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protective mechanical ventilation

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https://www.readbyqxmd.com/read/29470503/sevoflurane-posttreatment-prevents-oxidative-and-inflammatory-injury-in-ventilator-induced-lung-injury
#1
Julie Wagner, Karl M Strosing, Sashko G Spassov, Ziwei Lin, Helen Engelstaedter, Sabine Tacke, Alexander Hoetzel, Simone Faller
Mechanical ventilation is a life-saving clinical treatment but it can induce or aggravate lung injury. New therapeutic strategies, aimed at reducing the negative effects of mechanical ventilation such as excessive production of reactive oxygen species, release of pro-inflammatory cytokines, and transmigration as well as activation of neutrophil cells, are needed to improve the clinical outcome of ventilated patients. Though the inhaled anesthetic sevoflurane is known to exert organ-protective effects, little is known about the potential of sevoflurane therapy in ventilator-induced lung injury...
2018: PloS One
https://www.readbyqxmd.com/read/29466596/acute-respiratory-distress-syndrome-advances-in-diagnosis-and-treatment
#2
Eddy Fan, Daniel Brodie, Arthur S Slutsky
Importance: Acute respiratory distress syndrome (ARDS) is a life-threatening form of respiratory failure that affects approximately 200 000 patients each year in the United States, resulting in nearly 75 000 deaths annually. Globally, ARDS accounts for 10% of intensive care unit admissions, representing more than 3 million patients with ARDS annually. Objective: To review advances in diagnosis and treatment of ARDS over the last 5 years. Evidence Review: We searched MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews from 2012 to 2017 focusing on randomized clinical trials, meta-analyses, systematic reviews, and clinical practice guidelines...
February 20, 2018: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/29465203/-use-of-protective-lung-ventilation-regimen-in-cardiac-surgery-patients
#3
T A Pshenichniy, B A Akselrod, I V Titova, N A Trekova, M V Khrustaleva
BACKGROUND: In cardiac surgery, protective lung ventilation and/or preventive brdnchoscopy (PB) are able to decrease lung injury effects of cardiopulmonary bypass (CPB) and mechanical ventilation. OBJECTIVES: define lung complication risks, evaluate the effect ofprotective lung ventilation (PLV) on lung functioning, and investigate the feasibility ofpreventive PB in higher pulmonary risk (PR) patients. MATERIALS AND METHODS: 66 patients participated in prospective randomized research...
September 2017: Anesteziologiia i Reanimatologiia
https://www.readbyqxmd.com/read/29463330/a-chemical-biological-radio-nuclear-cbrn-filter-can-be-added-to-the-air-outflow-port-of-a-ventilator-to-protect-a-home-ventilated-patient-from-inhalation-of-toxic-industrial-compounds
#4
Eliezer Be'eri, Simon Owen, Maurit Beeri, Scott R Millis, Arik Eisenkraft
OBJECTIVES: Chemical-biological-radio-nuclear (CBRN) gas masks are the standard means for protecting the general population from inhalation of toxic industrial compounds (TICs), for example after industrial accidents or terrorist attacks. However, such gas masks would not protect patients on home mechanical ventilation, as ventilator airflow would bypass the CBRN filter. We therefore evaluated in vivo the safety of adding a standard-issue CBRN filter to the air-outflow port of a home ventilator, as a method for providing TIC protection to such patients...
February 21, 2018: Disaster Medicine and Public Health Preparedness
https://www.readbyqxmd.com/read/29462011/positive-end-expiratory-pressure-alone-minimizes-atelectasis-formation-in-nonabdominal-surgery-a-randomized-controlled-trial
#5
Erland Östberg, Arnar Thorisson, Mats Enlund, Henrik Zetterström, Göran Hedenstierna, Lennart Edmark
BACKGROUND: Various methods for protective ventilation are increasingly being recommended for patients undergoing general anesthesia. However, the importance of each individual component is still unclear. In particular, the perioperative use of positive end-expiratory pressure (PEEP) remains controversial. The authors tested the hypothesis that PEEP alone would be sufficient to limit atelectasis formation during nonabdominal surgery. METHODS: This was a randomized controlled evaluator-blinded study...
February 19, 2018: Anesthesiology
https://www.readbyqxmd.com/read/29460470/the-inspired-sinewave-technique-a-novel-method-to-measure-lung-volume-and-ventilatory-heterogeneity
#6
Richard M Bruce, Phi Anh Phan, Edmund Pacpaco, Najib M Rahman, Andrew Farmery
The Inspired Sinewave Technique (IST) is a novel method which can provide simple, non-invasive cardiopulmonary measurements. Over successive tidal-breaths the concentration of a tracer gas (i.e. nitrous oxide, N2 O) is sinusoidally modulated in inspired air. Using a single-compartment tidal-ventilation lung model, the resulting amplitude/phase of the expired sinewave allows estimation of end-expired lung volume (ELV), pulmonary blood flow and three indices for ventilatory heterogeneity (VH; ELV180 /FRCpleth , ELV180 /FRCpred and ELV60 /ELV180 )...
February 19, 2018: Experimental Physiology
https://www.readbyqxmd.com/read/29456610/how-can-we-improve-adoption-of-protective-mechanical-ventilation-in-united-kingdom-critical-care-units
#7
Paul P Dean, Claire Horsfield
No abstract text is available yet for this article.
February 2018: Journal of the Intensive Care Society
https://www.readbyqxmd.com/read/29452815/variable-versus-conventional-lung-protective-mechanical-ventilation-during-open-abdominal-surgery-provar-a-randomised-controlled-trial
#8
P M Spieth, A Güldner, C Uhlig, T Bluth, T Kiss, C Conrad, K Bischlager, A Braune, R Huhle, A Insorsi, F Tarantino, L Ball, M J Schultz, N Abolmaali, T Koch, P Pelosi, M Gama de Abreu
BACKGROUND: Experimental studies showed that controlled variable ventilation (CVV) yielded better pulmonary function compared to non-variable ventilation (CNV) in injured lungs. We hypothesized that CVV improves intraoperative and postoperative respiratory function in patients undergoing open abdominal surgery. METHODS: Fifty patients planned for open abdominal surgery lasting >3 h were randomly assigned to receive either CVV or CNV. Mean tidal volumes and PEEP were set at 8 ml kg -1 (predicted body weight) and 5 cm H 2 O, respectively...
March 2018: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29451075/short-term-outcomes-of-preoperative-intra-aortic-balloon-pump-use-in-patients-undergoing-adjunctive-coronary-endarterectomy-a-retrospective-observational-study
#9
Liangshan Wang, Xing Hao, Xiaomeng Wang, Chengxiong Gu, Hong Wang, Xiaotong Hou
BACKGROUND: Coronary artery bypass grafting (CABG) combined with coronary endarterectomy (CE) can be associated with high operative mortality and morbidity. An intra-aortic balloon pump (IABP) has been the most widely used mechanical circulatory support device during perfusion treatment. However, the benefits of preoperative IABP in CABG combined with CE remain unknown. We conducted a retrospective observational study to evaluate the efficacy of preoperative IABP therapy in patients undergoing adjunctive right coronary artery (RCA) endarterectomy...
February 1, 2018: Perfusion
https://www.readbyqxmd.com/read/29444340/antipsychotics-delirium-and-acute-respiratory-distress-syndrome-what-is-the-link
#10
Heather Torbic, Abhijit Duggal
Acute respiratory distress syndrome (ARDS) is an acute inflammatory process that impairs the ability of the lungs to oxygenate and ultimately leads to respiratory failure. Patients who develop ARDS often have prolonged and complicated hospital courses putting them at risk for intensive care unit (ICU) delirium. Patients with ICU delirium often need chemical sedation, mechanical ventilation, prolonged duration of ICU and hospital stays, long-term cognitive impairment, and increased mortality. In a patient with ARDS, ICU delirium further complicates the hospital course and increases the risk of morbidly and mortality...
February 14, 2018: Pharmacotherapy
https://www.readbyqxmd.com/read/29436647/mir%C3%A2-21%C3%A2-5p-regulates-type-ii-alveolar-epithelial-cell-apoptosis-in-hyperoxic-acute-lung-injury
#11
Song Qin, Miao Chen, Hui Ji, Guo-Yue Liu, Hong Mei, Kang Li, Tao Chen
Hyperoxia‑induced acute lung injury (HALI) as one of the most common complications in patents on mechanical ventilation, and there are no efficient methods to overcome this at present. It was hypothesized that microRNA 21‑5p(miR‑21‑5p) can promote the survival of type II alveolar epithelial cells (AECII), alleviating HALI. The present study aimed to combine gene chip analysis with the overexpression miR‑21‑5p to develop a novel therapeutic option for HALI. It was found that AECII apoptosis was an important pathogenic event in the development of HALI, and the overexpression of miR‑21‑5p prevented HALI, associated with reducing AECII apoptosis...
February 6, 2018: Molecular Medicine Reports
https://www.readbyqxmd.com/read/29435738/alveolar-tidal-recruitment-derecruitment-and-overdistension-during-four-levels-of-end-expiratory-pressure-with-protective-tidal-volume-during-anesthesia-in-a-murine-lung-healthy-model
#12
Joao Henrique Neves Soares, Alysson Roncally Carvalho, Bruno Curty Bergamini, Maria Alice Kuster Gress, Frederico Caetano Jandre, Walter Araujo Zin, Antonio Giannella-Neto
PURPOSE: We compared respiratory mechanics between the positive end-expiratory pressure of minimal respiratory system elastance (PEEP minErs ) and three levels of PEEP during low-tidal-volume (6 mL/kg) ventilation in rats. METHODS: Twenty-four rats were anesthetized, paralyzed, and mechanically ventilated. Airway pressure (P aw ), flow (F), and volume (V) were fitted by a linear single compartment model (LSCM) P aw (t) = E rs × V(t) + R rs × F(t) + PEEP or a volume- and flow-dependent SCM (VFDSCM) P aw (t) = (E 1 + E 2 × V(t)) × V(t) + (K 1 + K 2 × |F(t)|) × F(t) + PEEP, where E rs and R rs are respiratory system elastance and resistance, respectively; E 1 and E 2 × V are volume-independent and volume-dependent E rs , respectively; and K 1 and K 2 × F are flow-independent and flow-dependent R rs , respectively...
February 12, 2018: Lung
https://www.readbyqxmd.com/read/29434789/effects-of-pumpless-extracorporeal-lung-assist-on-hemodynamics-gas-exchange-and-inflammatory-cascade-response-during-experimental-lung-injury
#13
Zhihai Ju, Jinhui Ma, Chen Wang, Jie Yu, Yeru Qiao, Feilong Hei
Pumpless extracorporeal lung assist (pECLA) has been reported to efficiently remove the systemic CO 2 production and provide mild to moderate oxygenation, thereby allowing for ventilator settings and modes prioritizing oxygenation and lung protection. However, an adequate bypass flow, the capacity to provide respiratory support and the effect on the inflammatory cascade response and tissue perfusion require further study to be determined. After induction of acute lung injury (ALI) by oleic acid injection, pECLA was implemented in 12 anaesthetized and mechanically ventilated dogs for 48 h...
February 2018: Experimental and Therapeutic Medicine
https://www.readbyqxmd.com/read/29434764/pediatric-acute-respiratory-distress-syndrome-current-views
#14
Jinfeng Liu, Wei Wang, Fengli Liu, Zhenguang Li
Acute respiratory distress syndrome (ARDS) mainly involves acute respiratory failure. In addition to this affected patients feel progressive arterial hypoxemia, dyspnea, and a marked increase in the work of breathing. The only clinical solution for the above pathological state is ventilation. Mechanical ventilation is necessary to support life in ARDs but it itself worsen lung injury and the term is known clinically as 'ventilation induced lung injury' (VILI). At the cellular level, respiratory epithelial cells are subjected to cyclic stretch, i...
February 2018: Experimental and Therapeutic Medicine
https://www.readbyqxmd.com/read/29432350/an-exploratory-reanalysis-of-the-randomized-trial-on-efficacy-of-corticosteroids-as-rescue-therapy-for-the-late-phase-of-acute-respiratory-distress-syndrome
#15
G Umberto Meduri, Lisa Bridges, Reed A C Siemieniuk, Mehmet Kocak
OBJECTIVES: In the Acute Respiratory Distress Syndrome Network randomized controlled trial, methylprednisolone treatment was associated with increased return to mechanical ventilation with partial loss of early improvements. We hypothesize a causal relationship between protocol-driven rapid discontinuation of methylprednisolone post extubation and return to mechanical ventilation. To explore this possibility, we investigated the timing that events occurred in each treatment arm during active treatment intervention (efficacy) and after stopping therapy...
February 9, 2018: Critical Care Medicine
https://www.readbyqxmd.com/read/29430447/mechanisms-involved-in-brain-dysfunction-in-mechanically-ventilated-critically-ill-patients-implications-and-therapeutics
#16
REVIEW
Marc Turon, Sol Fernández-Gonzalo, Candelaria de Haro, Rudys Magrans, Josefina López-Aguilar, Lluís Blanch
Critical illness may lead to significant long-term neurological morbidity and patients frequently develop neuropsychological disturbances including acute delirium or memory impairment after intensive care unit (ICU) discharge. Mechanical ventilation (MV) is a risk factor to the development of adverse neurocognitive outcomes. Patients undergoing MV for long periods present neurologic impairment with memory and cognitive alteration. Delirium is considered an acute form of brain dysfunction and its prevalence rises in mechanically ventilated patients...
January 2018: Annals of Translational Medicine
https://www.readbyqxmd.com/read/29430444/heart-lung-interactions-in-acute-respiratory-distress-syndrome-pathophysiology-detection-and-management-strategies
#17
REVIEW
Fernando Suarez Sipmann, Arnoldo Santos, Gerardo Tusman
Acute respiratory distress syndrome (ARDS) is the most severe form of acute respiratory failure characterized by diffuse alveolar and endothelial damage. The severe pathophysiological changes in lung parenchyma and pulmonary circulation together with the effects of positive pressure ventilation profoundly affect heart lung interactions in ARDS. The term pulmonary vascular dysfunction (PVD) refers to the specific involvement of the vascular compartment in ARDS and is expressed clinically by an increase in pulmonary arterial (PA) pressure and pulmonary vascular resistance both affecting right ventricular (RV) afterload...
January 2018: Annals of Translational Medicine
https://www.readbyqxmd.com/read/29429217/-phrenic-nerve-stimulation-protects-against-mechanical-ventilation-induced-diaphragmatic-dysfunction-through-myogenic-regulatory-factors
#18
G H An, M Chen, W F Zhan, B Hu, H X Zhang
Objective: To explore the protective effect of electrical stimulation of phrenic nerve on diaphragmatic function during mechanical ventilation. Methods: Forty healthy adult SD rats were randomly divided into 5 groups: blank control group (BC), spontaneous breathing group (SB), electrical stimulation group (ES), mechanical ventilation group (MV), and electrical stimulation and mechanical ventilation group (MS). The rats in each group were treated for 18 h except for the BC group. After treatment, the diaphragm muscle tissue was obtained and the diaphragm contractility including peak-to-peak value(Vpp) and maximum rate of contraction(+ dT/dt max) were measured...
February 12, 2018: Chinese Journal of Tuberculosis and Respiratory Diseases
https://www.readbyqxmd.com/read/29426051/-respiratory-failure-innovations-in-diagnostics-and-therapy
#19
Gunther Hempel, Philipp Simon, Peter Salz, Hermann Wrigge
Acute and chronic respiratory failures require immediate diagnosis and preferably individualized ventilation therapy. If possible, non-invasive ventilation should be considered to avoid complications of invasive mechanical ventilation. Especially in patients with ARDS and moderate to severe cases, non-invasive ventilation may not be suitable and should not be used uncritically.Invasive mechanical ventilation parameters should be adjusted individually. In the future, additional parameters such as transpulmonary pressure, monitoring of regional ventilation using electrical impedance tomography could help to individualize ventilator settings...
February 2018: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
https://www.readbyqxmd.com/read/29424792/in-depth-characterization-of-the-effects-of-cigarette-smoke-exposure-on-the-acute-trauma-response-and-hemorrhage-in-mice
#20
Clair Hartmann, Michael Gröger, Jan-Philipp Noirhomme, Angelika Scheuerle, Peter Möller, Ulrich Wachter, Markus Huber-Lang, Benedikt Nussbaum, Birgit Jung, Tamara Merz, Oscar McCook, Sandra Kress, Bettina Stahl, Enrico Calzia, Michael Georgieff, Peter Radermacher, Martin Wepler
INTRODUCTION: Hemorrhagic shock accounts for a large amount of trauma-related mortality. The severity of trauma can be further aggravated by an additional blunt chest trauma (TxT), which independently contributes to mortality upon the development of an acute lung injury (ALI). Besides, cigarette smoke (CS) exposure before TxT enhanced posttraumatic inflammation, thereby aggravating ALI. We therefore aimed to characterize the impact of an acute and/or chronic lung injury on organ dysfunction in a murine model of traumatic hemorrhagic shock (HS)...
February 8, 2018: Shock
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