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Bromiker R, Sokolover N, Ben-Hemo I, Idelson A, Gielchinsky Y, Almog A, Zeitlin Y, Herscovici T, Elron E, Klinger G. Congenital diaphragmatic hernia: quality improvement using a maximal lung protection strategy and early surgery-improved survival. Eur J Pediatr 2024; 183:697-705. [PMID: 37975943 DOI: 10.1007/s00431-023-05328-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/30/2023] [Accepted: 11/03/2023] [Indexed: 11/19/2023]
Abstract
To evaluate the effectiveness of a novel protocol, adopted in our institution, as a quality improvement project for congenital diaphragmatic hernia (CDH). A maximal lung protection (MLP) protocol was implemented in 2019. This strategy included immediate use of high-frequency oscillatory ventilation (HFOV) after birth, during the stay at the Neonatal Intensive Care Unit (NICU), and during surgical repair. HFOV strategy included low distending pressures and higher frequencies (15 Hz) with subsequent lower tidal volumes. Surgical repair was performed early, within 24 h of birth, if possible. A retrospective study of all inborn neonates prenatally diagnosed with CDH and without major associated anomalies was performed at the NICU of Schneider Children's Medical Center of Israel between 2009 and 2022. Survival rates and pulmonary outcomes of neonates managed with MLP were compared to the historical standard care cohort. Thirty-three neonates were managed with the MLP protocol vs. 39 neonates that were not. Major adverse outcomes decreased including death rate from 46 to 18% (p = 0.012), extracorporeal membrane oxygenation from 39 to 0% (p < 0.001), and pneumothorax from 18 to 0% (p = 0.013). CONCLUSION MLP with early surgery significantly improved survival and additional adverse outcomes of neonates with CDH. Prospective randomized studies are necessary to confirm the findings of the current study. WHAT IS KNOWN • Ventilator-induced lung injury was reported as the main cause of mortality in neonates with congenital diaphragmatic hernia (CDH). • Conventional ventilation is recommended by the European CDH consortium as the first-line ventilation modality; timing of surgery is controversial. WHAT IS NEW • A maximal lung protection strategy based on 15-Hz high-frequency oscillatory ventilation with low distending pressures as initial modality and early surgery significantly reduced mortality and other outcomes.
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Affiliation(s)
- Ruben Bromiker
- Department of Neonatology, Schneider Children`s Medical Center of Israel, 14 Kaplan St., Petah Tikva, 49202, Israel.
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Nir Sokolover
- Department of Neonatology, Schneider Children`s Medical Center of Israel, 14 Kaplan St., Petah Tikva, 49202, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Inbar Ben-Hemo
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ana Idelson
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Fetal Medicine Center, Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tikva, Israel
| | - Yuval Gielchinsky
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Fetal Medicine Center, Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tikva, Israel
| | - Anastasia Almog
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Pediatric and Adolescent Surgery, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Yelena Zeitlin
- Department of Pediatric Anesthesia, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Tina Herscovici
- Department of Neonatology, Schneider Children`s Medical Center of Israel, 14 Kaplan St., Petah Tikva, 49202, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Elron
- Department of Neonatology, Schneider Children`s Medical Center of Israel, 14 Kaplan St., Petah Tikva, 49202, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gil Klinger
- Department of Neonatology, Schneider Children`s Medical Center of Israel, 14 Kaplan St., Petah Tikva, 49202, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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2
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Ling RR, Ramanathan K, Shekar K. Ventilatory strategies during venovenous ECMO in ARDS: PEEPing at the elephant in the room. J Crit Care 2024; 79:154407. [PMID: 37696150 DOI: 10.1016/j.jcrc.2023.154407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 08/29/2023] [Indexed: 09/13/2023]
Affiliation(s)
- Ryan Ruiyang Ling
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
| | - Kollengode Ramanathan
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore; Cardiothoracic Intensive Care Unit, National University Heart Centre, National University Health System, Singapore
| | - Kiran Shekar
- Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, QLD, Australia; Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia; Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia; Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia.
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3
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Thornton LT, Marini JJ. Optimized ventilation power to avoid VILI. J Intensive Care 2023; 11:57. [PMID: 37986109 PMCID: PMC10658809 DOI: 10.1186/s40560-023-00706-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 11/09/2023] [Indexed: 11/22/2023] Open
Abstract
The effort to minimize VILI risk must be multi-pronged. The need to adequately ventilate, a key determinant of hazardous power, is reduced by judicious permissive hypercapnia, reduction of innate oxygen demand, and by prone body positioning that promotes both efficient pulmonary gas exchange and homogenous distributions of local stress. Modifiable ventilator-related determinants of lung protection include reductions of tidal volume, plateau pressure, driving pressure, PEEP, inspiratory flow amplitude and profile (using longer inspiration to expiration ratios), and ventilation frequency. Underappreciated conditional cofactors of importance to modulate the impact of local specific power may include lower vascular pressures and blood flows. Employed together, these measures modulate ventilation power with the intent to avoid VILI while achieving clinically acceptable targets for pulmonary gas exchange.
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Affiliation(s)
- Lauren T Thornton
- Department of Pulmonary and Critical Care Medicine, University of Minnesota, Minneapolis/St Paul, MN, USA
| | - John J Marini
- Department of Pulmonary and Critical Care Medicine, University of Minnesota, Minneapolis/St Paul, MN, USA.
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Li T, Wan M, Qing C, Guan X, Pi J, Lv H, Li W. Lung protection of Chimonanthus nitens Oliv. essential oil driven by the control of intestinal disorders and dysbiosis through gut-lung crosstalk. Life Sci 2023; 333:122156. [PMID: 37805165 DOI: 10.1016/j.lfs.2023.122156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/03/2023] [Accepted: 10/04/2023] [Indexed: 10/09/2023]
Abstract
This work aimed to investigate whether Chimonanthus nitens Oliv. essential oil (CEO)-mediated lung protection was implicated in gut-lung crosstalk. Results showed that CEO attenuated lung and intestinal impairment by improving histopathological changes and inhibiting TLR4/NF-κB signaling pathway in LPS-stimulated rats, suggesting that there might be a mechanism for its lung protection involved in gut-lung interaction through manipulating the overlap in pathological changes via the similar inflammatory response. Furthermore, CEO-triggered intestinal protection was in parallel with the mitigation of ROS production, apoptosis, Ca2+ transport and mitochondrial membrane potential loss in vivo, and its intestinal protection was confirmed in vitro through IEC-6 cells. Importantly, a combination with CEO and LPS significantly remodeled gut microbiota composition compared with LPS alone in rats, while no significant impact on lung microbiota. Therefore, CEO-exerted lung protection was linked to gut and lung interactions involvement with the control of intestinal disorders and dysbiosis.
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Affiliation(s)
- Teng Li
- State Key Laboratory of Food Science and Resources, Nanchang University, 235 Nanjing East Road, Nanchang 330047, China
| | - Min Wan
- State Key Laboratory of Food Science and Resources, Nanchang University, 235 Nanjing East Road, Nanchang 330047, China
| | - Cheng Qing
- The First Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Xiuping Guan
- Qianhu College, Nanchang University, Nanchang 330031, China
| | - Jinchan Pi
- College of Future Technology, Nanchang University, Nanchang 330031, China
| | - Hao Lv
- College of Optometry, Nanchang University, Nanchang 330031, China
| | - Wenjuan Li
- State Key Laboratory of Food Science and Resources, Nanchang University, 235 Nanjing East Road, Nanchang 330047, China.
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5
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Marini JJ, Thornton LT, Rocco PRM, Gattinoni L, Crooke PS. Practical assessment of risk of VILI from ventilating power: a conceptual model. Crit Care 2023; 27:157. [PMID: 37081517 PMCID: PMC10120146 DOI: 10.1186/s13054-023-04406-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 03/16/2023] [Indexed: 04/22/2023] Open
Abstract
At the bedside, assessing the risk of ventilator-induced lung injury (VILI) requires parameters readily measured by the clinician. For this purpose, driving pressure (DP) and end-inspiratory static 'plateau' pressure ([Formula: see text]) of the tidal cycle are unquestionably useful but lack key information relating to associated volume changes and cumulative strain. 'Mechanical power', a clinical term which incorporates all dissipated ('non-elastic') and conserved ('elastic') energy components of inflation, has drawn considerable interest as a comprehensive 'umbrella' variable that accounts for the influence of ventilating frequency per minute as well as the energy cost per tidal cycle. Yet, like the raw values of DP and [Formula: see text], the absolute levels of energy and power by themselves may not carry sufficiently precise information to guide safe ventilatory practice. In previous work we introduced the concept of 'damaging energy per cycle'. Here we describe how-if only in concept-the bedside clinician might gauge the theoretical hazard of delivered energy using easily observed static circuit pressures ([Formula: see text] and positive end expiratory pressure) and an estimate of the maximally tolerated (threshold) non-dissipated ('elastic') airway pressure that reflects the pressure component applied to the alveolar tissues. Because its core inputs are already in use and familiar in daily practice, the simplified mathematical model we propose here for damaging energy and power may promote deeper comprehension of the key factors in play to improve lung protective ventilation.
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Affiliation(s)
- John J Marini
- Department of Pulmonary and Critical Care Medicine, University of Minnesota, Minneapolis/St Paul, MN, USA.
| | - Lauren T Thornton
- Department of Pulmonary and Critical Care Medicine, University of Minnesota, Minneapolis/St Paul, MN, USA
| | - Patricia R M Rocco
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Biophysics Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Luciano Gattinoni
- Department of Anesthesiology, University of Göttingen, Göttingen, Germany
| | - Philip S Crooke
- Department of Mathematics, Vanderbilt University, Nashville, TN, USA
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6
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Cabeza Martín B, Arellano Pulido M, Arellano Pulido R, Pescador Chamorro I, Peleteiro Pensado A, Barragán González L. Use of intraoperative high frequency oscillatory ventilation in neonates with pulmonary hypoplasia. Rev Esp Anestesiol Reanim (Engl Ed) 2022; 69:602-605. [PMID: 36220732 DOI: 10.1016/j.redare.2021.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 05/14/2021] [Indexed: 06/16/2023]
Abstract
High-frequency oscillatory ventilation (HFOV) is a ventilatory modality widely used in neonatal intensive care units. Its main indication is restrictive lung pathology with difficult gas exchange using conventional mechanical ventilation (CMV). Patients receiving CMV require high intensity care, and immature lungs can be at risk for barotrauma and volutrauma. The few studies that have explored the use of HFOV in the operating room are mainly limited to HFVO during congenital diaphragmatic hernia repair. Limited experience of this ventilatory method in the operating room may be a disadvantage for the anesthesiologist. However, it is important to remember the benefits of this technique as a lung protection strategy. We report two cases of neonatal pulmonary hypoplasia of different etiology in which good oxygenation and ventilation was achieved with intraoperative HFOV.
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Affiliation(s)
- B Cabeza Martín
- Servicio de Anestesia y Reanimación, Hospital Universitario Gregorio Marañón de Madrid, Unidad de Anestesia Pediátrica, Madrid, Spain.
| | - M Arellano Pulido
- Servicio de Anestesia y Reanimación, Hospital Universitario Gregorio Marañón de Madrid, Unidad de Anestesia Pediátrica, Madrid, Spain
| | - R Arellano Pulido
- Servicio de Anestesia y Reanimación, Hospital Universitario Gregorio Marañón de Madrid, Unidad de Anestesia Pediátrica, Madrid, Spain
| | - I Pescador Chamorro
- Servicio de Neonatología, Hospital Universitario Gregorio Marañón de Madrid, Madrid, Spain
| | - A Peleteiro Pensado
- Servicio de Anestesia y Reanimación, Hospital Universitario Gregorio Marañón de Madrid, Unidad de Anestesia Pediátrica, Madrid, Spain
| | - L Barragán González
- Servicio de Anestesia y Reanimación, Hospital Universitario Gregorio Marañón de Madrid, Unidad de Anestesia Pediátrica, Madrid, Spain
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7
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Hosseinpour AR, González-Calle A, Adsuar-Gómez A. Reply to Rezaei et al. Eur J Cardiothorac Surg 2022; 62:6651066. [PMID: 35900164 DOI: 10.1093/ejcts/ezac391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Amir-Reza Hosseinpour
- Cardiac Surgery unit, Virgen del Rocio Children's Hospital, University Hospitals of Seville, Avenida Manuel Siurot s/n, Seville, 41013, Spain
| | - Antonio González-Calle
- Cardiac Surgery unit, Virgen del Rocio Children's Hospital, University Hospitals of Seville, Avenida Manuel Siurot s/n, Seville, 41013, Spain
| | - Alejandro Adsuar-Gómez
- Cardiac Surgery unit, Virgen del Rocio Children's Hospital, University Hospitals of Seville, Avenida Manuel Siurot s/n, Seville, 41013, Spain
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8
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Lassola S, Miori S, Sanna A, Pace R, Magnoni S, Vetrugno L, Umbrello M. Effect of chest wall loading during supine and prone position in a critically ill covid-19 patient: a new strategy for ARDS? Crit Care 2021; 25:442. [PMID: 34930393 PMCID: PMC8686100 DOI: 10.1186/s13054-021-03865-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 12/13/2021] [Indexed: 01/16/2023] Open
Affiliation(s)
- Sergio Lassola
- SC Anestesia E Rianimazione 1, Ospedale Santa Chiara, Trento, Italy
| | - Sara Miori
- SC Anestesia E Rianimazione 1, Ospedale Santa Chiara, Trento, Italy.
| | - Andrea Sanna
- SC Anestesia E Rianimazione 1, Ospedale Santa Chiara, Trento, Italy
| | - Rocco Pace
- SC Anestesia E Rianimazione 1, Ospedale Santa Chiara, Trento, Italy
| | - Sandra Magnoni
- SC Anestesia E Rianimazione 1, Ospedale Santa Chiara, Trento, Italy
| | - Luigi Vetrugno
- Department of Anesthesiology, Critical Care Medicine and Emergency, SS, Annunziata Hospital, Chieti, Italy.,Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy
| | - Michele Umbrello
- SC Anestesia E Rianimazione II, Ospedale San Carlo Borromeo, ASST Santi Paolo e Carlo, Milan, Italy
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9
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Li J, Ma S, Chang X, Ju S, Zhang M, Yu D, Rong J. Effect of pressure-controlled ventilation-volume guaranteed mode combined with individualized positive end-expiratory pressure on respiratory mechanics, oxygenation and lung injury in patients undergoing laparoscopic surgery in Trendelenburg position. J Clin Monit Comput 2021; 36:1155-1164. [PMID: 34448089 PMCID: PMC9293798 DOI: 10.1007/s10877-021-00750-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 08/12/2021] [Indexed: 11/30/2022]
Abstract
The study aimed to investigate the efficacy of PCV-VG combined with individual PEEP during laparoscopic surgery in the Trendelenburg position. 120 patients were randomly divided into four groups: VF group (VCV plus 5cmH2O PEEP), PF group (PCV-VG plus 5cmH2O PEEP), VI group (VCV plus individual PEEP), and PI group (PCV-VG plus individual PEEP). Pmean, Ppeak, Cdyn, PaO2/FiO2, VD/VT, A-aDO2 and Qs/Qt were recorded at T1 (15 min after the induction of anesthesia), T2 (60 min after pneumoperitoneum), and T3 (5 min at the end of anesthesia). The CC16 and IL-6 were measured at T1 and T3. Our results showed that the Pmean was increased in VI and PI group, and the Ppeak was lower in PI group at T2. At T2 and T3, the Cdyn of PI group was higher than that in other groups, and PaO2/FiO2 was increased in PI group compared with VF and VI group. At T2 and T3, A-aDO2 of PI and PF group was reduced than that in other groups. The Qs/Qt was decreased in PI group compared with VF and VI group at T2 and T3. At T2, VD/VT in PI group was decreased than other groups. At T3, the concentration of CC16 in PI group was lower compared with other groups, and IL-6 level of PI group was decreased than that in VF and VI group. In conclusion, the patients who underwent laparoscopic surgery, PCV-VG combined with individual PEEP produced favorable lung mechanics and oxygenation, and thus reducing inflammatory response and lung injury. Clinical Trial registry: chictr.org. identifier: ChiCTR-2100044928
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Affiliation(s)
- Jianli Li
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, 050051, China.
| | - Saixian Ma
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, 050051, China
| | - Xiujie Chang
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, 050051, China
| | - Songxu Ju
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, 050051, China
| | - Meng Zhang
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, 050051, China
| | - Dongdong Yu
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, 050051, China
| | - Junfang Rong
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, 050051, China
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10
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Liu YQ. [Management strategy of lung protection in patients with intra-abdominal infection]. Zhonghua Wei Chang Wai Ke Za Zhi 2020; 23:1032-1035. [PMID: 33212550 DOI: 10.3760/cma.j.cn.441530-20200810-00469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Lung protection is important in the treatment of patients with intra-abdominal infection (IAI). This article focuses on the management strategy of lung protection in IAI patients. In the implementation of IAI individual respiratory protection, good humidification and chest physical therapy, nutritional support, strict balloon management, keeping a semi-supine position, and reducing the duration and depth of analgesia and sedation are helpful to maintain effective coughing capacity and prevent silent aspiration. It is also necessary to prevent ventilator-associated lung injury in mechanical ventilation, and implement strategies of small tidal volume, limited platform pressure, diaphragmatic protection and right heart protection ventilation in acute respiratory distress syndrome (ARDS). Respiratory mechanical indicators, including airway resistance, respiratory compliance, maximum inspiratory pressure (MIP), and airway closure pressure (P0.1) can be used in IAI patients receiving mechanical ventilation for individualized assessment and monitoring of respiratory functional status. Patients with IAI who have not been treated with mechanical ventilation can use simplified bedside lung function indicators, including forced vital capacity of inhalation and exhalation, maximum inspiratory pressure and exhalation pressure, as well as volume and rate of 1s. In pulmonary rehabilitation, the protection technique of the seven-word principle of humidification, turning, patting, coughing, expansion, blowing and mobilization are implemented.
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Affiliation(s)
- Y Q Liu
- Department of Respiratory and Critical Care Medicine, Respiratory Medical Center of Fujian Province, the Second Affiliated Hospital, Fujian Medical University, Quanzhou, Fujian 362000, China
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11
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Chiumello D, Gotti M, Guanziroli M, Formenti P, Umbrello M, Pasticci I, Mistraletti G, Busana M. Bedside calculation of mechanical power during volume- and pressure-controlled mechanical ventilation. Crit Care 2020; 24:417. [PMID: 32653011 PMCID: PMC7351639 DOI: 10.1186/s13054-020-03116-w] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 06/29/2020] [Indexed: 12/15/2022]
Abstract
Background Mechanical power (MP) is the energy delivered to the respiratory system over time during mechanical ventilation. Our aim was to compare the currently available methods to calculate MP during volume- and pressure-controlled ventilation, comparing different equations with the geometric reference method, to understand whether the easier to use surrogate formulas were suitable for the everyday clinical practice. This would warrant a more widespread use of mechanical power to promote lung protection. Methods Forty respiratory failure patients, sedated and paralyzed for clinical reasons, were ventilated in volume-controlled ventilation, at two inspiratory flows (30 and 60 L/min), and pressure-controlled ventilation with a similar tidal volume. Mechanical power was computed both with the geometric method, as the area between the inspiratory limb of the airway pressure and the volume, and with two algebraic methods, a comprehensive and a surrogate formula. Results The bias between the MP computed by the geometric method and by the comprehensive algebraic method during volume-controlled ventilation was respectively 0.053 (0.77, − 0.81) J/min and − 0.4 (0.70, − 1.50) J/min at low and high flows (r2 = 0.96 and 0.97, p < 0.01). The MP measured and computed by the two methods were highly correlated (r2 = 0.95 and 0.94, p < 0.01) with a bias of − 0.0074 (0.91, − 0.93) and − 1.0 (0.45, − 2.52) J/min at high-low flows. During pressure-controlled ventilation, the bias between the MP measured and the one calculated with the comprehensive and simplified methods was correlated (r2 = 0.81, 0.94, p < 0.01) with mean differences of − 0.001 (2.05, − 2.05) and − 0.81 (2.11, − 0.48) J/min. Conclusions Both for volume-controlled and pressure-controlled ventilation, the surrogate formulas approximate the reference method well enough to warrant their use in the everyday clinical practice. Given that these formulas require nothing more than the variables already displayed by the intensive care ventilator, a more widespread use of mechanical power should be encouraged to promote lung protection against ventilator-induced lung injury.
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Affiliation(s)
- Davide Chiumello
- SC Anestesia e Rianimazione, Ospedale San Paolo - Polo Universitario, ASST Santi Paolo e Carlo, Via Di Rudinì, 8, 20142, Milan, Italy. .,Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy. .,Centro Ricerca Coordinata di Insufficienza Respiratoria, Milan, Italy.
| | - Miriam Gotti
- SC Anestesia e Rianimazione, Ospedale San Paolo - Polo Universitario, ASST Santi Paolo e Carlo, Via Di Rudinì, 8, 20142, Milan, Italy
| | - Mariateresa Guanziroli
- SC Anestesia e Rianimazione, Ospedale San Paolo - Polo Universitario, ASST Santi Paolo e Carlo, Via Di Rudinì, 8, 20142, Milan, Italy.,Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy
| | - Paolo Formenti
- SC Anestesia e Rianimazione, Ospedale San Paolo - Polo Universitario, ASST Santi Paolo e Carlo, Via Di Rudinì, 8, 20142, Milan, Italy
| | - Michele Umbrello
- SC Anestesia e Rianimazione, Ospedale San Paolo - Polo Universitario, ASST Santi Paolo e Carlo, Via Di Rudinì, 8, 20142, Milan, Italy
| | - Iacopo Pasticci
- SC Anestesia e Rianimazione, Ospedale San Paolo - Polo Universitario, ASST Santi Paolo e Carlo, Via Di Rudinì, 8, 20142, Milan, Italy.,Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy
| | - Giovanni Mistraletti
- SC Anestesia e Rianimazione, Ospedale San Paolo - Polo Universitario, ASST Santi Paolo e Carlo, Via Di Rudinì, 8, 20142, Milan, Italy.,Dipartimento di Fisiopatologia Medica Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy
| | - Mattia Busana
- Department of Anesthesiology, Emergency and Intensive Care Medicine, University of Göttingen, Göttingen, Germany
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12
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Ramos-Navarro C, González-Pacheco N, Rodríguez-Sánchez de la Blanca A, Sánchez-Luna M. Effect of a new respiratory care bundle on bronchopulmonary dysplasia in preterm neonates. Eur J Pediatr 2020; 179:1833-42. [PMID: 32488737 DOI: 10.1007/s00431-020-03694-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/15/2020] [Accepted: 05/16/2020] [Indexed: 02/03/2023]
Abstract
The development of devices that can fix the tidal volume in high-frequency oscillatory ventilation (HFOV) has allowed for a significant improvement in the management of HFOV. At our institution, this had led to the earlier use of HFOV and promoted a change in the treatment strategy involving the use of higher frequencies (above 15 Hz) and lower high-frequency tidal volumes (VThf). The purpose of this observational study was to assess how survival without bronchopulmonary dysplasia grades 2 and 3 (SF-BPD) is influenced by these modifications in the respiratory strategy applied to preterm infants (gestational age < 32 weeks at birth) who required mechanical ventilation (MV) in the first 3 days of life. We compared a baseline period (2012-2013) against a period in which this strategy had been fully implemented (2016-2017). A total of 182 patients were exposed to MV in the first 3 days of life being a higher proportion on HFOV at day 3 in the second period 79.5% (n 35) in 2016-2017 vs 55.4% (n 31) in 2012-2013. After adjusting for perinatal risk factors, the second period is associated with an increased rate of SF-BPD (OR 2.28; CI 95% 1.072-4.878); this effect is more evident in neonates born at a gestational age of less than 29 weeks (OR 4.87; 95% CI 1.9-12.48).Conclusions : The early use of HFOV combined with the use of higher frequencies and very low VT was associated with an increase in the study population's SF-BPD. What is Known: • High-frequency ventilation with volume guarantee improve ventilation stability and has been shown to reduce lung damage in animal models. What is New: • The strategy of an earlier use of high-frequency oscillatory ventilation combined with the use of higher frequencies and lower tidal volume is associated to an increase in survival without bronchopulmonary dysplasia in our population of preterm infants.
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Nentwich J, John S. [Current techniques for extracorporeal decarboxylation]. Med Klin Intensivmed Notfmed 2019; 114:733-40. [PMID: 31020339 DOI: 10.1007/s00063-019-0567-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 02/13/2019] [Indexed: 02/06/2023]
Abstract
The widespread use of extracorporeal lung assist (ECLA) in recent years has led to the introduction of different decarboxylation systems into clinical practice. Due to the large CO2 transport capacity of the blood such systems require considerably lower extracorporeal blood flows and therefore allow for effective decarboxylation with reduced invasiveness and complexity. While systems derived from classical lung assist are mainly used to control severe acute hypercapnic respiratory failure, recently a growing number of therapies based on renal replacement platforms have become available ("respiratory dialysis"). Such low-flow systems still allow for effective partial CO2 elimination and can control respiratory acidosis as well as facilitate or even enable protective and ultraprotective ventilation strategies in acute lung failure (ARDS). While the use of extracorporeal CO2 elimination (ECCO2R) has been shown to decrease ventilator-induced lung injury (VILI), positive effects on hard clinical endpoints such as mortality or duration of mechanical ventilation are still unproven. In light of limited evidence, ECCO2R must be regarded as an experimental procedure. Its use should therefore at present be restricted to centers with appropriate experience.
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Nentwich J, Wichmann D, Kluge S, Lindau S, Mutlak H, John S. Low-flow CO 2 removal in combination with renal replacement therapy effectively reduces ventilation requirements in hypercapnic patients: a pilot study. Ann Intensive Care 2019; 9:3. [PMID: 30617611 PMCID: PMC6323065 DOI: 10.1186/s13613-019-0480-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 01/02/2019] [Indexed: 01/21/2023] Open
Abstract
Background Lung-protective strategies are the cornerstone of mechanical ventilation in critically ill patients with both ARDS and other disorders. Extracorporeal CO2 removal (ECCO2R) may enhance lung protection by allowing even further reductions in tidal volumes and is effective in low-flow settings commonly used for renal replacement therapy. In this study, we describe for the first time the effects of a labeled and certified system combining ECCO2R and renal replacement therapy on pulmonary stress and strain in hypercapnic patients with renal failure. Methods Twenty patients were treated with the combined system which incorporates a membrane lung (0.32 m2) in a conventional renal replacement circuit. After changes in blood gases under ECCO2R were recorded, baseline hypercapnia was reestablished and the impact on ventilation parameters such as tidal volume and driving pressure was recorded. Results The system delivered ECCO2R at rate of 43.4 ± 14.1 ml/min, PaCO2 decreased from 68.3 ± 11.8 to 61.8 ± 11.5 mmHg (p < 0.05) and pH increased from 7.18 ± 0.09 to 7.22 ± 0.08 (p < 0.05). There was a significant reduction in ventilation requirements with a decrease in tidal volume from 6.2 ± 0.9 to 5.4 ± 1.1 ml/kg PBW (p < 0.05) corresponding to a decrease in plateau pressure from 30.6 ± 4.6 to 27.7 ± 4.1 cmH2O (p < 0.05) and a decrease in driving pressure from 18.3 ± 4.3 to 15.6 ± 3.9 cmH2O (p < 0.05), indicating reduced pulmonary stress and strain. No complications related to the procedure were observed. Conclusions The investigated low-flow ECCO2R and renal replacement system can ameliorate respiratory acidosis and decrease ventilation requirements in hypercapnic patients with concomitant renal failure. Trial registration NCT02590575, registered 10/23/2015.
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Affiliation(s)
- Jens Nentwich
- Medical Intensive Care, Department of Cardiology, Klinikum Nuremberg, Paracelsus Medical University, Nuremberg, Germany
| | - Dominic Wichmann
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Kluge
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Simone Lindau
- Department of Anesthesia, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt, Germany
| | - Haitham Mutlak
- Department of Anesthesia, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt, Germany
| | - Stefan John
- Medical Intensive Care, Department of Cardiology, Klinikum Nuremberg, Paracelsus Medical University, Nuremberg, Germany.
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Ganatra HA, Shamim D, Farnan A, Deshpande G. Favorable outcome with early initiation of VV-ECMO for unilateral lung disease in children. Respir Med Case Rep 2019; 26:73-7. [PMID: 30555780 DOI: 10.1016/j.rmcr.2018.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 11/26/2018] [Accepted: 11/26/2018] [Indexed: 11/20/2022] Open
Abstract
Unilateral lung diseases such as unilateral pneumonia, trauma or pulmonary hemorrhage can cause profound hypoxemic respiratory failure necessitating mechanical ventilation. These disorders are characterized by marked asymmetry in lung mechanics, with the affected lung having a lower compliance compared to the healthier lung, and management involves complex strategies such as simultaneous independent lung ventilation. However, such strategies can be challenging in pediatric populations due to technical limitations, and also lead to ventilator induced lung injury. We report two unique cases that support the use of venovenous extracorporeal membrane oxygenation as an alternative strategy for management of unilateral lung disease in children.
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Zhang L, Xiong W, Peng Y, Zhang W, Han R. The effect of an intraoperative, lung-protective ventilation strategy in neurosurgical patients undergoing craniotomy: study protocol for a randomized controlled trial. Trials 2018; 19:85. [PMID: 29394907 PMCID: PMC5797412 DOI: 10.1186/s13063-018-2447-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 01/03/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Ventilator-induced lung injury is a major cause of postoperative pulmonary complications (PPCs) in patients undergoing neurosurgery after general anesthesia. However, there is no study on the effect of a lung-protective ventilation strategy in patients undergoing neurosurgery. METHODS This is a single-center, randomized, parallel-group controlled trial which will be carried out at Beijing Tiantan Hospital, Capital Medical University. Three hundred and thirty-four patients undergoing intracranial tumor surgery will be randomly allocated to the control group and the protective-ventilation strategy group. In the control group, tidal volume (VT) will be set at 10-12 ml/kg of predicted body weight but PEEP and recruitment maneuvers will not be used. In the protective group, VT will be set at 6-8 ml/kg of predicted body weight, PEEP at 6-8 cmH2O, and a recruitment maneuver will be used intermittently. The primary outcome is pulmonary complications within 7 days postoperatively. Secondary outcomes include intraoperative brain relaxation, the postoperative complications within 30 days and the cost analysis. DISCUSSION This study aims to determine if the protective, pulmonary-ventilation strategy decreases the incidence of PPCs in patients undergoing neurosurgical anesthesia. If our results are positive, the study will indicate whether the protective, pulmonary-ventilation strategy is efficiently and safely used in neurosurgical patients undergoing the craniotomy. TRIAL REGISTRATION ClinicalTrials.gov, ID: NCT02386683 . Registered on 18 October 2014.
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Affiliation(s)
- Liyong Zhang
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, No. 6, Tiantan Xili, Dongcheng District, Beijing, 100050, People's Republic of China
| | - Wei Xiong
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, No. 6, Tiantan Xili, Dongcheng District, Beijing, 100050, People's Republic of China
| | - Yuming Peng
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, No. 6, Tiantan Xili, Dongcheng District, Beijing, 100050, People's Republic of China
| | - Wei Zhang
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, No. 6, Tiantan Xili, Dongcheng District, Beijing, 100050, People's Republic of China
| | - Ruquan Han
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, No. 6, Tiantan Xili, Dongcheng District, Beijing, 100050, People's Republic of China.
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Abstract
Perioperative pulmonary complications are known to be a major cause of morbidity and mortality, and as such, contribute a large burden to the health care system globally. Anesthesiologists have an important role during the perioperative period to identify patients at risk of these complications and intervene in order to reduce them. After describing perioperative pulmonary complications and risk factors for such, this article will address preoperative, intraoperative, and postoperative lung protective strategies to try and reduce the risk of these complications.
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Affiliation(s)
- Katherine Marseu
- Department of Anesthesia and Pain Management, Toronto General Hospital, University of Toronto, Toronto, Canada
| | - Peter Slinger
- Department of Anesthesia and Pain Management, Toronto General Hospital, University of Toronto, Toronto, Canada
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Ma J, Ye H. Effects of permissive hypercapnia on pulmonary and neurodevelopmental sequelae in extremely low birth weight infants: a meta-analysis. Springerplus 2016; 5:764. [PMID: 27386250 PMCID: PMC4912505 DOI: 10.1186/s40064-016-2437-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 05/27/2016] [Indexed: 11/17/2022]
Abstract
Objectives To perform a systematic review and meta-analysis of the efficacy and safety of permissive hypercapnia in extremely low birth weight infants. Methods A systematic search of MEDLINE, EMBASE, the Cochrane Database of randomized trials. Eligibility and quality of trials were assessed, and data on study design, patient characteristics, and relevant outcomes were extracted. Results Four studies that enrolled a total of 693 participants were selected. Meta-analysis revealed no effect of permissive hypercapnia on decreasing rates of bronchopulmonary dysplasia (BPD). Permissive hypercapnia also had no significant effect on mortality, intraventricular haemorrhage (IVH), IVH (grade 3–4), periventricular leukomalacia (PVL), necrotising enterocolitis (NEC), retinopathy of prematurity (ROP) or air leaks in extremely low birth weight infants. Neurodevelopmental outcomes were comparable at 18–22 months’ corrected age in two studies. permissive hypercapnia did not increase the risk of cerebral palsy, Mental Developmental Index <70, Psychomotor Developmental Index <70, visual deficit, or hearing deficit. Conclusions Permissive hypercapnia did not reduce the rate of BPD in extremely low birth weight infants. The rates of mortality, IVH, PVL, NEC, ROP and neurodevelopmental outcomes did not differ between these two groups. These results suggest that permissive hypercapnia does not bring extra benefits in extremely low birth weight infants.
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Affiliation(s)
- Jianglin Ma
- Department of Pediatrics, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310000 People's Republic of China
| | - Hui Ye
- Department of Pediatrics, Taizhou First People's Hospital, Taizhou, 318020 People's Republic of China
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Jain SV, Kollisch-Singule M, Sadowitz B, Dombert L, Satalin J, Andrews P, Gatto LA, Nieman GF, Habashi NM. The 30-year evolution of airway pressure release ventilation (APRV). Intensive Care Med Exp 2016; 4:11. [PMID: 27207149 PMCID: PMC4875584 DOI: 10.1186/s40635-016-0085-2] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 05/03/2016] [Indexed: 02/07/2023] Open
Abstract
Airway pressure release ventilation (APRV) was first described in 1987 and defined as continuous positive airway pressure (CPAP) with a brief release while allowing the patient to spontaneously breathe throughout the respiratory cycle. The current understanding of the optimal strategy to minimize ventilator-induced lung injury is to "open the lung and keep it open". APRV should be ideal for this strategy with the prolonged CPAP duration recruiting the lung and the minimal release duration preventing lung collapse. However, APRV is inconsistently defined with significant variation in the settings used in experimental studies and in clinical practice. The goal of this review was to analyze the published literature and determine APRV efficacy as a lung-protective strategy. We reviewed all original articles in which the authors stated that APRV was used. The primary analysis was to correlate APRV settings with physiologic and clinical outcomes. Results showed that there was tremendous variation in settings that were all defined as APRV, particularly CPAP and release phase duration and the parameters used to guide these settings. Thus, it was impossible to assess efficacy of a single strategy since almost none of the APRV settings were identical. Therefore, we divided all APRV studies divided into two basic categories: (1) fixed-setting APRV (F-APRV) in which the release phase is set and left constant; and (2) personalized-APRV (P-APRV) in which the release phase is set based on changes in lung mechanics using the slope of the expiratory flow curve. Results showed that in no study was there a statistically significant worse outcome with APRV, regardless of the settings (F-ARPV or P-APRV). Multiple studies demonstrated that P-APRV stabilizes alveoli and reduces the incidence of acute respiratory distress syndrome (ARDS) in clinically relevant animal models and in trauma patients. In conclusion, over the 30 years since the mode's inception there have been no strict criteria in defining a mechanical breath as being APRV. P-APRV has shown great promise as a highly lung-protective ventilation strategy.
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Affiliation(s)
- Sumeet V Jain
- Department of Surgery, SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY, 13210, USA
| | | | - Benjamin Sadowitz
- Department of Surgery, SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY, 13210, USA
| | - Luke Dombert
- Department of Surgery, SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY, 13210, USA
| | - Josh Satalin
- Department of Surgery, SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY, 13210, USA.
| | - Penny Andrews
- Multi-trauma Critical Care, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, 22 South Greene Street, Baltimore, MD, USA
| | - Louis A Gatto
- Department of Surgery, SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY, 13210, USA.,Department of Biological Sciences, 10 SUNY Cortland, Cortland, NY, 13045, USA
| | - Gary F Nieman
- Department of Surgery, SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY, 13210, USA
| | - Nader M Habashi
- Multi-trauma Critical Care, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, 22 South Greene Street, Baltimore, MD, USA
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Khazri O, Charradi K, Limam F, El May MV, Aouani E. Grape seed and skin extract protects against bleomycin-induced oxidative stress in rat lung. Biomed Pharmacother 2016; 81:242-249. [PMID: 27261600 DOI: 10.1016/j.biopha.2016.04.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 04/04/2016] [Accepted: 04/04/2016] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Lung fibrosis is a common side effect of the chemotherapeutic agent bleomycin and current evidence suggests that reactive oxygen species play a key role in the development of lung injury. We examined whether grape seed and skin extract (GSSE), a polyphenolic mixture exhibiting antioxidant properties, is able to protect against bleomycin-induced lung oxidative stress and injury. METHODS Rats were pre-treated during three weeks either with vehicle (ethanol 10% control) or GSSE (4g/kg), then administered with a single high dose bleomycin (15mg/kg) at the 7th day. RESULTS Bleomycin increased lung lipoperoxidation, carbonylation and decreased antioxidant enzyme activities as catalase (CAT), superoxide dismutase (SOD) and glutathione peroxidase (GPx). Bleomycin also induced copper depletion from the lung and iron accumulation within the lung, but had no effect on either zinc nor manganese. Correlatively bleomycin decreased the copper associated enzyme tyrosinase, increased the zinc dependent lactate dehydrogenase (LDH) and did not affect the manganese dependent glutamine synthetase. GSSE efficiently counteracted almost all bleomycin-induced oxidative stress, biochemical and morphological changes of lung tissue. CONCLUSION Data suggest that GSSE exerts potent antioxidant properties that could find potential application in the protection against bleomycin-induced lung fibrosis.
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Affiliation(s)
- Olfa Khazri
- Laboratoire des Substances Bio-Active (LSBA), Centre de Biotechnologie de Borj Cedria, BP-901, 2050 Hammam-Lif, Tunisia; Université de Carthage, Faculté des Sciences de Bizerte, 7021 Jarzouna, Tunisia.
| | - Kamel Charradi
- Laboratoire des Substances Bio-Active (LSBA), Centre de Biotechnologie de Borj Cedria, BP-901, 2050 Hammam-Lif, Tunisia; Université de Carthage, Faculté des Sciences de Bizerte, 7021 Jarzouna, Tunisia
| | - Ferid Limam
- Laboratoire des Substances Bio-Active (LSBA), Centre de Biotechnologie de Borj Cedria, BP-901, 2050 Hammam-Lif, Tunisia
| | | | - Ezzedine Aouani
- Laboratoire des Substances Bio-Active (LSBA), Centre de Biotechnologie de Borj Cedria, BP-901, 2050 Hammam-Lif, Tunisia; Université de Carthage, Faculté des Sciences de Bizerte, 7021 Jarzouna, Tunisia
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Romero A, Alonso B, Latorre I, García J. Respiratory monitoring with electrical impedance tomography for lung protective ventilation and alveolar recruitment maneuver in a patient with a single lung transplant and early graft dysfunction. ACTA ACUST UNITED AC 2015; 63:347-52. [PMID: 26633603 DOI: 10.1016/j.redar.2015.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 08/26/2015] [Accepted: 09/02/2015] [Indexed: 12/16/2022]
Abstract
A case is presented on a patient who underwent left single lung transplantation for emphysema type COPD. There was early graft dysfunction gradeiii during the immediate postoperative period, which required the implantation of an extracorporeal membrane oxygenator (ECMO). Respirator ventilatory parameters were adjusted to avoid lung distension, low tidal volume (Vc) (280ml), high respiratory rates (20rpm), and a positive pressure at end expiration (PEEP) level of 8cmH2O. On monitoring the pulmonary tidal volume distribution by bedside electrical impedance tomography (EIT), it was noted that most of the tidal volume was distributed in the native lung emphysema. An alveolar recruitment manoeuvre was performed, under control of the EIT, that enabled the current volume and distribution and the pressures required to ventilate the transplanted lung to be observed.
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Affiliation(s)
- A Romero
- Departamento de Anestesiología, Reanimación y Cuidados Críticos, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, España.
| | - B Alonso
- Departamento de Anestesiología, Reanimación y Cuidados Críticos, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, España
| | - I Latorre
- Departamento de Anestesiología, Reanimación y Cuidados Críticos, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, España
| | - J García
- Departamento de Anestesiología, Reanimación y Cuidados Críticos, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, España
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Schneck M, Holder K, Gielen S, Nuding S, Schröder J, Tamm AR, Werdan K, Ebelt H. Lung protective ventilation and hospital survival of cardiac intensive care patients. Med Klin Intensivmed Notfmed 2016; 111:508-13. [PMID: 26507497 DOI: 10.1007/s00063-015-0105-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 05/20/2015] [Accepted: 09/04/2015] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To detect connections between parameters of ventilation and outcomes of cardiac intensive care patients. DESIGN AND SETTING Noninterventional study. Between 05/11 and 05/12 all patients with acute heart failure and post cardiopulmonary resuscitation were registered. Lung protective ventilation was defined as peak inspiratory pressure (PIP) < 30 mmHg and tidal volume (Vt) < = 6 ml/kg. RESULTS In total, 129 patients were included in the study, 68.2 % male, age 67.9 ± 13.4 years, weight 71.4 ± 37.2 kg, predictive body weight 66.9 ± 8.8 kg, mortality 47.3 %. Lung protective ventilated patients at day 1: 17.3 % with a significant difference between surviving and nonsurviving patients (24.1 % vs. 9.6 %; p < 0.05). Logistic regression models showed a strong connection between PIP and survival (odds ratio 1.13; p < 0.05). Vt showed no significant influence on survival. CONCLUSION Our data recommends a strict observance of a low PIP for cardiac intensive care patients, whereas Vt seems to be of secondary importance.
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Wagner JJ, Bedarf JR, Russ M, Grosch-Ott S, Keckel T, Hiebl B, Schell H, Unger JK. Adverse influence of mixed acidemia on the biocompatibility of continuous veno-venous hemofiltration with respect to the lungs. Artif Organs 2013; 37:1049-58. [PMID: 23738674 DOI: 10.1111/aor.12104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Experimental data indicate that hypercapnic adidosis has anti-inflammatory effects. These anti-inflammatory effects may even be a beneficial property in case of low tidal volume ventilation with consecutive hypercapnic acidosis. It is unclear whether these anti-inflammatory effects predominate in critically ill patients who suffer from multiple pro- and anti-inflammatory insults like extracorporeal organ support (pro-inflammatory), metabolic acidosis (pro- and anti-inflammatory), as well as hypoxia (pro-inflammatory). Eighteen pigs were randomized into three groups, mechanically ventilated and connected to a continuous veno-venous hemofiltration (CVVH) as pro-inflammatory insult. A reference group with normal acid-base state obtained normoventilation; a normoxemic acidemia group obtained normoxemic, mixed acidemia due to infusion of lactic and hyperchloremic acid and low tidal volume ventilation, and in a hypoxemic acidemia group the mixed acidemia was paralleled by hypoxemia. Lung histology including pulmonary leukocyte invasion, blood gases, blood cell counts, and hemodynamics were examined. The histological examination of the lungs of acidemic pigs showed a suppressed invasion of leukocytes and thinner alveolar walls compared with normoventilated and with hypoxemic pigs. Enhanced congestion and alveolar red blood cells (RBCs) combined with an increase of the pulmonary artery pressure were observed in acidemic pigs in comparison with the reference group. Normoxemic acidemia reduced the pro-inflammatory reaction to the CVVH and mechanical ventilation in the ventilated lung areas in the form of pulmonary leukocyte invasion. However, this did not result in reduced scores for lung injury. Instead, an increased score for criteria which represent lung injury (congestion and alveolar RBCs) was observed in acidemic pigs.
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