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Ventilator induced lung injury

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https://www.readbyqxmd.com/read/29324568/effects-of-pressure-support-ventilation-on-ventilator-induced-lung-injury-in-mild-acute-respiratory-distress-syndrome-depend-on-level-of-positive-end-expiratory-pressure
#1
Paulo A F Magalhães, Gisele de A Padilha, Lillian Moraes, Cíntia L Santos, Ligia de A Maia, Cassia L Braga, Maria do Carmo M B Duarte, Lívia B Andrade, Alberto Schanaider, Vera L Capellozzi, Robert Huhle, Marcelo Gama de Abreu, Paolo Pelosi, Patricia R M Rocco, Pedro L Silva
BACKGROUND: Harmful effects of spontaneous breathing have been shown in experimental severe acute respiratory distress syndrome (ARDS). However, in the clinical setting, spontaneous respiration has been indicated only in mild ARDS. To date, no study has compared the effects of spontaneous assisted breathing with those of fully controlled mechanical ventilation at different levels of positive end-expiratory pressure (PEEP) on lung injury in ARDS. OBJECTIVE: To compare the effects of assisted pressure support ventilation (PSV) with pressure-controlled ventilation (PCV) on lung function, histology and biological markers at two different PEEP levels in mild ARDS in rats...
January 10, 2018: European Journal of Anaesthesiology
https://www.readbyqxmd.com/read/29324051/anti-il-8-antibody-potentiates-the-effect-of-exogenous-surfactant-in-respiratory-failure-caused-by-meconium-aspiration
#2
Pavol Mikolka, Jana Kopincova, Petra Kosutova, Maros Kolomaznik, Andrea Calkovska, Daniela Mokra
AIM: Meconium aspiration syndrome (MAS) is life-threatening respiratory failure of newborns which can be treated by exogenous surfactant. In response to meconium, increased levels of chemokine IL-8 (CXCL8) stimulate massive neutrophil infiltration of the lungs. Local accumulation and activation of neutrophils, on-going inflammation, lung edema, and oxidative damage contribute to inactivation of endogenous and therapeutically given surfactants. Therefore, we have hypothesized that addition of monoclonal anti-IL-8 antibody into exogenous surfactant can mitigate the neutrophil-induced local injury and the secondary surfactant inactivation and may finally result in improvement of respiratory functions...
January 11, 2018: Experimental Lung Research
https://www.readbyqxmd.com/read/29323931/esophageal-manometry-and-regional-transpulmonary-pressure-in-lung-injury
#3
Takeshi Yoshida, Marcelo B P Amato, Domenico Luca Grieco, Lu Chen, Cristhiano A S Lima, Rollin Roldan, Caio C A Morais, Susimeire Gomes, Eduardo L V Costa, Paulo F G Cardoso, Emmanuel Charbonney, Jean-Christophe M Richard, Laurent Brochard, Brian P Kavanagh
RATIONALE: Esophageal manometry is the clinically available method to estimate pleural pressure, thus enabling calculation of the transpulmonary pressure (PL). However, many concerns make uncertain in which lung region esophageal manometry reflects local PL. OBJECTIVES: To determine the accuracy of esophageal pressure (Pes) and in which regions esophageal manometry reflects Ppl and PL; to assess whether lung stress in non-dependent regions can be estimated at end-inspiration from PL...
January 11, 2018: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/29323413/extracorporeal-membrane-oxygenation-for-refractory-severe-respiratory-failure-in-acute-interstitial-pneumonia
#4
Gabriela Gonçalves-Venade, Nuno Lacerda-Príncipe, Roberto Roncon-Albuquerque, José Artur Paiva
Acute interstitial pneumonia (AIP) is a rare idiopathic interstitial lung disease with rapid progressive respiratory failure and high mortality. In the present report, three cases of AIP complicated by refractory respiratory failure supported with extracorporeal membrane oxygenation (ECMO) are presented. One male and two female patients (ages 27-59) were included. Venovenous ECMO support was provided using miniaturized systems, with two-site femoro-jugular circuit configuration. Despite lung protective ventilation, prone position and neuromuscular blockade, refractory respiratory failure of unknown etiology supervened (ratio of arterial oxygen partial pressure to fractional inspired oxygen 46-130) and ECMO was initiated after 3-7 days of mechanical ventilation...
January 11, 2018: Artificial Organs
https://www.readbyqxmd.com/read/29304863/gm-csf-overexpression-after-influenza-a-virus-infection-prevents-mortality-and-moderates-m1-like-airway-monocyte-macrophage-polarization
#5
E Scott Halstead, Todd M Umstead, Michael L Davies, Yuka Imamura Kawasawa, Patricia Silveyra, Judie Howyrlak, Linlin Yang, Weichao Guo, Sanmei Hu, Eranda Kurundu Hewage, Zissis C Chroneos
BACKGROUND: Influenza A viruses cause life-threatening pneumonia and lung injury in the lower respiratory tract. Application of high GM-CSF levels prior to infection has been shown to reduce morbidity and mortality from pathogenic influenza infection in mice, but the mechanisms of protection and treatment efficacy have not been established. METHODS: Mice were infected intranasally with influenza A virus (PR8 strain). Supra-physiologic levels of GM-CSF were induced in the airways using the double transgenic GM-CSF (DTGM) or littermate control mice starting on 3 days post-infection (dpi)...
January 5, 2018: Respiratory Research
https://www.readbyqxmd.com/read/29301259/sphingolipids-in-ventilator-induced-lung-injury-role-of-sphingosine-1-phosphate-lyase
#6
Vidyani Suryadevara, Panfeng Fu, David Lenin Ebenezer, Evgeny Berdyshev, Irina A Bronova, Long Shuang Huang, Anantha Harijith, Viswanathan Natarajan
Mechanical ventilation (MV) performed in respiratory failure patients to maintain lung function leads to ventilator-induced lung injury (VILI). This study investigates the role of sphingolipids and sphingolipid metabolizing enzymes in VILI using a rodent model of VILI and alveolar epithelial cells subjected to cyclic stretch (CS). MV (0 PEEP (Positive End Expiratory Pressure), 30 mL/kg, 4 h) in mice enhanced sphingosine-1-phosphate lyase (S1PL) expression, and ceramide levels, and decreased S1P levels in lung tissue, thereby leading to lung inflammation, injury and apoptosis...
January 1, 2018: International Journal of Molecular Sciences
https://www.readbyqxmd.com/read/29297365/regional-physiology-of-ards
#7
REVIEW
Luciano Gattinoni, Tommaso Tonetti, Michael Quintel
The acute respiratory distress (ARDS) lung is usually characterized by a high degree of inhomogeneity. Indeed, the same lung may show a wide spectrum of aeration alterations, ranging from completely gasless regions, up to hyperinflated areas. This inhomogeneity is normally caused by the presence of lung edema and/or anatomical variations, and is deeply influenced by the gravitational forces.For any given airway pressure generated by the ventilator, the pressure acting directly on the lung (i.e., the transpulmonary pressure or lung stress) is determined by two main factors: 1) the ratio between lung elastance and the total elastance of the respiratory system (which has been shown to vary widely in ARDS patients, between 0...
December 28, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29250319/patients-with-uninjured-lungs-may-also-benefit-from-lung-protective-ventilator-settings
#8
REVIEW
Roger Alencar, Vittorio D'Angelo, Rachel Carmona, Marcus J Schultz, Ary Serpa Neto
Although mechanical ventilation is a life-saving strategy in critically ill patients and an indispensable tool in patients under general anesthesia for surgery, it also acts as a double-edged sword. Indeed, ventilation is increasingly recognized as a potentially dangerous intrusion that has the potential to harm lungs, in a condition known as 'ventilator-induced lung injury' (VILI). So-called 'lung-protective' ventilator settings aiming at prevention of VILI have been shown to improve outcomes in patients with acute respiratory distress syndrome (ARDS), and, over the last few years, there has been increasing interest in possible benefit of lung-protective ventilation in patients under ventilation for reasons other than ARDS...
2017: F1000Research
https://www.readbyqxmd.com/read/29247675/adrenergic-and-glucocorticoid-receptor-antagonists-reduce-ozone-induced-lung-injury-and-inflammation
#9
Andres R Henriquez, Samantha J Snow, Mette C Schladweiler, Colette N Miller, Janice A Dye, Allen D Ledbetter, Judy E Richards, Kevin Mauge-Lewis, Marie A McGee, Urmila P Kodavanti
Recent studies showed that the circulating stress hormones, epinephrine and corticosterone/cortisol, are involved in mediating ozone-induced pulmonary effects through the activation of the sympathetic-adrenal-medullary (SAM) and hypothalamus-pituitary-adrenal (HPA) axes. Hence, we examined the role of adrenergic and glucocorticoid receptor inhibition in ozone-induced pulmonary injury and inflammation. Male 12-week old Wistar-Kyoto rats were pretreated daily for 7days with propranolol (PROP; a non-selective β adrenergic receptor [AR] antagonist, 10mg/kg, i...
December 13, 2017: Toxicology and Applied Pharmacology
https://www.readbyqxmd.com/read/29247545/neurally-adjusted-ventilatory-assist-can-be-used-to-wean-infants-with-congenital-diaphragmatic-hernias-off-respiratory-support
#10
Arata Oda, Liisa Lehtonen, Hanna Soukka
Neurally adjusted ventilatory assist (NAVA) is a mode of mechanical ventilation that triggers, cycles and delivers assistance in response to the electrical activity of the diaphragm (EAdi). The EAdi signal is measured with an EAdi catheter (Maquet, Solna, Sweden) that includes nine miniaturised electrodes and is positioned in the oesophagus at the level of the diaphragm. NAVA has been shown to decrease peak inspiratory pressures, which are potentially harmful for immature lungs (1,2) and, therefore, it may decrease ventilator induced lung injury, particularly pulmonary hypoplasia in congenital diaphragmatic hernia (CDH)...
December 16, 2017: Acta Paediatrica
https://www.readbyqxmd.com/read/29236845/comparison-between-conventional-protective-mechanical-ventilation-and-high-frequency-oscillatory-ventilation-associated-with-the-prone-position
#11
José Roberto Fioretto, Susiane Oliveira Klefens, Rafaelle Fernandes Pires, Cilmery Suemi Kurokawa, Mario Ferreira Carpi, Rossano César Bonatto, Marcos Aurélio Moraes, Carlos Fernando Ronchi
OBJECTIVE: To compare the effects of high-frequency oscillatory ventilation and conventional protective mechanical ventilation associated with the prone position on oxygenation, histology and pulmonary oxidative damage in an experimental model of acute lung injury. METHODS: Forty-five rabbits with tracheostomy and vascular access were underwent mechanical ventilation. Acute lung injury was induced by tracheal infusion of warm saline. Three experimental groups were formed: healthy animals + conventional protective mechanical ventilation, supine position (Control Group; n = 15); animals with acute lung injury + conventional protective mechanical ventilation, prone position (CMVG; n = 15); and animals with acute lung injury + high-frequency oscillatory ventilation, prone position (HFOG; n = 15)...
December 7, 2017: Revista Brasileira de Terapia Intensiva
https://www.readbyqxmd.com/read/29216437/epha2-modulation-associates-with-protective-effect-of-prone-position-in-ventilator-induced-lung-injury
#12
Byung Hoon Park, Mi Hwa Shin, Ivor S Douglas, Kyung Soo Chung, Joo Han Song, Song Yee Kim, Eun Young Kim, Ji Ye Jung, Young Ae Kang, Joon Chang, Young Sam Kim, Moo Suk Park
The erythropoietin-producing hepatoma receptor tyrosine kinase A2 (EphA2) and its ligand ephrinA1 play a pivotal role in inflammation and tissue injury by modulating the epithelial and endothelial barrier integrity. Therefore, EphA2 receptor may be a potential therapeutic target for modulating ventilator-induced lung injury (VILI). To support this hypothesis, here we analyzed EphA2/ephrinA1 signaling in the process of VILI and determined the role of EphA2/ephrinA1 signaling in the protective mechanism of prone positioning in a VILI model...
December 7, 2017: American Journal of Respiratory Cell and Molecular Biology
https://www.readbyqxmd.com/read/29212551/extracorporeal-membrane-oxygenation-for-life-threatening-asthma-refractory-to-mechanical-ventilation-analysis-of-the-extracorporeal-life-support-organization-registry
#13
Hye Ju Yeo, Dohyung Kim, Doosoo Jeon, Yun Seong Kim, Peter Rycus, Woo Hyun Cho
BACKGROUND: The use of extracorporeal membrane oxygenation (ECMO) in cases of near-fatal asthma (NFA) has increased, but the benefits and potential complications of this therapy have yet to be fully investigated. METHODS: Cases were extracted from the Extracorporeal Life Support Organization Registry between March 1992 and March 2016. All patients with a diagnosis of asthma (according to the International Classification of Diseases 9th edition), who also received ECMO, were extracted...
December 6, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29209598/inflammatory-mediators-in-tracheal-aspirates-of-preterm-infants-participating-in-a-randomized-trial-of-permissive-hypercapnia
#14
Sarah Gentner, Mandy Laube, Ulrike Uhlig, Yang Yang, Hans W Fuchs, Jens Dreyhaupt, Helmut D Hummler, Stefan Uhlig, Ulrich H Thome
Background: Ventilator-induced lung injury is considered to be a main factor in the pathogenesis of bronchopulmonary dysplasia (BPD). Optimizing ventilator strategies may reduce respiratory morbidities in preterm infants. Permissive hypercapnia has been suggested to attenuate lung injury. We aimed to determine if a higher PCO2 target range results in less lung injury compared to the control target range and possibly reduces pro-inflammatory cytokines and acid sphingomyelinase (ASM) in tracheal aspirates (TA), which has not been addressed before...
2017: Frontiers in Pediatrics
https://www.readbyqxmd.com/read/29206492/intravenous-controlled-release-hydrogen-sulfide-protects-against-ventilator-induced-lung-injury
#15
Lifeng Wang, Hao Yu, Yana Zhang, Caiyu Dong, Bo Liu
BACKGROUND: Despite its critical utility in providing life support to patients with impaired respiratory functions, prolonged mechanical ventilation has been found to cause a series of pathological changes in the lung that are collectively referred to as ventilator-induced lung injury (VILI). This study aims to investigate the therapeutic effects of mesoporous silica nanoparticles (DATS-MSN), which is capable of releasing H2S in a slow and controlled manner, on VILI. METHODS: A murine VILI model was generated...
November 2017: Experimental Lung Research
https://www.readbyqxmd.com/read/29204685/methylene-blue-protects-the-isolated-rat-lungs-from-ischemia-reperfusion-injury-by-attenuating-mitochondrial-oxidative-damage
#16
Wen-Fang Tian, Si Zeng, Qiong Sheng, Jun-Liang Chen, Ping Weng, Xiao-Tong Zhang, Jia-Jia Yuan, Qing-Feng Pang, Zhi-Qiang Wang
INTRODUCTION: Impaired mitochondrial function is a key factor attributing to the lung ischemia reperfusion injury (LIRI). Methylene blue (MB) has been reported to attenuate brain and renal ischemia-reperfusion injury. We hypothesized that MB also could have a protective effect against LIRI by preventing mitochondrial oxidative damage. METHODS: Isolated rat lungs were assigned to the following four groups (n = 6): a sham group: perfusion for 105 min without ischemia; I/R group: shutoff of perfusion and ventilation for 45 min followed by reperfusion for 60 min; and I/R + MB group and I/R + glutathione (GSH) group: 2 mg/kg MB or 4 μM glutathione were intraperitoneally administered for 2 h, and followed by 45 min of ischemia and 60 min of reperfusion...
December 4, 2017: Lung
https://www.readbyqxmd.com/read/29194341/applying-positive-end-expiratory-pressure-during-mechanical-ventilation-causes-pulmonary-redox-imbalance-and-inflammation-in-rats
#17
Mônica C Andrade, Ana B Farias Souza, Jacques G Horta, Guilherme de Paula Costa, André Talvani, Sílvia D Cangussú, Rodrigo C A de Menezes, Frank S Bezerra
BACKGROUND: Mechanical ventilation (MV) may induce or aggravate lung injury through the production of cytokines, inflammatory infiltration of neutrophils, and changes in the permeability of the alveolar-capillary barrier. The use of positive end-expiratory pressure (PEEP) helps improve gas exchanges avoiding alveolar collapse at the end of expiration. The present study aimed to analyze inflammatory response and redox imbalance in lungs of rats submitted to MV with and without PEEP. METHODS: Eighteen Wistar rats were divided into three groups: control (CG), PEEP group (PG), and zero PEEP (ZEEP) group (ZG)...
November 30, 2017: Shock
https://www.readbyqxmd.com/read/29194057/approaches-and-techniques-to-avoid-development-or-progression-of-acute-respiratory-distress-syndrome
#18
François Beloncle, Alain Mercat
PURPOSE OF REVIEW: Despite major improvement in ventilation strategies, hospital mortality and morbidity of the acute respiratory distress syndrome (ARDS) remain high. A lot of therapies have been shown to be ineffective for established ARDS. There is a growing interest in strategies aiming at avoiding development and progression of ARDS. RECENT FINDINGS: Recent advances in this field have explored identification of patients at high-risk, nonspecific measures to limit the risks of inflammation, infection and fluid overload, prevention strategies of ventilator-induced lung injury and patient self-inflicted lung injury, and pharmacological treatments...
February 2018: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/29193065/stereological-assessment-of-the-blood-air-barrier-and-the-surfactant-system-after-mesenchymal-stem-cell-pretreatment-in-a-porcine-non-heart-beating-donor-model-for-lung-transplantation
#19
Anke Schnapper, Astrid Christmann, Lars Knudsen, Parwis Rahmanian, Yeong-Hoon Choi, Mohamed Zeriouh, Samira Karavidic, Klaus Neef, Anja Sterner-Kock, Maria Guschlbauer, Florian Hofmaier, Alexandra C Maul, Thorsten Wittwer, Thorsten Wahlers, Christian Mühlfeld, Matthias Ochs
More frequent utilization of non-heart-beating donor (NHBD) organs for lung transplantation has the potential to relieve the shortage of donor organs. In particular with respect to uncontrolled NHBD, concerns exist regarding the risk of ischaemia/reperfusion (IR) injury-related graft damage or dysfunction. Due to their immunomodulating and tissue-remodelling properties, bone-marrow-derived mesenchymal stem cells (MSCs) have been suspected of playing a beneficial role regarding short- and long-term survival and function of the allograft...
November 28, 2017: Journal of Anatomy
https://www.readbyqxmd.com/read/29184987/ventilation-during-extracorporeal-support-why-and-how
#20
REVIEW
A Pesenti, E Carlesso, T Langer, T Mauri
The main target of extracorporeal support is to achieve viable gas exchange, while minimizing the risk of ventilator-induced lung injury, achieved through a decreased mechanical ventilation load on the natural lung. However, during veno-venous extracorporeal membrane oxygenation (ECMO), mechanical ventilation is still necessary in order to prevent lung collapse and/or if extracorporeal blood flow is not sufficient to guarantee adequate gas exchange. In this review, we will summarize the physiology of extracorporeal support and the rationale for continuing mechanical ventilation in this context...
November 28, 2017: Medizinische Klinik, Intensivmedizin und Notfallmedizin
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