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https://www.readbyqxmd.com/read/28436715/controlled-invasive-mechanical-ventilation-strategies-in-obese-patients-undergoing-surgery
#1
Lígia de Albuquerque Maia, Pedro Leme Silva, Paolo Pelosi, Patricia Rieken Macedo Rocco
The obesity prevalence is increasing in surgical population. As the number of obese surgical patients increases, so does the demand for mechanical ventilation. Nevertheless, ventilatory strategies in this population are challenging, since obesity results in pathophysiological changes in respiratory function. Areas covered: We reviewed the impact of obesity on respiratory system and the effects of controlled invasive mechanical ventilation strategies in obese patients undergoing surgery. To date, there is no consensus regarding the optimal invasive mechanical ventilation strategy for obese surgical patients, and no evidence that possible intraoperative beneficial effects on oxygenation and mechanics translate into better postoperative pulmonary function or improved outcomes...
April 24, 2017: Expert Review of Respiratory Medicine
https://www.readbyqxmd.com/read/28431421/sevoflurane-posttreatment-attenuates-lung-injury-induced-by-oleic-acid-in-dogs
#2
Guizhi Du, Shurong Wang, Zhuo Li, Jin Liu
BACKGROUND: In animal models, both sevoflurane and propofol protect against acute lung injury (ALI), especially when administered prior to ALI onset. We hypothesized that when compared to propofol, sevoflurane administration after the onset of acute respiratory distress syndrome would mitigate oleic acid (OA)-induced ALI in dogs. METHODS: Dogs were randomly assigned to receive intravenous OA to induce ALI (n = 7 for each OA group) or saline as an OA control (n = 6 for each control)...
May 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28430689/perioperative-outcomes-of-robotic-assisted-hysterectomy-compared-with-open-hysterectomy
#3
Bhargavi Gali, Jamie N Bakkum-Gamez, David J Plevak, Darrell Schroeder, Timothy O Wilson, Christopher J Jankowski
BACKGROUND: Increasing numbers of robotic hysterectomies (RH) are being performed. To provide ventilation (with pneumoperitoneum and steep Trendelenburg position) for these procedures, utilization of lung protective strategies with limiting airway pressures and tidal volumes is difficult. Little is known about the effects of intraoperative mechanical ventilation and high peak airway pressures on perioperative complications. We performed a retrospective review to determine whether patients undergoing RH had increased pulmonary complications compared to total abdominal hysterectomy (TAH)...
April 19, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28428256/regulation-of-lung-endothelial-permeability-and-inflammatory-responses-by-prostaglandin-a2-role-of-ep4-receptor
#4
Tomomi Ohmura, Yufeng Tian, Nicolene Sarich, Yunbo Ke, Angelo Meliton, Alok S Shah, Katrin Andreasson, Konstantin G Birukov, Anna A Birukova
A role of prostaglandin A2 (PGA2) in modulation of vascular endothelial function remains unknown. We investigated effects of PGA2 on pulmonary endothelial cell (EC) permeability and inflammatory activation and identified a receptor mediating these effects. PGA2 enhanced the EC barrier and protected against barrier dysfunction caused by vasoactive peptide thrombin and proinflammatory bacterial wall lipopolysacharide (LPS). Receptor screening using pharmacologic and molecular inhibitory approaches identified EP4 as a novel PGA2 receptor...
April 20, 2017: Molecular Biology of the Cell
https://www.readbyqxmd.com/read/28426531/high-fat-feeding-protects-mice-from-ventilator-induced-lung-injury-via-neutrophil-independent-mechanisms
#5
Michael R Wilson, Joanne E Petrie, Michael W Shaw, Cong Hu, Charlotte M Oakley, Samantha J Woods, Brijesh V Patel, Kieran P O'Dea, Masao Takata
OBJECTIVE: Obesity has a complex impact on acute respiratory distress syndrome patients, being associated with increased likelihood of developing the syndrome but reduced likelihood of dying. We propose that such observations are potentially explained by a model in which obesity influences the iatrogenic injury that occurs subsequent to intensive care admission. This study therefore investigated whether fat feeding protected mice from ventilator-induced lung injury. DESIGN: In vivo study...
April 19, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28424764/diffusion-tensor-imaging-colour-mapping-threshold-for-identification-of-ventilation-induced-brain-injury-after-intrauterine-inflammation-in-preterm-lambs
#6
Dhafer M Alahmari, Beatrice Skiöld, Samantha K Barton, Ilias Nitsos, Courtney McDonald, Suzanne L Miller, Valerie Zahra, Robert Galinsky, Qizhu Wu, Michael John Farrell, Timothy J Moss, Stuart B Hooper, James T Pearson, Graeme R Polglase
PURPOSE: The aim of this study is to examine whether advanced magnetic resonance imaging (MRI) techniques can detect early brain injury caused by intrauterine inflammation and inappropriate initial respiratory support in preterm lambs. HYPOTHESIS: Neuropathology caused by intrauterine inflammation is exacerbated by mechanical ventilation at birth and is detectable with advanced MRI techniques. METHODS: Pregnant ewes received intra-amniotic lipopolysaccharide (LPS) 7 days prior to delivery at ~125 days of gestation (85% of gestation), whereupon lambs were delivered and randomised to receive an injurious (LPS + INJ, n = 6) or protective (LPS + PROT, n = 6) ventilation strategy...
2017: Frontiers in Pediatrics
https://www.readbyqxmd.com/read/28424078/interleukin-6-displays-lung-anti-inflammatory-properties-and-exerts-protective-hemodynamic-effects-in-a-double-hit-murine-acute-lung-injury
#7
Guillaume Voiriot, Keyvan Razazi, Valérie Amsellem, Jeanne Tran Van Nhieu, Shariq Abid, Serge Adnot, Armand Mekontso Dessap, Bernard Maitre
BACKGROUND: Interleukin 6 (IL-6) is a predictive factor of poor prognosis in patients with acute respiratory distress syndrome (ARDS). However, its acute pulmonary hemodynamic effects and role in lung injury have not been investigated in a clinically relevant murine model of ARDS. METHODS: We used adult C57Bl6 wild-type (WT) and IL-6 knock-out (IL-6KO) mice. The animals received intravenous recombinant human IL-6 (rHuIL-6) or vehicle followed by intratracheal lipopolysaccharide (LPS) or saline before undergoing low tidal volume mechanical ventilation (MV) for 5 h...
April 19, 2017: Respiratory Research
https://www.readbyqxmd.com/read/28422775/a-contemporary-assessment-of-acute-mechanical-ventilation-in-beijing-description-costs-and-outcomes
#8
Yanping Ye, Bo Zhu, Li Jiang, Qi Jiang, Meiping Wang, Lin Hua, Xiuming Xi
OBJECTIVE: To evaluate the contemporary practice, outcomes, and costs related to mechanical ventilation among ICUs in China. DESIGN: A prospective observational cohort study. SETTING: Fourteen ICUs among 13 hospitals in Beijing, China. PATIENTS: Seven hundred ninety-three patients who received at least 24 hours of mechanical ventilation within the first 48 hours of ICU stay. INTERVENTION: None...
April 18, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28406813/effects-of-hypercapnia-and-hypercapnic-acidosis-on-hospital-mortality-in-mechanically-ventilated-patients
#9
Ravindranath Tiruvoipati, David Pilcher, Hergen Buscher, John Botha, Michael Bailey
OBJECTIVES: Lung-protective ventilation is used to prevent further lung injury in patients on invasive mechanical ventilation. However, lung-protective ventilation can cause hypercapnia and hypercapnic acidosis. There are no large clinical studies evaluating the effects of hypercapnia and hypercapnic acidosis in patients requiring mechanical ventilation. DESIGN: Multicenter, binational, retrospective study aimed to assess the impact of compensated hypercapnia and hypercapnic acidosis in patients receiving mechanical ventilation...
April 12, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28403395/individual-patient-data-analysis-of-tidal-volumes-used-in-three-large-randomized-control-trials-involving-patients-with-acute-respiratory-distress-syndrome
#10
J Poole, C McDowell, R Lall, G Perkins, D McAuley, F Gao, D Young
Background.: The acute respiratory distress syndrome (ARDS) is a condition with a high mortality and morbidity. Mechanical ventilation prevents immediate mortality but may further damage patients' lungs. Low tidal volume lung-protective strategies have been shown to increase survival by reducing this iatrogenic damage. Current guidelines recommend tidal volumes of 6-8 ml kg -1 of predicted body weight. We used data from three large randomized controlled trials of treatments for ARDS to determine compliance with these recommendations...
April 1, 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/28389539/microbiota-in-exhaled-breath-condensate-and-the-lung
#11
Laura Glendinning, Steven Wright, Peter Tennant, Andrew C Gill, David Collie, Gerry McLachlan
The lung microbiota is commonly sampled using relatively invasive bronchoscopic procedures. Exhaled breath condensate (EBC) collection potentially offers a less invasive alternative for lung microbiota sampling. We compared lung microbiota samples retrieved by protected specimen brushings (PSB) and exhaled breath condensate collection. We also sought to assess whether aerosolised antibiotic treatment would influence the lung microbiota and whether EBC was sensitive enough to detect such changes.EBC was collected from 6 conscious sheep, and then from the same anaesthetised sheep during mechanical ventilation...
April 7, 2017: Applied and Environmental Microbiology
https://www.readbyqxmd.com/read/28387889/a-study-of-the-protective-effect-and-mechanism-of-ketamine-on-acute-lung-injury-induced-by-mechanical-ventilation
#12
W-F Wang, S Liu, B Xu
OBJECTIVE: To investigate the protective effects and mechanism of ketamine on acute lung injury induced by mechanical ventilation. PATIENTS AND METHODS: 63 patients with acute lung injury caused by mechanical ventilation in our hospital between June 2014 and May 2015 were chosen and divided into three groups: group A, B, and C. Group A (20 cases) received conventional treatment. Group B (21 cases) was treated with propofol and group C (22 cases) with ketamine. The ventilator application time, the success rate of weaning, the mortality rate, inflammation index (IL-1, Caspase-1, and NF-κB), pulmonary function index and oxygen saturation were compared...
March 2017: European Review for Medical and Pharmacological Sciences
https://www.readbyqxmd.com/read/28387014/weak-by-the-machines-muscle-motor-protein-dysfunction-ndash-a-side-effect-of-intensive-care-unit-treatment
#13
REVIEW
O Friedrich, S Diermeier, L Larsson
Intensive care interventions involve periods of mechanical ventilation, sedation and complete mechanical silencing of patients. Critical illness myopathy (CIM) is an ICU-acquired myopathy that is associated with limb muscle weakness, muscle atrophy, electrical silencing of muscle and motor-proteinopathy. The hallmark of CIM is a preferential muscle myosin loss due to increased catabolic and reduced anabolic activity. The ubiquitin-proteasome pathway plays an important role, apart from recently identified novel mechanisms affecting nonlysosomal protein degradation or autophagy...
April 7, 2017: Acta Physiologica
https://www.readbyqxmd.com/read/28385915/physiology-in-medicine-understanding-dynamic-alveolar-physiology-to-minimize-ventilator-induced-lung-injury-vili
#14
Gary F Nieman, Joshua Satalin, Michaela Kollisch-Singule, Penny L Andrews, Hani Aiash, Nader M Habashi, Louis A Gatto
The acute respiratory distress syndrome (ARDS) remains a serious clinical problem with the main treatment being supportive in the form of mechanical ventilation. However, mechanical ventilation can be a double edge sword, if set improperly can exacerbate the tissue damage caused by ARDS and is known as ventilator induced lung injury (VILI). In order to minimize VILI we must understand the pathophysiologic mechanisms of tissue damage at the alveolar level. In this Physiology in Medicine paper the dynamic physiology of alveolar inflation and deflation during mechanical ventilation will be reviewed...
April 6, 2017: Journal of Applied Physiology
https://www.readbyqxmd.com/read/28380189/extracorporeal-respiratory-support-in-adult-patients
#15
Thiago Gomes Romano, Pedro Vitale Mendes, Marcelo Park, Eduardo Leite Vieira Costa
In patients with severe respiratory failure, either hypoxemic or hypercapnic, life support with mechanical ventilation alone can be insufficient to meet their needs, especially if one tries to avoid ventilator settings that can cause injury to the lungs. In those patients, extracorporeal membrane oxygenation (ECMO), which is also very effective in removing carbon dioxide from the blood, can provide life support, allowing the application of protective lung ventilation. In this review article, we aim to explore some of the most relevant aspects of using ECMO for respiratory support...
January 2017: Jornal Brasileiro de Pneumologia: Publicaça̋o Oficial da Sociedade Brasileira de Pneumologia e Tisilogia
https://www.readbyqxmd.com/read/28377920/automated-weaning-from-mechanical-ventilation-after-off-pump-coronary-artery-bypass-grafting
#16
Evgenia V Fot, Natalia N Izotova, Angelika S Yudina, Aleksei A Smetkin, Vsevolod V Kuzkov, Mikhail Y Kirov
BACKGROUND: The discontinuation of mechanical ventilation after coronary surgery may prolong and significantly increase the load on intensive care unit personnel. We hypothesized that automated mode using INTELLiVENT-ASV can decrease duration of postoperative mechanical ventilation, reduce workload on medical staff, and provide safe ventilation after off-pump coronary artery bypass grafting (OPCAB). The primary endpoint of our study was to assess the duration of postoperative mechanical ventilation during different modes of weaning from respiratory support (RS) after OPCAB...
2017: Frontiers in Medicine
https://www.readbyqxmd.com/read/28370427/ventilation-rates-in-recently-constructed-us-school-classrooms
#17
Stuart Batterman, Feng-Chiao Su, Andrew Wald, Floyd Watkins, Christopher Godwin, Geoffrey Thun
Low ventilation rates (VRs) in schools have been associated with absenteeism, poorer academic performance, and teacher dissatisfaction. We measured VRs in 37 recently constructed or renovated and mechanically-ventilated U.S. schools, including LEED and EnergyStar-certified buildings, using CO2 and the steady-state, build-up, decay and transient mass balance methods. The transient mass balance method better matched conditions (specifically, changes in occupancy) and minimized biases seen in the other methods...
April 2, 2017: Indoor Air
https://www.readbyqxmd.com/read/28363030/integrated-stress-response-mediates-epithelial-injury-in-mechanical-ventilation
#18
Tamas Dolinay, Blanca E Himes, Maya Shumyatcher, Gladys Gray Lawrence, Susan S Margulies
RATIONALE: Ventilator-induced lung injury (VILI) is a severe complication of mechanical ventilation that can lead to acute respiratory distress syndrome (ARDS). VILI is characterized by damage to the epithelial barrier with subsequent pulmonary edema and profound hypoxia. Available lung protective ventilator strategies offer only modest benefit in preventing VILI because they cannot impede alveolar overdistension and concomitant epithelial barrier dysfunction in the inflamed lung regions...
March 31, 2017: American Journal of Respiratory Cell and Molecular Biology
https://www.readbyqxmd.com/read/28350057/monoclonal-antibody-against-toll-like-receptor%C3%A2-4-attenuates-ventilator-induced-lung-injury-in-rats-by-inhibiting-myd88-and-nf-%C3%AE%C2%BAb-dependent-signaling
#19
Cuiyuan Huang, Linghui Pan, Fei Lin, Huijun Dai, Ruili Fu
The mechanisms through which mechanical ventilation causes non-infectious inflammatory diseases and lung injury are poorly understood. Animals models of this type of injury suggest that it involves signaling mediated by Toll‑like receptor (TLR)4 and 9. In this study, in order to gain further insight into the involvement of TLR4 in this type of injury, we performed in vivo and in vitro experiments to determine the mechanisms through which TLR4 triggers inflammation. We also examined whether the use of TLR4 monoclonal antibody (mAb) can alleviate this type of injury...
February 1, 2017: International Journal of Molecular Medicine
https://www.readbyqxmd.com/read/28348895/in-flight-hypoxemia-in-a-tracheostomy-dependent-infant
#20
Jason Quevreaux, Christopher Cropsey
Millions of passengers board commercial flights every year. Healthcare providers are often called upon to treat other passengers during in-flight emergencies. The case presented involves an anesthesia resident treating a tracheostomy-dependent infant who developed hypoxemia on a domestic flight. The patient had an underlying congenital muscular disorder and was mechanically ventilated while at altitude. Although pressurized, cabin barometric pressure while at altitude is less than at sea level. Due to this environment patients with underlying pulmonary or cardiac pathology might not be able to tolerate commercial flight...
2017: Case Reports in Anesthesiology
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