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[PMID]:28708679
[Au] Autor:Fumagalli J; Berra L; Zhang C; Pirrone M; Santiago RRS; Gomes S; Magni F; Dos Santos GAB; Bennett D; Torsani V; Fisher D; Morais C; Amato MBP; Kacmarek RM
[Ad] Endereço:1Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA.2Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Universita' degli Studi di Milano, Milan, Italy.3Pulmonary Division, Heart Institute, School of Medicine, University of São Paulo, São Paulo, Brazil.4Dipartimento di Medicina e Chirurgia, Universita' degli Studi di Milano-Bicocca, Milan, Italy.5Hospital das Clínicas da Faculdade de Medicina da USP (HCFMUSP)-Instituto de Radiologia (InRad), Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.6Respiratory Care Department, Massachusetts General Hospital, Boston, MA.
[Ti] Título:Transpulmonary Pressure Describes Lung Morphology During Decremental Positive End-Expiratory Pressure Trials in Obesity.
[So] Source:Crit Care Med;45(8):1374-1381, 2017 Aug.
[Is] ISSN:1530-0293
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: Atelectasis develops in critically ill obese patients when undergoing mechanical ventilation due to increased pleural pressure. The current study aimed to determine the relationship between transpulmonary pressure, lung mechanics, and lung morphology and to quantify the benefits of a decremental positive end-expiratory pressure trial preceded by a recruitment maneuver. DESIGN: Prospective, crossover, nonrandomized interventional study. SETTING: Medical and Surgical Intensive Care Units at Massachusetts General Hospital (Boston, MA) and University Animal Research Laboratory (São Paulo, Brazil). PATIENTS/SUBJECTS: Critically ill obese patients with acute respiratory failure and anesthetized swine. INTERVENTIONS: Clinical data from 16 mechanically ventilated critically ill obese patients were analyzed. An animal model of obesity with reversible atelectasis was developed by placing fluid filled bags on the abdomen to describe changes of lung mechanics, lung morphology, and pulmonary hemodynamics in 10 swine. MEASUREMENTS AND MAIN RESULTS: In obese patients (body mass index, 48 ± 11 kg/m), 21.7 ± 3.7 cm H2O of positive end-expiratory pressure resulted in the lowest elastance of the respiratory system (18.6 ± 6.1 cm H2O/L) after a recruitment maneuver and decremental positive end-expiratory pressure and corresponded to a positive (2.1 ± 2.2 cm H2O) end-expiratory transpulmonary pressure. Ventilation at lowest elastance positive end-expiratory pressure preceded by a recruitment maneuver restored end-expiratory lung volume (30.4 ± 9.1 mL/kg ideal body weight) and oxygenation (273.4 ± 72.1 mm Hg). In the swine model, lung collapse and intratidal recruitment/derecruitment occurred when the positive end-expiratory transpulmonary pressure decreased below 2-4 cm H2O. After the development of atelectasis, a decremental positive end-expiratory pressure trial preceded by lung recruitment identified the positive end-expiratory pressure level (17.4 ± 2.1 cm H2O) needed to restore poorly and nonaerated lung tissue, reestablishing lung elastance and oxygenation while avoiding increased pulmonary vascular resistance. CONCLUSIONS: In obesity, low-to-negative values of transpulmonary pressure predict lung collapse and intratidal recruitment/derecruitment. A decremental positive end-expiratory pressure trial preceded by a recruitment maneuver reverses atelectasis, improves lung mechanics, distribution of ventilation and oxygenation, and does not increase pulmonary vascular resistance.
[Mh] Termos MeSH primário: Estado Terminal
Pulmão/patologia
Obesidade/fisiopatologia
Atelectasia Pulmonar/fisiopatologia
Respiração Artificial/efeitos adversos
[Mh] Termos MeSH secundário: Animais
Modelos Animais de Doenças
Impedância Elétrica
Seres Humanos
Unidades de Terapia Intensiva
Pulmão/diagnóstico por imagem
Obesidade/terapia
Respiração por Pressão Positiva Intrínseca
Estudos Prospectivos
Mecânica Respiratória
Suínos
Tomografia Computadorizada por Raios X
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170816
[Lr] Data última revisão:
170816
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170715
[St] Status:MEDLINE
[do] DOI:10.1097/CCM.0000000000002460


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[PMID]:28094413
[Au] Autor:Gloning S; Pieper K; Zoellner M; Meyer-Lindenberg A
[Ad] Endereço:Simon Gloning, Chirurgische und Gynäkologische Kleintierklinik, Ludwig-Maximilians-Universität, Veterinärstraße 13, 80539 München, Germany, Email: simon.gloning@gmail.com.
[Ti] Título:Electrical impedance tomography for lung ventilation monitoring of the dog.
[So] Source:Tierarztl Prax Ausg K Kleintiere Heimtiere;45(1):15-21, 2017 Feb 09.
[Is] ISSN:1434-1239
[Cp] País de publicação:Germany
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Electrical impedance tomography (EIT) is a radiation free technique which takes advantage of the different electrical conductivities of different tissues. Its main field of application is lung ventilation monitoring. The aim of this prospective study was to evaluate the feasibility of collecting EIT information on a sample of dogs with different thoracic shapes under clinical conditions by connecting an electrode belt without fur clipping. MATERIAL AND METHODS: Fifteen pulmonary healthy dogs were anaesthetized, positioned in sternal recumbency and ventilated in a pressure-controlled mode at three different positive end-expiratory pressure levels (PEEP) of 0, 5 and 10 cmH O for five breaths each, with a peak inspiratory pressure of 15 cmH O. The impedance changes were recorded with a commercial EIT device applied around the thorax. Subsequently, the ventilation regime was repeated and a computed tomography scan (CT) of the same thoracic segment was performed for each PEEP level. The tidal volume (V ) was recorded. For the collection of EIT data the sum of regional impedance changes was recorded. The impedance value of the entire lung (global) was recorded and the ventilated area was quartered into four regions of interest (ROI). In a CT image with the fewest adjacent organs, lung tissue was selected to obtain the mean value of lung radiodensitiy in Hounsfield-Units (HU) for the entire lung and for the four ROIs. RESULTS: EIT recordings via the electrode belt were possible without clipping. There was a significant correlation for the parameters of aeration as measured by EIT and CT for both the entire ventilated lung and the corresponding ROIs. The increasing PEEP resulted in a proportional increase of the impedance, and there was a negative correlation between EIT and V . The better ventilated dorsal ROIs could be identified using both EIT and CT. An intra-assay coefficient of variation showed a good reproducibility for lung ventilation in anaesthetized dogs in the EIT. DISCUSSION: The results show that EIT is a reliable method for evaluating the ventilation of dogs in a clinical setting. The accuracy of EIT might be improved by using a mesh corresponding to the different thoracic shapes of the dogs.
[Mh] Termos MeSH primário: Cães/fisiologia
Pulmão/fisiologia
Ventilação Pulmonar/fisiologia
[Mh] Termos MeSH secundário: Animais
Impedância Elétrica
Tomografia Computadorizada Multidetectores/veterinária
Respiração por Pressão Positiva Intrínseca/veterinária
Estudos Prospectivos
Reprodutibilidade dos Testes
Volume de Ventilação Pulmonar
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170809
[Lr] Data última revisão:
170809
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170118
[St] Status:MEDLINE
[do] DOI:10.15654/TPK-150569


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[PMID]:27782908
[Au] Autor:Zhang C; Pirrone M; Imber DA; Ackman JB; Fumagalli J; Kacmarek RM; Berra L
[Ad] Endereço:From the *Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts; †Anesthesia and Operation Center, Chinese PLA General Hospital, Beijing, China; and Departments of ‡Radiology and §Respiratory Care, Massachusetts General Hospital, Boston, Massachusetts.
[Ti] Título:Optimization of Mechanical Ventilation in a 31-Year-Old Morbidly Obese Man With Refractory Hypoxemia.
[So] Source:A A Case Rep;8(1):7-10, 2017 Jan 01.
[Is] ISSN:2325-7237
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Morbidly obese, critically ill patients are prone to develop hypoxemic respiratory failure and ventilator dependency. The best method for recruiting the lungs of these patients and keeping alveoli open without causing injury remains unclear. We present the case of a 31-year-old patient with severe refractory hypoxemia reversed by lung recruitment maneuvers and subsequent application of positive end-expiratory pressure (PEEP) at a level determined by a decremental PEEP trial. The patient was extubated at a high PEEP level of 22 cm H2O followed by noninvasive ventilatory support after extubation. This case suggests that a recruitment maneuver followed by PEEP titration is necessary in obese patients for optimizing mechanical ventilation. Extubation to noninvasive ventilatory support with the identified optimal PEEP may decrease an inappropriate increased work of breathing and the risk of reintubation.
[Mh] Termos MeSH primário: Pressão Positiva Contínua nas Vias Aéreas/métodos
Hipóxia/terapia
Síndrome de Hipoventilação por Obesidade/complicações
Obesidade Mórbida/complicações
[Mh] Termos MeSH secundário: Adulto
Seres Humanos
Hipóxia/diagnóstico
Hipóxia/etiologia
Masculino
Respiração por Pressão Positiva Intrínseca/diagnóstico
Respiração por Pressão Positiva Intrínseca/etiologia
Respiração por Pressão Positiva Intrínseca/terapia
Resultado do Tratamento
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1701
[Cu] Atualização por classe:170118
[Lr] Data última revisão:
170118
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161027
[St] Status:MEDLINE
[do] DOI:10.1213/XAA.0000000000000408


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[PMID]:27855477
[Au] Autor:Hodgson C; Goligher EC; Young ME; Keating JL; Holland AE; Romero L; Bradley SJ; Tuxen D
[Ad] Endereço:Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia, 3181.
[Ti] Título:Recruitment manoeuvres for adults with acute respiratory distress syndrome receiving mechanical ventilation.
[So] Source:Cochrane Database Syst Rev;11:CD006667, 2016 11 17.
[Is] ISSN:1469-493X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Recruitment manoeuvres involve transient elevations in airway pressure applied during mechanical ventilation to open ('recruit') collapsed lung units and increase the number of alveoli participating in tidal ventilation. Recruitment manoeuvres are often used to treat patients in intensive care who have acute respiratory distress syndrome (ARDS), but the effect of this treatment on clinical outcomes has not been well established. This systematic review is an update of a Cochrane review originally published in 2009. OBJECTIVES: Our primary objective was to determine the effects of recruitment manoeuvres on mortality in adults with acute respiratory distress syndrome.Our secondary objective was to determine, in the same population, the effects of recruitment manoeuvres on oxygenation and adverse events (e.g. rate of barotrauma). SEARCH METHODS: For this updated review, we searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (OVID), Embase (OVID), the Cumulative Index to Nursing and Allied Health Literature (CINAHL, EBSCO), Latin American and Caribbean Health Sciences (LILACS) and the International Standard Randomized Controlled Trial Number (ISRCTN) registry from inception to August 2016. SELECTION CRITERIA: We included randomized controlled trials (RCTs) of adults who were mechanically ventilated that compared recruitment manoeuvres versus standard care for patients given a diagnosis of ARDS. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trial quality and extracted data. We contacted study authors for additional information. MAIN RESULTS: Ten trials met the inclusion criteria for this review (n = 1658 participants). We found five trials to be at low risk of bias and five to be at moderate risk of bias. Six of the trials included recruitment manoeuvres as part of an open lung ventilation strategy that was different from control ventilation in aspects other than the recruitment manoeuvre (such as mode of ventilation, higher positive end-expiratory pressure (PEEP) titration and lower tidal volume or plateau pressure). Six studies reported mortality outcomes. Pooled data from five trials (1370 participants) showed a reduction in intensive care unit (ICU) mortality (risk ratio (RR) 0.83, 95% confidence interval (CI) 0.72 to 0.97, P = 0.02, low-quality evidence), pooled data from five trials (1450 participants) showed no difference in 28-day mortality (RR 0.86, 95% CI 0.74 to 1.01, P = 0.06, low-quality evidence) and pooled data from four trials (1313 participants) showed no difference in in-hospital mortality (RR 0.88, 95% CI 0.77 to 1.01, P = 0.07, low-quality evidence). Data revealed no differences in risk of barotrauma (RR 1.09, 95% CI 0.78 to 1.53, P = 0.60, seven studies, 1508 participants, moderate-quality evidence). AUTHORS' CONCLUSIONS: We identified significant clinical heterogeneity in the 10 included trials. Results are based upon the findings of several (five) trials that included an "open lung ventilation strategy", whereby the intervention group differed from the control group in aspects other than the recruitment manoeuvre (including co-interventions such as higher PEEP, different modes of ventilation and higher plateau pressure), making interpretation of the results difficult. A ventilation strategy that included recruitment manoeuvres in participants with ARDS reduced intensive care unit mortality without increasing the risk of barotrauma but had no effect on 28-day and hospital mortality. We downgraded the quality of the evidence to low, as most of the included trials provided co-interventions as part of an open lung ventilation strategy, and this might have influenced results of the outcome.
[Mh] Termos MeSH primário: Lesão Pulmonar Aguda/terapia
Respiração Artificial/métodos
Síndrome do Desconforto Respiratório do Adulto/terapia
[Mh] Termos MeSH secundário: Lesão Pulmonar Aguda/mortalidade
Adulto
Seres Humanos
Consumo de Oxigênio
Respiração por Pressão Positiva Intrínseca
Pressão/efeitos adversos
Ensaios Clínicos Controlados Aleatórios como Assunto
Síndrome do Desconforto Respiratório do Adulto/mortalidade
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Em] Mês de entrada:1612
[Cu] Atualização por classe:161230
[Lr] Data última revisão:
161230
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161118
[St] Status:MEDLINE


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[PMID]:27555619
[Au] Autor:Wirth S; Seywert L; Spaeth J; Schumann S
[Ad] Endereço:Department of Anesthesiology and Intensive Care Medicine, University Medical Center Freiburg, Freiburg, Germany. steffen.wirth@uniklinik-freiburg.de.
[Ti] Título:Compensating Artificial Airway Resistance via Active Expiration Assistance.
[So] Source:Respir Care;61(12):1597-1604, 2016 Dec.
[Is] ISSN:1943-3654
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Artificial airway resistance as provided by small-lumen tracheal tubes or catheters increases the risk of intrinsic PEEP (PEEPi). We hypothesized that by active expiration assistance, larger minute volumes could be generated without causing PEEPi compared with conventional mechanical ventilation when using small-lumen tracheal tubes or a cricothyrotomy catheter. METHODS: We investigated the active expiration assistance in a physical model of the respiratory system and estimated its hypothetical performance in terms of maximal flow generated with endotracheal tubes ranging from 3.0 to 8.0 mm inner diameter (ID); with microlaryngeal tubes of 4.0, 5.0, and 6.0 mm ID; and with a cricothyrotomy catheter. Furthermore, we determined the minute volumes that could be achieved without generating PEEPi by ventilating a physical lung model using conventional mechanical ventilation or using active expiration assistance. RESULTS: The inspiratory and expiratory flow during active expiration assistance increased with increasing supply flow and decreased with decreasing ID of the connected endotracheal tubes (both P < .001). With small-lumen tracheal tubes, the active expiration assistance generated similar or higher minute volumes than conventional ventilation. Conventional mechanical ventilation with PEEPi <1 cm H O was not achievable via a microlaryngeal tube of 4.0 mm ID and smaller lumen tubes. CONCLUSIONS: For mechanical ventilation via small-lumen tubes or thin catheters, active compensation of airway resistance might be a necessary means to generate adequate minute ventilation without causing PEEPi. Active expiration assistance can generate reasonable respiratory minute volumes via small-lumen tubes or thin catheters.
[Mh] Termos MeSH primário: Resistência das Vias Respiratórias/fisiologia
Expiração/fisiologia
Pulmão/fisiopatologia
Respiração por Pressão Positiva Intrínseca/prevenção & controle
Respiração Artificial/métodos
[Mh] Termos MeSH secundário: Estudos de Viabilidade
Seres Humanos
Intubação Intratraqueal
Medidas de Volume Pulmonar
Modelos Anatômicos
Respiração por Pressão Positiva Intrínseca/etiologia
Respiração Artificial/efeitos adversos
Respiração Artificial/instrumentação
Traqueia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170908
[Lr] Data última revisão:
170908
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160825
[St] Status:MEDLINE


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[PMID]:27185694
[Au] Autor:Gemma M; Nicelli E; Corti D; De Vitis A; Patroniti N; Foti G; Calvi MR; Beretta L
[Ad] Endereço:Anesthesia and Intensive Care, Department of Anesthesiology, San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy. Electronic address: gemma.marco@hsr.it.
[Ti] Título:Intrinsic positive end-expiratory pressure during ventilation through small endotracheal tubes during general anesthesia: incidence, mechanism, and predictive factors.
[So] Source:J Clin Anesth;31:124-30, 2016 Jun.
[Is] ISSN:1873-4529
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:STUDY OBJECTIVE: To assess the safety of mechanical ventilation and effectiveness of extrinsic positive end-expiratory pressure (PEEP) (PEEPe) in improving peripheral oxygen saturation (SpO2) during direct microlaryngeal laser surgery; to assess the incidence, amount, and nature (dynamic hyperinflation or airflow obstruction) of ensuing intrinsic PEEP (PEEPi); and to find a surrogate PEEPi indicator. DESIGN: Quasiexperimental. SETTING: S. Raffaele Hospital (Milano), November 2009 to December 2010. PATIENTS: Fifty-two adults scheduled for direct microlaryngeal laser surgery. Exclusion criterion is pregnancy. INTERVENTIONS: Twenty-one percent O2 mechanical ventilation through 4.5- to 5.5-mm internal diameter endotracheal tubes; in 29 patients, after measurement of PEEPi, an identical amount of PEEPe was added; and PEEPi. MEASUREMENTS: SpO2, peak (Pawpeak) and plateau (Pawplateau) airway pressure, and end-expiratory carbon dioxide were measured every 5 minutes. Respiratory compliance (Crs) was computed. PEEPi was measured (end-expiratory occlusion method). MAIN RESULTS: PEEPi ≥5 cm H2O occurred in 14 patients (27%) after intubation, in 16 (30%) at the beginning, and in 14 (27.3%) at the end of surgery. Thirty-one patients (59.4%) exhibited PEEPi ≥5 cm H2O on at least 1 time point. PEEPi at the beginning of surgery was positively correlated with Pawplateau, Crs, tidal volume, and body mass index. Body mass index was the only predictor for the occurrence of PEEPi ≥5 cm H2O. At the beginning of surgery, the Pawplateau receiver operating characteristic curve predicting PEEPi ≥5 cm H2O had area under the receiver operating characteristic curve of 0.85; best cutoff value of 15.5 cm H2O (sensitivity, 88.9%; specificity, 75%; correctly classified cases, 86.1%). When PEEPe was applied, in 23 cases (82.1%), total PEEP equaled PEEPe+ PEEPi; in 3 (10.7%), it was lower; and in 2 (7.1%), it was higher. Application of PEEPe increased SpO2 (P< .05) and Crs (P< .05). CONCLUSIONS: During ventilation through small endotracheal tubes, PEEPi (mostly due to dynamic hyperinflation) is common. Hemodynamic complications, barotrauma, and O2 desaturation (reversible with PEEPe) are rare. Pawplateau provided by ventilators is useful in suspecting and monitoring the occurrence of PEEPi and allows detection of lung overdistension as PEEPe is applied.
[Mh] Termos MeSH primário: Anestesia Geral
Respiração por Pressão Positiva Intrínseca/epidemiologia
Respiração Artificial/instrumentação
[Mh] Termos MeSH secundário: Feminino
Seres Humanos
Incidência
Masculino
Meia-Idade
Fatores de Risco
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1703
[Cu] Atualização por classe:170317
[Lr] Data última revisão:
170317
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160518
[St] Status:MEDLINE


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[PMID]:27035239
[Au] Autor:Villar J; Ambrós A; Soler JA; Martínez D; Ferrando C; Solano R; Mosteiro F; Blanco J; Martín-Rodríguez C; Fernández MM; López J; Díaz-Domínguez FJ; Andaluz-Ojeda D; Merayo E; Pérez-Méndez L; Fernández RL; Kacmarek RM; Stratification and Outcome of Acute Respiratory Distress Syndrome (STANDARDS) Network
[Ad] Endereço:1CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain. 2Research Unit, Hospital Universitario Dr. Negrin, Las Palmas de Gran Canaria, Spain. 3Intensive Care Unit, Hospital General de Ciudad Real, Ciudad Real, Spain. 4Intensive Care Unit, Hospital Universitario Morales Meseguer, Murcia, Spain. 5Intensive Care Unit, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain. 6Post-Surgical Unit, Department of Anesthesia, Hospital Clínico de Valencia, Valencia, Spain. 7Intensive Care Unit, Hospital Virgen de la Luz, Cuenca, Spain. 8Intensive Care Unit, Hospital Universitario A Coruña, Coruña, Spain. 9Intensive Care Unit, Hospital Universitario Río Hortega, Valladolid, Spain. 10Intensive Care Unit, Hospital Universitario Mutua de Terrassa, Barcelona, Spain. 11Intensive Care Unit, Hospital Universitario La Paz, Madrid, Spain. 12Intensive Care Unit, Hospital General de León, León, Spain. 13Intensive Care Unit, Hospital Clínico de Valladolid, Valladolid, Spain. 14Intensive Care Unit, Hospital del Bierzo, Ponferrada, León, Spain. 15Research Unit, Hospital Universitario NS de Candelaria, Santa Cruz de Tenerife, Spain. 16Department of Respiratory Care, Massachusetts General Hospital, Boston, MA. 17Department of Anesthesia, Harvard University, Boston, MA.
[Ti] Título:Age, PaO2/FIO2, and Plateau Pressure Score: A Proposal for a Simple Outcome Score in Patients With the Acute Respiratory Distress Syndrome.
[So] Source:Crit Care Med;44(7):1361-9, 2016 Jul.
[Is] ISSN:1530-0293
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: Although there is general agreement on the characteristic features of the acute respiratory distress syndrome, we lack a scoring system that predicts acute respiratory distress syndrome outcome with high probability. Our objective was to develop an outcome score that clinicians could easily calculate at the bedside to predict the risk of death of acute respiratory distress syndrome patients 24 hours after diagnosis. DESIGN: A prospective, multicenter, observational, descriptive, and validation study. SETTING: A network of multidisciplinary ICUs. PATIENTS: Six-hundred patients meeting Berlin criteria for moderate and severe acute respiratory distress syndrome enrolled in two independent cohorts treated with lung-protective ventilation. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Using individual demographic, pulmonary, and systemic data at 24 hours after acute respiratory distress syndrome diagnosis, we derived our prediction score in 300 acute respiratory distress syndrome patients based on stratification of variable values into tertiles, and validated in an independent cohort of 300 acute respiratory distress syndrome patients. Primary outcome was in-hospital mortality. We found that a 9-point score based on patient's age, PaO2/FIO2 ratio, and plateau pressure at 24 hours after acute respiratory distress syndrome diagnosis was associated with death. Patients with a score greater than 7 had a mortality of 83.3% (relative risk, 5.7; 95% CI, 3.0-11.0), whereas patients with scores less than 5 had a mortality of 14.5% (p < 0.0000001). We confirmed the predictive validity of the score in a validation cohort. CONCLUSIONS: A simple 9-point score based on the values of age, PaO2/FIO2 ratio, and plateau pressure calculated at 24 hours on protective ventilation after acute respiratory distress syndrome diagnosis could be used in real time for rating prognosis of acute respiratory distress syndrome patients with high probability.
[Mh] Termos MeSH primário: Avaliação de Resultados (Cuidados de Saúde)/métodos
Oxigênio/sangue
Respiração com Pressão Positiva
Síndrome do Desconforto Respiratório do Adulto
[Mh] Termos MeSH secundário: APACHE
Adulto
Fatores Etários
Idoso
Feminino
Mortalidade Hospitalar
Seres Humanos
Masculino
Meia-Idade
Oxigênio/administração & dosagem
Respiração por Pressão Positiva Intrínseca
Valor Preditivo dos Testes
Prognóstico
Estudos Prospectivos
Curva ROC
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY; OBSERVATIONAL STUDY; VALIDATION STUDIES
[Nm] Nome de substância:
S88TT14065 (Oxygen)
[Em] Mês de entrada:1705
[Cu] Atualização por classe:170727
[Lr] Data última revisão:
170727
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:160402
[St] Status:MEDLINE
[do] DOI:10.1097/CCM.0000000000001653


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[PMID]:26796617
[Au] Autor:Ku SC
[Ad] Endereço:Division of Pulmonary and Critical Care Medicine Department of Internal Medicine National Taiwan University Hospital Taipei, Taiwan scku1015@ntu.edu.tw.
[Ti] Título:It's Time to Reappraise the Impact of Auto-PEEP.
[So] Source:Respir Care;61(2):258-9, 2016 Feb.
[Is] ISSN:1943-3654
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Respiração por Pressão Positiva Intrínseca
Respiração com Pressão Positiva
[Mh] Termos MeSH secundário: Seres Humanos
[Pt] Tipo de publicação:COMMENT; EDITORIAL
[Em] Mês de entrada:1608
[Cu] Atualização por classe:160122
[Lr] Data última revisão:
160122
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160123
[St] Status:MEDLINE
[do] DOI:10.4187/respcare.04658


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[PMID]:26640077
[Au] Autor:To KW; Chan TO; Ng S; Ngai J; Hui DS
[Ad] Endereço:Division of Respiratory Medicine, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
[Ti] Título:Role of nasal positive end expiratory pressure valve as an alternative treatment for obstructive sleep apnoea in Chinese patients.
[So] Source:Respirology;21(3):541-5, 2016 Apr.
[Is] ISSN:1440-1843
[Cp] País de publicação:Australia
[La] Idioma:eng
[Ab] Resumo:BACKGROUND AND OBJECTIVE: As compliance of continuous positive airway pressure (CPAP) for treatment of obstructive sleep apnoea (OSA) is often suboptimal, a less cumbersome treatment is desirable. We explored the clinical usefulness of nasal positive end expiratory pressure (nPEEP) valves. METHODS: Symptomatic OSA patients (apnoea hypopnea index (AHI) >5/h by polysomnography (PSG) or >10/h by type III devices), who declined CPAP, were recruited. A nPEEP valve was attached to each nostril before bed. After successful acclimatization for 1 week, treatment was continued for 4 weeks. The nPEEP valves provided expiratory resistance to build up PEEP. PSG was performed at week 4. RESULTS: Among 196 subjects, 46 (23%) failed acclimatization and 14 (7%) withdrew. Among the 120 patients with a valid PSG, 72 (60%) and 75 (63%) had >50% reduction in mean (standard deviation) overall AHI 26 (16)/h to 18 (18)/h and mean supine AHI 31 (19)/h to 11(16)/h, respectively, P < 0.001. Compared with responders, patients with <50% reduction in AHI had a higher mean overall AHI (30/h vs 23/h, P = 0.03), higher mean supine AHI (35/h vs 26/h, P = 0.04), more severe mean oxygen desaturation nadir (76.7% vs 82.7%, P < 0.01) and longer mean period of desaturation <90% SaO2 (7.7 vs 2.4, P = 0.02). Breathing discomfort and dry mouth were the most common side effects. Compared with a dental device, there was a larger mean reduction in supine AHI using nPEEP (29 (14)/h vs 16 (17)/h). CONCLUSION: nPEEP valves were useful in selected patients with mild or positional-related OSA.
[Mh] Termos MeSH primário: Pressão Positiva Contínua nas Vias Aéreas/métodos
Cooperação do Paciente
Respiração por Pressão Positiva Intrínseca/terapia
Apneia Obstrutiva do Sono/terapia
[Mh] Termos MeSH secundário: China/epidemiologia
Feminino
Seres Humanos
Incidência
Masculino
Meia-Idade
Polissonografia
Respiração por Pressão Positiva Intrínseca/etiologia
Respiração por Pressão Positiva Intrínseca/fisiopatologia
Apneia Obstrutiva do Sono/complicações
Apneia Obstrutiva do Sono/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1612
[Cu] Atualização por classe:161230
[Lr] Data última revisão:
161230
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:151208
[St] Status:MEDLINE
[do] DOI:10.1111/resp.12703


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[PMID]:26604329
[Au] Autor:Natalini G; Tuzzo D; Rosano A; Testa M; Grazioli M; Pennestrì V; Amodeo G; Marsilia PF; Tinnirello A; Berruto F; Fiorillo M; Filippini M; Peratoner A; Minelli C; Bernardini A; VENTILAB Group
[Ad] Endereço:Department of Anesthesia and Intensive Care, Fondazione Poliambulanza Hospital, Brescia, Italy. giuseppe.natalini@gmail.com.
[Ti] Título:Assessment of Factors Related to Auto-PEEP.
[So] Source:Respir Care;61(2):134-41, 2016 Feb.
[Is] ISSN:1943-3654
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Previous physiological studies have identified factors that are involved in auto-PEEP generation. In our study, we examined how much auto-PEEP is generated from factors that are involved in its development. METHODS: One hundred eighty-six subjects undergoing controlled mechanical ventilation with persistent expiratory flow at the beginning of each inspiration were enrolled in the study. Volume-controlled continuous mandatory ventilation with PEEP of 0 cm H2O was applied while maintaining the ventilator setting as chosen by the attending physician. End-expiratory and end-inspiratory airway occlusion maneuvers were performed to calculate respiratory mechanics, and tidal flow limitation was assessed by a maneuver of manual compression of the abdomen. RESULTS: The variable with the strongest effect on auto-PEEP was flow limitation, which was associated with an increase of 2.4 cm H2O in auto-PEEP values. Moreover, auto-PEEP values were directly related to resistance of the respiratory system and body mass index and inversely related to expiratory time/time constant. Variables that were associated with the breathing pattern (tidal volume, frequency minute ventilation, and expiratory time) did not show any relationship with auto-PEEP values. The risk of auto-PEEP ≥5 cm H2O was increased by flow limitation (adjusted odds ratio 17; 95% CI: 6-56.2), expiratory time/time constant ratio <1.85 (12.6; 4.7-39.6), respiratory system resistance >15 cm H2O/L s (3; 1.3-6.9), age >65 y (2.8; 1.2-6.5), and body mass index >26 kg/m(2) (2.6; 1.1-6.1). CONCLUSIONS: Flow limitation, expiratory time/time constant, resistance of the respiratory system, and obesity are the most important variables that affect auto-PEEP values. Frequency expiratory time, tidal volume, and minute ventilation were not independently associated with auto-PEEP. Therapeutic strategies aimed at reducing auto-PEEP and its adverse effects should be primarily oriented to the variables that mainly affect auto-PEEP values.
[Mh] Termos MeSH primário: Obstrução das Vias Respiratórias/complicações
Respiração por Pressão Positiva Intrínseca/etiologia
Mecânica Respiratória/fisiologia
[Mh] Termos MeSH secundário: Fatores Etários
Idoso
Obstrução das Vias Respiratórias/fisiopatologia
Resistência das Vias Respiratórias/fisiologia
Índice de Massa Corporal
Estudos Transversais
Feminino
Fluxo Expiratório Forçado/fisiologia
Seres Humanos
Capacidade Inspiratória/fisiologia
Modelos Lineares
Masculino
Meia-Idade
Respiração por Pressão Positiva Intrínseca/fisiopatologia
Pressão
Respiração Artificial/métodos
Volume de Ventilação Pulmonar
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1610
[Cu] Atualização por classe:161230
[Lr] Data última revisão:
161230
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:151126
[St] Status:MEDLINE
[do] DOI:10.4187/respcare.04063



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