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https://www.readbyqxmd.com/read/28918955/shifts-in-the-relationship-between-motor-unit-recruitment-thresholds-versus-derecruitment-thresholds-during-fatigue
#1
Matt S Stock, Jacob A Mota
Muscle fatigue is associated with diminished twitch force amplitude. We examined changes in the motor unit recruitment versus derecruitment threshold relationship during fatigue. Nine men (mean age = 26 years) performed repeated isometric contractions at 50% maximal voluntary contraction (MVC) knee extensor force until exhaustion. Surface electromyographic signals were detected from the vastus lateralis, and were decomposed into their constituent motor unit action potential trains. Motor unit recruitment and derecruitment thresholds and firing rates at recruitment and derecruitment were evaluated at the beginning, middle, and end of the protocol...
September 14, 2017: Medical Engineering & Physics
https://www.readbyqxmd.com/read/28736528/linking-ventilator-injury-induced-leak-across-the-blood-gas-barrier-to-derangements-in-murine-lung-function
#2
Bradford J Smith, Elizabeth Bartolak-Suki, Bela Suki, Gregory S Roy, Katharine L Hamlington, Chantel M Charlebois, Jason H T Bates
Mechanical ventilation is vital to the management of acute respiratory distress syndrome, but it frequently leads to ventilator-induced lung injury (VILI). Understanding the pathophysiological processes involved in the development of VILI is an essential prerequisite for improving lung-protective ventilation strategies. The goal of this study was to relate the amount and nature of material accumulated in the airspaces to biomarkers of injury and the derecruitment behavior of the lung in VILI. Forty-nine BALB/c mice were mechanically ventilated with combinations of tidal volume and end-expiratory pressures to produce varying degrees of overdistension and atelectasis while lung function was periodically assessed...
2017: Frontiers in Physiology
https://www.readbyqxmd.com/read/28708679/transpulmonary-pressure-describes-lung-morphology-during-decremental-positive-end-expiratory-pressure-trials-in-obesity
#3
Jacopo Fumagalli, Lorenzo Berra, Changsheng Zhang, Massimiliano Pirrone, Roberta R De Santis Santiago, Susimeire Gomes, Federico Magni, Glaucia A B Dos Santos, Desmond Bennett, Vinicius Torsani, Daniel Fisher, Caio Morais, Marcelo B P Amato, Robert M Kacmarek
OBJECTIVES: Atelectasis develops in critically ill obese patients when undergoing mechanical ventilation due to increased pleural pressure. The current study aimed to determine the relationship between transpulmonary pressure, lung mechanics, and lung morphology and to quantify the benefits of a decremental positive end-expiratory pressure trial preceded by a recruitment maneuver. DESIGN: Prospective, crossover, nonrandomized interventional study. SETTING: Medical and Surgical Intensive Care Units at Massachusetts General Hospital (Boston, MA) and University Animal Research Laboratory (São Paulo, Brazil)...
August 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28696966/defining-a-ventilation-strategy-for-flexible-bronchoscopy-on-mechanically-ventilated-patients-in-the-medical-intensive-care-unit
#4
Yonatan Y Greenstein, Eric Shakespeare, Peter Doelken, Paul H Mayo
BACKGROUND: Flexible bronchoscopy (FB) in intubated patients on mechanical ventilation increases airway resistance. During FB, two ventilatory strategies are possible: maintaining tidal volume (VT) while maintaining baseline CO2 or allowing reduction of VT. The former strategy carries risk of hyperinflation due to expiratory flow limitation with FB. The aim of the authors was too study end expiratory lung volume (EELV) during FB of intubated subjects while limiting VT. METHODS: We studied 16 subjects who were intubated on mechanical ventilation and required FB...
July 2017: Journal of Bronchology & Interventional Pulmonology
https://www.readbyqxmd.com/read/28632529/respiratory-system-mechanics-during-low-versus-high-positive-end-expiratory-pressure-in-open-abdominal-surgery-a-substudy-of-provhilo-randomized-controlled-trial
#5
Davide D'Antini, Robert Huhle, Jacob Herrmann, Demet S Sulemanji, Jun Oto, Pasquale Raimondo, Lucia Mirabella, Sabrine N T Hemmes, Marcus J Schultz, Paolo Pelosi, David W Kaczka, Marcos Francisco Vidal Melo, Marcelo Gama de Abreu, Gilda Cinnella
BACKGROUND: In the 2014 PROtective Ventilation using HIgh versus LOw positive end-expiratory pressure (PROVHILO) trial, intraoperative low tidal volume ventilation with high positive end-expiratory pressure (PEEP = 12 cm H2O) and lung recruitment maneuvers did not decrease postoperative pulmonary complications when compared to low PEEP (0-2 cm H2O) approach without recruitment breaths. However, effects of intraoperative PEEP on lung compliance remain poorly understood. We hypothesized that higher PEEP leads to a dominance of intratidal overdistension, whereas lower PEEP results in intratidal recruitment/derecruitment (R/D)...
June 19, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28372575/implementing-a-bedside-assessment-of-respiratory-mechanics-in-patients-with-acute-respiratory-distress-syndrome
#6
Lu Chen, Guang-Qiang Chen, Kevin Shore, Orest Shklar, Concetta Martins, Brian Devenyi, Paul Lindsay, Heather McPhail, Ashley Lanys, Ibrahim Soliman, Mazin Tuma, Michael Kim, Kerri Porretta, Pamela Greco, Hilary Every, Chris Hayes, Andrew Baker, Jan O Friedrich, Laurent Brochard
BACKGROUND: Despite their potential interest for clinical management, measurements of respiratory mechanics in patients with acute respiratory distress syndrome (ARDS) are seldom performed in routine practice. We introduced a systematic assessment of respiratory mechanics in our clinical practice. After the first year of clinical use, we retrospectively assessed whether these measurements had any influence on clinical management and physiological parameters associated with clinical outcomes by comparing their value before and after performing the test...
April 4, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/28347624/efficacy-and-safety-of-normal-saline-instillation-and-paediatric-endotracheal-suction-an-integrative-review
#7
REVIEW
Jessica O'Leary, Marion L Mitchell, Marie Cooke, Andreas Schibler
OBJECTIVE: To synthesise research findings regarding the efficacy and safety of normal saline instillation (NSI) during endotracheal suction in the paediatric intensive care unit. DATA SOURCES: The Cochrane Library, PROSPERO, the National Health Service Centre for Reviews and Dissemination, PubMed and Cumulative Index to Nursing and Allied Health (CINAHL) databases were systematically searched. Subject headings included "suctioning, endotracheal", "suction", "sodium chloride", "normal saline" and "paediatrics"...
March 24, 2017: Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses
https://www.readbyqxmd.com/read/28150228/personalizing-mechanical-ventilation-according-to-physiologic-parameters-to-stabilize-alveoli-and-minimize-ventilator-induced-lung-injury-vili
#8
REVIEW
Gary F Nieman, Joshua Satalin, Penny Andrews, Hani Aiash, Nader M Habashi, Louis A Gatto
It has been shown that mechanical ventilation in patients with, or at high-risk for, the development of acute respiratory distress syndrome (ARDS) can be a double-edged sword. If the mechanical breath is improperly set, it can amplify the lung injury associated with ARDS, causing a secondary ventilator-induced lung injury (VILI). Conversely, the mechanical breath can be adjusted to minimize VILI, which can reduce ARDS mortality. The current standard of care ventilation strategy to minimize VILI attempts to reduce alveolar over-distension and recruitment-derecruitment (R/D) by lowering tidal volume (Vt) to 6 cc/kg combined with adjusting positive-end expiratory pressure (PEEP) based on a sliding scale directed by changes in oxygenation...
December 2017: Intensive Care Medicine Experimental
https://www.readbyqxmd.com/read/28107207/dynamic-mechanical-interactions-between-neighboring-airspaces-determine-cyclic-opening-and-closure-in-injured-lung
#9
Ludovic Broche, Gaetano Perchiazzi, Liisa Porra, Angela Tannoia, Mariangela Pellegrini, Savino Derosa, Alessandra Sindaco, João Batista Borges, Loïc Degrugilliers, Anders Larsson, Göran Hedenstierna, Anthony S Wexler, Alberto Bravin, Sylvia Verbanck, Bradford J Smith, Jason H T Bates, Sam Bayat
OBJECTIVES: Positive pressure ventilation exposes the lung to mechanical stresses that can exacerbate injury. The exact mechanism of this pathologic process remains elusive. The goal of this study was to describe recruitment/derecruitment at acinar length scales over short-time frames and test the hypothesis that mechanical interdependence between neighboring lung units determines the spatial and temporal distributions of recruitment/derecruitment, using a computational model. DESIGN: Experimental animal study...
April 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/27923984/short-term-effect-of-volume-recruitment-derecruitment-manoeuvre-on-chest-wall-motion-in-duchenne-muscular-dystrophy
#10
Henri Meric, Line Falaize, Didier Pradon, Matthieu Lacombe, Michel Petitjean, David Orlikowski, Hélène Prigent, Frédéric Lofaso
Because progressive respiratory muscle weakness leads to decreased chest-wall motion with eventual ribcage stiffening, the purpose was to compare vital capacity (VC) and contributions of chest-wall compartments before and after volume recruitment-derecruitment manoeuvres (VRDM) in Duchenne muscular dystrophy (DMD). We studied nine patients with DMD and VC lower than 30% of predicted. VRDM was performed using 15 insufflations-exsufflations of +30 to -30 cmH2O. VC and three-dimensional chest-wall motion were measured, as well as oxygen saturation, transcutaneous partial pressure of carbon dioxide and the rapid shallow breathing index (respiratory rate/tidal volume) before (baseline) and immediately and 1 hour after VRDM...
December 6, 2016: Chronic Respiratory Disease
https://www.readbyqxmd.com/read/27842745/managing-acute-lung-injury
#11
REVIEW
Gregory A Schmidt
The foundation of mechanical ventilation for acute respiratory distress syndrome involves limiting lung overdistention by using small tidal volumes or transpulmonary pressures. Potential for additional lung recruitment with higher positive end-expiratory pressure (PEEP) should be assessed. When stress index indicates tidal recruitment-derecruitment, PEEP is increased to higher values. Alternatively, a high PEEP table is used in all patients. When these conventional approaches are insufficient to sustain acceptable gas exchange, rescue is attempted using extracorporeal therapies, airway pressure-release ventilation, inhaled vasodilators, or high-frequency oscillatory ventilation...
December 2016: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/27585545/intratidal-recruitment-derecruitment-persists-at-low-and-moderate-positive-end-expiratory-pressure-in-paediatric-patients
#12
Steffen Wirth, Lisa Artner, Tobias Broß, Sara Lozano-Zahonero, Johannes Spaeth, Stefan Schumann
In paediatric patients positive end-expiratory pressure (PEEP) is traditionally set lower than in adults. We investigated whether moderately higher PEEP improves respiratory mechanics and regional ventilation. Therefore, 40 children were mechanically ventilated with PEEP 2 and 5 cmH2O. Volume-dependent compliance profiles were analysed as a measure of intratidal recruitment/derecruitment. Regional ventilation was assessed using electrical impedance tomography. Mean compliance was 17.9±9.9 mL·cmH2O(-1) (PEEP 2 cmH2O), and 19...
August 29, 2016: Respiratory Physiology & Neurobiology
https://www.readbyqxmd.com/read/27519921/new-method-of-preoxygenation-for-orotracheal-intubation-in-patients-with-hypoxaemic-acute-respiratory-failure-in-the-intensive-care-unit-non-invasive-ventilation-combined-with-apnoeic-oxygenation-by-high-flow-nasal-oxygen-the-randomised-optiniv-study-protocol
#13
Samir Jaber, Nicolas Molinari, Audrey De Jong
INTRODUCTION: Tracheal intubation in the intensive care unit (ICU) is associated with severe life-threatening complications including severe hypoxaemia. Preoxygenation before intubation has been recommended in order to decrease such complications. Non-invasive ventilation (NIV)-assisted preoxygenation allows increased oxygen saturation during the intubation procedure, by applying a positive end-expiratory pressure (PEEP) to prevent alveolar derecruitment. However, the NIV mask has to be taken off after preoxygenation to allow the passage of the tube through the mouth...
August 12, 2016: BMJ Open
https://www.readbyqxmd.com/read/27405798/intraoperative-compliance-profiles-and-regional-lung-ventilation-improve-with-increasing-positive-end-expiratory-pressure
#14
S Wirth, M Kreysing, J Spaeth, S Schumann
BACKGROUND: Anaesthesia and mechanical ventilation can lead to impaired lung. Intraoperative positive end-expiratory pressure (PEEP) should prevent intratidal recruitment/derecruitment without causing overdistension. The intratidal compliance profile indicates both unwanted phenomena. We hypothesized that a higher than usual PEEP improves the intratidal compliance and the regional lung ventilation of patients with healthy lungs. METHODS: After ethics approval, 30 adult patients scheduled for limb surgery were investigated at PEEP 5, 7 and 9 cm H2 O during mechanical ventilation...
October 2016: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/27324326/pneumoperitoneum-deteriorates-intratidal-respiratory-system-mechanics-an-observational-study-in-lung-healthy-patients
#15
Steffen Wirth, Andreas Biesemann, Johannes Spaeth, Stefan Schumann
BACKGROUND: Pneumoperitoneum during laparoscopic surgery leads to atelectasis and impairment of oxygenation. Positive end-expiratory pressure (PEEP) is supposed to counteract atelectasis. We hypothesized that the derecruiting effects of pneumoperitoneum would deteriorate the intratidal compliance profile in patients undergoing laparoscopic surgery. METHODS: In 30 adult patients scheduled for surgery with pneumoperitoneum, respiratory variables were measured during mechanical ventilation...
February 2017: Surgical Endoscopy
https://www.readbyqxmd.com/read/27281471/fatigue-and-exhaustion-in-hypoxia-the-role-of-cerebral-oxygenation
#16
REVIEW
Jui-Lin Fan, Bengt Kayser
Fan, Jui-Lin, and Bengt Kayser. Fatigue and exhaustion in hypoxia: the role of cerebral oxygenation. High Alt Med Biol. 17:72-84, 2016.-It is well established that ascent to high altitude is detrimental to one's aerobic capacity and exercise performance. However, despite more than a century of research on the effects of hypoxia on exercise performance, the underlying mechanisms remain incompletely understood. While the cessation of exercise, or the reduction of its intensity, at exhaustion, implies reduced motor recruitment by the central nervous system, the mechanisms leading up to this muscular derecruitment remain elusive...
June 2016: High Altitude Medicine & Biology
https://www.readbyqxmd.com/read/27244715/intratidal-overdistention-and-derecruitment-in-the-injured-lung-a-simulation-study
#17
Reza Amini, Jacob Herrmann, David W Kaczka
GOAL: Ventilated patients with the acute respiratory distress syndrome (ARDS) are predisposed to cyclic parenchymal overdistention and derecruitment, which may worsen existing injury. We hypothesized that intratidal variations in global mechanics, as assessed at the airway opening, would reflect such distributed processes. METHODS: We developed a computational lung model for determining local instantaneous pressure distributions and mechanical impedances continuously during a breath...
March 2017: IEEE Transactions on Bio-medical Engineering
https://www.readbyqxmd.com/read/27199315/increasing-positive-end-expiratory-pressure-re-improves-intraoperative-respiratory-mechanics-and-lung-ventilation-after-prone-positioning
#18
J Spaeth, K Daume, U Goebel, S Wirth, S Schumann
BACKGROUND: Turning a patient prone, changes the respiratory mechanics and potentially the level of positive end-expiratory pressure (PEEP) that is necessary to prevent alveolar collapse. In this prospective clinical study we examined the impact of PEEP on the intratidal respiratory mechanics and regional lung aeration in the prone position. We hypothesized that a higher PEEP is required to maintain compliance and regional ventilation in the prone position. METHODS: After ethical approval, 45 patients with healthy lungs undergoing lumbar spine surgery were examined in the supine position at PEEP 6 cm H2O and in the prone position at PEEP (6, 9 and 12 cm H2O)...
June 2016: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/27146989/influence-of-the-contractile-properties-of-muscle-on-motor-unit-firing-rates-during-a-moderate-intensity-contraction-in-vivo
#19
Michael A Trevino, Trent J Herda, Andrew C Fry, Philip M Gallagher, John P Vardiman, Eric M Mosier, Jonathan D Miller
It is suggested that firing rate characteristics of motor units (MUs) are influenced by the physical properties of the muscle. However, no study has correlated MU firing rates at recruitment, targeted force, or derecruitment with the contractile properties of the muscle in vivo. Twelve participants (age = 20.67 ± 2.35 yr) performed a 40% isometric maximal voluntary contraction of the leg extensors that included linearly increasing, steady force, and decreasing segments. Muscle biopsies were collected with myosin heavy chain (MHC) content quantified, and surface electromyography (EMG) was recorded from the vastus lateralis...
August 1, 2016: Journal of Neurophysiology
https://www.readbyqxmd.com/read/27142073/identification-of-regional-overdistension-recruitment-and-cyclic-alveolar-collapse-with-electrical-impedance-tomography-in-an-experimental-ards-model
#20
Songqiao Liu, Li Tan, Knut Möller, Inez Frerichs, Tao Yu, Ling Liu, Yingzi Huang, Fengmei Guo, Jingyuan Xu, Yi Yang, Haibo Qiu, Zhanqi Zhao
BACKGROUND: Information on regional ventilation distribution in mechanically ventilated patients is important to develop lung protective ventilation strategies. In the present prospective animal study, we introduce an electrical impedance tomography (EIT)-based method to classify lungs into normally ventilated, overinflated, tidally recruited/derecruited and recruited regions. METHODS: Acute respiratory distress syndrome (ARDS) was introduced with repeated bronchoalveolar lavage in ten healthy male pigs until the ratio of arterial partial pressure of oxygen and fraction of inspired oxygen (PaO2/FiO2) decreased to less than 100 mmHg and remained stable for 30 minutes...
May 3, 2016: Critical Care: the Official Journal of the Critical Care Forum
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