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https://www.readbyqxmd.com/read/29778239/time-dependent-changes-in-cardiorespiratory-functions-of-anesthetized-rats-exposed-to-sustained-hypoxia
#1
Kouki Kato, Ryosuke Morinaga, Seigo Fushuku, Nobuaki Nakamuta, Yoshio Yamamoto
Although cardiovascular responses may be altered by respiratory changes under prolonged hypoxia, the relationship between respiratory and cardiovascular changes remains unknown. The aim of the present study is to clarify cardiorespiratory changes in anesthetized rats during and after hypoxic conditions using simultaneous recordings of cardiorespiratory variables with 20-sec recording intervals. After air breathing for 20 min (pre-exposure period), rats were subjected to 10% O2 for 2 h (hypoxic exposure period) and then air for 30 min (recovery period)...
July 2018: Autonomic Neuroscience: Basic & Clinical
https://www.readbyqxmd.com/read/29776982/variable-effectiveness-of-stepwise-implementation-of-nudge-type-interventions-to-improve-provider-compliance-with-intraoperative-low-tidal-volume-ventilation
#2
Vikas N O'Reilly-Shah, George S Easton, Craig S Jabaley, Grant C Lynde
BACKGROUND: Identifying mechanisms to improve provider compliance with quality metrics is a common goal across medical disciplines. Nudge interventions are minimally invasive strategies that can influence behavioural changes and are increasingly used within healthcare settings. We hypothesised that nudge interventions may improve provider compliance with lung-protective ventilation (LPV) strategies during general anaesthesia. METHODS: We developed an audit and feedback dashboard that included information on both provider-level and department-level compliance with LPV strategies in two academic hospitals, two non-academic hospitals and two academic surgery centres affiliated with a single healthcare system...
May 18, 2018: BMJ Quality & Safety
https://www.readbyqxmd.com/read/29771711/respiratory-muscle-effort-during-expiration-in-successful-and-failed-weaning-from-mechanical-ventilation
#3
Jonne Doorduin, Lisanne H Roesthuis, Diana Jansen, Johannes G van der Hoeven, Hieronymus W H van Hees, Leo M A Heunks
BACKGROUND: Respiratory muscle weakness in critically ill patients is associated with difficulty in weaning from mechanical ventilation. Previous studies have mainly focused on inspiratory muscle activity during weaning; expiratory muscle activity is less well understood. The current study describes expiratory muscle activity during weaning, including tonic diaphragm activity. The authors hypothesized that expiratory muscle effort is greater in patients who fail to wean compared to those who wean successfully...
May 16, 2018: Anesthesiology
https://www.readbyqxmd.com/read/29763713/practice-of-mechanical-ventilation-in-cardiac-arrest-patients-and-effects-of-targeted-temperature-management-a-substudy-of-the-targeted-temperature-management-trial
#4
Matthew B A Harmon, David M P van Meenen, Annelou L I P van der Veen, Jan M Binnenkade, Josef Dankiewicz, Florian Ebner, Niklas Nielsen, Paolo Pelosi, Marcus J Schultz, Janneke Horn, Hans Friberg, Nicole P Juffermans
AIMS: Mechanical ventilation practices in patients with cardiac arrest are not well described. Also, the effect of temperature on mechanical ventilation settings is not known. The aims of this study were 1) to describe practice of mechanical ventilation and its relation with outcome 2) to determine effects of different target temperatures strategies (33 °C versus 36 °C) on mechanical ventilation settings. METHODS: This is a substudy of the TTM-trial in which unconscious survivors of a cardiac arrest due to a cardiac cause were randomized to two TTM strategies, 33 °C (TTM33) and 36 °C (TTM36)...
May 12, 2018: Resuscitation
https://www.readbyqxmd.com/read/29762314/effectiveness-of-dexmedetomidine-versus-propofol-on-extubation-times-length-of-stay-and-mortality-rates-in-adult-cardiac-surgery-patients-a-systematic-review-and-meta-analysis
#5
John Nguyen, Noel Nacpil
OBJECTIVE: To determine the effects of dexmedetomidine versus propofol on extubation time, intensive care unit (ICU) length of stay, total hospital length of stay and in-hospital mortality rates in cardiac surgery patients. INTRODUCTION: Recovery from cardiovascular surgery involves weaning from mechanical ventilation. Mechanical ventilation decreases the work of breathing for patients by inhaling oxygen and exhaling carbon dioxide via a ventilator or breathing machine...
May 2018: JBI Database of Systematic Reviews and Implementation Reports
https://www.readbyqxmd.com/read/29744251/comparison-of-different-cuff-pressure-use-with-the-supreme-laryngeal-mask-airway-on-haemodynamic-response-seal-pressure-and-postoperative-adverse-events-a-prospective-randomized-study
#6
Achmet Ali, Demet Altun, Nukhet Sivrikoz, Mesut Yornuk, Namigar Turgut, İbrahim Özkan Akıncı
Objective: The Supreme™ laryngeal mask airway (SLMA) is a supra glottic airway (SGA) device that is used as an alternative to endotracheal tubes. In the present study, we aimed to compare the use of the SLMA with normal cuff pressure and low cuff pressure, primarily for haemodynamic response. Methods: In the present study, 120 patients diagnosed with hypertension and scheduled for varicose vein or inguinal hernia operation were enrolled and 99 patients finished...
April 2018: Turkish Journal of Anaesthesiology and Reanimation
https://www.readbyqxmd.com/read/29743121/high-frequency-oscillatory-ventilation-guided-by-transpulmonary-pressure-in-acute-respiratory-syndrome-an-experimental-study-in-pigs
#7
Philipp Klapsing, Onnen Moerer, Christoph Wende, Peter Herrmann, Michael Quintel, Annalen Bleckmann, Jan Florian Heuer
BACKGROUND: Recent clinical studies have not shown an overall benefit of high-frequency oscillatory ventilation (HFOV), possibly due to injurious or non-individualized HFOV settings. We compared conventional HFOV (HFOVcon ) settings with HFOV settings based on mean transpulmonary pressures (PLmean ) in an animal model of experimental acute respiratory distress syndrome (ARDS). METHODS: ARDS was induced in eight pigs by intrabronchial installation of hydrochloric acid (0...
May 9, 2018: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29743094/feasibility-and-safety-of-low-flow-extracorporeal-co-2-removal-managed-with-a-renal-replacement-platform-to-enhance-lung-protective-ventilation-of-patients-with-mild-to-moderate-ards
#8
Matthieu Schmidt, Samir Jaber, Elie Zogheib, Thomas Godet, Gilles Capellier, Alain Combes
BACKGROUND: Extracorporeal carbon-dioxide removal (ECCO2 R) might allow ultraprotective mechanical ventilation with lower tidal volume (VT) (< 6 ml/kg predicted body weight), plateau pressure (Pplat ) (< 30 cmH2 O), and driving pressure to limit ventilator-induced lung injury. This study was undertaken to assess the feasibility and safety of ECCO2 R managed with a renal replacement therapy (RRT) platform to enable very low tidal volume ventilation of patients with mild-to-moderate acute respiratory distress syndrome (ARDS)...
May 10, 2018: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29739857/how-ventilation-is-delivered-during-cardiopulmonary-resuscitation-an-international-survey
#9
Ricardo Luiz Cordioli, Laurent Brochard, Laurent Suppan, Aissam Lyazidi, François Templier, Abdo Khoury, Stephane Delisle, Dominique Savary, Jean-Christophe Richard
BACKGROUND: Recommendations regarding ventilation during cardiopulmonary resuscitation (CPR) are based on a low level of scientific evidence. We hypothesized that practices about ventilation during CPR might be heterogeneous and may differ worldwide. To address this question, we surveyed physicians from several countries on their practices during CPR. METHODS: We used a Web-based opinion survey. Links to the survey were sent by e-mail newsletters and displayed on the Web sites of medical societies involved in CPR practice from December 2013 to March 2014...
May 8, 2018: Respiratory Care
https://www.readbyqxmd.com/read/29739430/relax-restricted-versus-liberal-positive-end-expiratory-pressure-in-patients-without-ards-protocol-for-a-randomized-controlled-trial
#10
Anna Geke Algera, Luigi Pisani, Dennis C J Bergmans, Sylvia den Boer, Corianne A J de Borgie, Frank H Bosch, Karina Bruin, Thomas G Cherpanath, Rogier M Determann, Arjen M Dondorp, Dave A Dongelmans, Henrik Endeman, Jasper J Haringman, Janneke Horn, Nicole P Juffermans, David M van Meenen, Nardo J van der Meer, Maruschka P Merkus, Hazra S Moeniralam, Ilse Purmer, Pieter Roel Tuinman, Mathilde Slabbekoorn, Peter E Spronk, Alexander P J Vlaar, Marcelo Gama de Abreu, Paolo Pelosi, Ary Serpa Neto, Marcus J Schultz, Frederique Paulus
BACKGROUND: Evidence for benefit of high positive end-expiratory pressure (PEEP) is largely lacking for invasively ventilated, critically ill patients with uninjured lungs. We hypothesize that ventilation with low PEEP is noninferior to ventilation with high PEEP with regard to the number of ventilator-free days and being alive at day 28 in this population.  METHODS/DESIGN: The "REstricted versus Liberal positive end-expiratory pressure in patients without ARDS" trial (RELAx) is a national, multicenter, randomized controlled, noninferiority trial in adult intensive care unit (ICU) patients with uninjured lungs who are expected not to be extubated within 24 h...
May 9, 2018: Trials
https://www.readbyqxmd.com/read/29716909/survival-of-patients-with-severe-acute-respiratory-distress-syndrome-treated-without-extracorporeal-membrane-oxygenation
#11
Sarina K Sahetya, Roy G Brower, R Scott Stephens
BACKGROUND: Case series have reported favorable outcomes with extracorporeal membrane oxygenation (ECMO) in patients with severe acute respiratory distress syndrome. However, those patients were generally young, with few comorbid conditions. OBJECTIVE: To characterize the clinical features and survival rates of patients with severe acute respiratory distress syndrome who met criteria for ECMO but were managed without it. METHODS: Patients who met the study criteria were identified prospectively...
May 2018: American Journal of Critical Care: An Official Publication, American Association of Critical-Care Nurses
https://www.readbyqxmd.com/read/29709437/the-effects-of-an-open-lung-approach-during-one-lung-ventilation-on-postoperative-pulmonary-complications-and-driving-pressure-a-descriptive-multicenter-national-study
#12
Javier Belda, Carlos Ferrando, Ignacio Garutti
OBJECTIVE: Thoracic surgical procedures are associated with an increased risk of postoperative pulmonary complications (PPCs), which seem to be related directly to intraoperative driving pressure. The authors conducted this study to describe the incidence of PPCs in patients in whom an individualized open-lung approach was applied during one-lung ventilation. DESIGN: This was a prospective, multicenter, national descriptive study. SETTING: Thoracic surgery patients undergoing one-lung ventilation...
March 27, 2018: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29708892/continuous-negative-abdominal-pressure-reduces-ventilator-induced-lung-injury-in-a-porcine-model
#13
Takeshi Yoshida, Doreen Engelberts, Gail Otulakowski, Bhushan Katira, Martin Post, Niall D Ferguson, Laurent Brochard, Marcelo B P Amato, Brian P Kavanagh
BACKGROUND: In supine patients with acute respiratory distress syndrome, the lung typically partitions into regions of dorsal atelectasis and ventral aeration ("baby lung"). Positive airway pressure is often used to recruit atelectasis, but often overinflates ventral (already aerated) regions. A novel approach to selective recruitment of dorsal atelectasis is by "continuous negative abdominal pressure." METHODS: A randomized laboratory study was performed in anesthetized pigs...
April 27, 2018: Anesthesiology
https://www.readbyqxmd.com/read/29706811/use-of-neuromuscular-blocking-agents-in-acute-respiratory-distress-syndrome
#14
REVIEW
G Tsai-Nguyen, Ariel M Modrykamien
Acute respiratory distress syndrome is the result of an acute inflammatory response of the lungs, causing severe hypoxemia. A variety of therapeutic modalities have been extensively studied, with only a few demonstrating improvement in survival. Specifically, mechanical ventilation with use of low tidal volumes, prone positioning, and treatment with neuromuscular blocking agents have proven beneficial. This article focuses on the utilization of neuromuscular blocking agents in this entity. In particular, we briefly review the mechanism of action of neuromuscular blockades, the latest published evidence supporting their use in acute respiratory distress syndrome, and current recommendations for their utilization in clinical practice...
April 2018: Proceedings of the Baylor University Medical Center
https://www.readbyqxmd.com/read/29702974/case-report-of-the-successful-treatment-of-lung-injury-caused-by-occupational-exposure-to-methyl-chloroformate-and-literature-review
#15
Jiayi Zhao, Rong Chai, Yiping Han, Jing Sheng, Chong Bai, Haidong Huang
BACKGROUND: The treatment of acute lung injuries caused by the inhalation of methyl chloroformate remains a difficult clinical problem, with a poor prognosis and a high mortality. CASE PRESENTATION: After inhalation injuries from methyl chloroformate poisoning, bronchoscopy plays an important role in the diagnosis and treatment of patients. A low tidal air volume and earlier application of steroids are also essential for successful treatment. The grading of acute exposure guideline levels (AEGLs) can direct the selection of a therapeutic regimen for patients with methyl chloroformate poisoning...
April 2018: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29694993/new-ventilator-strategies-high-frequency-oscillatory-ventilation-combined-with-volume-guarantee
#16
M Sánchez-Luna, N González-Pacheco, J Belik, M Santos, F Tendillo
High-frequency oscillatory ventilation (HFOV) has been proposed as an alternative method of invasive ventilation in immature infants to prevent ventilator lung injury. To better control the size of the high-frequency tidal volume and to prevent large tidal volumes, a new strategy of controlling the tidal volume during HFOV (VThf) has been developed, HFOV-volume guarantee (VG). Data from preclinical, neonatal animal studies in normal and surfactant-depleted lungs have demonstrated the feasibility of this technique to directly control the VThf in the normal compliance and low compliance situations...
May 2018: American Journal of Perinatology
https://www.readbyqxmd.com/read/29692886/what-are-the-optimum-components-in-a-care-bundle-aimed-at-reducing-post-operative-pulmonary-complications-in-high-risk-patients
#17
Sophie V Griffiths, Daniel H Conway, Michael Sander, Ib Jammer, Michael P W Grocott, Ben C Creagh-Brown
Background: Post-operative pulmonary complications (POPC) are common, predictable and associated with increased morbidity and mortality, independent of pre-operative risk. Interventions to reduce the incidence of POPC have been studied individually, but the use of a care bundle has not been widely investigated. The purpose of our work was to use Delphi consensus methodology and an independently chosen expert panel to formulate a care bundle for patients identified as being at high of POPC, as preparation towards an evaluation of its effectiveness at reducing POPC...
2018: Perioperative Medicine
https://www.readbyqxmd.com/read/29691422/pulmonary-effects-of-adjusting-tidal-volume-to-actual-or-ideal-body-weight-in-ventilated-obese-mice
#18
Elise Guivarch, Guillaume Voiriot, Anahita Rouzé, Stéphane Kerbrat, Jeanne Tran Van Nhieu, Philippe Montravers, Bernard Maitre, Armand Mekontso Dessap, Mathieu Desmard, Jorge Boczkowski
Obese patients could be more susceptible to mechanical ventilation (MV)-induced lung injury than non-obese patients due to weight-dependent changes in lung properties. The aim of this study was therefore to evaluate the pulmonary effects of 2 hours low VT MV in a diet-induced obese mice model, with VT calculated on either the actual body weight (VT aw) or the ideal body weight (VT iw) . First, we hypothesized that a MV with VT aw would be associated with altered lung mechanics and an increased lung inflammation...
April 24, 2018: Scientific Reports
https://www.readbyqxmd.com/read/29688788/respiratory-effects-of-low-versus-high-tidal-volume-with-or-without-positive-end-expiratory-pressure-in-anesthetized-dogs-with-healthy-lungs
#19
Valentina De Monte, Antonello Bufalari, Salvatore Grasso, Fabienne Ferrulli, Alberto Maria Crovace, Luca Lacitignola, Francesco Staffieri
OBJECTIVE To evaluate the impact of 2 tidal volumes (TV s) with or without positive end-expiratory pressure (PEEP) on lung mechanics, aeration, and gas exchange in healthy anesthetized dogs. ANIMALS 40 mixed-breed dogs with healthy lungs. PROCEDURES Anesthetized dogs were randomly assigned to 4 groups (n = 10/group) with different ventilatory settings: TV of 8 mL/kg and PEEP of 0 cm H2 O (low TV group), TV of 8 mL/kg and PEEP of 5 cm H2 O (low TV plus PEEP group), TV of 15 mL/kg and PEEP of 0 cm H2 O (high TV group), or TV of 15 mL/kg and PEEP of 5 cm H2 O (high TV plus PEEP group)...
May 2018: American Journal of Veterinary Research
https://www.readbyqxmd.com/read/29686542/factors-among-patients-receiving-prone-positioning-for-the-acute-respiratory-distress-syndrome-found-useful-for-predicting-mortality-in-the-intensive-care-unit
#20
Ariel M Modrykamien, Yahya Daoud
Optimal mechanical ventilation management in patients with the acute respiratory distress syndrome (ARDS) involves the use of low tidal volumes and limited plateau pressure. Refractory hypoxemia may not respond to this strategy, requiring other interventions. The use of prone positioning in severe ARDS resulted in improvement in 28-day survival. To determine whether mechanical ventilation strategies or other parameters affected survival in patients undergoing prone positioning, a retrospective analysis was conducted of a consecutive series of patients with severe ARDS treated with prone positioning...
January 2018: Proceedings of the Baylor University Medical Center
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