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physiology of pleural space

Stephen H Loring, George P Topulos, Rolf D Hubmayr
Recent studies applying the principles of respiratory mechanics to respiratory disease have used inconsistent and mutually exclusive definitions of the term "transpulmonary pressure." By the traditional definition, transpulmonary pressure is the pressure across the whole lung, including the intrapulmonary airways, (i.e., the pressure difference between the opening to the pulmonary airway and the pleural surface). However, more recently transpulmonary pressure has also been defined as the pressure across only the lung tissue (i...
December 15, 2016: American Journal of Respiratory and Critical Care Medicine
Helen Williams
It is proposed that negative central nervous system (CNS) pressure is one of the filling mechanisms of the fluid spaces of the CNS. Negative CNS pressure is caused by the combination of gravitational force and body movement. The venous system imposes pressure fluctuations on the CNS due to changes in posture and body cavity pressure. It is proposed here that filling of veins, arteries and cerebrospinal (CSF) spaces are all assisted by negative CNS pressure. Hyperemia in the CNS in response to pressure changes with movement was described in the first part of this hypothesis...
September 2016: Medical Hypotheses
Giancarlo Gargano, Anna Lucia Paltrinieri, Claudio Gallo, Luciana Di Pancrazio, Maria Federica Roversi, Fabrizio Ferrari
BACKGROUND: Thymic enlargement is a common and physiological finding in children and neonates' X-rays, but it is usually asymptomatic. Occasionally it can cause respiratory distress. In most cases the aetiology of this expansion remains unclear and it is diagnosed as a thymic hyperplasia. True thymic hyperplasia is defined as a gland expansion, both in size and weight, while maintaining normal microscopic architecture. Often it is a diagnosis of exclusion and prognosis is good. Thymic haemorrhage is an unusual condition related to high foetal and neonatal mortality...
2015: Italian Journal of Pediatrics
Jonathan Strutt, Anupam Kharbanda
Pediatric thoracostomy procedures are used in the emergency department to treat diseases of the pleural space. As children have unique thoracic anatomy and physiology, they may present with management challenges that the emergency clinician must consider. This issue reviews the use of chest tubes and pigtail catheters in pediatric patients, techniques and indications for placement, and possible complications. Diagnostic and treatment options for diseases of the pleural space, such as spontaneous pneumothorax, traumatic injury, and parapneumonic effusions/empyema, are examined...
November 2015: Pediatric Emergency Medicine Practice
Georg F Weber
BACKGROUND: Infectious diseases of the airways are a major health care problem world wide. New treatment strategies focus on employing the body's immune system to enhance its protective capacities during airway disease. One source for immune-competent cells is the pleural space, however, its immune-physiological function remains poorly understood. The aim of this study was to develop an experimental technique in rodents that allows for an in vivo analysis of pleural space immune cells participating in the host defense during airway disease...
2015: BMC Pulmonary Medicine
Georg F Weber
BACKGROUND: Infectious diseases of the airways are a major health care problem world wide. New treatment strategies focus on employing the body's immune system to enhance its protective capacities during airway disease. One source for immune-competent cells is the pleural space, however, its immune-physiological function remains poorly understood. The aim of this study was to develop an experimental technique in rodents that allows for an in vivo analysis of pleural space immune cells participating in the host defense during airway disease...
December 2015: BMC Pulmonary Medicine
Charalampos Charalampidis, Andrianna Youroukou, George Lazaridis, Sofia Baka, Ioannis Mpoukovinas, Vasilis Karavasilis, Ioannis Kioumis, Georgia Pitsiou, Antonis Papaiwannou, Anastasia Karavergou, Kosmas Tsakiridis, Nikolaos Katsikogiannis, Eirini Sarika, Konstantinos Kapanidis, Leonidas Sakkas, Ipokratis Korantzis, Sofia Lampaki, Konstantinos Zarogoulidis, Paul Zarogoulidis
The pleural cavity is created between the 4(th) and 7(th) week of embryologic development. These embryonic components of visceral and parietal pleurae develop different anatomic characteristics with regard to vascular, lymphatic, and nervous supply. There are two layers: a superficial mesothelial cell layer facing the pleural space and an underlying connective tissue layer. The pleura might present inflammatory response and maintenance of the pleural fluid is observed. The latter function is especially important in the mechanical coupling of the lung and chest wall...
February 2015: Journal of Thoracic Disease
Michael Klopp, Hans Hoffmann, Hendrik Dienemann
A chest tube is used to drain the contents of the pleural space to reconstitute the physiologic pressures within the pleural space and to allow the lungs to fully expand. Indications for chest tube placement include pneumothorax, hemothorax, pleural effusion, pleural empyema, and major thoracic surgery. The most appropriate site for chest tube placement is the 4th or 5th intercostal space in the mid- or anterior- axillary line. Attention to technique in placing the chest tube is vital to avoid complications from the procedure...
March 2015: Deutsche Medizinische Wochenschrift
Alexander G Markov, Salah Amasheh
Pleura consists of visceral and parietal cell layers, producing a fluid, which is necessary for lubrication of the pleural space. Function of both mesothelial cell layers is necessary for the regulation of a constant pleural fluid volume and composition to facilitate lung movement during breathing. Recent studies have demonstrated that pleural mesothelial cells show a distinct expression pattern of tight junction proteins which are known to ubiquitously determine paracellular permeability. Most tight junction proteins provide a sealing function to epithelia, but some have been shown to have a paracellular channel function or ambiguous properties...
2014: Frontiers in Physiology
Muhammad Zaman Khan Assir, Malik M Faheem, Jorge A Brenes-Salazar, Tariq Waseem
We report a case of paradoxical respiratory sinus arrhythmia (PRSA) caused by a retro-cardiac empyema in an ambulatory patient. The case describes the dynamics and deleterious impact of PRSA on cardio-respiratory cycle, its electrocardiographic, radiologic and echocardiographic findings. Furthermore, it discusses a probable mechanism of paradoxical respiratory sinus arrhythmia in the setting of a retrocardiac mass and suggests a need for physicians to check for the changes in ventilation perfusion mismatch and rise in physiological dead space in such patients...
October 2014: Autonomic Neuroscience: Basic & Clinical
Chien-Wei Hsu, Shu-Fen Sun
Pneumothorax is a potentially lethal complication associated with mechanical ventilation. Most of the patients with pneumothorax from mechanical ventilation have underlying lung diseases; pneumothorax is rare in intubated patients with normal lungs. Tension pneumothorax is more common in ventilated patients with prompt recognition and treatment of pneumothorax being important to minimize morbidity and mortality. Underlying lung diseases are associated with ventilator-related pneumothorax with pneumothoraces occurring most commonly during the early phase of mechanical ventilation...
February 4, 2014: World Journal of Critical Care Medicine
James D Tutor
Chylothorax, the accumulation of chyle in the pleural space, is a relatively rare cause of pleural effusion in children. It can cause significant respiratory morbidity, as well as lead to malnutrition and immunodeficiency. Thus, a chylothorax requires timely diagnosis and treatment. This review will first discuss the anatomy and physiology of the lymphatic system and discuss various causes that can lead to development of a chylothorax in infants and children. Then, methods of diagnosis and treatment will be reviewed...
April 2014: Pediatrics
Sundar Chidambaram, Venkatesan Sangareddi, Gnanavelu Ganesan, V E Dhandapani, M S Ravi, K Meenakshi, D Muthukumar, N Swaminathan, G Ravishankar
BACKGROUND: The close relationship between pleural space and pericardial space and the dependence of their pressure kinetics are well known. This study evaluates the effects of increased intra pleural pressure due to pleural effusion on cardiovascular system. METHODS: Forty patients above the age of 12 who had massive unilateral/bilateral pleural effusion due to non-cardiac etiology were included in the study. Therapeutic thoracocentesis was done for massive pleural effusion...
December 2013: Indian Heart Journal
K-U Schmitt, M Walti, O Schälli, E Styger, T Prud'homme
BACKGROUND: A simulator of the respiratory system which includes the pleural space is currently lacking. However, such mechanical models are essential to develop and test new medical devices regulating the pressure in the pleural space. OBJECTIVE: It was the aim of this study to develop a model which mimics the pleural space. The device should be able to represent biomechanical functions of the respiratory system and it is intended for applications in research and development to study pleural space mechanics...
2013: Technology and Health Care: Official Journal of the European Society for Engineering and Medicine
M Ismail, A Comerford, W A Wall
In this paper, we develop a total lung model based on a tree of 0D airway and acinar models for studying respiratory mechanics during spontaneous breathing. This model utilizes both computer tomography-based geometries and artificially generated lobe-filling airway trees to model the entire conducting region of the lung. Beyond the conducting airways, we develop an acinar model, which takes into account the alveolar tissue resistance, compliance, and the intrapleural pressure. With this methodology, we compare four different 0D models of airway mechanics and determine the best model based on a comparison with a 3D-0D coupled model of the conducting airways; this methodology is possible because the majority of airway resistance is confined to the lower generations, that is, the trachea and the first few bronchial generations...
November 2013: International Journal for Numerical Methods in Biomedical Engineering
Nancy Biegler, Paul B McBeth, Martha C Tevez-Molina, Janelle McMillan, Innes Crawford, Douglas R Hamilton, Andrew W Kirkpatrick
PURPOSE: Remote telementored ultrasound (RTMUS) is a new discipline that allows a remote expert to guide variably experienced clinical responders through focused ultrasound examinations. We used the examination of the pleural spaces after tube thoracostomy (TT) removal by a nurse with no prior ultrasound experience as an illustrative but highly accurate example of the technique using a simple cost-effective system. MATERIALS AND METHODS: The image outputs of a handheld ultrasound machine and a head-mounted Web camera were input into a customized graphical user interface and streamed over a freely available voice over Internet protocol system that allowed two-way audio and visual communication between the novice examiner and the remote expert...
December 2012: Telemedicine Journal and E-health: the Official Journal of the American Telemedicine Association
C-N Schlürmann, R Schmidt, J Kalbhenn
Intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) may have a significant impact on physiological functions and is therefore a special challenge for anesthetists. In the presented case after opening the parietal pleura during subphrenical peritonectomy the HIPEC solution accidentally leaked into the right hemithorax with subsequent pleural effusion of more than 2,000 ml. After extubation the patient presented with acute oxygen desaturation and orthopnea. Following pleural sonography and chest X-ray in the operating theatre and recovery area, a thorax drainage was inserted into the pleural space and ventilation support was provided by non-invasive continuous positive air pressure (CPAP) ventilation...
November 2012: Der Anaesthesist
Christophe A Dooms, Paul R De Leyn, Jonas Yserbyt, Herbert Decaluwe, Vincent Ninane
An alveolar-pleural fistula is a communication between the pulmonary parenchyma distal to a segmental bronchus and the pleural space. A postoperative pulmonary expiratory air leak after an anatomic pulmonary resection is usually managed conservatively. The use of endobronchial valves is a minimal invasive method that may be effective for the treatment of a persistent postoperative pulmonary air leak. We present and discuss the advantages of a digital thoracic drainage system for the accurate, objective and reproducible air leak assessment during endobronchial valve placement...
2012: Respiration; International Review of Thoracic Diseases
Jeremy R Hogg, Michael Caccavale, Benjamin Gillen, Gavin McKenzie, Jay Vlaminck, Chad J Fleming, Andrew Stockland, Jeremy L Friese
Small-caliber tube thoracostomy is a valuable treatment for various pathologic conditions of the pleural space. Smaller caliber tubes placed under image guidance are becoming increasingly useful in numerous situations, are less painful than larger surgical tubes, and provide more accurate positioning when compared with tubes placed without image guidance. Basic anatomy and physiology of the pleural space, indications, and contraindications of small caliber tube thoracostomy, techniques for image-guided placement, complications and management of tube thoracostomy, and fundamental principles of pleurodesis are discussed in this review...
March 2011: Seminars in Interventional Radiology
Risha Bhatia, Georg M Schmölzer, Peter G Davis, David G Tingay
PURPOSE: Diagnosis of pneumothorax relies on clinical suspicion and chest X-ray, and is often delayed. We aimed to determine whether electrical impedance tomography (EIT) can accurately identify the presence of surgically created pneumothoraces before significant changes in clinical parameters. METHODS: Six anesthetized and muscle-relaxed piglets with surfactant-depleted lungs were studied. Following chest drain insertion into the right ventral chest, 10-20 ml aliquots of air were instilled into the pleural space to a maximum volume of 200 ml...
February 2012: Intensive Care Medicine
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