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Ventilation in COPD

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https://www.readbyqxmd.com/read/28729471/hypoxic-vascular-response-and-ventilation-perfusion-matching-in-end-stage-copd-may-depend-on-p22phox
#1
Chandran Nagaraj, Christoph Tabeling, Bence M Nagy, Pritesh P Jain, Leigh M Marsh, Rita Papp, Michael Pienn, Martin Witzenrath, Bahil Ghanim, Walter Klepetko, E Kenneth Weir, Stefan Heschl, Grazyna Kwapiszewska, Andrea Olschewski, Horst Olschewski
Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease in which the amount of emphysema and airway disease may be very different between individuals, even in end-stage disease. Emphysema formation may be linked to the involvement of the small pulmonary vessels. The NAPDH oxidase (Nox) family is emerging as a key disease-related factor in vascular diseases, but currently its role in hypoxia-induced pulmonary remodelling in COPD remains unclear.Here we investigate the role of p22phox, a regulatory subunit of Nox, in COPD lungs, hypoxic pulmonary vasoconstriction (HPV), hypoxia-induced pulmonary vascular remodelling and pulmonary hypertension...
July 2017: European Respiratory Journal: Official Journal of the European Society for Clinical Respiratory Physiology
https://www.readbyqxmd.com/read/28721033/interfaces-and-ventilator-settings-for-long-term-noninvasive-ventilation-in-copd-patients
#2
Jens Callegari, Friederike Sophie Magnet, Steven Taubner, Melanie Berger, Sarah Bettina Schwarz, Wolfram Windisch, Jan Hendrik Storre
INTRODUCTION: The establishment of high-intensity (HI) noninvasive ventilation (NIV) that targets elevated PaCO2 has led to an increase in the use of long-term NIV to treat patients with chronic hypercapnic COPD. However, the role of the ventilation interface, especially in more aggressive ventilation strategies, has not been systematically assessed. METHODS: Ventilator settings and NIV compliance were assessed in this prospective cross-sectional monocentric cohort study of COPD patients with pre-existing NIV...
2017: International Journal of Chronic Obstructive Pulmonary Disease
https://www.readbyqxmd.com/read/28719228/successful-use-of-noninvasive-ventilation-in-chronic-obstructive-pulmonary-disease-how-do-high-performing-hospitals-do-it
#3
Kimberly A Fisher, Kathleen M Mazor, Sarah Goff, Mihaela S Stefan, Penelope S Pekow, Lauren A Williams, Vida Rastegar, Michael B Rothberg, Nicholas S Hill, Peter K Lindenauer
RATIONALE: Noninvasive ventilation (NIV) is a cornerstone of treatment for patients with severe exacerbations of chronic obstructive pulmonary disease (COPD) where it has been shown to reduce the need for intubation, hospital length of stay, and mortality. Despite high quality evidence and strong recommendations in clinical guidelines, use of NIV varies widely across hospitals. OBJECTIVE: To identify approaches used by hospitals which have been successful in implementing NIV to treat patients with severe exacerbations of COPD...
July 18, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28711381/effectiveness-assessment-of-a-guideline-based-protocol-for-ventilatory-support-management-of-copd-exacerbations-in-an-emergency-department
#4
Franciele Plachi, Fernando Nataniel Vieira, Danilo Cortozi Berton, Marli Knorst, Alexandre Simões Dias, Fernanda Machado Balzan
OBJECTIVES: To investigate clinical outcomes according to ventilatory support indication in subjects with chronic obstructive pulmonary disease exacerbation in a "real-life" Emergency Department and to analyze potential predictors of successful noninvasive positive pressure ventilation. METHODS: Retrospective cohort performed over an 18-month period, comparing the following patient groups with chronic obstructive pulmonary disease exacerbation: Group A composed of patients initially selected to receive noninvasive positive pressure ventilation without the subsequent need for invasive mechanical ventilation (successful-noninvasive positive pressure ventilation); Group B composed of patients transitioning from noninvasive positive pressure ventilation to invasive mechanical ventilation (failed-noninvasive positive pressure ventilation); and Group C composed of patients who presented with immediate need for invasive mechanical ventilation (without prior noninvasive positive pressure ventilation)...
July 5, 2017: Brazilian Journal of Physical Therapy
https://www.readbyqxmd.com/read/28707030/-update-acute-hypercapnic-respiratory-failure
#5
REVIEW
F Seiler, F C Trudzinski, M Kredel, C Lotz, P M Lepper, R M Muellenbach
BACKGROUND: Hypercapnic respiratory failure is a frequent problem in critical care and mainly affects patients with acute exacerbation of COPD (AECOPD) and acute respiratory distress syndrome (ARDS). In recent years, the usage of extracorporeal CO2 removal (ECCO2R) has been increasing. OBJECTIVE: Summarizing the state of the art in the management of hypercapnic respiratory failure with special regard to the role of ECCO2R. METHODS: Review based on a selective literature search and the clinical and scientific experience of the authors...
July 13, 2017: Medizinische Klinik, Intensivmedizin und Notfallmedizin
https://www.readbyqxmd.com/read/28702957/non-invasive-ventilation-for-the-management-of-acute-hypercapnic-respiratory-failure-due-to-exacerbation-of-chronic-obstructive-pulmonary-disease
#6
REVIEW
Christian R Osadnik, Vanessa S Tee, Kristin V Carson-Chahhoud, Joanna Picot, Jadwiga A Wedzicha, Brian J Smith
BACKGROUND: Non-invasive ventilation (NIV) with bi-level positive airway pressure (BiPAP) is commonly used to treat patients admitted to hospital with acute hypercapnic respiratory failure (AHRF) secondary to an acute exacerbation of chronic obstructive pulmonary disease (AECOPD). OBJECTIVES: To compare the efficacy of NIV applied in conjunction with usual care versus usual care involving no mechanical ventilation alone in adults with AHRF due to AECOPD. The aim of this review is to update the evidence base with the goals of supporting clinical practice and providing recommendations for future evaluation and research...
July 13, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28694199/initiation-of-non-invasive-ventilation-for-sleep-related-hypoventilation-disorders-advanced-modes-and-devices
#7
REVIEW
Bernardo J Selim, Lisa Wolfe, John M Coleman, Naresh Dewan
Although non-invasive ventilation (NIV) has been used since the 1960's in the polio epidemic, the development of modern bilevel PAP devices did not become a reality until the 1990's. Over the last 25 years bilevel PAP technology options have exponentially increased. The number of patients receiving this treatment both in the acute setting as well as at home is steadily growing. However, a knowledge gap exists in the way these device settings are adjusted to achieve synchrony and match patient's unique respiratory failure physiology...
July 7, 2017: Chest
https://www.readbyqxmd.com/read/28679605/discontinuing-noninvasive-ventilation-in-severe-chronic-obstructive-pulmonary-disease-exacerbations-a-randomised-controlled-trial
#8
Jacobo Sellares, Miquel Ferrer, Antonio Anton, Hugo Loureiro, Carolina Bencosme, Rodrigo Alonso, Pilar Martinez-Olondris, Javier Sayas, Patricia Peñacoba, Antoni Torres
We assessed whether prolongation of nocturnal noninvasive ventilation (NIV) after recovery from acute hypercapnic respiratory failure (AHRF) in chronic obstructive pulmonary disease (COPD) patients with NIV could prevent subsequent relapse of AHRF.A randomised controlled trial was performed in 120 COPD patients without previous domiciliary ventilation, admitted for AHRF and treated with NIV. When the episode was resolved and patients tolerated unassisted breathing for 4 h, they were randomly allocated to receive three additional nights of NIV (n=61) or direct NIV discontinuation (n=59)...
July 2017: European Respiratory Journal: Official Journal of the European Society for Clinical Respiratory Physiology
https://www.readbyqxmd.com/read/28665692/excess-ventilation-in-copd-heart-failure-overlap-implications-for-dyspnea-and-exercise-intolerance
#9
Alcides Rocha, Flavio F Arbex, Priscilla A Sperandio, Aline Souza, Ligia Biazzim, Frederico Mancuso, Danilo C Berton, Bruno Hochhegger, Maria Clara N Alencar, Luiz E Nery, Denis E O'Donnell, J Alberto Neder
BACKGROUND: An increased ventilatory response to exertional metabolic demand (high ventilation (⩒E)-carbon dioxide output (⩒CO2) relationship) is a common finding in patients with coexistent COPD-heart failure. We aimed to determine the mechanisms underlying high ⩒E-⩒CO2 and its impact on operating lung volumes, dyspnea and exercise tolerance in these patients. METHODS: Twenty-two ex-smokers with combined COPD and heart failure with reduced left ventricular ejection fraction (LVEF) undertook, after careful treatment optimization, a progressive cycle exercise test with capillary (c) blood gas collection...
June 30, 2017: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28645458/pulmonary-3-he-magnetic-resonance-imaging-biomarkers-of-regional-airspace-enlargement-in-alpha-1-antitrypsin-deficiency
#10
Eric Lessard, Heather M Young, Anurag Bhalla, Damien Pike, Khadija Sheikh, David G McCormack, Alexei Ouriadov, Grace Parraga
RATIONALE AND OBJECTIVES: Thoracic x-ray computed tomography (CT) and hyperpolarized (3)He magnetic resonance imaging (MRI) provide quantitative measurements of airspace enlargement in patients with emphysema. For patients with panlobular emphysema due to alpha-1 antitrypsin deficiency (AATD), sensitive biomarkers of disease progression and response to therapy have been difficult to develop and exploit, especially those biomarkers that correlate with outcomes like quality of life. Here, our objective was to generate and compare CT and diffusion-weighted inhaled-gas MRI measurements of emphysema including apparent diffusion coefficient (ADC) and MRI-derived mean linear intercept (Lm) in patients with AATD, chronic obstructive pulmonary disease (COPD) ex-smokers, and elderly never-smokers...
June 20, 2017: Academic Radiology
https://www.readbyqxmd.com/read/28636452/epidemiology-of-niv-for-acute-respiratory-failure-in-copd-patients-results-from-the-international-surveys-vs-the-real-world
#11
Aylin Ozsancak Ugurlu, Mehmet Ali Habesoglu
Non-invasive ventilation (NIV) has been recommended as the  first-line ventilation modality for acute respiratory failure (ARF) due to acute exacerbation of chronic obstructive pulmonary disease (AECOPD) based on strong evidence. However, everyday clinical practice may differ from findings of multiple randomized controlled trials. Physicians and respiratory therapists involved in NIV management have been queried about its utilization and effectiveness. In addition to these estimates, cohort studies and analysis of large inpatient dataset of patients with AECOPD and ARF managed with NIV have been extensively published over the last two decades...
June 21, 2017: COPD
https://www.readbyqxmd.com/read/28635909/-chronic-obstructive-pulmonary-disease-concurrent-with-metabolic-syndrome-pathophysiological-and-clinical-features
#12
A V Budnevsky, E S Ovsyannikov, N B Labzhania
Chronic obstructive pulmonary disease (COPD) still remains a serious public health problem, which is a common cause of disability and death in the able-bodied population. Furthermore, the number of patients with metabolic syndrome (MS) is steadily increasing worldwide. Recently, there is also an increase in the number of patients with COPD concurrent with MS, which is a mutually confounding risk factor for concomitant cardiovascular disease and adversely affects prognosis in these patients. Systemic subclinical inflammation is a common link between COPD and the components of MS...
2017: Terapevticheskiĭ Arkhiv
https://www.readbyqxmd.com/read/28627376/inhaled-salbutamol-dose-delivered-by-jet-nebulizer-vibrating-mesh-nebulizer-and-metered-dose-inhaler-with-spacer-during-invasive-mechanical-ventilation
#13
Muhammad E ElHansy, Marina Emad, Assem Fouad Mohamed El Essawy, Mohamed Bakry Al-Kholy, Maha M Abdelrahman, Amira S A Said, Raghda R S Hussein, Mohamed E Abdelrahim
BACKGROUND: Patient receiving invasive mechanical ventilation (IMV) may benefit from medical aerosol, but guidance on dosing with different aerosol devices is limited to in-vitro studies. The study was designed to compare aerosol delivery with five different types of aerosol generators during IMV. METHOD: In randomized design, 60 (30 female) mechanically ventilated chronic obstructive pulmonary disease (COPD) patients were assigned to one of 5 groups. Groups 1-4 received 5000 μg salbutamol using Aerogen Pro (PRO), Aerogen Solo (SOLO), NIVO vibrating mesh and jet nebulizers (JN), respectively, while group 5 received 800 μg (8 puffs) of salbutamol via metered dose inhaler with AeroChamber-MV (MDI-AC)...
June 13, 2017: Pulmonary Pharmacology & Therapeutics
https://www.readbyqxmd.com/read/28623885/monitoring-the-electric-activity-of-the-diaphragm-during-noninvasive-positive-pressure-ventilation-a-case-report
#14
Fabia Diniz-Silva, Anna Miethke-Morais, Adriano M Alencar, Henrique T Moriya, Pedro Caruso, Eduardo L V Costa, Juliana C Ferreira
BACKGROUND: In patients with post-extubation respiratory distress, delayed reintubation may worsen clinical outcomes. Objective measures of extubation failure at the bedside are lacking, therefore clinical parameters are currently used to guide the need of reintubation. Electrical activity of the diaphragm (EAdi) provides clinicians with valuable, objective information about respiratory drive and could be used to monitor respiratory effort. CASE PRESENTATION: We describe the case of a patient with Chronic Obstructive Pulmonary Disease (COPD), from whom we recorded EAdi during four different ventilatory conditions: 1) invasive mechanical ventilation, 2) spontaneous breathing trial (SBT), 3) unassisted spontaneous breathing, and 4) Noninvasive Positive Pressure Ventilation (NPPV)...
June 17, 2017: BMC Pulmonary Medicine
https://www.readbyqxmd.com/read/28622013/acetazolamide-use-in-severe-chronic-obstructive-pulmonary-disease-pros-and-cons
#15
Rosemary Adamson, Erik R Swenson
Acetazolamide is a carbonic anhydrase (CA) inhibitor sometimes used as a respiratory stimulant for patients with chronic obstructive pulmonary disease (COPD) with the goal of improving oxygenation, reducing carbon dioxide retention, and aiding liberation from mechanical ventilation and/or attempting to correct a metabolic alkalosis. However, the net effect of CA inhibition is multifactorial and complex, because CA is inhibited in many tissues that may negatively affect the patient with lung disease. The full impact of acetazolamide and other CA inhibitors depends critically on dosing, age, and pulmonary, renal, hepatic, hematological, and respiratory muscle function and reserves...
July 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28618112/older-patients-with-late-stage-copd-their-illness-experiences-and-involvement-in-decision-making-regarding-mechanical-ventilation-and-noninvasive-ventilation
#16
Heidi Jerpseth, Vegard Dahl, Per Nortvedt, Kristin Halvorsen
Older patients with late-stage COPD: their illness experiences and involvement in decision-making regarding mechanical ventilation and noninvasive ventilation AIMS AND OBJECTIVES: The aim of this study was twofold: first, to explore the illness experiences of older patients' with late-stage chronic obstructive pulmonary disease; and second, to develop knowledge about how patients perceive their preferences to be taken into account in decision-making processes concerning mechanical ventilation and /or non-invasive ventilation...
June 15, 2017: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/28615935/serum-inflammatory-biomarkers-and-clinical-outcomes-of-copd-exacerbation-caused-by-different-pathogens
#17
Theerasuk Kawamatawong, Apitch Apiwattanaporn, Warisara Siricharoonwong
BACKGROUND AND OBJECTIVE: COPD exacerbation is characterized by worsening of symptoms, warranting change in treatment. Systemic and airway inflammation play roles in the pathogenesis of COPD exacerbation. We hypothesized whether increased serum inflammatory biomarkers are associated with the clinical outcomes of COPD exacerbation caused by different infectious pathogens. METHODS: COPD patients with exacerbation were recruited from a hospital emergency department during 2014-2015...
2017: International Journal of Chronic Obstructive Pulmonary Disease
https://www.readbyqxmd.com/read/28615933/development-of-a-nomogram-for-predicting-in-hospital-mortality-of-patients-with-exacerbation-of-chronic-obstructive-pulmonary-disease
#18
Yukiyo Sakamoto, Yasuhiro Yamauchi, Hideo Yasunaga, Hideyuki Takeshima, Wakae Hasegawa, Taisuke Jo, Yusuke Sasabuchi, Hiroki Matsui, Kiyohide Fushimi, Takahide Nagase
BACKGROUND AND OBJECTIVES: Patients with chronic obstructive pulmonary disease (COPD) often experience exacerbations of their disease, sometimes requiring hospital admission and being associated with increased mortality. Although previous studies have reported mortality from exacerbations of COPD, there is limited information about prediction of individual in-hospital mortality. We therefore aimed to use data from a nationwide inpatient database in Japan to generate a nomogram for predicting in-hospital mortality from patients' characteristics on admission...
2017: International Journal of Chronic Obstructive Pulmonary Disease
https://www.readbyqxmd.com/read/28615117/impact-of-copd-on-outcomes-in-hospitalized-patients-with-community-acquired-pneumonia-analysis-of-the-spanish-national-hospital-discharge-database-2004-2013
#19
Javier de Miguel-Díez, Ana López-de-Andrés, Valentín Hernández-Barrera, Isabel Jiménez-Trujillo, Manuel Méndez-Bailón, José M de Miguel-Yanes, Rodrigo Jiménez-García
AIM: To examine trends in incidence and outcomes of community-acquired pneumonia (CAP) hospitalizations among patients with or without COPD in Spain (2004-2013). METHODS: We used national hospital discharge data to select all hospital admissions for CAP. Incidence was calculated overall and according to the presence or absence of COPD. RESULTS: We identified 901,136 hospital admissions for CAP (32.25% with COPD). Incidence of hospitalizations of CAP increased significantly over time among patients with and without COPD, but it was higher among people with COPD for all years analyzed...
June 11, 2017: European Journal of Internal Medicine
https://www.readbyqxmd.com/read/28613389/continuous-non-invasive-pco2-monitoring-in-weaning-patients-transcutaneous-is-advantageous-over-end-tidal-pco2
#20
Sarah B Schwarz, Wolfram Windisch, Friederike S Magnet, Claudia Schmoor, Christian Karagiannidis, Jens Callegari, Sophie E Huttmann, Jan H Storre
BACKGROUND AND OBJECTIVE: Continuous partial pressure of carbon dioxide (PCO2 ) assessment is essential for the success of mechanical ventilation (MV). Non-invasive end-tidal PCO2 (PetCO2 ) and transcutaneous PCO2 (PtcCO2 ) measurements serve as alternatives to the gold standard arterial PCO2 (PaCO2 ) method, but their eligibility in critical care is unclear. METHODS: The present study therefore performed methodological comparisons of PaCO2 versus PetCO2 and PtcCO2 , respectively, in weaning patients receiving invasive MV via tracheal cannulas...
June 14, 2017: Respirology: Official Journal of the Asian Pacific Society of Respirology
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