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ventilator associated lung injury

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https://www.readbyqxmd.com/read/27923979/functional-respiratory-imaging-regional-strain-and-expiratory-time-constants-at-three-levels-of-positive-end-expiratory-pressure-in-an-ex%C3%A2-vivo-pig-model
#1
William R Henderson, Yannick Molgat-Seon, Wim Vos, Rachel Lipson, Francisca Ferreira, Miranda Kirby, Cedric Van Holsbeke, Paolo B Dominelli, Donald E G Griesdale, Mypinder Sekhon, Harvey O Coxson, John Mayo, A William Sheel
Heterogeneity in regional end expiratory lung volume (EELV) may lead to variations in regional strain (ε). High ε levels have been associated with ventilator-associated lung injury (VALI). While both whole lung and regional EELV may be affected by changes in positive end-expiratory pressure (PEEP), regional variations are not revealed by conventional respiratory system measurements. Differential rates of deflation of adjacent lung units due to regional variation in expiratory time constants (τE) may create localized regions of ε that are significantly greater than implied by whole lung measures...
December 2016: Physiological Reports
https://www.readbyqxmd.com/read/27875410/should-we-use-driving-pressure-to-set-tidal-volume
#2
Domenico L Grieco, Lu Chen, Martin Dres, Laurent Brochard
PURPOSE OF REVIEW: Ventilator-induced lung injury (VILI) can occur despite use of tidal volume (VT) limited to 6 ml/kg of predicted body weight, especially in patients with a smaller aerated compartment (i.e. the baby lung) in which, indeed, tidal ventilation takes place. Because respiratory system static compliance (CRS) is mostly affected by the volume of the baby lung, the ratio VT/CRS (i.e. the driving pressure, ΔP) may potentially help tailoring interventions on VT setting. RECENT FINDINGS: Driving pressure is the ventilatory variable most strongly associated with changes in survival and has been shown to be the key mediator of the effects of mechanical ventilation on outcome in the acute respiratory distress syndrome...
November 19, 2016: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/27855271/experimental-lung-injury-reduces-klf2-to-increase-endothelial-permeability-via-regulation-of-rapgef3-rac1-signaling
#3
Ru-Ting Huang, David Wu, Angelo Meliton, Myung-Jin Oh, Matthew Krause, Joyce A Lloyd, Recep Nigdelioglu, Robert B Hamanaka, Mukesh K Jain, Anna Birukova, John P Kress, Konstantin G Birukov, Gökhan M Mutlu, Yun Fang
RATIONALE: The acute respiratory distress syndrome (ARDS) is caused by widespread endothelial barrier disruption and uncontrolled cytokine storm. Genome-wide association studies (GWAS) have linked multiple genes to ARDS. Although mechano-sensitive transcription factor Krüppel-like factor 2 (KLF2) is a major regulator of endothelial function, its role in regulating pulmonary vascular integrity in lung injury and ARDS-associated GWAS genes remains poorly understood. OBJECTIVES: To examine KLF2 expression in multiple animal models of acute lung injury and further elucidate the KLF2-mediated pathways involved in endothelial barrier disruption and cytokine storm in experimental lung injury...
November 17, 2016: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/27836935/extracorporeal-membrane-oxygenation-ecmo-for-lung-injury-in-severe-acute-respiratory-distress-syndrome-ards-review-of-the-literature
#4
Summer Paolone
Despite advances in mechanical ventilation, severe acute respiratory distress syndrome (ARDS) is associated with high morbidity and mortality rates ranging from 26% to 58%. Extracorporeal membrane oxygenation (ECMO) is a modified cardiopulmonary bypass circuit that serves as an artificial membrane lung and blood pump to provide gas exchange and systemic perfusion for patients when their own heart and lungs are unable to function adequately. ECMO is a complex network that provides oxygenation and ventilation and allows the lungs to rest and recover from respiratory failure while minimizing iatrogenic ventilator-induced lung injury...
November 10, 2016: Clinical Nursing Research
https://www.readbyqxmd.com/read/27836209/-extracorporeal-co2-removal-as-life-support-system-for-a-severe-organizing-pneumonia
#5
G Rival, O Millet, G Capellier
INTRODUCTION: Acute lung injuries are usually found in intensive care unit. The diffuse alveolar damage (DAD) is the associated histological pattern and the most severe end-stage of the disease. Organizing pneumonia (OP), for which corticosteroids are the reference therapy, can mimic DAD. While postponing the response to treatment, to limit mechanical ventilation side effects, extracorporeal membrane oxygene can be proposed. We present a case of a severe OP for which extracorporeal CO2 removal (ECCO2R) is used as a bridge to recovery under corticosteroid therapy...
November 8, 2016: Revue de Pneumologie Clinique
https://www.readbyqxmd.com/read/27828898/pediatric-ventilator-associated-infections-the-ventilator-associated-infection-study
#6
Douglas F Willson, Michelle Hoot, Robinder Khemani, Christopher Carrol, Aileen Kirby, Adam Schwarz, Rainer Gedeit, Sholeen T Nett, Simon Erickson, Heidi Flori, Spencer Hays, Mark Hall
OBJECTIVE: Suspected ventilator-associated infection is the most common reason for antibiotics in the PICU. We sought to characterize the clinical variables associated with continuing antibiotics after initial evaluation for suspected ventilator-associated infection and to determine whether clinical variables or antibiotic treatment influenced outcomes. DESIGN: Prospective, observational cohort study conducted in 47 PICUs in the United States, Canada, and Australia...
November 8, 2016: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/27787436/mitochondrial-dna-damps-in-ventilator-associated-pneumonia-prevention-and-reversal-by-intratracheal-dnase-i
#7
Jon D Simmons, Daniel R Freno, C Annie Muscat, Boniface Obiako, Yann-Leei L Lee, Viktor M Pastukh, Sidney B Brevard, Mark N Gillespie
INTRODUCTIONS: Previous studies in isolated perfused rat lungs have revealed that endothelial barrier disruption after intra-tracheal administration of pseudomonas aeruginosa (strain 103; PA103) only occurs after accumulation of extracellular mitochondrial DNA (mtDNA) Damage Associated Molecular Patterns (DAMPs) in the perfusate and is suppressed by addition of DNase to the perfusion medium. Herein, we tested the hypothesis that intra-tracheal DNase - a route of administration readily translatable to patient with ventilator-associated pneumonia (VAP) - also enhances degradation of mtDNA and prevents bacteria-induced lung injury...
October 25, 2016: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/27776936/compliance-guided-versus-fio2-driven-positive-end-expiratory-pressure-in-patients-with-moderate-or-severe-acute-respiratory-distress-syndrome-according-to-the-berlin-definition
#8
M-C Pintado, R de Pablo, M Trascasa, J-M Milicua, M Sánchez-García
OBJECTIVE: To study the effect of setting positive end-expiratory pressure (PEEP) in an individualized manner (based on highest static compliance) compared to setting PEEP according to FiO2 upon mortality at 28 and 90 days, in patients with different severity acute respiratory distress syndrome (ARDS). SETTING: A Spanish medical-surgical ICU. DESIGN: A post hoc analysis of a randomized controlled pilot study. PATIENTS: Patients with ARDS...
October 21, 2016: Medicina Intensiva
https://www.readbyqxmd.com/read/27764049/current-trends-in-anesthesia-for-esophagectomy
#9
Chris Durkin, Travis Schisler, Jens Lohser
PURPOSE OF REVIEW: Despite marked improvements in perioperative outcomes, esophagectomy continues to be a high-risk operation associated with significant morbidity and mortality. Progress has been achieved through evidence-based changes in preoperative optimization, intraoperative ventilation strategies, fluid therapy, and analgesia, as well as expedited postoperative recovery pathways. This review will summarize the recent literature on the anesthetic management of patients undergoing esophageal resection...
October 18, 2016: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/27761886/comparison-between-effects-of-pressure-support-and-pressure-controlled-ventilation-on-lung-and-diaphragmatic-damage-in-experimental-emphysema
#10
Gisele de A Padilha, Lucas F B Horta, Lillian Moraes, Cassia L Braga, Milena V Oliveira, Cíntia L Santos, Isalira P Ramos, Marcelo M Morales, Vera Luiza Capelozzi, Regina C S Goldenberg, Marcelo Gama de Abreu, Paolo Pelosi, Pedro L Silva, Patricia R M Rocco
BACKGROUND: In patients with emphysema, invasive mechanical ventilation settings should be adjusted to minimize hyperinflation while reducing respiratory effort and providing adequate gas exchange. We evaluated the impact of pressure-controlled ventilation (PCV) and pressure support ventilation (PSV) on pulmonary and diaphragmatic damage, as well as cardiac function, in experimental emphysema. METHODS: Emphysema was induced by intratracheal instillation of porcine pancreatic elastase in Wistar rats, once weekly for 4 weeks...
December 2016: Intensive Care Medicine Experimental
https://www.readbyqxmd.com/read/27696446/determinants-of-red-blood-cell-transfusion-in-pediatric-trauma-patients-admitted-to-the-intensive-care-unit
#11
Nadia Roumeliotis, Thierry Ducruet, Scot T Bateman, Adrienne G Randolph, Jacques Lacroix, Guillaume Emeriaud
BACKGROUND: There are no well-designed prospective studies evaluating transfusion practices in pediatric trauma. We sought to describe red blood cell (RBC) transfusion practices in trauma patients who were admitted to a pediatric intensive care unit (PICU). STUDY DESIGN AND METHODS: This study is a post-hoc analysis of a prospective, 6-month observational study in 30 PICUs. We studied a total of 580 patients aged less than 18 years who had been admitted to a PICU for more than 48 hours, including 95 who were trauma patients...
October 2, 2016: Transfusion
https://www.readbyqxmd.com/read/27685807/the-role-of-cystathionine-%C3%AE-lyase-in-blunt-chest-trauma-in-cigarette-smoke-exposed-mice
#12
Clair Hartmann, Sebastian Hafner, Angelika Scheuerle, Peter Möller, Markus Huber-Lang, Birgit Jung, Benedikt Nußbaum, Oscar McCook, Michael Gröger, Florian Wagner, Sandra Weber, Bettina Stahl, Enrico Calzia, Michael Georgieff, Csaba Szabó, Rui Wang, Peter Radermacher, Katja Wagner
Pre-traumatic cigarette smoke (CS) exposure aggravates post-traumatic acute lung injury (ALI). Cystathionine-γ-lyase (CSE) protects against ALI and CS exposure-induced chronic obstructive lung disease (COPD). Therefore, we tested the hypothesis whether genetic CSE knockout (CSE) would aggravate post-traumatic ALI after CS exposure. After 3-4 weeks of CS exposure, anesthetized wild type (WT) and CSE mice underwent blunt chest trauma, surgical instrumentation and 4 hours of lung-protective mechanical ventilation...
September 28, 2016: Shock
https://www.readbyqxmd.com/read/27667769/patterns-of-perioperative-thoracic-fluid-indices-changes-in-liver-transplantation-with-or-without-postoperative-acute-lung-injury
#13
Kuang-Cheng Chan, Chun-Yu Wu, Ming-Hui Hung, Po-Huang Lee, Ya-Jung Cheng
BACKGROUND/PURPOSE: Postoperative acute lung injury (ALI) after liver transplantation is clinically relevant and common. The perioperative thoracic fluid indices changes as well as the association with ALI in liver transplantation have not been thoroughly investigated. METHODS: A total of 52 consecutive adult recipients for elective living donor liver transplantation were enrolled. Each recipient received the same perioperative care plan. Thoracic fluid indices, including the cardiac index, intrathoracic blood volume index (ITBVI), extravascular lung water index (EVLWI), and pulmonary vascular permeability index (PVPI), were obtained at seven time points (pretransplantation, anhepatic phase, 30 minutes after reperfusion, 2 hours after reperfusion, and postoperative days 1-3) using the pulse contour cardiac output system...
September 22, 2016: Journal of the Formosan Medical Association, Taiwan Yi Zhi
https://www.readbyqxmd.com/read/27651443/changes-in-therapeutic-intensity-level-following-airway-pressure-release-ventilation-in-severe-traumatic-brain-injury
#14
Jeffrey J Fletcher, Thomas J Wilson, Venkatakrishna Rajajee, Scott B Davidson, Jon C Walsh
PURPOSE: Airway pressure release ventilation (APRV) utilizes high levels of airway pressure coupled with brief expiratory release to facilitate open lung ventilation. The aim of our study was to evaluate the effects of APRV-induced elevated airway pressure mean in patients with severe traumatic brain injury. MATERIALS AND METHODS: This was a retrospective cohort study at a 424-bed Level I trauma center. Linear mixed effects models were developed to assess the difference in therapeutic intensity level (TIL), intracranial pressure (ICP), and cerebral perfusion pressure (CPP) over time following the application of APRV...
September 20, 2016: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/27649710/-extracorporeal-membrane-oxygenation-for-treatment-of-acute-respiratory-failure-in-adults
#15
Charles Marinus Pedersen, Reinhold Jensen, Christian Lindskov
Extracorporeal membrane oxygenation (ECMO) can support gas exchange independently of mechanical ventilation in patients with severe acute respiratory failure. Veno-venous ECMO is a temporary technique for providing life support by pulmonary dysfunction. ECMO should be considered for patients with respiratory failure when they cannot survive with conventional therapy. ECMO may be used either as a rescue therapy or to prevent ventilator-associated lung injury. Exact criteria for ECMO are not available. Transportation while using ECMO is safe when a team from the management centre provides it...
September 19, 2016: Ugeskrift for Laeger
https://www.readbyqxmd.com/read/27631452/-respiratory-and-extracorporeal-lung-support
#16
Christopher Lotz, Norbert Roewer, Ralf M Muellenbach
Mechanical ventilation is the most commonly used form of respiratory support to restore or maintain adequate gas exchange. However, mechanical ventilation does not provide a physiological form of breathing. Neither does it provide an optimal ventilation / perfusion ratio due to passive movement of the diagphragm favoring the non-dependent parts of the lung. Furthermore, patients are in danger of ventilator-associated/induced lung injury (VALI/VILI). Hence, lung protective ventilation is mandatory in patients with an acute respiratory distress syndrome (ARDS) and should likewise be used in the operating room...
September 2016: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
https://www.readbyqxmd.com/read/27608777/predicting-survival-in-ards
#17
EDITORIAL
Niteen D Karnik, Anish V Gupta
Acute respiratory distress syndrome (ARDS) is a fulminant clinical disorder of varied etiology, characterized by diffuse lung injury and severe hypoxemia. It is a leading cause of ICU admission and the associated high mortality has sparked a lot of research on etiology, outcome, scoring systems, mortality predictors, biomarkers including inflammatory cytokines and even genomics in ARDS. The previously used AECC (American European Consensus Conference) definition (1994) of ARDS was replaced by the recent Berlin definition (2012) so as to improve its validity and reliability...
November 2015: Journal of the Association of Physicians of India
https://www.readbyqxmd.com/read/27604331/the-impact-of-an-education-program-and-written-guideline-on-adherence-to-low-tidal-volume-ventilation
#18
Celeste Nota, John D Santamaria, David Reid, Antony E Tobin
BACKGROUND: Low tidal volume ventilation reduces mortality in patients with acute lung injury (ALI) and may reduce the risk of ALI in ventilated patients. A previous audit of our ventilation practices showed poor adherence to low tidal volume ventilation, and we subsequently introduced written ventilation guidelines and an education program to change practice. OBJECTIVES: To determine if adherence to low tidal volume ventilation (defined as mandatory tidal volumes of =?6...
September 2016: Critical Care and Resuscitation: Journal of the Australasian Academy of Critical Care Medicine
https://www.readbyqxmd.com/read/27588449/complex-sources-of-variation-in-tissue-expression-data-analysis-of-the-gtex-lung-transcriptome
#19
Matthew N McCall, Peter B Illei, Marc K Halushka
The sources of gene expression variability in human tissues are thought to be a complex interplay of technical, compositional, and disease-related factors. To better understand these contributions, we investigated expression variability in a relatively homogeneous tissue expression dataset from the Genotype-Tissue Expression (GTEx) resource. In addition to identifying technical sources, such as sequencing date and post-mortem interval, we also identified several biological sources of variation. An in-depth analysis of the 175 genes with the greatest variation among 133 lung tissue samples identified five distinct clusters of highly correlated genes...
September 1, 2016: American Journal of Human Genetics
https://www.readbyqxmd.com/read/27576283/-acute-respiratory-distress-syndrome
#20
Elisa Estenssoro, Arnaldo Dubin
Acute respiratory distress syndrome (ARDS) is an acute respiratory failure produced by an inflammatory edema secondary to increased lung capillary permeability. This causes alveolar flooding and subsequently deep hypoxemia, with intrapulmonary shunt as its most important underlying mechanism. Characteristically, this alteration is unresponsive to high FIO2 and only reverses with end-expiratory positive pressure (PEEP). Pulmonary infiltrates on CXR and CT are the hallmark, together with decreased lung compliance...
2016: Medicina
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