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recruitment and ards

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https://www.readbyqxmd.com/read/29134246/does-high-peep-prevent-alveolar-cycling
#1
REVIEW
M Cressoni, C Chiurazzi, D Chiumello, L Gattinoni
Acute respiratory distress syndrome (ARDS) patients need mechanical ventilation to sustain gas exchange. Animal experiments showed that mechanical ventilation with high volume/plateau pressure and no positive end-expiratory pressure (PEEP) damages healthy lungs, while low tidal volumes and the application of higher PEEP levels are protective. PEEP makes the lung homogeneous, reducing the pressure multiplication at the interface between lung units with different inflation statuses and keeps the lung open through the whole respiratory cycle, avoiding intratidal opening and closing...
November 13, 2017: Medizinische Klinik, Intensivmedizin und Notfallmedizin
https://www.readbyqxmd.com/read/29134245/esophageal-pressure-research-or-clinical-tool
#2
REVIEW
E Baedorf Kassis, S H Loring, D Talmor
Esophageal manometry has traditionally been utilized for respiratory physiology research, but clinicians have recently found numerous applications within the intensive care unit. Esophageal pressure (PEs) is a surrogate for pleural pressures (PPl), and the difference between airway pressure (PAO) and PEs provides a good estimate for the pressure across the lung also known as the transpulmonary pressure (PL). Differentiating the effects of mechanical ventilation and spontaneous breathing on the respiratory system, chest wall, and across the lung allows for improved personalization in clinical decision making...
November 13, 2017: Medizinische Klinik, Intensivmedizin und Notfallmedizin
https://www.readbyqxmd.com/read/29096634/prediction-of-high-airway-pressure-using-a-non-linear-autoregressive-model-of-pulmonary-mechanics
#3
Ruby Langdon, Paul D Docherty, Christoph Schranz, J Geoffrey Chase
BACKGROUND: For mechanically ventilated patients with acute respiratory distress syndrome (ARDS), suboptimal PEEP levels can cause ventilator induced lung injury (VILI). In particular, high PEEP and high peak inspiratory pressures (PIP) can cause over distension of alveoli that is associated with VILI. However, PEEP must also be sufficient to maintain recruitment in ARDS lungs. A lung model that accurately and precisely predicts the outcome of an increase in PEEP may allow dangerous high PIP to be avoided, and reduce the incidence of VILI...
November 2, 2017: Biomedical Engineering Online
https://www.readbyqxmd.com/read/29072830/preliminary-results-colorectal-cancer-screening-using-fecal-immunochemical-test-fit-in-a-thai-population-aged-45-74-years-a-population-based-randomized-controlled-trial
#4
Pongdech Sarakarn, Supannee Promthet, Patravoot Vatanasapt, Nakhon Tipsunthonsak, Kriangsak Jenwitheesuk, Naowarat Maneenin, Chananya Jirapornkul, Siriporn Kamsa-ard, Tiptiya Haengsorn, Channarong Arkkhaboot, Sam Li-Sheng Chen, Amy Ming-Fang Yen, Sherry Yueh-Hsia Chiu, Jean Ching-Yuan Fann, Tony Hsiu-Hsi Chen
Objective: The aim of this paper is to provide some details and the results to date of a colorectal cancer screening trial using a fecal immunochemical test (FIT). Methods: A population-based randomized controlled trial began in May, 2016. All people aged 45 to 74 years living in Nam Phong District, Khon Kaen Province, Thailand, and willing to participate are being recruited using an outreach method. Enrolled participants are randomly allocated by a computer-generated randomization program either to a study arm (receive sample kit for FIT) or to a control arm (no provision of kit)...
October 26, 2017: Asian Pacific Journal of Cancer Prevention: APJCP
https://www.readbyqxmd.com/read/29066591/the-role-of-rescue-therapies-in-the-treatment-of-severe-ards
#5
REVIEW
Francesco Alessandri, Francesco Pugliese, V Marco Ranieri
ARDS is characterized by a non-cardiogenic pulmonary edema with bilateral chest radiograph opacities and hypoxemia refractory to oxygen therapy. It is a common cause of admission to the ICU due to hypoxemic respiratory failure requiring mechanical ventilation. Corticosteroids are not recommended in ARDS patients. Rescue therapies alleviate hypoxemia in patients unable to maintain reasonable oxygenation: recruitment maneuvers, prone positioning, inhaled nitric oxide, high-frequency oscillatory ventilation, and extracorporeal membrane oxygenation improve oxygenation, but their impact on mortality remains unproven...
October 24, 2017: Respiratory Care
https://www.readbyqxmd.com/read/29043837/lung-recruitment-maneuvers-for-adult-patients-with-acute-respiratory-distress-syndrome-a-systematic-review-and-meta-analysis
#6
Ewan Goligher, Carol Hodgson, Neill Kj Adhikari, Maureen O Meade, Hannah Wunsch, Elizabeth Uleryk, Ognjen Gajic, Marcelo Amato, Niall D Ferguson, Gordon D Rubenfeld, Eddy Fan
RATIONALE: In patients with acute respiratory distress syndrome (ARDS), lung recruitment maneuvers (LRMs) may prevent ventilator-induced lung injury and improve survival. OBJECTIVES: To summarize the current evidence in support of the use of LRMs in adult patients with ARDS. METHODS: We conducted a systematic review and meta-analysis of randomized trials comparing mechanical ventilation strategies with and without LRMs. Eligible trials were identified from previously published systematic reviews and an updated literature search...
October 18, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/29043834/higher-peep-versus-lower-peep-strategies-for-patients-with-acute-respiratory-distress-syndrome-a-systematic-review-and-meta-analysis
#7
Allan J Walkey, Lorenzo Del Sorbo, Carol Hodgson, Neill Kj Adhikari, Hannah Wunsch, Maureen O Meade, Elizabeth Uleryk, Dean Hess, Daniel S Talmor, B Taylor Thompson, Roy G Brower, Eddy Fan
RATIONALE: Higher positive end-expiratory pressure (PEEP) levels may reduce atelectrauma but increase over-distention lung injury. Whether higher PEEP improves clinical outcomes among patients with acute respiratory distress syndrome (ARDS) is unclear. OBJECTIVE: To compare clinical outcomes of mechanical ventilation strategies using higher PEEP levels versus lower PEEP strategies in patients with ARDS. METHODS: We performed a systematic review and meta-analysis of clinical trials investigating mechanical ventilation strategies using higher versus lower PEEP levels...
October 18, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/29043832/high-frequency-oscillation-for-adult-patients-with-acute-respiratory-distress-syndrome-a-systematic-review-and-meta-analysis
#8
Ewan Goligher, Laveena Munshi, Neill Kj Adhikari, Maureen O Meade, Carol Hodgson, Hannah Wunsch, Elizabeth Uleryk, Ognjen Gajic, Marcelo Amato, Niall D Ferguson, Gordon D Rubenfeld, Eddy Fan
RATIONALE: By minimizing tidal lung strain and maintaining alveolar recruitment, high frequency oscillatory ventilation (HFOV) may protect against ventilator-induced lung injury. OBJECTIVES: To summarize the current evidence in support of the use of HFOV in adult patients with ARDS. METHODS: We conducted a systematic review and meta-analysis of randomized trials comparing mortality rates with the use of HFOV vs. conventional mechanical ventilation for adult patients with acute respiratory distress syndrome...
October 18, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28990087/sirna-directed-against-nf%C3%A2-%C3%AE%C2%BAb-inhibits-mononuclear-macrophage-cells-releasing-proinflammatory-cytokines-in%C3%A2-vitro
#9
Chunting Wu, Jiahui Zhao, Guangfa Zhu, Yan Huang, Liyan Jin
Acute lung injury (ALI) is a condition of acute respiratory failure, characterized by diffuse pulmonary infiltrates and severe hypoxemia. During ALI, the acute phase of inflammation induces the recruitment of activated inflammatory cells, including macrophages and lymphocytes, to the damaged lesions. Nuclear factor (NF)‑κB is a key protein in many signal transduction pathways, over‑activation of which is followed by an approach of inflammation cells and release of pre‑inflammation cytokines. The aim of the present study was to explore the effect of NF‑κB P65 siRNA retroviruses on the activation of NF‑κB signaling pathway and release of pro‑inflammatory cytokines in THP‑1 cells...
December 2017: Molecular Medicine Reports
https://www.readbyqxmd.com/read/28979537/tension-pneumomediastinum-a-literal-form-of-chest-tightness
#10
David J Clancy, Andrew S Lane, Peter W Flynn, Ian M Seppelt
Tension pneumomediastinum is a rare and life-threatening complication of mediastinal emphysema which can occur with mechanical ventilation. We present a case of tension mediastinum associated with mechanical ventilation in a patient with Acute Respiratory Distress Syndrome due to Pneumocystis jirovecii pneumonia. We discuss the mechanism and pathophysiology of tension pneumomediastinum, the potential association with Pneumocystis jirovecii pneumonia and recruitment manouvres, and its definitive emergency treatment...
February 2017: J Intensive Care Soc
https://www.readbyqxmd.com/read/28977263/does-the-use-of-high-peep-levels-prevent-ventilator-induced-lung-injury
#11
Guillermo Bugedo, Jaime Retamal, Alejandro Bruhn
Overdistention and intratidal alveolar recruitment have been advocated as the main physical mechanisms responsible for ventilator-induced lung injury. Limiting tidal volume has a demonstrated survival benefit in patients with acute respiratory distress syndrome and is recognized as the cornerstone of protective ventilation. In contrast, the use of high positive end-expiratory pressure levels in clinical trials has yielded conflicting results and remains controversial. In the present review, we will discuss the benefits and limitations of the open lung approach and will discuss some recent experimental and clinical trials on the use of high versus low/moderate positive end-expiratory pressure levels...
April 2017: Revista Brasileira de Terapia Intensiva
https://www.readbyqxmd.com/read/28977255/statistical-analysis-plan-for-the-alveolar-recruitment-for-acute-respiratory-distress-syndrome-trial-art-a-randomized-controlled-trial
#12
Lucas Petri Damiani, Otavio Berwanger, Denise Paisani, Ligia Nasi Laranjeira, Erica Aranha Suzumura, Marcelo Britto Passos Amato, Carlos Roberto Ribeiro Carvalho, Alexandre Biasi Cavalcanti
BACKGROUND: The Alveolar Recruitment for Acute Respiratory Distress Syndrome Trial (ART) is an international multicenter randomized pragmatic controlled trial with allocation concealment involving 120 intensive care units in Brazil, Argentina, Colombia, Italy, Poland, Portugal, Malaysia, Spain, and Uruguay. The primary objective of ART is to determine whether maximum stepwise alveolar recruitment associated with PEEP titration, adjusted according to the static compliance of the respiratory system (ART strategy), is able to increase 28-day survival in patients with acute respiratory distress syndrome compared to conventional treatment (ARDSNet strategy)...
April 2017: Revista Brasileira de Terapia Intensiva
https://www.readbyqxmd.com/read/28973363/effect-of-lung-recruitment-and-titrated-positive-end-expiratory-pressure-peep-vs-low-peep-on-mortality-in-patients-with-acute-respiratory-distress-syndrome-a-randomized-clinical-trial
#13
RANDOMIZED CONTROLLED TRIAL
Alexandre Biasi Cavalcanti, Érica Aranha Suzumura, Ligia Nasi Laranjeira, Denise de Moraes Paisani, Lucas Petri Damiani, Helio Penna Guimarães, Edson Renato Romano, Marisa de Moraes Regenga, Luzia Noriko Takahashi Taniguchi, Cassiano Teixeira, Roselaine Pinheiro de Oliveira, Flavia Ribeiro Machado, Fredi Alexander Diaz-Quijano, Meton Soares de Alencar Filho, Israel Silva Maia, Eliana Bernardete Caser, Wilson de Oliveira Filho, Marcos de Carvalho Borges, Priscilla de Aquino Martins, Mirna Matsui, Gustavo Adolfo Ospina-Tascón, Thiago Simões Giancursi, Nelson Dario Giraldo-Ramirez, Silvia Regina Rios Vieira, Maria da Graça Pasquotto de Lima Assef, Mohd Shahnaz Hasan, Wojciech Szczeklik, Fernando Rios, Marcelo Britto Passos Amato, Otávio Berwanger, Carlos Roberto Ribeiro de Carvalho
Importance: The effects of recruitment maneuvers and positive end-expiratory pressure (PEEP) titration on clinical outcomes in patients with acute respiratory distress syndrome (ARDS) remain uncertain. Objective: To determine if lung recruitment associated with PEEP titration according to the best respiratory-system compliance decreases 28-day mortality of patients with moderate to severe ARDS compared with a conventional low-PEEP strategy. Design, Setting, and Participants: Multicenter, randomized trial conducted at 120 intensive care units (ICUs) from 9 countries from November 17, 2011, through April 25, 2017, enrolling adults with moderate to severe ARDS...
October 10, 2017: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/28973075/lung-recruitment-and-titrated-peep-in-moderate-to-severe-ards-is-the-door-closing-on-the-open-lung
#14
EDITORIAL
Sarina K Sahetya, Roy G Brower
No abstract text is available yet for this article.
October 10, 2017: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/28972887/lianqinjiedu-decoction-attenuates-lps-induced-inflammation-and-acute-lung-injury-in-rats-via-tlr4-nf-%C3%AE%C2%BAb-pathway
#15
Guiming Deng, Hai He, Zheng Chen, Linqi OuYang, Xiaoqin Xiao, Jinwen Ge, Biao Xiang, Sichen Jiang, Shaowu Cheng
Acute lung injury (ALI) and its severe form acute respiratory distress syndrome remain the leading cause of morbidity and mortality. LianQinJieDu (LQJD), which is a traditional Chinese medicine, has been clinically used for antiviral drug. The present study investigated whether Lianqinjiedu(LQJD) ameliorates lipopolysaccharide(LPS)-induced acute lung injury in rats and aimed to determine the anti-inflammatory effects of LQJD. Rat model with ALI induced by intraperitoneal injection of LPS was treated by oral administration of LQJD...
September 30, 2017: Biomedicine & Pharmacotherapy, Biomédecine & Pharmacothérapie
https://www.readbyqxmd.com/read/28967868/respiratory-mechanics-to-understand-ards-and-guide-mechanical-ventilation
#16
Tommaso Mauri, Marta Lazzeri, Giacomo Bellani, Alberto Zanella, Giacomo Grasselli
As precision medicine is becoming standard of care to select tailored rather than average treatments, physiological measurements might represent the first step to apply personalized therapy in the intensive care unit (ICU). Systematic assessment of respiratory mechanics in patients with the acute respiratory distress syndrome (ARDS) could represent a step towards this direction for two main reasons. On the one hand, respiratory mechanics are a powerful physiological method to understand the severity of this syndrome in each single patient...
October 2, 2017: Physiological Measurement
https://www.readbyqxmd.com/read/28962192/clinical-significance-of-mechanical-ventilation-on-ischemic-reperfusion-injury-caused-by-lung-chest-trauma-and-vegf-expression-levels-in-peripheral-blood
#17
Zhong-Yi Sun, Hong-Gang Xia, De-Qing Zhu, Li-Min Deng, Peng-Zhi Zhu, Dong-Bin Wang
We investigated the clinical significance of mechanical ventilation on ischemic-reperfusion injury caused by lung chest trauma as well as vascular endothelial growth factor (VEGF) expression levels in peripheral blood. Sixty-eight patients with severe chest trauma complicated with acute respiratory distress syndrome that were treated at our Tianjin Hospital from September 2013 to July 2016 were recruited. These patients were randomly and evenly divided into two groups, the research group and the control group...
September 2017: Experimental and Therapeutic Medicine
https://www.readbyqxmd.com/read/28962107/experimental-study-of-airway-pressure-release-ventilation-in-the-treatment-of-acute-respiratory-distress-syndrome
#18
Guan-Jie Han, Jia-Qiong Li, Cui-Gai Pan, Jing-Xi Sun, Zai-Xiang Shi, Ji-Yuan Xu, Mao-Qin Li
Airway pressure release ventilation (APRV) is a ventilator mode which has demonstrated potential benefits in acute respiratory distress syndrome (ARDS) patients. We therefore sought to compare relevant pulmonary data and safety outcomes of this mode to the conventional ventilation and sustained inflation. Canines admitted after intravenous injection of oleic acid requiring mechanical ventilation were randomly divided into 3 groups (n=6), namely conventional ventilation group, low tidal volume ventilation with recruitment group (LTV+SI) and APRV group...
September 2017: Experimental and Therapeutic Medicine
https://www.readbyqxmd.com/read/28961282/physiologic-effects-of-alveolar-recruitment-and-inspiratory-pauses-during-moderately-high-frequency-ventilation-delivered-by-a-conventional-ventilator-in-a-severe-lung-injury-model
#19
Ricardo Luiz Cordioli, Eduardo Leite Vieira Costa, Luciano Cesar Pontes Azevedo, Susimeire Gomes, Marcelo Britto Passos Amato, Marcelo Park
BACKGROUND AND AIMS: To investigate whether performing alveolar recruitment or adding inspiratory pauses could promote physiologic benefits (VT) during moderately-high-frequency positive pressure ventilation (MHFPPV) delivered by a conventional ventilator in a porcine model of severe acute respiratory distress syndrome (ARDS). METHODS: Prospective experimental laboratory study with eight pigs. Induction of acute lung injury with sequential pulmonary lavages and injurious ventilation was initially performed...
2017: PloS One
https://www.readbyqxmd.com/read/28953669/ultrasonic-monitoring-in-the-assessment-of-pulmonary-recruitment-and-the-best-positive-end-expiratory-pressure
#20
RANDOMIZED CONTROLLED TRIAL
Ke-Qiang Tang, Shao-Ling Yang, Bin Zhang, Hong-Xiang Liu, Dong-Ying Ye, Hong-Ze Zhang, Shuang Ma
The aim of this study was to explore the clinical value of ultrasonic monitoring in the assessment of pulmonary recruitment and the best positive end-expiratory pressure (PEEP).Between January 2015 and June 2017, 40 patients with acute respiratory distress syndrome in our hospital were randomly divided into 2 groups: ultrasound group (ULS group; n = 20) and oxygenation group (OXY group; n = 20). The PEEP incremental method was used to perform recruitment maneuvers. Ultrasound scoring and the oxygenation method were used to evaluate the pulmonary recruitment endpoint...
September 2017: Medicine (Baltimore)
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