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https://www.readbyqxmd.com/read/28528537/intraoperative-mechanical-ventilation-state-of-the-art
#1
Lorenzo Ball, Federico Costantino, Giulia Orefice, Karthikka Chandrapatham, Paolo Pelosi
Mechanical ventilation is a cornerstone of the intraoperative management of the surgical patient and is still mandatory in several surgical procedures. In the last decades, research focused on preventing postoperative pulmonary complications (PPCs), both improving risk stratification through the use of predictive scores and protecting the lung adopting so-called protective ventilation strategies. The aim of this review is to give an up-to-date overview of the currently suggested intraoperative ventilation strategies, along with their pathophysiologic rationale, with a focus on challenging conditions, such as obesity, one-lung ventilation and cardiopulmonary bypass...
May 19, 2017: Minerva Anestesiologica
https://www.readbyqxmd.com/read/28522438/anti-inflammatory-effects-of-oxpapc-involve-endothelial-cell-mediated-generation-of-lxa4
#2
Yunbo Ke, Noureddine Zebda, Olga Oskokova, Taras Afonyushkin, Evgeny Berdyshev, Yufeng Tian, Fanyong Meng, Nicolene Sarich, Valery N Bochkov, Ji Ming Wang, Anna A Birukova, Konstantin G Birukov
Rationale: Oxidation of 1-palmitoyl-2-arachidonoyl-sn-glycero-3-phosphorylcholine generates a group of bioactive oxidized phospholipid products (OxPAPC) with a broad range of biological activities. Barrier-enhancing and anti-inflammatory effects of OxPAPC on pulmonary endothelial cells (EC) are critical for prevention of acute lung injury caused by bacterial pathogens or excessive mechanical ventilation. Anti-inflammatory properties of OxPAPC are associated with its antagonistic effects on toll-like receptors and suppression of RhoA GTPase signaling...
May 18, 2017: Circulation Research
https://www.readbyqxmd.com/read/28520106/prophylactic-sustained-inflation-is-just-one-step-to-preventing-bronchopulmonary-dysplasia
#3
G Lista, I Bresesti
I am glad to see that the Sustained Lung Inflation (SLI) trial (1) still draws a great deal of attention and I would like to clarify some aspects of the trial, in response to the comments by Gupta and Argarwal (2) in Acta Paediatrica. A meta-analysis carried out in 2016 demonstrated that starting non-invasive respiratory support from birth could reduce the incidence of bronchopulmonary dysplasia and death. However, about 50% of very low birth weight infants who are initially on nasal continuous positive airway pressure need subsequent intubation and mechanical ventilation...
May 18, 2017: Acta Paediatrica
https://www.readbyqxmd.com/read/28512431/variable-ventilation-improved-respiratory-system-mechanics-and-ameliorated-pulmonary-damage-in-a-rat-model-of-lung-ischemia-reperfusion
#4
André Soluri-Martins, Lillian Moraes, Raquel S Santos, Cintia L Santos, Robert Huhle, Vera L Capelozzi, Paolo Pelosi, Pedro L Silva, Marcelo Gama de Abreu, Patricia R M Rocco
Lung ischemia-reperfusion injury remains a major complication after lung transplantation. Variable ventilation (VV) has been shown to improve respiratory function and reduce pulmonary histological damage compared to protective volume-controlled ventilation (VCV) in different models of lung injury induced by endotoxin, surfactant depletion by saline lavage, and hydrochloric acid. However, no study has compared the biological impact of VV vs. VCV in lung ischemia-reperfusion injury, which has a complex pathophysiology different from that of other experimental models...
2017: Frontiers in Physiology
https://www.readbyqxmd.com/read/28502073/early-impact-of-abdominal-compartment-syndrome-on-liver-kidney-and-lung-damage-in-a-rodent-model
#5
Ricardo Lima, Pedro L Silva, Vera L Capelozzi, Mariana G Oliveira, Maria Cristina E Santana, Fernanda F Cruz, Paolo Pelosi, Alberto Schanaider, Manu L N G Malbrain, Patricia R M Rocco
BACKGROUND: Abdominal compartment syndrome (ACS) sometimes occurs in critically ill patients following damage control surgery. The purpose of the present study was to develop a model of ACS and to evaluate its pathologic impact on liver, kidney, and lung morphology. METHODS: Twenty Wistar rats (mass 300-350 g) were randomly divided into four groups: 1) intra-abdominal hypertension (IAH): a laparotomy was performed and the abdomen packed with cotton until an intra-abdominal pressure (IAP) of 15 mm Hg was reached; 2) hypovolemia (HYPO): blood was withdrawn until a mean arterial pressure ~60 mm Hg was reached; 3) IAH + HYPO (to resemble clinical ACS); and 4) sham surgery...
May 14, 2017: Anaesthesiology Intensive Therapy
https://www.readbyqxmd.com/read/28497033/intrapulmonary-percussive-ventilation-as-an-airway-clearance-technique-during-venoarterial-extracorporeal-life-support-in-an-infant-with-pertussis
#6
Conrad Krawiec, Ken Ballinger, E Scott Halstead
Initiation of extracorporeal life support (ECLS) is often followed by complete opacification of pulmonary parenchyma and volume loss. The optimal mechanical ventilator management and lung recruitment strategy of a pediatric patient requiring extracorporeal membrane oxygenation is not known. We present a case of a 4-week old infant who developed a severe pertussis infection requiring ECLS. The severity of his illness and pertussis infection-associated intraluminal bronchiole obstruction made medical management challenging...
2017: Frontiers in Pediatrics
https://www.readbyqxmd.com/read/28493943/open-lung-approach-versus-standard-protective-strategies-effects-on-driving-pressure-and-ventilatory-efficiency-during-anesthesia-a-pilot-randomized-controlled-trial
#7
Carlos Ferrando, Fernando Suarez-Sipmann, Gerardo Tusman, Irene León, Esther Romero, Estefania Gracia, Ana Mugarra, Blanca Arocas, Natividad Pozo, Marina Soro, Francisco J Belda
BACKGROUND: Low tidal volume (VT) during anesthesia minimizes lung injury but may be associated to a decrease in functional lung volume impairing lung mechanics and efficiency. Lung recruitment (RM) can restore lung volume but this may critically depend on the post-RM selected PEEP. This study was a randomized, two parallel arm, open study whose primary outcome was to compare the effects on driving pressure of adding a RM to low-VT ventilation, with or without an individualized post-RM PEEP in patients without known previous lung disease during anesthesia...
2017: PloS One
https://www.readbyqxmd.com/read/28493877/co2-driven-endotracheal-tube-cuff-control-in-critically-ill-patients-a-randomized-controlled-study
#8
Gennaro De Pascale, Mariano Alberto Pennisi, Maria Sole Vallecoccia, Giuseppe Bello, Riccardo Maviglia, Luca Montini, Valentina Di Gravio, Salvatore Lucio Cutuli, Giorgio Conti, Massimo Antonelli
BACKGROUND: To determine the safety and clinical efficacy of an innovative integrated airway system (AnapnoGuard™ 100 system) that continuously monitors and controls the cuff pressure (Pcuff), while facilitating the aspiration of subglottic secretions (SS). METHODS: This was a prospective, single centre, open-label, randomized, controlled feasibility and safety trial. The primary endpoint of the study was the rate of device related adverse events (AE) and serious AE (SAE) as a result of using AnapnoGuard (AG) 100 during mechanical ventilation...
2017: PloS One
https://www.readbyqxmd.com/read/28493197/risk-factors-for-ventilator-associated-pneumonia-among-patients-undergoing-major-oncological-surgery-for-head-and-neck-cancer
#9
Yutao Liu, Yaxia Di, Shuai Fu
Patients undergoing major oncological surgery for head and neck cancer (SHNC) have a particularly high risk of nosocomial infections. We aimed to identify risk factors for ventilator-associated pneumonia (VAP) in patients undergoing SHNC. The study included 465 patients who underwent SHNC between June 2011 and June 2014. The rate of VAP, risk factors for VAP, and biological aspects of VAP were retrospectively evaluated. The incidence of VAP was 19.6% (n = 95) in patients who required more than 48 h of mechanical ventilation...
May 11, 2017: Frontiers of Medicine
https://www.readbyqxmd.com/read/28490015/salidroside-attenuates-ventilation-induced-lung-injury-via-sirt1-dependent-inhibition-of-nlrp3-inflammasome
#10
Yan Wang, Chu-Fan Xu, Yu-Jian Liu, Yan-Fei Mao, Zhou Lv, Si-Yuan Li, Xiao-Yan Zhu, Lai Jiang
BACKGROUND: Salidroside (SDS) is the main effective ingredient of Rhodiola rosea L with a variety of pharmacologic properties. We aim to investigate the effects of SDS on ventilation induced lung injury (VILI) and explore the possible underlying molecular mechanism. METHODS: Lung injury was induced in male ICR mice via mechanical ventilation (30 ml/kg) for 4h. The mice were divided in four groups:(1) Control group; (2) Ventilation group; (3) SDS group; (4) Ventilation with SDS group...
May 10, 2017: Cellular Physiology and Biochemistry
https://www.readbyqxmd.com/read/28479114/bronchopulmonary-dysplasia-where-have-all-the-stem-cells-gone-origin-and-potential-function-of-resident-lung-stem-cells
#11
Marius Alexander Möbius, Bernard Thébaud
Celebrating its 50(th) anniversary in 2017, bronchopulmonary dysplasia (BPD) - the chronic lung disease of prematurity that follows ventilator and O2 therapy for acute respiratory failure - remains the most frequent complication of extreme prematurity. Survival of premature infants born at increasingly earlier stages of gestation has made the prevention of lung injury increasingly challenging. BPD is postulated to be a misdirection of many functions in the developing lung including growth factor signalling and matrix as well as cellular composition, resulting in impaired alveolar and lung vascular growth...
May 4, 2017: Chest
https://www.readbyqxmd.com/read/28469503/use-of-aminocaproic-acid-in-combination-with-extracorporeal-membrane-oxygenation-in-a-case-of-leptospirosis-pulmonary-hemorrhage-syndrome
#12
Miguel Pardinas, Rodrigo Mendirichaga, Gaurav Budhrani, Rajan Garg, Luis Rosario, Rene Rico, Anthony Panos, Horst Baier, Stefanie Krick
A 32-year-old man presented with a 10-day history of fever, chills, nausea, vomiting, myalgia, nonproductive cough, and worsening dyspnea after freshwater swimming in the Caribbean 1 week prior to presentation. Shortly after arrival at the hospital, the patient developed severe respiratory distress with massive hemoptysis. Based on serologic workup, he was diagnosed with leptospirosis pulmonary hemorrhage syndrome leading to diffuse alveolar hemorrhage, severe hypoxemic respiratory failure, and multiorgan failure...
2017: Clinical Medicine Insights. Circulatory, Respiratory and Pulmonary Medicine
https://www.readbyqxmd.com/read/28459403/-evaluation-value-of-oxygenation-index-of-mechanical-ventilation-on-the-prognosis-of-patients-with-ards-a-retrospective-analysis-with-228-patients
#13
Ziyi Jia, Xiaowei Liu, Zhi Liu
OBJECTIVE: To investigate the evaluation value of oxygenation index at different times of mechanical ventilation (MV) on the prognosis of patients with acute respiratory distress syndrome (ARDS). METHODS: A retrospectively analysis was conducted. A total of 228 patients with ARDS admitted to Department of Emergency of China Medical University Affiliated First Hospital from February 2014 to June 2016 were enrolled. All patients underwent MV treatment, and recruitment maneuver (RM) was performed by pressure-controlled ventilation (PCV) 30 minutes after the implementation of the protective ventilation strategy...
January 2017: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/28459402/-effect-of-different-transpulmonary-pressures-guided-mechanical-ventilation-on-respiratory-and-hemodynamics-of-patients-with-ards-a-prospective-randomized-controlled-trial
#14
Jianqiu Li, Zhihui Luo, Xiaolei Li, Zhongyi Huang, Jie Han, Zifeng Li, Zhaoxiong Zhou, Houwang Chen
OBJECTIVE: To assess the effect of different transpulmonary pressures (Ptp) guided mechanical ventilation (MV) on respiratory function and hemodynamics parameters of patients with acute respiratory distress syndrome (ARDS), and to find out a more optimized Ptp. METHODS: A prospective randomized controlled trial (RCT) was conducted. The ventilated patients with ARDS admitted to Department of Critical Care Medicine (ICU) of Shenzhen Shajing Affiliated Hospital of Guangzhou Medical University and Department of Emergency and Critical Care Medicine (EICU) of Shenzhen Hospital of South Medical University from February 2013 to August 2016 were enrolled...
January 2017: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/28454590/protective-intraoperative-ventilation-with-higher-versus-lower-levels-of-positive-end-expiratory-pressure-in-obese-patients-probese-study-protocol-for-a-randomized-controlled-trial
#15
T Bluth, R Teichmann, T Kiss, I Bobek, J Canet, G Cinnella, L De Baerdemaeker, C Gregoretti, G Hedenstierna, S N Hemmes, M Hiesmayr, M W Hollmann, S Jaber, J G Laffey, M J Licker, K Markstaller, I Matot, G Müller, G H Mills, J P Mulier, C Putensen, R Rossaint, J Schmitt, M Senturk, A Serpa Neto, P Severgnini, J Sprung, M F Vidal Melo, H Wrigge, M J Schultz, P Pelosi, M Gama de Abreu
BACKGROUND: Postoperative pulmonary complications (PPCs) increase the morbidity and mortality of surgery in obese patients. High levels of positive end-expiratory pressure (PEEP) with lung recruitment maneuvers may improve intraoperative respiratory function, but they can also compromise hemodynamics, and the effects on PPCs are uncertain. We hypothesized that intraoperative mechanical ventilation using high PEEP with periodic recruitment maneuvers, as compared with low PEEP without recruitment maneuvers, prevents PPCs in obese patients...
April 28, 2017: Trials
https://www.readbyqxmd.com/read/28453540/pre-and-posttreatment-with-hydrogen-sulfide-prevents-ventilator-induced-lung-injury-by-limiting-inflammation-and-oxidation
#16
Simone Faller, Raphael Seiler, Rosa Donus, Helen Engelstaedter, Alexander Hoetzel, Sashko Gregoriev Spassov
Although essential in critical care medicine, mechanical ventilation often results in ventilator-induced lung injury. Low concentrations of hydrogen sulfide have been proven to have anti-inflammatory and anti-oxidative effects in the lung. The aim of this study was to analyze the kinetic effects of pre- and posttreatment with hydrogen sulfide in order to prevent lung injury as well as inflammatory and oxidative stress upon mechanical ventilation. Mice were either non-ventilated or mechanically ventilated with a tidal volume of 12 ml/kg for 6 h...
2017: PloS One
https://www.readbyqxmd.com/read/28445238/hydrogen-sulfide-confers-lung-protection-during-mechanical-ventilation-via-cyclooxygenase-2-15-deoxy-%C3%AE-12-14-prostaglandin-j2-and-peroxisome-proliferator-activated-receptor-gamma
#17
Sashko G Spassov, Simone Faller, Matthias Hummel, Khaled Helo, Andreas Ihle, Stefan W Ryter, Karl M Strosing, Alexander Hoetzel
OBJECTIVES: Hydrogen sulfide reduces ventilator-induced lung injury in mice. Here, we have examined the underlying mechanisms of hydrogen sulfide-mediated lung protection and determined the involvement of cyclooxygenase 2, 15-deoxy Δ-prostaglandin J2, and peroxisome proliferator-activated receptor gamma in this response. DESIGN: Randomized, experimental study. SETTING: University medical center research laboratory. SUBJECTS: C57BL/6 mice and in vitro cell catheters...
April 25, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28444071/reducing-pressure-ulcers-in-patients-with-prolonged-acute-mechanical-ventilation-a-quasi-experimental-study
#18
Cecilia Inés Loudet, María Cecilia Marchena, María Roxana Maradeo, Silvia Laura Fernández, María Victoria Romero, Graciela Esther Valenzuela, Isabel Eustaquia Herrera, Martha Teresa Ramírez, Silvia Rojas Palomino, Mariana Virginia Teberobsky, Leandro Ismael Tumino, Ana Laura González, Rosa Reina, Elisa Estenssoro
Objective: To determine the effectiveness of a quality management program in reducing the incidence and severity of pressure ulcers in critical care patients. Methods: This was a quasi-experimental, before-and-after study that was conducted in a medical-surgical intensive care unit. Consecutive patients who had received mechanical ventilation for ≥ 96 hours were included. A "Process Improvement" team designed a multifaceted interventional process that consisted of an educational session, a pressure ulcer checklist, a smartphone application for lesion monitoring and decision-making, and a "family prevention bundle"...
January 2017: Revista Brasileira de Terapia Intensiva
https://www.readbyqxmd.com/read/28436715/controlled-invasive-mechanical-ventilation-strategies-in-obese-patients-undergoing-surgery
#19
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 28, 2017: Expert Review of Respiratory Medicine
https://www.readbyqxmd.com/read/28431421/sevoflurane-posttreatment-attenuates-lung-injury-induced-by-oleic-acid-in-dogs
#20
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
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