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https://www.readbyqxmd.com/read/27786562/spontaneous-breathing-during-mechanical-ventilation-risks-mechanisms-management
#1
Takeshi Yoshida, Yuji Fujino, Marcelo B P Amato, Brian P Kavanagh
Spontaneous respiratory effort during mechanical ventilation has long been recognized to improve oxygenation (1, 2) and because oxygenation is a key management target, such effort may seem beneficial. Also, disuse and loss of peripheral muscle and diaphragm function is increasingly recognized (3), and thus spontaneous breathing may confer additional advantage. Of course, all patients will need to transition to spontaneous effort if they are to become independent of the ventilator. Finally, epidemiologic data suggest that the use of partial (vs...
October 27, 2016: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/27596161/chest-electrical-impedance-tomography-examination-data-analysis-terminology-clinical-use-and-recommendations-consensus-statement-of-the-translational-eit-development-study-group
#2
Inéz Frerichs, Marcelo B P Amato, Anton H van Kaam, David G Tingay, Zhanqi Zhao, Bartłomiej Grychtol, Marc Bodenstein, Hervé Gagnon, Stephan H Böhm, Eckhard Teschner, Ola Stenqvist, Tommaso Mauri, Vinicius Torsani, Luigi Camporota, Andreas Schibler, Gerhard K Wolf, Diederik Gommers, Steffen Leonhardt, Andy Adler
Electrical impedance tomography (EIT) has undergone 30 years of development. Functional chest examinations with this technology are considered clinically relevant, especially for monitoring regional lung ventilation in mechanically ventilated patients and for regional pulmonary function testing in patients with chronic lung diseases. As EIT becomes an established medical technology, it requires consensus examination, nomenclature, data analysis and interpretation schemes. Such consensus is needed to compare, understand and reproduce study findings from and among different research groups, to enable large clinical trials and, ultimately, routine clinical use...
September 5, 2016: Thorax
https://www.readbyqxmd.com/read/27348299/genomic-analysis-of-local-variation-and-recent-evolution-in-plasmodium-vivax
#3
Richard D Pearson, Roberto Amato, Sarah Auburn, Olivo Miotto, Jacob Almagro-Garcia, Chanaki Amaratunga, Seila Suon, Sivanna Mao, Rintis Noviyanti, Hidayat Trimarsanto, Jutta Marfurt, Nicholas M Anstey, Timothy William, Maciej F Boni, Christiane Dolecek, Hien Tinh Tran, Nicholas J White, Pascal Michon, Peter Siba, Livingstone Tavul, Gabrielle Harrison, Alyssa Barry, Ivo Mueller, Marcelo U Ferreira, Nadira Karunaweera, Milijaona Randrianarivelojosia, Qi Gao, Christina Hubbart, Lee Hart, Ben Jeffery, Eleanor Drury, Daniel Mead, Mihir Kekre, Susana Campino, Magnus Manske, Victoria J Cornelius, Bronwyn MacInnis, Kirk A Rockett, Alistair Miles, Julian C Rayner, Rick M Fairhurst, Francois Nosten, Ric N Price, Dominic P Kwiatkowski
The widespread distribution and relapsing nature of Plasmodium vivax infection present major challenges for the elimination of malaria. To characterize the genetic diversity of this parasite in individual infections and across the population, we performed deep genome sequencing of >200 clinical samples collected across the Asia-Pacific region and analyzed data on >300,000 SNPs and nine regions of the genome with large copy number variations. Individual infections showed complex patterns of genetic structure, with variation not only in the number of dominant clones but also in their level of relatedness and inbreeding...
August 2016: Nature Genetics
https://www.readbyqxmd.com/read/27334266/esophageal-and-transpulmonary-pressure-in-the-clinical-setting-meaning-usefulness-and-perspectives
#4
REVIEW
Tommaso Mauri, Takeshi Yoshida, Giacomo Bellani, Ewan C Goligher, Guillaume Carteaux, Nuttapol Rittayamai, Francesco Mojoli, Davide Chiumello, Lise Piquilloud, Salvatore Grasso, Amal Jubran, Franco Laghi, Sheldon Magder, Antonio Pesenti, Stephen Loring, Luciano Gattinoni, Daniel Talmor, Lluis Blanch, Marcelo Amato, Lu Chen, Laurent Brochard, Jordi Mancebo
PURPOSE: Esophageal pressure (Pes) is a minimally invasive advanced respiratory monitoring method with the potential to guide management of ventilation support and enhance specific diagnoses in acute respiratory failure patients. To date, the use of Pes in the clinical setting is limited, and it is often seen as a research tool only. METHODS: This is a review of the relevant technical, physiological and clinical details that support the clinical utility of Pes. RESULTS: After appropriately positioning of the esophageal balloon, Pes monitoring allows titration of controlled and assisted mechanical ventilation to achieve personalized protective settings and the desired level of patient effort from the acute phase through to weaning...
September 2016: Intensive Care Medicine
https://www.readbyqxmd.com/read/27248585/the-recruitability-paradox
#5
Marcelo B P Amato, Roberta R De Santis Santiago
No abstract text is available yet for this article.
June 1, 2016: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/27033882/imaging-in-acute-respiratory-distress-syndrome
#6
REVIEW
Antonio Pesenti, Guido Musch, Daniel Lichtenstein, Francesco Mojoli, Marcelo B P Amato, Gilda Cinnella, Luciano Gattinoni, Michael Quintel
PURPOSE: Imaging has become increasingly important across medical specialties for diagnostic, monitoring, and investigative purposes in acute respiratory distress syndrome (ARDS). METHODS: This review addresses the use of imaging techniques for the diagnosis and management of ARDS as well as gaining knowledge about its pathogenesis and pathophysiology. The techniques described in this article are computed tomography, positron emission tomography, and two easily accessible imaging techniques available at the bedside-ultrasound and electrical impedance tomography (EIT)...
May 2016: Intensive Care Medicine
https://www.readbyqxmd.com/read/27002273/spontaneous-effort-during-mechanical-ventilation-maximal-injury-with-less-positive-end-expiratory-pressure
#7
Takeshi Yoshida, Rollin Roldan, Marcelo A Beraldo, Vinicius Torsani, Susimeire Gomes, Roberta R De Santis, Eduardo L V Costa, Mauro R Tucci, Raul G Lima, Brian P Kavanagh, Marcelo B P Amato
OBJECTIVES: We recently described how spontaneous effort during mechanical ventilation can cause "pendelluft," that is, displacement of gas from nondependent (more recruited) lung to dependent (less recruited) lung during early inspiration. Such transfer depends on the coexistence of more recruited (source) liquid-like lung regions together with less recruited (target) solid-like lung regions. Pendelluft may improve gas exchange, but because of tidal recruitment, it may also contribute to injury...
August 2016: Critical Care Medicine
https://www.readbyqxmd.com/read/26947624/association-between-driving-pressure-and-development-of-postoperative-pulmonary-complications-in-patients-undergoing-mechanical-ventilation-for-general-anaesthesia-a-meta-analysis-of-individual-patient-data
#8
Ary Serpa Neto, Sabrine N T Hemmes, Carmen S V Barbas, Martin Beiderlinden, Ana Fernandez-Bustamante, Emmanuel Futier, Ognjen Gajic, Mohamed R El-Tahan, Abdulmohsin A Al Ghamdi, Ersin Günay, Samir Jaber, Serdar Kokulu, Alf Kozian, Marc Licker, Wen-Qian Lin, Andrew D Maslow, Stavros G Memtsoudis, Dinis Reis Miranda, Pierre Moine, Thomas Ng, Domenico Paparella, V Marco Ranieri, Federica Scavonetto, Thomas Schilling, Gabriele Selmo, Paolo Severgnini, Juraj Sprung, Sugantha Sundar, Daniel Talmor, Tanja Treschan, Carmen Unzueta, Toby N Weingarten, Esther K Wolthuis, Hermann Wrigge, Marcelo B P Amato, Eduardo L V Costa, Marcelo Gama de Abreu, Paolo Pelosi, Marcus J Schultz
BACKGROUND: Protective mechanical ventilation strategies using low tidal volume or high levels of positive end-expiratory pressure (PEEP) improve outcomes for patients who have had surgery. The role of the driving pressure, which is the difference between the plateau pressure and the level of positive end-expiratory pressure is not known. We investigated the association of tidal volume, the level of PEEP, and driving pressure during intraoperative ventilation with the development of postoperative pulmonary complications...
April 2016: Lancet Respiratory Medicine
https://www.readbyqxmd.com/read/26289012/understanding-recruitment-maneuvers
#9
Erica Aranha Suzumura, Marcelo Britto Passos Amato, Alexandre Biasi Cavalcanti
No abstract text is available yet for this article.
May 2016: Intensive Care Medicine
https://www.readbyqxmd.com/read/26266914/moderately-high-frequency-ventilation-with-a-conventional-ventilator-allows-reduction-of-tidal-volume-without-increasing-mean-airway-pressure
#10
Ricardo Luiz Cordioli, Marcelo Park, Eduardo Leite Vieira Costa, Susimeire Gomes, Laurent Brochard, Marcelo Britto Passos Amato, Luciano Cesar Pontes Azevedo
BACKGROUND: The aim of this study was to explore if positive-pressure ventilation delivered by a conventional ICU ventilator at a moderately high frequency (HFPPV) allows a safe reduction of tidal volume (V T) below 6 mL/kg in a porcine model of severe acute respiratory distress syndrome (ARDS) and at a lower mean airway pressure than high-frequency oscillatory ventilation (HFOV). METHODS: This is a prospective study. In eight pigs (median weight 34 [29,36] kg), ARDS was induced by pulmonary lavage and injurious ventilation...
December 2014: Intensive Care Medicine Experimental
https://www.readbyqxmd.com/read/26258686/correlation-of-lung-collapse-and-gas-exchange-a-computer-tomographic-study-in-sheep-and-pigs-with-atelectasis-in-otherwise-normal-lungs
#11
Samuel J Wolf, Alexander P Reske, Sören Hammermüller, Eduardo L V Costa, Peter M Spieth, Pierre Hepp, Alysson R Carvalho, Jens Kraßler, Hermann Wrigge, Marcelo B P Amato, Andreas W Reske
BACKGROUND: Atelectasis can provoke pulmonary and non-pulmonary complications after general anaesthesia. Unfortunately, there is no instrument to estimate atelectasis and prompt changes of mechanical ventilation during general anaesthesia. Although arterial partial pressure of oxygen (PaO2) and intrapulmonary shunt have both been suggested to correlate with atelectasis, studies yielded inconsistent results. Therefore, we investigated these correlations. METHODS: Shunt, PaO2 and atelectasis were measured in 11 sheep and 23 pigs with otherwise normal lungs...
2015: PloS One
https://www.readbyqxmd.com/read/25746507/lung-inflammation-persists-after-27-hours-of-protective-acute-respiratory-distress-syndrome-network-strategy-and-is-concentrated-in-the-nondependent-lung
#12
João Batista Borges, Eduardo L V Costa, Maria Bergquist, Luca Lucchetta, Charles Widström, Enn Maripuu, Fernando Suarez-Sipmann, Anders Larsson, Marcelo B P Amato, Göran Hedenstierna
OBJECTIVE: PET with [18F]fluoro-2-deoxy-D-glucose can be used to image cellular metabolism, which during lung inflammation mainly reflects neutrophil activity, allowing the study of regional lung inflammation in vivo. We aimed at studying the location and evolution of inflammation by PET imaging, relating it to morphology (CT), during the first 27 hours of application of protective-ventilation strategy as suggested by the Acute Respiratory Distress Syndrome Network, in a porcine experimental model of acute respiratory distress syndrome...
May 2015: Critical Care Medicine
https://www.readbyqxmd.com/read/25693014/driving-pressure-and-survival-in-the-acute-respiratory-distress-syndrome
#13
Marcelo B P Amato, Maureen O Meade, Arthur S Slutsky, Laurent Brochard, Eduardo L V Costa, David A Schoenfeld, Thomas E Stewart, Matthias Briel, Daniel Talmor, Alain Mercat, Jean-Christophe M Richard, Carlos R R Carvalho, Roy G Brower
BACKGROUND: Mechanical-ventilation strategies that use lower end-inspiratory (plateau) airway pressures, lower tidal volumes (VT), and higher positive end-expiratory pressures (PEEPs) can improve survival in patients with the acute respiratory distress syndrome (ARDS), but the relative importance of each of these components is uncertain. Because respiratory-system compliance (CRS) is strongly related to the volume of aerated remaining functional lung during disease (termed functional lung size), we hypothesized that driving pressure (ΔP=VT/CRS), in which VT is intrinsically normalized to functional lung size (instead of predicted lung size in healthy persons), would be an index more strongly associated with survival than VT or PEEP in patients who are not actively breathing...
February 19, 2015: New England Journal of Medicine
https://www.readbyqxmd.com/read/25383882/positive-end-expiratory-pressure-and-variable-ventilation-in-lung-healthy-rats-under-general-anesthesia
#14
Luciana M Camilo, Mariana B Ávila, Luis Felipe S Cruz, Gabriel C M Ribeiro, Peter M Spieth, Andreas A Reske, Marcelo Amato, Antonio Giannella-Neto, Walter A Zin, Alysson R Carvalho
OBJECTIVES: Variable ventilation (VV) seems to improve respiratory function in acute lung injury and may be combined with positive end-expiratory pressure (PEEP) in order to protect the lungs even in healthy subjects. We hypothesized that VV in combination with moderate levels of PEEP reduce the deterioration of pulmonary function related to general anesthesia. Hence, we aimed at evaluating the alveolar stability and lung protection of the combination of VV at different PEEP levels. DESIGN: Randomized experimental study...
2014: PloS One
https://www.readbyqxmd.com/read/25323531/first-time-imaging-of-effects-of-inspired-oxygen-concentration-on-regional-lung-volumes-and-breathing-pattern-during-hypergravity
#15
João Batista Borges, Göran Hedenstierna, Jakob S Bergman, Marcelo B P Amato, Jacques Avenel, Stéphanie Montmerle-Borgdorff
PURPOSE: Aeroatelectasis can develop in aircrew flying the latest generation high-performance aircraft. Causes alleged are relative hyperoxia, increased gravity in the head-to-foot direction (+Gz), and compression of legs and stomach by anti-G trousers (AGT). We aimed to assess, in real time, the effects of hyperoxia, +Gz accelerations and AGT inflation on changes in regional lung volumes and breathing pattern evaluated in an axial plane by electrical impedance tomography (EIT). METHODS: The protocol mimicked a routine peacetime flight in combat aircraft...
February 2015: European Journal of Applied Physiology
https://www.readbyqxmd.com/read/25310077/-mechanical-ventilation-in-the-acute-lung-injury-acute-respiratory-distress-syndrome
#16
Marcelo B P Amato, Carlos R R Carvalho, Sílvia Vieira, Alexandre Isola, Vivian Rotman, Marcelo Moock, Anderson José, Suelene Aires Franca
BACKGROUND AND OBJECTIVES: The II Brazilian Consensus Conference on Mechanical Ventilation was published in 2000. Knowledge on the field of mechanical ventilation evolved rapidly since then, with the publication of numerous clinical studies with potential impact on the ventilatory management of critically ill patients. Moreover, the evolving concept of evidence - based medicine determined the grading of clinical recommendations according to the methodological value of the studies on which they are based...
September 2007: Revista Brasileira de Terapia Intensiva
https://www.readbyqxmd.com/read/25295817/brazilian-recommendations-of-mechanical-ventilation-2013-part-2
#17
Carmen Sílvia Valente Barbas, Alexandre Marini Ísola, Augusto Manoel de Carvalho Farias, Alexandre Biasi Cavalcanti, Ana Maria Casati Gama, Antonio Carlos Magalhães Duarte, Arthur Vianna, Ary Serpa Neto, Bruno de Arruda Bravim, Bruno do Valle Pinheiro, Bruno Franco Mazza, Carlos Roberto Ribeiro de Carvalho, Carlos Toufen Júnior, Cid Marcos Nascimento David, Corine Taniguchi, Débora Dutra da Silveira Mazza, Desanka Dragosavac, Diogo Oliveira Toledo, Eduardo Leite Costa, Eliana Bernadete Caser, Eliezer Silva, Fabio Ferreira Amorim, Felipe Saddy, Filomena Regina Barbosa Gomes Galas, Gisele Sampaio Silva, Gustavo Faissol Janot de Matos, João Claudio Emmerich, Jorge Luis dos Santos Valiatti, José Mario Meira Teles, Josué Almeida Victorino, Juliana Carvalho Ferreira, Luciana Passuello do Vale Prodomo, Ludhmila Abrahão Hajjar, Luiz Claudio Martins, Luis Marcelo Sá Malbouisson, Mara Ambrosina de Oliveira Vargas, Marco Antonio Soares Reis, Marcelo Brito Passos Amato, Marcelo Alcântara Holanda, Marcelo Park, Marcia Jacomelli, Marcos Tavares, Marta Cristina Paulette Damasceno, Murillo Santucci César Assunção, Moyzes Pinto Coelho Duarte Damasceno, Nazah Cherif Mohamed Youssef, Paulo José Zimmermann Teixeira, Pedro Caruso, Péricles Almeida Delfino Duarte, Octavio Messeder, Raquel Caserta Eid, Ricardo Goulart Rodrigues, Rodrigo Francisco de Jesus, Ronaldo Adib Kairalla, Sandra Justino, Sergio Nogueira Nemer, Simone Barbosa Romero, Verônica Moreira Amado
Perspectives on invasive and noninvasive ventilatory support for critically ill patients are evolving, as much evidence indicates that ventilation may have positive effects on patient survival and the quality of the care provided in intensive care units in Brazil. For those reasons, the Brazilian Association of Intensive Care Medicine (Associação de Medicina Intensiva Brasileira - AMIB) and the Brazilian Thoracic Society (Sociedade Brasileira de Pneumologia e Tisiologia - SBPT), represented by the Mechanical Ventilation Committee and the Commission of Intensive Therapy, respectively, decided to review the literature and draft recommendations for mechanical ventilation with the goal of creating a document for bedside guidance as to the best practices on mechanical ventilation available to their members...
July 2014: Revista Brasileira de Terapia Intensiva
https://www.readbyqxmd.com/read/25097070/effects-of-alveolar-recruitment-maneuvers-on-clinical-outcomes-in-patients-with-acute-respiratory-distress-syndrome-a-systematic-review-and-meta-analysis
#18
REVIEW
Erica Aranha Suzumura, Mabel Figueiró, Karina Normilio-Silva, Lígia Laranjeira, Claudia Oliveira, Anna Maria Buehler, Diogo Bugano, Marcelo Britto Passos Amato, Carlos Roberto Ribeiro Carvalho, Otavio Berwanger, Alexandre Biasi Cavalcanti
PURPOSE: To assess the effects of alveolar recruitment maneuvers (ARMs) on clinical outcomes in patients with acute respiratory distress syndrome (ARDS). METHODS: We conducted a search of the MEDLINE, EMBASE, LILACS, CINAHL, CENTRAL, Scopus, and Web of Science (from inception to July 2014) databases for all (i.e. no language restriction) randomized controlled trials (RCTs) evaluating the effects of ARMs versus no ARMs in adults with ARDS. Four teams of two reviewers independently assessed the eligibility of the studies identified during the search and appraised the risk of bias and extracted data from those which were assessed as meeting the inclusion criteria...
September 2014: Intensive Care Medicine
https://www.readbyqxmd.com/read/25028944/brazilian-recommendations-of-mechanical-ventilation-2013-part-i
#19
REVIEW
Carmen Sílvia Valente Barbas, Alexandre Marini Isola, Augusto Manoel de Carvalho Farias, Alexandre Biasi Cavalcanti, Ana Maria Casati Gama, Antonio Carlos Magalhães Duarte, Arthur Vianna, Ary Serpa Neto, Bruno de Arruda Bravim, Bruno do Valle Pinheiro, Bruno Franco Mazza, Carlos Roberto Ribeiro de Carvalho, Carlos Toufen Júnior, Cid Marcos Nascimento David, Corine Taniguchi, Débora Dutra da Silveira Mazza, Desanka Dragosavac, Diogo Oliveira Toledo, Eduardo Leite Costa, Eliana Bernardete Caser, Eliezer Silva, Fabio Ferreira Amorim, Felipe Saddy, Filomena Regina Barbosa Gomes Galas, Gisele Sampaio Silva, Gustavo Faissol Janot de Matos, João Claudio Emmerich, Jorge Luis Dos Santos Valiatti, José Mario Meira Teles, Josué Almeida Victorino, Juliana Carvalho Ferreira, Luciana Passuello do Vale Prodomo, Ludhmila Abrahão Hajjar, Luiz Cláudio Martins, Luiz Marcelo Sá Malbouisson, Mara Ambrosina de Oliveira Vargas, Marco Antonio Soares Reis, Marcelo Brito Passos Amato, Marcelo Alcântara Holanda, Marcelo Park, Marcia Jacomelli, Marcos Tavares, Marta Cristina Paulette Damasceno, Murillo Santucci César Assunção, Moyzes Pinto Coelho Duarte Damasceno, Nazah Cherif Mohamad Youssef, Paulo José Zimmermann Teixeira, Pedro Caruso, Péricles Almeida Delfino Duarte, Octavio Messeder, Raquel Caserta Eid, Ricardo Goulart Rodrigues, Rodrigo Francisco de Jesus, Ronaldo Adib Kairalla, Sandra Justino, Sérgio Nogueira Nemer, Simone Barbosa Romero, Verônica Moreira Amado
Perspectives on invasive and noninvasive ventilatory support for critically ill patients are evolving, as much evidence indicates that ventilation may have positive effects on patient survival and the quality of the care provided in intensive care units in Brazil. For those reasons, the Brazilian Association of Intensive Care Medicine (Associação de Medicina Intensiva Brasileira - AMIB) and the Brazilian Thoracic Society (Sociedade Brasileira de Pneumonia e Tisiologia - SBPT), represented by the Mechanical Ventilation Committee and the Commission of Intensive Therapy, respectively, decided to review the literature and draft recommendations for mechanical ventilation with the goal of creating a document for bedside guidance as to the best practices on mechanical ventilation available to their members...
April 2014: Revista Brasileira de Terapia Intensiva
https://www.readbyqxmd.com/read/24612764/cycling-off-modes-during-pressure-support-ventilation-effects-on-breathing-pattern-patient-effort-and-comfort
#20
RANDOMIZED CONTROLLED TRIAL
Fabrícia C Hoff, Mauro R Tucci, Marcelo B P Amato, Laura J Santos, Josué A Victorino
PURPOSE: Expiratory asynchrony during pressure support ventilation (PSV) has been recognized as a cause of patient discomfort, increased workload, and impaired weaning process. We evaluated breathing pattern, patient comfort, and patient effort during PSV comparing 2 flow termination criteria: fixed at 5% of peak inspiratory flow vs automatic, real-time, breath-by-breath adjustment within the range of 5% to 55%. MATERIALS AND METHODS: Randomized crossover clinical trial...
June 2014: Journal of Critical Care
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