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  1 / 11013 MEDLINE  
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Massad, Eduardo
Registro de Ensaios Clínicos
Texto completo SciELO Brasil
[PMID]:29236912
[Au] Autor:Garcia MK; Rizzo L; Yazbek-Júnior P; Yutiyama D; Silva FJD; Matheus D; Mastrocolla LE; Massad E
[Ad] Endereço:Instituto de Medicina e Reabilitacao, Hospital das Clinicas (HCFMUSP), Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.
[Ti] Título:Cardiorespiratory performance of coronary artery disease patients on land versus underwater treadmill tests: a comparative study.
[So] Source:Clinics (Sao Paulo);72(11):667-674, 2017 Nov.
[Is] ISSN:1980-5322
[Cp] País de publicação:Brazil
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To compare responses to a cardiopulmonary exercise test on land versus on an underwater treadmill, to assess the cardiorespiratory performance of coronary artery disease patients while immersed in warm water and to compare with the performance of healthy individuals. METHODS: The sample population consisted of 40 subjects, which included 20 coronary artery disease patients aged 63.7±8.89 years old, functional class I and II, according to the New York Hearth Association, and 20 healthy subjects aged 64.7±7.09 years old. The statistical significances were calculated through an ANOVA test with a (1 - ß) power of 0.861. ClinicalTrials.gov: NCT00989248 (22). RESULTS: Significant differences were uncovered in coronary artery disease group regarding the variables heart beats (HB), (p>0.01), oxygen consumption (VO2), (p>0.01) and carbon dioxide production (VCO2) (p<0.01). Also, for the same group, in relation to the environment, water versus on land for HB, VO2, VCO2 and oxygen for each heart beat (VO2/HB) all of than (p<0.01). The stages for data collected featured the subject's performance throughout the experiment, and within the given context, variables rating of perceived exertion (RPE), HB, VO2, VCO2 and VO2/HB (p<0.01) showed significant interactions between test stages and environment. Additionally, there was a significant interaction between the etiology and the test stages for the variables HB, VO2 and VCO2 (p<0.01). Electrocardiographic changes compatible with myocardial ischemia or arrhythmia were not observed. The subjects exhibited lower scores on Borg's perceived exertion scale in the water than at every one of the test stages on land (p<0.01). CONCLUSION: This study show that a cardiopulmonary exercise test can be safely conducted in subjects in immersion and that the procedures, resources and equipment used yielded replicable and reliable data. Significant differences observed in water versus on land allow us to conclude that coronary artery disease patients are able to do physical exercise in water and that the physiological effects of immersion do not present any risk for such patients, as exercise was well tolerated by all subjects.
[Mh] Termos MeSH primário: Doença da Artéria Coronariana/reabilitação
Teste de Esforço/métodos
Frequência Cardíaca/fisiologia
Imersão
Consumo de Oxigênio/fisiologia
Ventilação Pulmonar/fisiologia
[Mh] Termos MeSH secundário: Estudos de Casos e Controles
Doença da Artéria Coronariana/fisiopatologia
Feminino
Seres Humanos
Masculino
Meia-Idade
Fatores de Tempo
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180207
[Lr] Data última revisão:
180207
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171214
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE


  2 / 11013 MEDLINE  
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[PMID]:28742774
[Au] Autor:Josephs SA; Lemmink GA; Strong JA; Barry CL; Hurford WE
[Ad] Endereço:From the Department of Anesthesiology, University of Cincinnati College of Medicine, Cincinnati, Ohio.
[Ti] Título:Improving Adherence to Intraoperative Lung-Protective Ventilation Strategies at a University Medical Center.
[So] Source:Anesth Analg;126(1):150-160, 2018 01.
[Is] ISSN:1526-7598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Intraoperative lung-protective ventilation (ILPV) is defined as tidal volumes <8 mL/kg ideal bodyweight and is increasingly a standard of care for major abdominal surgical procedures performed under general anesthesia. In this study, we report the result of a quality improvement initiative targeted at improving adherence to ILPV guidelines in a large academic teaching hospital. METHODS: We performed a time-series study to determine whether anesthesia provider adherence to ILPV was affected by certain improvement interventions and patient ideal body weight (IBW). Tidal volume data were collected at 3 different time points for 191 abdominal surgical cases from June 2014 through April 2015. Improvement interventions during that period included education at departmental grand rounds, creation of a departmental ILPV policy, feedback of tidal volume and failure rate data at grand rounds sessions, and reducing default ventilator settings for tidal volume. Mean tidal volume per kilogram of ideal body weight (VT/kg IBW) and rates of noncompliance with ILPV were analyzed before and after the interventions. A survey was administered to assess provider attitudes after implementation of improvement interventions. Responses before and after interventions and between physician and nonphysician providers were analyzed. RESULTS: Reductions in mean VT/kg IBW and rates of failure for providers to use ILPV occurred after improvement interventions. Patients with IBW <65 kg received higher VT/kg IBW and had higher rates of failure to use ILPV than patients with IBW >65 kg. Surveyed providers demonstrated stronger agreement to having knowledge and practice consistent with ILPV after interventions. CONCLUSIONS: Our interventions improved anesthesia provider adherence to low tidal volume ILPV. IBW was found to be an important factor related to provider adherence to ILPV. Provider attitudes about their knowledge and practice consistent with ILPV also changed with our interventions.
[Mh] Termos MeSH primário: Centros Médicos Acadêmicos/normas
Fidelidade a Diretrizes/normas
Pulmão/fisiologia
Monitorização Intraoperatória/normas
Ventilação Pulmonar/fisiologia
Respiração Artificial/normas
[Mh] Termos MeSH secundário: Adulto
Idoso
Feminino
Seres Humanos
Análise de Séries Temporais Interrompida/métodos
Análise de Séries Temporais Interrompida/normas
Masculino
Meia-Idade
Monitorização Intraoperatória/métodos
Respiração Artificial/métodos
Estudos Retrospectivos
Volume de Ventilação Pulmonar/fisiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180130
[Lr] Data última revisão:
180130
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170726
[St] Status:MEDLINE
[do] DOI:10.1213/ANE.0000000000002299


  3 / 11013 MEDLINE  
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[PMID]:29176899
[Au] Autor:Smith LJ; Macleod KA; Collier GJ; Horn FC; Sheridan H; Aldag I; Taylor CJ; Cunningham S; Wild JM; Horsley A
[Ad] Endereço:POLARIS, Academic Radiology, University of Sheffield, Sheffield, United Kingdom.
[Ti] Título:Supine posture changes lung volumes and increases ventilation heterogeneity in cystic fibrosis.
[So] Source:PLoS One;12(11):e0188275, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Lung Clearance Index (LCI) is recognised as an early marker of cystic fibrosis (CF) lung disease. The effect of posture on LCI however is important when considering longitudinal measurements from infancy and when comparing LCI to imaging studies. METHODS: 35 children with CF and 28 healthy controls (HC) were assessed. Multiple breath washout (MBW) was performed both sitting and supine in triplicate and analysed for LCI, Scond, Sacin, and lung volumes. These values were also corrected for the Fowler dead-space to create 'alveolar' indices. RESULTS: From sitting to supine there was a significant increase in LCI and a significant decrease in FRC for both CF and HC (p<0.01). LCI, when adjusted to estimate 'alveolar' LCI (LCIalv), increased the magnitude of change with posture for both LCIalv and FRCalv in both groups, with a greater effect of change in lung volume in HC compared with children with CF. The % change in LCIalv for all subjects correlated significantly with lung volume % changes, most notably tidal volume/functional residual capacity (Vtalv/FRCalv (r = 0.54,p<0.001)). CONCLUSION: There is a significant increase in LCI from sitting to supine, which we believe to be in part due to changes in lung volume and also increasing ventilation heterogeneity related to posture. This may have implications in longitudinal measurements from infancy to older childhood and for studies comparing supine imaging methods to LCI.
[Mh] Termos MeSH primário: Fibrose Cística/patologia
Fibrose Cística/fisiopatologia
Pulmão/patologia
Pulmão/fisiopatologia
Ventilação Pulmonar
Decúbito Dorsal
[Mh] Termos MeSH secundário: Estudos de Casos e Controles
Criança
Feminino
Capacidade Residual Funcional
Seres Humanos
Masculino
Tamanho do Órgão
Alvéolos Pulmonares/patologia
Alvéolos Pulmonares/fisiopatologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171219
[Lr] Data última revisão:
171219
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171128
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0188275


  4 / 11013 MEDLINE  
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ALMEIDA, Dirceu
[PMID]:27779551
[Au] Autor:Alencar MC; Arbex FF; Souza A; Mazzuco A; Sperandio PA; Rocha A; Hirai DM; Mancuso F; Berton DC; Borghi-Silva A; Almeida D; OʼDonnel DE; Neder JA
[Ad] Endereço:Divisions of Respirology (Drs Alencar, Arbex, and Neder, Mss Souza and Sperandio, and Messrs Rocha and Hirai) and Cardiology (Drs Mancuso and Almeida), Federal University of Sao Paulo, Brazil; Respiratory Investigation Unit and Laboratory of Clinical Exercise Physiology, Queen's University and Kingston General Hospital, Kingston, Ontario, Canada (Mr Hirai and Drs O'Donnel and Neder); Department of Physiotherapy, Federal University of Sao Carlos, Brazil (Mss Mazzuco and Borghi-Silva); and Division of Respirology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil (Dr Berton).
[Ti] Título:Does Exercise Ventilatory Inefficiency Predict Poor Outcome in Heart Failure Patients With COPD?
[So] Source:J Cardiopulm Rehabil Prev;36(6):454-459, 2016 Nov/Dec.
[Is] ISSN:1932-751X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:PURPOSE: To investigate whether the opposite effects of heart failure (HF) and chronic obstructive pulmonary disease (COPD) on exercise ventilatory inefficiency (minute ventilation [(Equation is included in full-text article.)E]-carbon dioxide output [(Equation is included in full-text article.)CO2] relationship) would negatively impact its prognostic relevance. METHODS: After treatment optimization and an incremental cardiopulmonary exercise test, 30 male patients with HF-COPD (forced expiratory volume in 1 second [FEV1] = 57% ± 17% predicted, ejection fraction = 35% ± 6%) were prospectively followed up during 412 ± 261 days for major cardiac events. RESULTS: Fourteen patients (46%) had a negative outcome. Patients who had an event had lower echocardiographically determined right ventricular fractional area change (RVFAC), greater ventilatory inefficiency (higher (Equation is included in full-text article.)E/(Equation is included in full-text article.)CO2 nadir), and lower end-tidal CO2 (PETCO2) (all P < .05). Multivariate Cox models revealed that (Equation is included in full-text article.)E/(Equation is included in full-text article.)CO2 nadir >36, ΔPETCO2(PEAK-REST)≥2 mm Hg, and PETCO2PEAK≤33 mm Hg added prognostic value to RVFAC≤45%. Kaplan-Meyer analyses showed that although 18% of patients with RVFAC>45% had a major cardiac event after 1 year, no patient with RVFAC>45% and (Equation is included in full-text article.)E/(Equation is included in full-text article.)CO2 nadir ≤36 (or PETCO2PEAK>33 mm Hg) had a negative event. Conversely, although 69% of patients with RVFAC≤45% had a major cardiac event after 1 year, all patients with RVFAC≤45% and ΔPETCO2(PEAK-REST)≥2 mm Hg had a negative event. CONCLUSION: Ventilatory inefficiency remains a powerful prognostic marker in HF despite the presence of mechanical ventilatory constraints induced by COPD. If these preliminary findings are confirmed in larger studies, optimal thresholds for outcome prediction are likely greater than those traditionally recommended for HF patients without COPD.
[Mh] Termos MeSH primário: Tolerância ao Exercício/fisiologia
Insuficiência Cardíaca/complicações
Pulmão/fisiopatologia
Avaliação de Resultados da Assistência ao Paciente
Doença Pulmonar Obstrutiva Crônica/complicações
Ventilação Pulmonar/fisiologia
[Mh] Termos MeSH secundário: Idoso
Seguimentos
Insuficiência Cardíaca/fisiopatologia
Insuficiência Cardíaca/terapia
Seres Humanos
Masculino
Estudos Prospectivos
Doença Pulmonar Obstrutiva Crônica/fisiopatologia
Doença Pulmonar Obstrutiva Crônica/terapia
Testes de Função Respiratória
Índice de Gravidade de Doença
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171211
[Lr] Data última revisão:
171211
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161026
[St] Status:MEDLINE


  5 / 11013 MEDLINE  
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[PMID]:29016620
[Au] Autor:Agustí A; Compte A; Faner R; Garcia-Aymerich J; Noell G; Cosio BG; Rodriguez-Roisin R; Celli B; Anto JM
[Ad] Endereço:Respiratory Institute, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain.
[Ti] Título:The EASI model: A first integrative computational approximation to the natural history of COPD.
[So] Source:PLoS One;12(10):e0185502, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The natural history of chronic obstructive pulmonary disease (COPD) is still not well understood. Traditionally believed to be a self-inflicted disease by smoking, now we know that not all smokers develop COPD, that other inhaled pollutants different from cigarette smoke can also cause it, and that abnormal lung development can also lead to COPD in adulthood. Likewise, the inflammatory response that characterizes COPD varies significantly between patients, and not all of them perceive symptoms (mostly breathlessness) similarly. To investigate the variability and determinants of different "individual natural histories" of COPD, we developed a theoretical, multi-stage, computational model of COPD (EASI) that integrates dynamically and represents graphically the relationships between exposure (E) to inhaled particles and gases (smoking), the biological activity (inflammatory response) of the disease (A), the severity (S) of airflow limitation (FEV1) and the impact (I) of the disease (breathlessness) in different clinical scenarios. EASI shows that the relationships between E, A, S and I vary markedly within individuals (through life) and between individuals (at the same age). It also helps to delineate some potentially relevant, but often overlooked concepts, such as disease progression, susceptibility to COPD and issues related to symptom perception. In conclusion, EASI is an initial conceptual model to interpret the longitudinal and cross-sectional relationships between E, A, S and I in different clinical scenarios. Currently, it does not have any direct clinical application, thus it requires experimental validation and further mathematical development. However, it has the potential to open novel research and teaching alternatives.
[Mh] Termos MeSH primário: Exposição por Inalação/análise
Pulmão/fisiopatologia
Modelos Estatísticos
Doença Pulmonar Obstrutiva Crônica/etiologia
Fumar/fisiopatologia
[Mh] Termos MeSH secundário: Simulação por Computador
Progressão da Doença
Suscetibilidade a Doenças
Dispneia/fisiopatologia
Feminino
Seres Humanos
Masculino
Doença Pulmonar Obstrutiva Crônica/diagnóstico
Doença Pulmonar Obstrutiva Crônica/fisiopatologia
Ventilação Pulmonar/fisiologia
Índice de Gravidade de Doença
Abandono do Hábito de Fumar/estatística & dados numéricos
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171031
[Lr] Data última revisão:
171031
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171011
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0185502


  6 / 11013 MEDLINE  
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[PMID]:28972124
[Au] Autor:Wu R; Liu Y; Wang L; Li B; Xu F
[Ad] Endereço:State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, Key Laboratory of Magnetic Resonance in Biological System, Wuhan Institute of Physics and Mathematics, Center of Excellence for Brain Science and Intelligent Technology, the Chinese Academy of Sciences, Wuhan 430071, China,
[Ti] Título:Activity Patterns Elicited by Airflow in the Olfactory Bulb and Their Possible Functions.
[So] Source:J Neurosci;37(44):10700-10711, 2017 Nov 01.
[Is] ISSN:1529-2401
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Olfactory sensory neurons (OSNs) can sense both odorants and airflows. In the olfactory bulb (OB), the coding of odor information has been well studied, but the coding of mechanical stimulation is rarely investigated. Unlike odor-sensing functions of OSNs, the airflow-sensing functions of OSNs are also largely unknown. Here, the activity patterns elicited by mechanical airflow in male rat OBs were mapped using fMRI and correlated with local field potential recordings. In an attempt to reveal possible functions of airflow sensing, the relationship between airflow patterns and physiological parameters was also examined. We found the following: (1) the activity pattern in the OB evoked by airflow in the nasal cavity was more broadly distributed than patterns evoked by odors; (2) the pattern intensity increases with total airflow, while the pattern topography with total airflow remains almost unchanged; and (3) the heart rate, spontaneous respiratory rate, and electroencephalograph power in the ß band decreased with regular mechanical airflow in the nasal cavity. The mapping results provide evidence that the signals elicited by mechanical airflow in OSNs are transmitted to the OB, and that the OB has the potential to code and process mechanical information. Our functional data indicate that airflow rhythm in the olfactory system can regulate the physiological and brain states, providing an explanation for the effects of breath control in meditation, yoga, and Taoism practices. Presentation of odor information in the olfactory bulb has been well studied, but studies about breathing features are rare. Here, using blood oxygen level-dependent functional MRI for the first time in such an investigation, we explored the global activity patterns in the rat olfactory bulb elicited by airflow in the nasal cavity. We found that the activity pattern elicited by airflow is broadly distributed, with increasing pattern intensity and similar topography under increasing total airflow. Further, heart rate, spontaneous respiratory rate in the lung, and electroencephalograph power in the ß band decreased with regular airflow in the nasal cavity. Our study provides further understanding of the airflow map in the olfactory bulb o, and evidence for the possible mechanosensitivity functions of olfactory sensory neurons.
[Mh] Termos MeSH primário: Bulbo Olfatório/fisiologia
Neurônios Receptores Olfatórios/fisiologia
Ventilação Pulmonar/fisiologia
Taxa Respiratória/fisiologia
[Mh] Termos MeSH secundário: Animais
Eletroencefalografia/métodos
Masculino
Cavidade Nasal/fisiologia
Odorantes
Ratos
Ratos Sprague-Dawley
Volume de Ventilação Pulmonar/fisiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171113
[Lr] Data última revisão:
171113
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171004
[St] Status:MEDLINE
[do] DOI:10.1523/JNEUROSCI.2210-17.2017


  7 / 11013 MEDLINE  
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[PMID]:28912263
[Au] Autor:Naeije R; Gerges M; Vachiery JL; Caravita S; Gerges C; Lang IM
[Ad] Endereço:From the Department of Cardiology, Cliniques Universitaires de Bruxelles, Hôpital Académique Erasme, Brussels, Belgium (R.N., J.-L.V., S.C.); Department of Internal Medicine II, Division of Cardiology, General Hospital of Vienna (AKH-Wien), Medical University of Vienna, Austria (M.G., C.G., I.M.L.);
[Ti] Título:Hemodynamic Phenotyping of Pulmonary Hypertension in Left Heart Failure.
[So] Source:Circ Heart Fail;10(9), 2017 Sep.
[Is] ISSN:1941-3297
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Increased pulmonary venous pressure secondary to left heart disease is the most common cause of pulmonary hypertension (PH). The diagnosis of PH due to left heart disease relies on a clinical probability assessment followed by the invasive measurements of a mean pulmonary artery pressure (PAP) ≥25 mm Hg and mean wedged PAP (PAWP) >15 mm Hg. A combination of mean PAP and mean PAWP defines postcapillary PH. Postcapillary PH is generally associated with a diastolic pulmonary pressure gradient (diastolic PAP minus mean PAWP) <7 mm Hg, a transpulmonary pressure gradient (mean PAP minus mean PAWP) <12 mm Hg, and pulmonary vascular resistance ≤3 Wood units (WU). This combination of criteria defines isolated postcapillary PH. Postcapillary PH with elevated vascular gradients and pulmonary vascular resistance defines combined post- and precapillary PH (Cpc-PH). Postcapillary PH is associated with a decreased survival in proportion to increased pulmonary vascular gradients, decreased pulmonary arterial compliance, and reduced right ventricular function. The Cpc-PH subcategory occurs in 12% to 13% of patients with PH due to left heart disease. Patients with Cpc-PH have severe PH, with higher diastolic pulmonary pressure gradient, transpulmonary pressure gradient, and pulmonary vascular resistance and more pronounced ventilatory responses to exercise, lower pulmonary arterial compliance, depressed right ventricular ejection fraction, and shorter life expectancy than isolated postcapillary PH. Cpc-PH bears similarities to pulmonary arterial hypertension. Whether Cpc-PH is amenable to therapies targeting the pulmonary circulation remains to be tested by properly designed randomized controlled trials.
[Mh] Termos MeSH primário: Pressão Arterial
Insuficiência Cardíaca/complicações
Hipertensão Pulmonar/etiologia
Artéria Pulmonar/fisiopatologia
Pressão Propulsora Pulmonar
Função Ventricular Esquerda
[Mh] Termos MeSH secundário: Tolerância ao Exercício
Insuficiência Cardíaca/diagnóstico
Insuficiência Cardíaca/mortalidade
Insuficiência Cardíaca/fisiopatologia
Seres Humanos
Hipertensão Pulmonar/diagnóstico
Hipertensão Pulmonar/mortalidade
Hipertensão Pulmonar/fisiopatologia
Fenótipo
Valor Preditivo dos Testes
Prognóstico
Veias Pulmonares/fisiopatologia
Ventilação Pulmonar
Fatores de Risco
Índice de Gravidade de Doença
Resistência Vascular
Rigidez Vascular
Pressão Venosa
Função Ventricular Direita
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170925
[Lr] Data última revisão:
170925
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170916
[St] Status:MEDLINE


  8 / 11013 MEDLINE  
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[PMID]:28910340
[Au] Autor:Kowalczyk M; Sawulski S; Dabrowski W; Grzycka-Kowalczyk L; Kotlinska-Hasiec E; Wronska-Sewruk A; Florek A; Rutyna R
[Ad] Endereço:1st Department of Anaesthesiology and Intensive Care, Medical University of Lublin, Lublin, Poland.
[Ti] Título:Successful 1:1 proportion ventilation with a unique device for independent lung ventilation using a double-lumen tube without complications in the supine and lateral decubitus positions. A pilot study.
[So] Source:PLoS One;12(9):e0184537, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Adequate blood oxygenation and ventilation/perfusion matching should be main goal of anaesthetic and intensive care management. At present, one of the methods of improving gas exchange restricted by ventilation/perfusion mismatching is independent ventilation with two ventilators. Recently, however, a unique device has been developed, enabling ventilation of independent lungs in 1:1, 2:1, 3:1, and 5:1 proportions. The main goal of the study was to evaluate the device's utility, precision and impact on pulmonary mechanics. Secondly- to measure the gas distribution in supine and lateral decubitus position. MATERIALS AND METHODS: 69 patients who underwent elective thoracic surgery were eligible for the study. During general anaesthesia, after double lumen tube intubation, the aforementioned control system was placed between the anaesthetic machine and the patient. In the supine and lateral decubitus (left/right) positions, measurements of conventional and independent (1:1 proportion) ventilation were performed separately for each lung, including the following: tidal volume, peak pressure and dynamic compliance. RESULTS: Our results show that conventional ventilation using Robertshaw tube in the supine position directs 47% of the tidal volume to the left lung and 53% to the right lung. Furthermore, in the left lateral position, 44% is directed to the dependent lung and 56% to the non-dependent lung. In the right lateral position, 49% is directed to the dependent lung and 51% to the non-dependent lung. The control system positively affected non-dependent and dependent lung ventilation by delivering equal tidal volumes into both lungs with no adverse effects, regardless of patient's position. CONCLUSIONS: We report that gas distribution is uneven during conventional ventilation using Robertshaw tube in the supine and lateral decubitus positions. However, this recently released control system enables precise and safe independent ventilation in the supine and the left and right lateral decubitus positions.
[Mh] Termos MeSH primário: Oxigênio/sangue
Ventilação Pulmonar/fisiologia
Respiração Artificial/instrumentação
Procedimentos Cirúrgicos Torácicos/métodos
[Mh] Termos MeSH secundário: Adulto
Procedimentos Cirúrgicos Eletivos/instrumentação
Procedimentos Cirúrgicos Eletivos/métodos
Feminino
Seres Humanos
Intubação Intratraqueal
Masculino
Meia-Idade
Projetos Piloto
Decúbito Ventral
Decúbito Dorsal
Procedimentos Cirúrgicos Torácicos/instrumentação
Volume de Ventilação Pulmonar
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
S88TT14065 (Oxygen)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171012
[Lr] Data última revisão:
171012
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170915
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0184537


  9 / 11013 MEDLINE  
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[PMID]:28857808
[Au] Autor:Kretzschmar M; Kozian A; Baumgardner JE; Borges JB; Hedenstierna G; Larsson A; Hachenberg T; Schilling T
[Ad] Endereço:From the Hedenstierna Laboratory, Department of Surgical Sciences (M.K., A.K., J.B.B., A.L., T.S.), and Clinical Physiology, Department of Medical Sciences (G.H.), Uppsala University, Uppsala, Sweden; Department of Anesthesiology and Intensive Care Medicine, Otto von Guericke University Magdeburg, Magdeburg, Germany (M.K., A.K., T.H., T.S.); Oscillogy LLC, Pittsburgh, Pennsylvania (J.E.B.); and Department of Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (J.E.B.).
[Ti] Título:Effect of Bronchoconstriction-induced Ventilation-Perfusion Mismatch on Uptake and Elimination of Isoflurane and Desflurane.
[So] Source:Anesthesiology;127(5):800-812, 2017 Nov.
[Is] ISSN:1528-1175
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Increasing numbers of patients with obstructive lung diseases need anesthesia for surgery. These conditions are associated with pulmonary ventilation/perfusion (VA/Q) mismatch affecting kinetics of volatile anesthetics. Pure shunt might delay uptake of less soluble anesthetic agents but other forms of VA/Q scatter have not yet been examined. Volatile anesthetics with higher blood solubility would be less affected by VA/Q mismatch. We therefore compared uptake and elimination of higher soluble isoflurane and less soluble desflurane in a piglet model. METHODS: Juvenile piglets (26.7 ± 1.5 kg) received either isoflurane (n = 7) or desflurane (n = 7). Arterial and mixed venous blood samples were obtained during wash-in and wash-out of volatile anesthetics before and during bronchoconstriction by methacholine inhalation (100 µg/ml). Total uptake and elimination were calculated based on partial pressure measurements by micropore membrane inlet mass spectrometry and literature-derived partition coefficients and assumed end-expired to arterial gradients to be negligible. VA/Q distribution was assessed by the multiple inert gas elimination technique. RESULTS: Before methacholine inhalation, isoflurane arterial partial pressures reached 90% of final plateau within 16 min and decreased to 10% after 28 min. By methacholine nebulization, arterial uptake and elimination delayed to 35 and 44 min. Desflurane needed 4 min during wash-in and 6 min during wash-out, but with bronchoconstriction 90% of both uptake and elimination was reached within 15 min. CONCLUSIONS: Inhaled methacholine induced bronchoconstriction and inhomogeneous VA/Q distribution. Solubility of inhalational anesthetics significantly influenced pharmacokinetics: higher soluble isoflurane is less affected than fairly insoluble desflurane, indicating different uptake and elimination during bronchoconstriction.
[Mh] Termos MeSH primário: Anestésicos Inalatórios/sangue
Broncoconstrição/fisiologia
Isoflurano/análogos & derivados
Isoflurano/sangue
Ventilação Pulmonar/fisiologia
Relação Ventilação-Perfusão/fisiologia
[Mh] Termos MeSH secundário: Anestésicos Inalatórios/administração & dosagem
Animais
Animais Recém-Nascidos
Isoflurano/administração & dosagem
Ventilação Pulmonar/efeitos dos fármacos
Respiração Artificial/métodos
Suínos
Relação Ventilação-Perfusão/efeitos dos fármacos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anesthetics, Inhalation); CRS35BZ94Q (desflurane); CYS9AKD70P (Isoflurane)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171026
[Lr] Data última revisão:
171026
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170901
[St] Status:MEDLINE
[do] DOI:10.1097/ALN.0000000000001847


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[PMID]:28720186
[Au] Autor:Steinman Y; van den Oord MHAH; Frings-Dresen MHW; Sluiter JK
[Ti] Título:Flight Performance During Exposure to Acute Hypobaric Hypoxia.
[So] Source:Aerosp Med Hum Perform;88(8):760-767, 2017 Aug 01.
[Is] ISSN:2375-6314
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: The purpose of the present study was to examine the influence of hypobaric hypoxia (HH) on a pilot's flight performance during exposure to simulated altitudes of 91, 3048, and 4572 m (300, 10,000, and 15,000 ft) and to monitor the pilot's physiological reactions. METHOD: In a single-blinded counter-balanced design, 12 male pilots were exposed to HH while flying in a flight simulator that had been placed in a hypobaric chamber. Flight performance of the pilots, pilot's alertness level, Spo2, heart rate (HR), minute ventilation (VE), and breathing frequency (BF) were measured. RESULTS: A significant difference was found in Flight Profile Accuracy (FPA) between the three altitudes. Post hoc analysis showed no significant difference in performance between 91 m and 3048 m. A trend was observed at 4572 m, suggesting a decrease in flight performance at that altitude. Significantly lower alertness levels were observed at the start of the flight at 4572 m compared to 91 m, and at the end of the flight at 4572 m compared to the start at that altitude. Spo2 and BF decreased, and HR increased significantly with altitude. DISCUSSION: The present study did not provide decisive evidence for a decrease in flight performance during exposure to simulated altitudes of 3048 and 4572 m. However, large interindividual variation in pilots' flight performance combined with a gradual decrease in alertness levels observed in the present study puts into question the ability of pilots to safely fly an aircraft while exposed to these altitudes without supplemental oxygen.Steinman Y, van den Oord MHAH, Frings-Dresen MHW, Sluiter JK. Flight performance during exposure to acute hypobaric hypoxia. Aerosp Med Hum Perform. 2017; 88(8):760-767.
[Mh] Termos MeSH primário: Altitude
Pressão Atmosférica
Frequência Cardíaca
Hipóxia/fisiopatologia
Pilotos
Ventilação Pulmonar
Taxa Respiratória
Análise e Desempenho de Tarefas
Vigília
[Mh] Termos MeSH secundário: Adulto
Medicina Aeroespacial
Aeronaves
Seres Humanos
Hipóxia/psicologia
Masculino
Treinamento por Simulação
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170926
[Lr] Data última revisão:
170926
[Sb] Subgrupo de revista:IM; S
[Da] Data de entrada para processamento:170720
[St] Status:MEDLINE
[do] DOI:10.3357/AMHP.4789.2017



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