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https://www.readbyqxmd.com/read/27842745/managing-acute-lung-injury
#1
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
#2
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
#3
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
#4
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
#5
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...
June 20, 2016: Surgical Endoscopy
https://www.readbyqxmd.com/read/27281471/fatigue-and-exhaustion-in-hypoxia-the-role-of-cerebral-oxygenation
#6
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
#7
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...
May 24, 2016: 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
#8
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
#9
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
#10
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
https://www.readbyqxmd.com/read/27106287/surfactant-dysfunction-during-overexpression-of-tgf-%C3%AE-1-precedes-profibrotic-lung-remodeling-in-vivo
#11
Elena Lopez-Rodriguez, Caroline Boden, Mercedes Echaide, Jesus Perez-Gil, Martin Kolb, Jack Gauldie, Ulrich A Maus, Matthias Ochs, Lars Knudsen
Transforming growth factor-β1 (TGF-β1) is involved in regulation of cellular proliferation, differentiation, and fibrogenesis, inducing myofibroblast migration and increasing extracellular matrix synthesis. Here, TGF-β1 effects on pulmonary structure and function were analyzed. Adenovirus-mediated gene transfer of TGF-β1 in mice lungs was performed and evaluated by design-based stereology, invasive pulmonary function testing, and detailed analyses of the surfactant system 1 and 2 wk after gene transfer...
June 1, 2016: American Journal of Physiology. Lung Cellular and Molecular Physiology
https://www.readbyqxmd.com/read/27038617/speaking-valves-in-tracheostomised-icu-patients-weaning-off-mechanical-ventilation-do-they-facilitate-lung-recruitment
#12
Anna-Liisa Sutt, Lawrence R Caruana, Kimble R Dunster, Petrea L Cornwell, Chris M Anstey, John F Fraser
BACKGROUND: Patients who require positive pressure ventilation through a tracheostomy are unable to phonate due to the inflated tracheostomy cuff. Whilst a speaking valve (SV) can be used on a tracheostomy tube, its use in ventilated ICU patients has been inhibited by concerns regarding potential deleterious effects to recovering lungs. The objective of this study was to assess end expiratory lung impedance (EELI) and standard bedside respiratory parameters before, during and after SV use in tracheostomised patients weaning from mechanical ventilation...
2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/26778906/fatal-derecruitment-of-occluded-left-anterior-descending-collaterals-after-left-circumflex-revascularization
#13
Marouane Boukhris, Salvatore D Tomasello, Alfredo R Galassi
Coronary arteries are not definitely functionally terminal arteries, as previously thought; indeed, they are linked and interconnected by a rich network of collaterals. Chronic total occlusions (CTOs) represent a subset of frequent lesions encountered in everyday catheterization laboratory practice, generally associated with a developed system of collateral connections. These latter have the capacity to prevent myocardial necrosis and may even uphold metabolic supply to the ischemic territory to maintain its contractile capacity...
January 2016: Journal of the Saudi Heart Association
https://www.readbyqxmd.com/read/26513624/the-change-in-motor-unit-firing-rates-at-de-recruitment-relative-to-recruitment-is-correlated-with-type-i-myosin-heavy-chain-isoform-content-of-the-vastus-lateralis-in-vivo
#14
T J Herda, J D Miller, M A Trevino, E M Mosier, P M Gallagher, A C Fry, J P Vardiman
AIM: To investigate the change in motor unit (MU) firing rates (FR) at de-recruitment relative to recruitment and the relation to % type I myosin heavy chain isoform content (type I %MHC) of the vastus lateralis (VL) in vivo. METHODS: Ten subjects performed a 22-s submaximal isometric trapezoid muscle action that included a linearly increasing, steady force at 50% maximal voluntary contraction, and linearly decreasing segments. Surface electromyographic signals were collected from the VL and were decomposed into constituent MU action potentials trains...
April 2016: Acta Physiologica
https://www.readbyqxmd.com/read/26446805/electrical-impedance-tomography-guided-prone-positioning-in-a-patient-with-acute-cor-pulmonale-associated-with-severe-acute-respiratory-distress-syndrome
#15
Toru Kotani, Hitoshi Tanabe, Hiroaki Yusa, Satoshi Saito, Kenji Yamazaki, Makoto Ozaki
Electrical impedance tomography (EIT) is a noninvasive technique used to assess regional gas distribution in the lung. We experienced a patient with acute cor pulmonale during high positive-pressure ventilation for the treatment of severe acute respiratory distress syndrome. Prone positioning was beneficial for unloading the right ventricle for treatment of acute cor pulmonale. EIT played a role in detecting lung derecruitment at the patient's bedside. Impedance distribution in ventral, mid-ventral, mid-dorsal, and dorsal layers before and 20 min after the start of prone positioning was 9, 48, 44, and 0 %, and 10, 25, 48, and 16 %, respectively...
February 2016: Journal of Anesthesia
https://www.readbyqxmd.com/read/26446221/fast-oscillatory-commands-from-the-motor-cortex-can-be-decoded-by-the-spinal-cord-for-force-control
#16
Renato N Watanabe, Andre F Kohn
UNLABELLED: Oscillations in the beta and gamma bands (13-30 Hz; 35-70 Hz) have often been observed in motor cortical outputs that reach the spinal cord, acting on motoneurons and interneurons. However, the frequencies of these oscillations are above the muscle force frequency range. A current view is that the transformation of the motoneuron pool inputs into force is linear. For this reason possible roles for these oscillations are unclear, since if this transformation is linear, the high frequencies in the motoneuron inputs (e...
October 7, 2015: Journal of Neuroscience: the Official Journal of the Society for Neuroscience
https://www.readbyqxmd.com/read/26320150/the-role-of-inducible-nitric-oxide-synthase-for-interstitial-remodeling-of-alveolar-septa-in-surfactant-protein-d-deficient-mice
#17
Lars Knudsen, Elena N Atochina-Vasserman, Christopher B Massa, Bastian Birkelbach, Chang-Jiang Guo, Pamela Scott, Beat Haenni, Michael F Beers, Matthias Ochs, Andrew J Gow
Surfactant protein D (SP-D) modulates the lung's immune system. Its absence leads to NOS2-independent alveolar lipoproteinosis and NOS2-dependent chronic inflammation, which is critical for early emphysematous remodeling. With aging, SP-D knockout mice develop an additional interstitial fibrotic component. We hypothesize that this age-related interstitial septal wall remodeling is mediated by NOS2. Using invasive pulmonary function testing such as the forced oscillation technique and quasistatic pressure-volume perturbation and design-based stereology, we compared 29-wk-old SP-D knockout (Sftpd(-/-)) mice, SP-D/NOS2 double-knockout (DiNOS) mice, and wild-type mice (WT)...
November 1, 2015: American Journal of Physiology. Lung Cellular and Molecular Physiology
https://www.readbyqxmd.com/read/26275684/simultaneous-monitoring-of-intratidal-compliance-and-resistance-in-mechanically-ventilated-piglets-a-feasibility-study-in-two-different-study-groups
#18
Sarah Buehler, Stefan Schumann, László Vimláti, Michael Lichtwarck-Aschoff, Josef Guttmann
Compliance measures the force counteracting parenchymal lung distension. In mechanical ventilation, intratidal compliance-volume (C(V))-profiles therefore change depending on PEEP, tidal volume (VT), and underlying mechanical lung properties. Resistance counteracts gas flow through the airways. Due to anatomical linking between parenchyma and airways, intratidal resistance-volume (R(V))-profiles are hypothesised to change in a non-linear way as well. We analysed respiratory system mechanics in fifteen piglets with lavage-induced lung injury and nine healthy piglets ventilated at different PEEP/VT-settings...
December 2015: Respiratory Physiology & Neurobiology
https://www.readbyqxmd.com/read/26215818/alveolar-instability-atelectrauma-is-not-identified-by-arterial-oxygenation-predisposing-the-development-of-an-occult-ventilator-induced-lung-injury
#19
Penny L Andrews, Benjamin Sadowitz, Michaela Kollisch-Singule, Joshua Satalin, Shreyas Roy, Kathy Snyder, Louis A Gatto, Gary F Nieman, Nader M Habashi
BACKGROUND: Improperly set mechanical ventilation (MV) with normal lungs can advance lung injury and increase the incidence of acute respiratory distress syndrome (ARDS). A key mechanism of ventilator-induced lung injury (VILI) is an alteration in alveolar mechanics including alveolar instability or recruitment/derecruitment (R/D). We hypothesize that R/D cannot be identified by PaO2 (masking occult VILI), and if protective ventilation is not applied, ARDS incidence will increase. METHODS: Sprague-Dawley rats (n = 8) were anesthetized, surgically instrumented, and placed on MV...
December 2015: Intensive Care Medicine Experimental
https://www.readbyqxmd.com/read/26135952/lisa-surfactant-administration-in-spontaneous-breathing-which-evidence-from-the-literature
#20
G Lista, A La Verde, F Castoldi
Recent human and animal studies demonstrated that surfactant can be delivered intratracheally without traditional intubation and bagging, but using a fine catheter inserted into the trachea of spontaneously breathing preterm infants on CPAP. This strategy, known as LISA (less invasive surfactant administration) or MIST (minimal invasive surfactant therapy), seems to reduce failure of non-invasive respiratory approach. Avoiding mechanical ventilation and manual inflation it is possible to reduce lung injury due to baro-volutrauma...
June 29, 2015: Acta Bio-medica: Atenei Parmensis
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