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Find video protocols related to scientific articles indexed in Pubmed.
Effects of Ultraprotective Ventilation, Extracorporeal Carbon Dioxide Removal, and Spontaneous Breathing on Lung Morphofunction and Inflammation in Experimental Severe Acute Respiratory Distress Syndrome.
Anesthesiology
PUBLISHED: 11-06-2014
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To investigate the role of ultraprotective mechanical ventilation (UP-MV) and extracorporeal carbon dioxide removal with and without spontaneous breathing (SB) to improve respiratory function and lung protection in experimental severe acute respiratory distress syndrome.
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Spontaneous breathing in mild and moderate versus severe acute respiratory distress syndrome.
Curr Opin Crit Care
PUBLISHED: 10-25-2014
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This review summarizes the most recent clinical and experimental data on the impact of spontaneous breathing in acute respiratory distress syndrome (ARDS).
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Higher levels of spontaneous breathing reduce lung injury in experimental moderate acute respiratory distress syndrome*.
Crit. Care Med.
PUBLISHED: 08-28-2014
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To assess the effects of different levels of spontaneous breathing during biphasic positive airway pressure/airway pressure release ventilation on lung function and injury in an experimental model of moderate acute respiratory distress syndrome.
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Modulation of Stress versus Time Product during Mechanical Ventilation Influences Inflammation as Well as Alveolar Epithelial and Endothelial Response in Rats.
Anesthesiology
PUBLISHED: 08-19-2014
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Mechanical ventilation can lead to lung biotrauma when mechanical stress exceeds safety thresholds. The authors investigated whether the duration of mechanical stress, that is, the impact of a stress versus time product (STP), influences biotrauma. The authors hypothesized that higher STP levels are associated with increased inflammation and with alveolar epithelial and endothelial cell injury.
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Effects of sigh during pressure control and pressure support ventilation in pulmonary and extrapulmonary mild acute lung injury.
Crit Care
PUBLISHED: 08-12-2014
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Sigh improves oxygenation and lung mechanics during pressure control ventilation (PCV) and pressure support ventilation (PSV) in patients with acute respiratory distress syndrome. However, so far, no study has evaluated the biological impact of sigh during PCV or PSV on the lung and distal organs in experimental pulmonary (p) and extrapulmonary (exp) mild acute lung injury (ALI).
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Prospective external validation of a predictive score for postoperative pulmonary complications.
Anesthesiology
PUBLISHED: 06-06-2014
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No externally validated risk score for postoperative pulmonary complications (PPCs) is currently available. The authors tested the generalizability of the Assess Respiratory Risk in Surgical Patients in Catalonia risk score for PPCs in a large European cohort (Prospective Evaluation of a RIsk Score for postoperative pulmonary COmPlications in Europe).
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High versus low positive end-expiratory pressure during general anaesthesia for open abdominal surgery (PROVHILO trial): a multicentre randomised controlled trial.
Lancet
PUBLISHED: 06-02-2014
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The role of positive end-expiratory pressure in mechanical ventilation during general anaesthesia for surgery remains uncertain. Levels of pressure higher than 0 cm H2O might protect against postoperative pulmonary complications but could also cause intraoperative circulatory depression and lung injury from overdistension. We tested the hypothesis that a high level of positive end-expiratory pressure with recruitment manoeuvres protects against postoperative pulmonary complications in patients at risk of complications who are receiving mechanical ventilation with low tidal volumes during general anaesthesia for open abdominal surgery.
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The biological effects of higher and lower positive end-expiratory pressure in pulmonary and extrapulmonary acute lung injury with intra-abdominal hypertension.
Crit Care
PUBLISHED: 05-27-2014
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Mechanical ventilation with high positive end-expiratory pressure (PEEP) has been used in patients with acute respiratory distress syndrome (ARDS) and intra-abdominal hypertension (IAH), but the role of PEEP in minimizing lung injury remains controversial. We hypothesized that in the presence of acute lung injury (ALI) with IAH: 1) higher PEEP levels improve pulmonary morphofunction and minimize lung injury; and 2) the biological effects of higher PEEP are more effective in extrapulmonary (exp) than pulmonary (p) ALI.
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The effects of salbutamol on epithelial ion channels depend on the etiology of acute respiratory distress syndrome but not the route of administration.
Respir. Res.
PUBLISHED: 04-24-2014
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We investigated the effects of intravenous and intratracheal administration of salbutamol on lung morphology and function, expression of ion channels, aquaporin, and markers of inflammation, apoptosis, and alveolar epithelial/endothelial cell damage in experimental pulmonary (p) and extrapulmonary (exp) mild acute respiratory distress syndrome (ARDS).
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Variable versus conventional lung protective mechanical ventilation during open abdominal surgery: study protocol for a randomized controlled trial.
Trials
PUBLISHED: 04-17-2014
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General anesthesia usually requires mechanical ventilation, which is traditionally accomplished with constant tidal volumes in volume- or pressure-controlled modes. Experimental studies suggest that the use of variable tidal volumes (variable ventilation) recruits lung tissue, improves pulmonary function and reduces systemic inflammatory response. However, it is currently not known whether patients undergoing open abdominal surgery might benefit from intraoperative variable ventilation.
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A new adaptive controller for volume-controlled mechanical ventilation in small animals.
Exp. Lung Res.
PUBLISHED: 04-10-2014
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This study aimed to develop and evaluate an adaptive control system for volume-controlled ventilation (VCV) in small animals to guarantee accurate delivery of tidal volume (VT) in the presence of changes in lung mechanics.
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Approaches to ventilation in intensive care.
Dtsch Arztebl Int
PUBLISHED: 03-05-2014
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Mechanical ventilation is a common and often life-saving intervention in intensive care medicine. About 35% of all patients in intensive care are mechanically ventilated; about 15% of these patients develop a ventilation-associated pneumonia. The goal of ventilation therapy is to lessen the work of respiration and pulmonary gas exchange and thereby maintain or restore an adequate oxygen supply to the body's tissues. Mechanical ventilation can be carried out in many different modes; the avoidance of ventilation-induced lung damage through protective ventilation strategies is currently a major focus of clinical interest.
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Association between tidal volume size, duration of ventilation, and sedation needs in patients without acute respiratory distress syndrome: an individual patient data meta-analysis.
Intensive Care Med
PUBLISHED: 03-04-2014
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Mechanical ventilation with lower tidal volumes (?6 ml/kg of predicted body weight, PBW) could benefit patients without acute respiratory distress syndrome (ARDS). However, tidal volume reduction could be associated with increased patient discomfort and sedation needs, and consequent longer duration of ventilation. The aim of this individual patient data meta-analysis was to assess the associations between tidal volume size, duration of mechanical ventilation, and sedation needs in patients without ARDS.
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Higher levels of spontaneous breathing induce lung recruitment and reduce global stress/strain in experimental lung injury.
Anesthesiology
PUBLISHED: 01-11-2014
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Spontaneous breathing (SB) in the early phase of the acute respiratory distress syndrome is controversial. Biphasic positive airway pressure/airway pressure release ventilation (BIPAP/APRV) is commonly used, but the level of SB necessary to maximize potential beneficial effects is unknown.
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Albumin versus crystalloid solutions in patients with the acute respiratory distress syndrome: a systematic review and meta-analysis.
Crit Care
PUBLISHED: 01-03-2014
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In patients with acute respiratory distress syndrome (ARDS) fluid therapy might be necessary. The aim of this systematic review and meta-analysis is to determine the effects of colloid therapy compared to crystalloids on mortality and oxygenation in adults with ARDS.
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Protocol for a systematic review and individual patient data meta-analysis of benefit of so-called lung-protective ventilation settings in patients under general anesthesia for surgery.
Syst Rev
PUBLISHED: 01-02-2014
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Almost all patients under general anesthesia for surgery need mechanical ventilation. The harmful effects of short-term intra-operative ventilation on pulmonary integrity are increasingly recognized. Recent investigations suggest protection against so-called ventilation-associated lung injury with the use of lower tidal volumes and/or the use of higher levels of positive end-expiratory pressure (PEEP). This review and meta-analysis will evaluate the effects of these protective measures on pulmonary and extra-pulmonary complications, and try to discriminate the effects of lower tidal volumes from those of higher levels of PEEP.
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Liquid- and air-filled catheters without balloon as an alternative to the air-filled balloon catheter for measurement of esophageal pressure.
PLoS ONE
PUBLISHED: 01-01-2014
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Measuring esophageal pressure (Pes) using an air-filled balloon catheter (BC) is the common approach to estimate pleural pressure and related parameters. However, Pes is not routinely measured in mechanically ventilated patients, partly due to technical and practical limitations and difficulties. This study aimed at comparing the conventional BC with two alternative methods for Pes measurement, liquid-filled and air-filled catheters without balloon (LFC and AFC), during mechanical ventilation with and without spontaneous breathing activity. Seven female juvenile pigs (32-42 kg) were anesthetized, orotracheally intubated, and a bundle of an AFC, LFC, and BC was inserted in the esophagus. Controlled and assisted mechanical ventilation were applied with positive end-expiratory pressures of 5 and 15 cmH2O, and driving pressures of 10 and 20 cmH2O, in supine and lateral decubitus.
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Recruitment maneuvers modulate epithelial and endothelial cell response according to acute lung injury etiology.
Crit. Care Med.
PUBLISHED: 07-27-2013
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To investigate the effects of the rate of increase in airway pressure and duration of lung recruitment maneuvers in experimental pulmonary and extrapulmonary acute lung injury.
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Rationale and study design of ViPS -- variable pressure support for weaning from mechanical ventilation: study protocol for an international multicenter randomized controlled open trial.
Trials
PUBLISHED: 07-09-2013
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In pressure support ventilation (PSV), a non-variable level of pressure support is delivered by the ventilator when triggered by the patient. In contrast, variable PSV delivers a level of pressure support that varies in a random fashion, introducing more physiological variability to the respiratory pattern. Experimental studies show that variable PSV improves gas exchange, reduces lung inflammation and the mean pressure support, compared to non-variable PSV. Thus, it can theoretically shorten weaning from the mechanical ventilator.Methods/design: The ViPS (variable pressure support) trial is an international investigator-initiated multicenter randomized controlled open trial comparing variable vs. non-variable PSV. Adult patients on controlled mechanical ventilation for more than 24 hours who are ready to be weaned are eligible for the study. The randomization sequence is blocked per center and performed using a web-based platform. Patients are randomly assigned to one of the two groups: variable PSV or non-variable PSV. In non-variable PSV, breath-by-breath pressure support is kept constant and targeted to achieve a tidal volume of 6 to 8 ml/kg. In variable PSV, the mean pressure support level over a specific time period is targeted at the same mean tidal volume as non-variable PSV, but individual levels vary randomly breath-by-breath. The primary endpoint of the trial is the time to successful weaning, defined as the time from randomization to successful extubation.
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Effects of intravascular volume replacement on lung and kidney function and damage in nonseptic experimental lung injury.
Anesthesiology
PUBLISHED: 07-09-2013
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Intravascular volume replacement is often required in the presence of increased pulmonary capillary leakage, for example in patients with volutrauma with major hemorrhage. In the present study, the effects of Ringers acetate (RA), gelatin-polysuccinate (GEL), and a modern hydroxyethyl starch (HES, 6% 130/0.42) on lung and kidney function and damage were compared in a two-hit model of acute lung injury. The authors hypothesized that GEL and HES, compared to RA: (1) reduced lung histological damage, (2) impaired kidney morphology and function.
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Short-term effects of noisy pressure support ventilation in patients with acute hypoxemic respiratory failure.
Crit Care
PUBLISHED: 06-14-2013
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This study aims at comparing the very short-term effects of conventional and noisy (variable) pressure support ventilation (PSV) in mechanically ventilated patients with acute hypoxemic respiratory failure.
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Biphasic positive airway pressure minimizes biological impact on lung tissue in mild acute lung injury independent of etiology.
Crit Care
PUBLISHED: 04-03-2013
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Biphasic positive airway pressure (BIVENT) is a partial support mode that employs pressure-controlled, time-cycled ventilation set at two levels of continuous positive airway pressure with unrestricted spontaneous breathing. BIVENT can modulate inspiratory effort by modifying the frequency of controlled breaths. Nevertheless, the optimal amount of inspiratory effort to improve respiratory function while minimizing ventilator-associated lung injury during partial ventilatory assistance has not been determined. Furthermore, it is unclear whether the effects of partial ventilatory support depend on acute lung injury (ALI) etiology. This study aimed to investigate the impact of spontaneous and time-cycled control breaths during BIVENT on the lung and diaphragm in experimental pulmonary (p) and extrapulmonary (exp) ALI.
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Protective mechanical ventilation during general anesthesia for open abdominal surgery improves postoperative pulmonary function.
Anesthesiology
PUBLISHED: 04-02-2013
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The impact of intraoperative ventilation on postoperative pulmonary complications is not defined. The authors aimed at determining the effectiveness of protective mechanical ventilation during open abdominal surgery on a modified Clinical Pulmonary Infection Score as primary outcome and postoperative pulmonary function.
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Nonventilatory strategies to prevent postoperative pulmonary complications.
Curr Opin Anaesthesiol
PUBLISHED: 02-07-2013
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In this review, we aimed at providing the most recent and relevant clinical evidence regarding the use of nonventilatory strategies to prevent postoperative pulmonary complications (PPCs) after noncardiac surgery.
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Coherence analysis overestimates the role of baroreflex in governing the interactions between heart period and systolic arterial pressure variabilities during general anesthesia.
Auton Neurosci
PUBLISHED: 01-07-2013
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During general anesthesia positive pressure mechanical ventilation (MV) profoundly affects intrathoracic pressure and venous return, thus soliciting cardiopulmonary reflexes and modifying stroke volume. As a consequence heart period, approximated as the temporal distance between two consecutive R peaks on the ECG (RR), and systolic arterial pressure (SAP) variability series are usually highly correlated at the MV frequency (MVF) and this significant correlation is commonly taken as an indication of an active baroreflex. In this study the involvement of baroreflex was tested according to a time-domain linear Granger causality approach accounting explicitly for MV in two experimental protocols. In the first protocol volatile (VA) or intravenous (IA) anesthetic was administered in humans during pressure controlled MV (PCMV). In the second protocol IA was administered in pigs during PCMV or pressure support MV (PSMV). Causality analysis was contrasted with RR-SAP squared coherence. Significant coherence values at MVF were always found in both protocols. On the contrary, a significant causal link from SAP to RR was less frequently found in humans independently of the anesthesiological strategy and in animals during PCMV. PSMV was superior to PCMV in animals because it was able to better preserve a link from SAP to RR. During general anesthesia the involvement of baroreflex in governing RR-SAP variability interactions is largely overestimated by RR-SAP squared coherence and causality analysis can be exploited to rank anesthesiological strategies and MV modes according to the ability of preserving a working baroreflex.
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Mechanical ventilation during anaesthesia: challenges and opportunities for investigating the respiration-related cardiovascular oscillations.
Biomed Tech (Berl)
PUBLISHED: 07-06-2011
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The vast majority of the available literature regarding cardiovascular oscillations refers to spontaneously breathing subjects. Only a few studies investigated cardiovascular oscillations, and especially respiration-related ones (RCVO), during intermittent positive pressure mechanical ventilation (IPPV) under anaesthesia. Only a handful considered assisted IPPV, in which spontaneous breathing activity is supported, rather than replaced as in controlled IPPV. In this paper, we review the current understanding of RCVO physiology during IPPV, from literature retrieved through PubMed website. In particular, we describe how during controlled IPPV under anaesthesia respiratory sinus arrhythmia appears to be generated by non-neural mechano-electric feedback in the heart (indirectly influenced by tonic sympathetic regulation of vascular tone and heart contractility) and not by phasic vagal modulation of central origin and/or baroreflex mechanisms. Furthermore, assisted IPPV differs from controlled IPPV in terms of RCVO, reintroducing significant central respiratory vagal modulation of respiratory sinus arrhythmia. This evidence indicates against applying to IPPV interpretative paradigms of RCVO derived from spontaneously breathing subjects, and against considering together IPPV and spontaneously breathing subjects for RCVO-based risk assessment. Finally, we highlight the opportunities that IPPV offers for future investigations of RCVO genesis and interactions, and we indicate several possibilities for clinical applications of RCVO during IPPV.
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Use of computed tomography scanning to guide lung recruitment and adjust positive-end expiratory pressure.
Curr Opin Crit Care
PUBLISHED: 03-19-2011
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We discuss the possible role of computed tomography (CT) to guide protective mechanical ventilation in acute lung injury/acute respiratory distress syndrome (ALI/ARDS), especially tidal volume (VT) and positive-end expiratory pressure (PEEP) settings and recruitment manoeuvres.
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Rationale and study design of PROVHILO - a worldwide multicenter randomized controlled trial on protective ventilation during general anesthesia for open abdominal surgery.
Trials
PUBLISHED: 02-09-2011
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Post-operative pulmonary complications add to the morbidity and mortality of surgical patients, in particular after general anesthesia >2 hours for abdominal surgery. Whether a protective mechanical ventilation strategy with higher levels of positive end-expiratory pressure (PEEP) and repeated recruitment maneuvers; the "open lung strategy", protects against post-operative pulmonary complications is uncertain. The present study aims at comparing a protective mechanical ventilation strategy with a conventional mechanical ventilation strategy during general anesthesia for abdominal non-laparoscopic surgery.
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Computed tomographic assessment of lung weights in trauma patients with early posttraumatic lung dysfunction.
Crit Care
PUBLISHED: 01-31-2011
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Quantitative computed tomography (qCT)-based assessment of total lung weight (Mlung) has the potential to differentiate atelectasis from consolidation and could thus provide valuable information for managing trauma patients fulfilling commonly used criteria for acute lung injury (ALI). We hypothesized that qCT would identify atelectasis as a frequent mimic of early posttraumatic ALI.
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Distribution of regional lung aeration and perfusion during conventional and noisy pressure support ventilation in experimental lung injury.
J. Appl. Physiol.
PUBLISHED: 01-26-2011
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In acute lung injury (ALI), pressure support ventilation (PSV) may improve oxygenation compared with pressure-controlled ventilation (PCV), and benefit from random variation of pressure support (noisy PSV). We investigated the effects of PCV, PSV, and noisy PSV on gas exchange as well as the distribution of lung aeration and perfusion in 12 pigs with ALI induced by saline lung lavage in supine position. After injury, animals were mechanically ventilated with PCV, PSV, and noisy PSV for 1 h/mode in random sequence. The driving pressure was set to a mean tidal volume of 6 ml/kg and positive end-expiratory pressure to 8 cmH?O in all modes. Functional variables were measured, and the distribution of lung aeration was determined by static and dynamic computed tomography (CT), whereas the distribution of pulmonary blood flow (PBF) was determined by intravenously administered fluorescent microspheres. PSV and noisy PSV improved oxygenation and reduced venous admixture compared with PCV. Mechanical ventilation with PSV and noisy PSV did not decrease nonaerated areas but led to a redistribution of PBF from dorsal to ventral lung regions and reduced tidal reaeration and hyperinflation compared with PCV. Noisy PSV further improved oxygenation and redistributed PBF from caudal to cranial lung regions compared with conventional PSV. We conclude that assisted ventilation with PSV and noisy PSV improves oxygenation compared with PCV through redistribution of PBF from dependent to nondependent zones without lung recruitment. Random variation of pressure support further redistributes PBF and improves oxygenation compared with conventional PSV.
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Impact of pressure profile and duration of recruitment maneuvers on morphofunctional and biochemical variables in experimental lung injury.
Crit. Care Med.
PUBLISHED: 01-26-2011
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To investigate the effects of the rate of airway pressure increase and duration of recruitment maneuvers on lung function and activation of inflammation, fibrogenesis, and apoptosis in experimental acute lung injury.
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Pressure support improves oxygenation and lung protection compared to pressure-controlled ventilation and is further improved by random variation of pressure support.
Crit. Care Med.
PUBLISHED: 01-26-2011
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To explore whether 1) conventional pressure support ventilation improves lung function and attenuates the pulmonary inflammatory response compared to pressure-controlled ventilation and 2) random variation of pressure support levels (noisy pressure support ventilation) adds further beneficial effects to pressure support ventilation.
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Pilot study of vaporization of perfluorohexane during high-frequency oscillatory ventilation in experimental acute lung injury.
Exp. Lung Res.
PUBLISHED: 09-27-2010
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Inhalation of perfluorohexane vapor (PFH) and high-frequency oscillatory ventilation (HFOV) both have been shown to improve lung function in acute lung injury (ALI). Their combination implies synergistic action. The authors investigated technical aspects of PFH vaporization during HFOV and effects on gas exchange in a pilot study of experimental ALI. Eighteen anesthetized sheep were randomly assigned to HFOV or HFOV with PFH inhalation after oleic acid-induced ALI. HFOV was set to a continuous distending pressure of 25 cm H?O, and an oscillation of 80 to 100 cm H?O at a frequency of 5 Hz. PFH vapor was delivered by means of bypassed high-flow oxygen through a thin endotracheal tube. PFH concentration was measured by infrared absorption. Blood gases and hemodynamic data were taken. PaO? significantly increased from 9.1 ± 0.9 to 32.7 ± 9.5 kPa (mean ± SEM) in the HFOV group and from 12.5 ± 1.1 to 27.0 ± 6.8 kPa in the HFOV PFH group. PaCO? significantly decreased from 6.3 ± 0.3 to 5.5 ± 0.5 kPa in the HFOV group and from 5.7 ± 0.4 to 4.9 ± 0.5 kPa in the HFOV PFH group. Changes in gas exchange were not different between groups. These results show that the inhalation of PFH during HFOV is technically feasible, but did not enhance gas exchange in a 210-minute observation period of experimental ALI.
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Pros and cons of recruitment maneuvers in acute lung injury and acute respiratory distress syndrome.
Expert Rev Respir Med
PUBLISHED: 07-28-2010
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In patients with acute lung injury and acute respiratory distress syndrome, a protective mechanical ventilation strategy characterized by low tidal volumes has been associated with reduced mortality. However, such a strategy may result in alveolar collapse, leading to cyclic opening and closing of atelectatic alveoli and distal airways. Thus, recruitment maneuvers (RMs) have been used to open up collapsed lungs, while adequate positive end-expiratory pressure (PEEP) levels may counteract alveolar derecruitment during low tidal volume ventilation, improving respiratory function and minimizing ventilator-associated lung injury. Nevertheless, considerable uncertainty remains regarding the appropriateness of RMs. The most commonly used RM is conventional sustained inflation, associated with respiratory and cardiovascular side effects, which may be minimized by newly proposed strategies: prolonged or incremental PEEP elevation; pressure-controlled ventilation with fixed PEEP and increased driving pressure; pressure-controlled ventilation applied with escalating PEEP and constant driving pressure; and long and slow increase in pressure. The efficiency of RMs may be affected by different factors, including the nature and extent of lung injury, capability of increasing inspiratory transpulmonary pressures, patient positioning and cardiac preload. Current evidence suggests that RMs can be used before setting PEEP, after ventilator circuit disconnection or as a rescue maneuver to overcome severe hypoxemia; however, their routine use does not seem to be justified at present. The development of new lung recruitment strategies that have fewer hemodynamic and biological effects on the lungs, as well as randomized clinical trials analyzing the impact of RMs on morbidity and mortality of acute lung injury/acute respiratory distress syndrome patients, are warranted.
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Pretreatment with perfluorohexane vapor attenuates fMLP-induced lung injury in isolated perfused rabbit lungs.
Exp. Lung Res.
PUBLISHED: 07-27-2010
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The authors investigated the protective effects and dose dependency of perfluorohexane (PFH) vapor on leukocyte-mediated lung injury in isolated, perfused, and ventilated rabbit lungs. Lungs received either 18 vol.% (n = 7), 9 vol.% (n = 7), or 4.5 vol.% (n = 7) PFH. Fifteen minutes after beginning of PFH application, lung injury was induced with formyl-Met-Leu-Phe (fMLP). Control lungs (n = 7) received fMLP only. In addition 5 lungs (PFH-sham) remained uninjured receiving 18 vol.% PFH only. Pulmonary artery pressure (mPAP), peak inspiratory pressure (P(max)), and lung weight were monitored for 90 minutes. Perfusate samples were taken at regular intervals for analysis and representative lungs were fixed for histological analysis. In the control, fMLP application led to a significant increase of mPAP, P(max), lung weight, and lipid mediators. Pretreatment with PFH attenuated the rise in these parameters. This was accompanied by preservation of the structural integrity of the alveolar architecture and air-blood barrier. In uninjured lungs, mPAP, P(max), lung weight, and lipid mediator formation remained uneffected in the presence of PFH. The authors concluded that pretreatment with PFH vapor leads to an attenuation of leukocyte-mediated lung injury. Vaporization of perfluorocarbons (PFCs) offers new therapeutic options, making use of their protective and anti-inflammatory properties in prophylaxis or in early treatment of acute lung injury.
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Regional lung aeration and ventilation during pressure support and biphasic positive airway pressure ventilation in experimental lung injury.
Crit Care
PUBLISHED: 03-16-2010
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There is an increasing interest in biphasic positive airway pressure with spontaneous breathing (BIPAP+SBmean), which is a combination of time-cycled controlled breaths at two levels of continuous positive airway pressure (BIPAP+SBcontrolled) and non-assisted spontaneous breathing (BIPAP+SBspont), in the early phase of acute lung injury (ALI). However, pressure support ventilation (PSV) remains the most commonly used mode of assisted ventilation. To date, the effects of BIPAP+SBmean and PSV on regional lung aeration and ventilation during ALI are only poorly defined.
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Hypervolemia induces and potentiates lung damage after recruitment maneuver in a model of sepsis-induced acute lung injury.
Crit Care
PUBLISHED: 02-06-2010
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Recruitment maneuvers (RMs) seem to be more effective in extrapulmonary acute lung injury (ALI), caused mainly by sepsis, than in pulmonary ALI. Nevertheless, the maintenance of adequate volemic status is particularly challenging in sepsis. Since the interaction between volemic status and RMs is not well established, we investigated the effects of RMs on lung and distal organs in the presence of hypovolemia, normovolemia, and hypervolemia in a model of extrapulmonary lung injury induced by sepsis.
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Effects of perfluorohexane vapor in the treatment of experimental lung injury.
Pulm Pharmacol Ther
PUBLISHED: 01-29-2010
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We investigated the effects of vaporized perfluorohexane (PFH) on pulmonary vascular tone, pulmonary vascular resistance and peak inspiratory pressure as well as lipid mediator formation in the treatment of calcium ionophore induced lung injury in a model of the isolated perfused and ventilated rabbit lungs.
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Pressure support ventilation and biphasic positive airway pressure improve oxygenation by redistribution of pulmonary blood flow.
Anesth. Analg.
PUBLISHED: 08-20-2009
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Spontaneous breathing (SB) activity may improve gas exchange during mechanical ventilation mainly by the recruitment of previously collapsed regions. Pressure support ventilation (PSV) and biphasic positive airway pressure (BIPAP) are frequently used modes of SB, but little is known about the mechanisms of improvement of lung function during these modes of assisted mechanical ventilation. We evaluated the mechanisms behind the improvement of gas exchange with PSV and BIPAP.
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A novel adaptive control system for noisy pressure-controlled ventilation: a numerical simulation and bench test study.
Intensive Care Med
PUBLISHED: 04-24-2009
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There is growing interest in the use of both variable and pressure-controlled ventilation (PCV). The combination of these approaches as "noisy PCV" requires adaptation of the mechanical ventilator to the respiratory system mechanics. Thus, we developed and evaluated a new control system based on the least-mean-squares adaptive approach, which automatically and continuously adjusts the driving pressure during PCV to achieve the desired variability pattern of tidal volume (V (T)).
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Effects of different levels of pressure support variability in experimental lung injury.
Anesthesiology
PUBLISHED: 02-06-2009
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Noisy pressure support ventilation has been reported to improve respiratory function compared to conventional assisted mechanical ventilation. We aimed at determining the optimal level of pressure support variability during noisy pressure support ventilation.
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Impact of intravascular volume replacement and transfusion on outcome: where are we now?
Best Pract Res Clin Anaesthesiol
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Intravenous fluid administration is often required to counteract haemodynamic instability during emergency and elective surgeries, as well as in the intensive care unit. However, the best type and the amount of fluid required are controversial. A recent meta-analysis suggested that there is no difference among different types of colloids on outcome. Furthermore, colloids and crystalloids seem to be comparable in terms of efficiency in reverting haemodynamic instability, as well as morbidity and mortality. The interpretation of the results of different randomised controlled trials is somewhat difficult - the context must be always kept in mind. For example, results may differ in septic as compared to non-septic patient populations. Another important aspect concerns the effects on the macro- versus microcirculation. More recent studies emphasise that the microcirculation has to be taken into account when studying and interpreting the interaction between fluid therapy and the underlying disease. Nevertheless, the macrocirculation and clinical parameters have to be considered as well. Given that red blood cells remain the most important oxygen carriers, recent evidence regarding blood age may stimulate new studies according to the actual range for blood storage. Artificial oxygen carriers may play a role in specific situations, where the transfusion is indicated but the access to blood is problematic, but there is doubt that they may replace blood transfusion.
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Comparative effects of proportional assist and variable pressure support ventilation on lung function and damage in experimental lung injury.
Crit. Care Med.
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To investigate the effects of proportional assist ventilation, variable pressure support, and conventional pressure support ventilation on lung function and damage in experimental acute lung injury.
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Effects of assisted and variable mechanical ventilation on cardiorespiratory interactions in anesthetized pigs.
Physiol Meas
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The physiological importance of respiratory sinus arrhythmia (RSA) and cardioventilatory coupling (CVC) has not yet been fully elucidated, but these phenomena might contribute to improve ventilation/perfusion matching, with beneficial effects on gas exchange. Furthermore, decreased RSA amplitude has been suggested as an indicator of impaired autonomic control and poor clinical outcome, also during positive-pressure mechanical ventilation (MV). However, it is currently unknown how different modes of MV, including variable tidal volumes (V(T)), affect RSA and CVC during anesthesia. We compared the effects of pressure controlled (PCV) versus pressure assisted (PSV) ventilation, and of random variable versus constant V(T), on RSA and CVC in eight anesthetized pigs. At comparable depth of anesthesia, global hemodynamics, and ventilation, RSA amplitude increased from 20 ms in PCV to 50 ms in PSV (p < 0.05). CVC was detected (using proportional Shannon entropy of the interval between each inspiration onset and the previous R-peak in ECG) in two animals in PCV and seven animals in PSV. Variable V(T) did not significantly influence these phenomena. Furthermore, heart period and systolic arterial pressure oscillations were in phase during PCV but in counter-phase during PSV. At the same depth of anesthesia in pigs, PSV increases RSA amplitude and CVC compared to PCV. Our data suggest that the central respiratory drive, but not the baroreflex or the mechano-electric feedback in the heart, is the main mechanism behind the RSA increase. Hence, differences in RSA and CVC between mechanically ventilated patients might reflect the difference in ventilation mode rather than autonomic impairment. Also, since gas exchange did not increase from PCV to PSV, it is questionable whether RSA has any significance in improving ventilation/perfusion matching during MV.
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Lung recruitment in ARDS: we are still confused, but on a higher PEEP level.
Crit Care
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Recruitment maneuvers and the application of high levels of positive end-expiratory pressure combined with lung protective mechanical ventilation strategies have been proposed to improve pulmonary function in patients with severe acute respiratory distress syndrome. However, the optimal way to achieve and maintain alveolar recruitment is still under debate.
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Spontaneous breathing activity in acute lung injury and acute respiratory distress syndrome.
Curr Opin Anaesthesiol
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We aimed at providing the most recent and relevant evidence regarding spontaneous breathing activity during mechanical ventilation in acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). Both clinical and experimental data are depicted.
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Chronic obstructive pulmonary disease.
Curr Opin Anaesthesiol
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Chronic obstructive pulmonary disease (COPD) is a common cause of primary hospital admission and also a common coexisting disease among surgical patients. This translational review focused on recent studies related to the perioperative care of COPD patients.
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What is Visualize?

JoVE Visualize is a tool created to match the last 5 years of PubMed publications to methods in JoVE's video library.

How does it work?

We use abstracts found on PubMed and match them to JoVE videos to create a list of 10 to 30 related methods videos.

Video X seems to be unrelated to Abstract Y...

In developing our video relationships, we compare around 5 million PubMed articles to our library of over 4,500 methods videos. In some cases the language used in the PubMed abstracts makes matching that content to a JoVE video difficult. In other cases, there happens not to be any content in our video library that is relevant to the topic of a given abstract. In these cases, our algorithms are trying their best to display videos with relevant content, which can sometimes result in matched videos with only a slight relation.