastase inhibitor approved in Japan and the Republic of Korea for acute lung injury, including acute respiratory distress syndrome in patients with systemic inflammatory response syndrome. The aim of this review is to examine the clinical utility of sivelestat in different disease states, using data from nonclinical and clinical studies...
2014: Therapeutics and Clinical Risk Management
https://www.readbyqxmd.com/read/25112501/the-assessment-of-transpulmonary-pressure-in-mechanically-ventilated-ards-patients
#18
Davide Chiumello, Massimo Cressoni, Andrea Colombo, Giovanni Babini, Matteo Brioni, Francesco Crimella, Stefan Lundin, Ola Stenqvist, Luciano Gattinoni
PURPOSE: The optimal method for estimating transpulmonary pressure (i.e. the fraction of the airway pressure transmitted to the lung) has not yet been established. METHODS: In this study on 44 patients with acute respiratory distress syndrome (ARDS), we computed the end-inspiratory transpulmonary pressure as the change in airway and esophageal pressure from end-inspiration to atmospheric pressure (i.e. release derived) and as the product of the end-inspiratory airway pressure and the ratio of lung to respiratory system elastance (i...
November 2014: Intensive Care Medicine
https://www.readbyqxmd.com/read/24409355/noninvasive-positive-pressure-ventilation-for-the-treatment-of-acute-respiratory-distress-syndrome-following-esophagectomy-for-esophageal-cancer-a-clinical-comparative-study
#19
Kai-Yan Yu, Lei Zhao, Zi Chen, Min Yang
OBJECTIVE: To evaluate the therapeutic efficacy of noninvasive positive pressure ventilation (NPPV) in the treatment of acute respiratory distress syndrome (ARDS) following esophagectomy for esophageal cancer. METHODS: In this retrospective evaluation, we included 64 patients with ARDS following esophagectomy for esophageal cancer between January 2009 and December 2011. The primary evaluations were 28-day fatality and actual fatality. The secondary evaluations were sex, age, onset time, pH value, PaO2/FiO2, sequential organ failure assessment (SOFA) score, acute physiology and chronic health evaluation (APACHE-II) score, and presence or absence after surgery of major surgery-related complications such as cardiac arrest, anastomotic fistula, and acute renal dysfunction...
December 2013: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/24361970/extracorporeal-gas-exchange-and-spontaneous-breathing-for-the-treatment-of-acute-respiratory-distress-syndrome-an-alternative-to-mechanical-ventilation
#20
Thomas Langer, Vittoria Vecchi, Slava M Belenkiy, Jeremy W Cannon, Kevin K Chung, Leopoldo C Cancio, Luciano Gattinoni, Andriy I Batchinsky
OBJECTIVES: Venovenous extracorporeal gas exchange is increasingly used in awake, spontaneously breathing patients as a bridge to lung transplantation. Limited data are available on a similar use of extracorporeal gas exchange in patients with acute respiratory distress syndrome. The aim of this study was to investigate the use of extracorporeal gas exchange in awake, spontaneously breathing sheep with healthy lungs and with acute respiratory distress syndrome and describe the interactions between the native lung (healthy and diseased) and the artificial lung (extracorporeal gas exchange) in this setting...
March 2014: Critical Care Medicine
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