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  1 / 1876 MEDLINE  
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[PMID]:28464295
[Au] Autor:Stewart M; Kollmar R; Nakase K; Silverman J; Sundaram K; Orman R; Lazar J
[Ad] Endereço:Department of Neurology, SUNY Downstate Medical Center, Brooklyn, New York, U.S.A.
[Ti] Título:Obstructive apnea due to laryngospasm links ictal to postictal events in SUDEP cases and offers practical biomarkers for review of past cases and prevention of new ones.
[So] Source:Epilepsia;58(6):e87-e90, 2017 06.
[Is] ISSN:1528-1167
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Seizure spread into autonomic and respiratory brainstem regions is thought to play an important role in sudden unexpected death in epilepsy (SUDEP). As the clinical dataset of cases of definite SUDEP available for study grows, evidence points to a sequence of events that includes postictal apnea, bradycardia, and asystole as critical events that can lead to death. One possible link between the precipitating seizure and the critical postictal sequence is seizure-driven laryngospasm sufficient to completely obstruct the airway for an extended period, but ictal laryngospasm is difficult to fully assess. Herein, we demonstrate in a rat model how the electrical artifacts of attempts to inspire during airway obstruction and features of the cardiac rhythm establish this link between ictal and postictal activity and can be used as practical biomarkers of obstructive apnea due to laryngospasm or other causes of airway obstruction.
[Mh] Termos MeSH primário: Sistema Nervoso Autônomo/fisiopatologia
Biomarcadores
Tronco Encefálico/fisiopatologia
Morte Súbita/etiologia
Morte Súbita/prevenção & controle
Modelos Animais de Doenças
Eletrocardiografia
Eletromiografia
Epilepsia/complicações
Epilepsia/fisiopatologia
Laringismo/complicações
Laringismo/fisiopatologia
Centro Respiratório/fisiopatologia
Processamento de Sinais Assistido por Computador
Apneia Obstrutiva do Sono/complicações
Apneia Obstrutiva do Sono/fisiopatologia
[Mh] Termos MeSH secundário: Animais
Masculino
Ratos Sprague-Dawley
Fatores de Risco
Convulsões/complicações
Convulsões/fisiopatologia
Trabalho Respiratório
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Biomarkers)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:180107
[Lr] Data última revisão:
180107
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170503
[St] Status:MEDLINE
[do] DOI:10.1111/epi.13765


  2 / 1876 MEDLINE  
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[PMID]:28671972
[Au] Autor:Tulaimat A; Trick WE
[Ad] Endereço:Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Cook County Health and Hospitals System, Chicago, Illinois, United States of America.
[Ti] Título:DiapHRaGM: A mnemonic to describe the work of breathing in patients with respiratory failure.
[So] Source:PLoS One;12(7):e0179641, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The assessment of the work of breathing in the definitions of respiratory failure is vague and variable. OBJECTIVE: Identify a parsimonious set of signs to describe the work of breathing in hypoxemic, acutely ill patients. METHODS: We examined consecutive medical ICU patients receiving oxygen with a mask, non-invasive ventilation, or T-piece. A physician inspected each patient for 10 seconds, rated the level of respiratory distress, and then examined the patient for vital signs and 17 other physical signs. We used the rating of distress as a surrogate for measuring the work of breathing, constructed three multivariate models to identify the one with the smallest number of signs and largest explained variance, and validated it with bootstrap analysis. RESULTS: We performed 402 observations on 240 patients. Respiratory distress was absent in 78, mild in 157, moderate in 107, and severe in 60. Respiratory rate, hypoxia, heart rate, and frequency of most signs increased as distress increased. Respiratory rate and hypoxia explained 43% of the variance in respiratory distress. Diaphoresis, gasping, and contraction of the sternomastoid explained an additional 28%. Heart rate, blood pressure, alertness, agitation, body posture, nasal flaring, audible breathing, cyanosis, tracheal tug, retractions, paradox, scalene or abdominal muscles contraction did not increase the explained variance in respiratory distress. CONCLUSION: Most of the variance is respiratory distress can be explained by five signs summarized by the mnemonic DiapHRaGM (diaphoresis, hypoxia, respiratory rate, gasping, accessory muscle). This set of signs may allow for efficient, standardized assessments of the work of breathing of hypoxic patients.
[Mh] Termos MeSH primário: Insuficiência Respiratória/fisiopatologia
Trabalho Respiratório
[Mh] Termos MeSH secundário: Seres Humanos
Unidades de Terapia Intensiva
[Pt] Tipo de publicação:JOURNAL ARTICLE; VALIDATION STUDIES
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171006
[Lr] Data última revisão:
171006
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170704
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0179641


  3 / 1876 MEDLINE  
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[PMID]:28592029
[Au] Autor:Zhang JH; Luo Q; Zhang HJ; Chen RC
[Ad] Endereço:State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Disease, the First Affiliated Hospital, Guangzhou Medical University, Guangzhou 510120, Guangdong, China.
[Ti] Título:[Effects of noninvasive proportional assist vs pressure support ventilation on respiratory work in chronic obstructive pulmonary disease patients with hypercapnia].
[So] Source:Zhonghua Jie He He Hu Xi Za Zhi;40(6):450-456, 2017 Jun 12.
[Is] ISSN:1001-0939
[Cp] País de publicação:China
[La] Idioma:chi
[Ab] Resumo:To investigate the effect of noninvasive proportional assist ventilation (PAV) on respiratory work in chronic obstructive pulmonary disease(COPD) patients, in comparison to noninvasive pressure support ventilation(PSV). Ten severe COPD patients with hypercapnia during acute exacerbation were examined. The baseline inspiratory pressure of PSV (PS) and the assistance level of PAV(PA) were titrated by patients' tolerance. In addition to the baseline PS and PA, an additional decrease by 25% (PS-=75% PS, PA-=75% PA) or increase by 25% (PS+ =125% PS, PA+ =125% PA) of the assist level were applied to the patients. After the assessment of unassisted spontaneous breathing (SB), the patient was placed on the 6 levels of noninvasive-PSV and noninvasive-PAV in random sequence. Each level lasted at least 20 minutes. Respiratory rate (RR), tidal volume (Vt), and respiratory work(Wex, Wip and Wv) were measured. Asynchrony index (AI) was calculated. During ventilation, Vt was significantly higher with each assist level than with SB. The Vt was significant increased with PS+ than with PA+ . An increase in expiratory work(Wex) and decrease in inspiratory work(Wip) were observed respectively, with the increasing assist level. The inspiratory muscles assessed by Wip were more unloaded at PS compared with PA [PS: (1.59±1.27) J/min PA: (4.99±3.48) J/min <0.01]. However, the Wex was significantly higher with PS+ than with PA+ [PS+ : (1.17±0.54) J/min PA+ : (0.49±0.56)J/min, <0.01]. The AI was increased with the increasing assist level of PSV [PS-: (0.46±0.57)%, PS: (1.36±1.24)% PS+ : (5.26±4.77)]. No asynchrony events were observed at PA- and PA. "Runaway" (expiratory asynchrony) was observed during PA+ [AI: (2.62±2.72)%]. Noninvasive-PAV can increase the Vt and decrease the Wip of the COPD patients with hypercapnia and avoid the over-assistance. The "Runaway" will occur at assist level higher than that set by tolerance. Physiological data can monitor the patient's responses and the ventilator-patient interaction, which may provide objective criteria for ventilator setting.
[Mh] Termos MeSH primário: Hipercapnia/terapia
Ventilação não Invasiva
Respiração com Pressão Positiva/métodos
Doença Pulmonar Obstrutiva Crônica/terapia
Respiração Artificial/métodos
Insuficiência Respiratória/terapia
[Mh] Termos MeSH secundário: Idoso
Expiração
Feminino
Seres Humanos
Masculino
Meia-Idade
Doença Pulmonar Obstrutiva Crônica/complicações
Insuficiência Respiratória/etiologia
Volume de Ventilação Pulmonar
Resultado do Tratamento
Ventiladores Mecânicos
Trabalho Respiratório
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170912
[Lr] Data última revisão:
170912
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170609
[St] Status:MEDLINE
[do] DOI:10.3760/cma.j.issn.1001-0939.2017.06.011


  4 / 1876 MEDLINE  
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[PMID]:28366356
[Au] Autor:Kamerkar A; Hotz J; Morzov R; Newth CJL; Ross PA; Khemani RG
[Ad] Endereço:Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA.
[Ti] Título:Comparison of Effort of Breathing for Infants on Nasal Modes of Respiratory Support.
[So] Source:J Pediatr;185:26-32.e3, 2017 Jun.
[Is] ISSN:1097-6833
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To directly compare effort of breathing between high flow nasal cannula (HFNC), nasal intermittent mechanical ventilation (NIMV), and nasal continuous positive airway pressure (NCPAP). STUDY DESIGN: This was a single center prospective cross-over study for patients <6 months in the cardiothoracic or pediatric intensive care unit receiving nasal noninvasive respiratory support after extubation. We measured effort of breathing using esophageal manometry with pressure-rate product (PRP) on all 3 modes. NIMV synchrony was determined by comparing patient efforts (esophageal manometry) with mechanically delivered breaths (spirometry in ventilator circuit). On NIMV, PRP and synchrony was also measured after adding a nasal clip on 26 patients. RESULTS: Forty-two children were included. Median (IQR) age was 2 (0.5, 4) months. There was no difference in median PRP between HFNC 6 liters per minute, 355 (270,550), NIMV 12/5 cm H O, 341 (235, 472), and NCPAP 5 cm H O, 340 (245,506) (P?=?.33). Results were similar regardless of HFNC flow rate or NIMV inspiratory pressure. Median PRP on CPAP of 5 cm H O prior to extubation 255 (176, 375) was significantly lower than all postextubation values (P??.07)). However, as NIMV synchrony improved (>60%), PRP on NIMV was lower than on HFNC. CONCLUSIONS: For infants, effort of breathing is similar on HFNC, NIMV, and NCPAP after extubation, regardless of flow rate or inspiratory pressure. We speculate that bi-level NIMV may be superior if high levels of synchrony can be achieved.
[Mh] Termos MeSH primário: Extubação
Pressão Positiva Contínua nas Vias Aéreas
Ventilação com Pressão Positiva Intermitente
Oxigenoterapia/métodos
Trabalho Respiratório
[Mh] Termos MeSH secundário: Cânula
Estudos Cross-Over
Esôfago
Feminino
Cardiopatias Congênitas/cirurgia
Seres Humanos
Lactente
Recém-Nascido
Unidades de Terapia Intensiva Pediátrica
Masculino
Manometria
Cuidados Pós-Operatórios
Estudos Prospectivos
Insuficiência Respiratória/terapia
Espirometria
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170906
[Lr] Data última revisão:
170906
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170404
[St] Status:MEDLINE


  5 / 1876 MEDLINE  
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[PMID]:27997805
[Au] Autor:Mauri T; Turrini C; Eronia N; Grasselli G; Volta CA; Bellani G; Pesenti A
[Ad] Endereço:1 Department of Anesthesia, Critical Care and Emergency, IRCCS (Institute for Treatment and Research) Ca' Granda Maggiore Policlinico Hospital Foundation, Milan, Italy.
[Ti] Título:Physiologic Effects of High-Flow Nasal Cannula in Acute Hypoxemic Respiratory Failure.
[So] Source:Am J Respir Crit Care Med;195(9):1207-1215, 2017 May 01.
[Is] ISSN:1535-4970
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: High-flow nasal cannula (HFNC) improves the clinical outcomes of nonintubated patients with acute hypoxemic respiratory failure (AHRF). OBJECTIVES: To assess the effects of HFNC on gas exchange, inspiratory effort, minute ventilation, end-expiratory lung volume, dynamic compliance, and ventilation homogeneity in patients with AHRF. METHODS: This was a prospective randomized crossover study in nonintubated patients with AHRF with Pa /setFi less than or equal to 300 mm Hg admitted to the intensive care unit. We randomly applied HFNC set at 40 L/min compared with a standard nonocclusive facial mask at the same clinically set Fi (20 min/step). MEASUREMENTS AND MAIN RESULTS: Toward the end of each phase, we measured arterial blood gases, inspiratory effort, and work of breathing by esophageal pressure swings (ΔPes) and pressure time product, and we estimated changes in lung volumes and ventilation homogeneity by electrical impedance tomography. We enrolled 15 patients aged 60 ± 14 years old with Pa /setFi 130 ± 35 mm Hg. Seven (47%) had bilateral lung infiltrates. Compared with the facial mask, HFNC significantly improved oxygenation (P < 0.001) and lowered respiratory rate (P < 0.01), ΔPes (P < 0.01), and pressure time product (P < 0.001). During HFNC, minute ventilation was reduced (P < 0.001) at constant arterial CO tension and pH (P = 0.27 and P = 0.23, respectively); end-expiratory lung volume increased (P < 0.001), and tidal volume did not change (P = 0.44); the ratio of tidal volume to ΔPes (an estimate of dynamic lung compliance) increased (P < 0.05); finally, ventilation distribution was more homogeneous (P < 0.01). CONCLUSIONS: In patients with AHRF, HFNC exerts multiple physiologic effects including less inspiratory effort and improved lung volume and compliance. These benefits might underlie the clinical efficacy of HFNC.
[Mh] Termos MeSH primário: Oxigenoterapia/métodos
Insuficiência Respiratória/terapia
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Gasometria
Cânula
Estudos Cross-Over
Feminino
Seres Humanos
Hipóxia/fisiopatologia
Hipóxia/terapia
Medidas de Volume Pulmonar
Masculino
Meia-Idade
Estudos Prospectivos
Insuficiência Respiratória/fisiopatologia
Trabalho Respiratório
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170713
[Lr] Data última revisão:
170713
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:161221
[St] Status:MEDLINE
[do] DOI:10.1164/rccm.201605-0916OC


  6 / 1876 MEDLINE  
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[PMID]:27798315
[Au] Autor:Sangha H; Whitacre T
[Ad] Endereço:1 Medical Intensive Care Unit, University of Missouri Healthcare System, Columbia, MO, USA.
[Ti] Título:Detection of Ventilator Autotriggering by an Esophageal Catheter Used to Monitor the Neural Input and Diaphragm Excitation.
[So] Source:J Intensive Care Med;32(2):170-173, 2017 Feb.
[Is] ISSN:1525-1489
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Patient-ventilator synchrony has been the focus of attention in the field of mechanical ventilation for quite some time now. Toward that end, the modern ventilators are equipped with very sensitive pneumatic triggering mechanisms, which allow for minimal wasting of patient effort. The increasingly sensitive pneumatic triggers have the potential to cause autotriggering, where stimuli other than neural signals (eg, cardiac oscillations) can trigger the mechanical breath. Although autotriggering has been well documented in brain-dead patients, its existence is difficult to prove in patients who have the ability to trigger breath through neural diaphragmatic activity. The only way to be sure that the triggered breath is indeed from the neural diaphragmatic activity rather than a spurious change in pressure or flow is to monitor neural signals during triggered mechanical breaths. Autotriggering can have deleterious effects including diaphragmatic atrophy, increased duration on the mechanical ventilator, and increased stay in the intensive care unit. Esophageal catheters, with the ability to measure phrenic nerve and diaphragmatic activity, allow for the detection of the extent of autotriggering. This article demonstrates the hitherto unknown but potentially common occurrence of autotriggering through nonneural stimuli and their amelioration by making the pneumatic autotriggering less sensitive. The full extent of the phenomenon and its deleterious effects remain to be explored in larger patient populations.
[Mh] Termos MeSH primário: Cateteres Venosos Centrais/efeitos adversos
Diafragma/fisiopatologia
Respiração com Pressão Positiva
Síndrome do Desconforto Respiratório do Adulto/fisiopatologia
Choque Séptico/fisiopatologia
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Gasometria
Falha de Equipamento
Feminino
Hemodinâmica
Seres Humanos
Masculino
Meia-Idade
Respiração com Pressão Positiva/efeitos adversos
Respiração com Pressão Positiva/métodos
Síndrome do Desconforto Respiratório do Adulto/diagnóstico
Síndrome do Desconforto Respiratório do Adulto/terapia
Choque Séptico/diagnóstico
Choque Séptico/terapia
Resultado do Tratamento
Trabalho Respiratório
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170919
[Lr] Data última revisão:
170919
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161101
[St] Status:MEDLINE
[do] DOI:10.1177/0885066616674192


  7 / 1876 MEDLINE  
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[PMID]:27768396
[Au] Autor:Sklar MC; Burns K; Rittayamai N; Lanys A; Rauseo M; Chen L; Dres M; Chen GQ; Goligher EC; Adhikari NKJ; Brochard L; Friedrich JO
[Ad] Endereço:1 Department of Anesthesiology and.
[Ti] Título:Effort to Breathe with Various Spontaneous Breathing Trial Techniques. A Physiologic Meta-analysis.
[So] Source:Am J Respir Crit Care Med;195(11):1477-1485, 2017 Jun 01.
[Is] ISSN:1535-4970
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Spontaneous breathing trials (SBTs) are designed to simulate conditions after extubation, and it is essential to understand the physiologic impact of different methods. OBJECTIVES: We conducted a systematic review and pooled measures reflecting patient respiratory effort among studies comparing SBT methods in a meta-analysis. METHODS: We searched Medline, Excerpta Medica Database, and Web of Science from inception to January 2016 to identify randomized and nonrandomized clinical trials reporting physiologic measurements of respiratory effort (pressure-time product) or work of breathing during at least two SBT techniques. Secondary outcomes included the rapid shallow breathing index (RSBI), and effort measured before and after extubation. The quality of physiologic measurement and research design was appraised for each study. Outcomes were analyzed using ratio of means. MEASUREMENTS AND MAIN RESULTS: Among 4,138 citations, 16 studies (n = 239) were included. Compared with T-piece, pressure support ventilation significantly reduced work by 30% (ratio of means [RoM], 0.70; 95% confidence interval [CI], 0.57-0.86), effort by 30% (RoM, 0.70; 95% CI, 0.60-0.82), and RSBI by 20% (RoM, 0.80; 95% CI, 0.75-0.86). Continuous positive airway pressure had significantly lower pressure-time product by 18% (RoM, 0.82; 95% CI, 0.68-0.999) compared with T-piece, and reduced RSBI by 16% (RoM, 0.84; 95% CI, 0.74-0.95). Studies comparing SBTs with the postextubation period demonstrated that pressure support induced significantly lower effort and RSBI; T-piece reduced effort, but not the work, compared with postextubation. Work, effort, and RSBI measured while intubated on the ventilator with continuous positive airway pressure of 0 cm H O were no different than extubation. CONCLUSIONS: Pressure support reduces respiratory effort compared with T-piece. Continuous positive airway pressure of 0 cm H O and T-piece more accurately reflect the physiologic conditions after extubation.
[Mh] Termos MeSH primário: Respiração
Trabalho Respiratório/fisiologia
[Mh] Termos MeSH secundário: Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170731
[Lr] Data última revisão:
170731
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:161022
[St] Status:MEDLINE
[do] DOI:10.1164/rccm.201607-1338OC


  8 / 1876 MEDLINE  
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[PMID]:27553588
[Au] Autor:Donaldsson S; Drevhammar T; Taittonen L; Klemming S; Jonsson B
[Ad] Endereço:Department of Neonatology, Karolinska University Hospital, Stockholm, Sweden.
[Ti] Título:Initial stabilisation of preterm infants: a new resuscitation system with low imposed work of breathing for use with face mask or nasal prongs.
[So] Source:Arch Dis Child Fetal Neonatal Ed;102(3):F203-F207, 2017 May.
[Is] ISSN:1468-2052
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: T-piece resuscitation systems are pressure unstable and have high imposed work of breathing (iWOB). Pressure stable respiratory support with low iWOB might improve outcome. We have developed a new resuscitation system that can be used with nasal prongs or face mask. The aim of the study was to describe the in vitro performance of the new system and to perform a clinical feasibility trial of initial stabilisation of preterm infants. METHOD: A mechanical lung model was used to determine iWOB at increasing levels of continuous positive airway pressure (CPAP). The feasibility trial included 36 infants (27-34 weeks of gestation), who were randomised into three groups (T-piece, new system with face mask or new system with prongs). Collected data included problems with usage, safety, time to stable breathing, need for positive pressure ventilation and intubation. RESULTS: In the mechanical lung model, the new system reduced iWOB with 91.5% (mask) and 86.6% (medium prongs) compared with Neopuff (4 cm CPAP, p<0.001). Informed consent was obtained from 45 patients, 39 were randomised and 36 needed support. Randomisation resulted in an imbalance: The group of new system infants had lower gestational age compared with the T-piece group. Thirteen patients needed positive pressure ventilation (median 20 cm H O). One infant was intubated. The study did not reveal problems with the equipment or safety. CONCLUSIONS: Compared with T-piece systems, the new system had a marked reduction in iWOB in bench tests. The feasibility trial did not reveal problems with usability or safety.
[Mh] Termos MeSH primário: Cuidado do Lactente/métodos
Recém-Nascido Prematuro/fisiologia
Máscaras
Ressuscitação/métodos
Trabalho Respiratório/fisiologia
[Mh] Termos MeSH secundário: Índice de Apgar
Pressão Positiva Contínua nas Vias Aéreas/efeitos adversos
Pressão Positiva Contínua nas Vias Aéreas/instrumentação
Pressão Positiva Contínua nas Vias Aéreas/métodos
Estudos de Viabilidade
Feminino
Seres Humanos
Recém-Nascido
Masculino
Modelos Anatômicos
Pneumotórax/etiologia
Respiração com Pressão Positiva/efeitos adversos
Respiração com Pressão Positiva/instrumentação
Respiração com Pressão Positiva/métodos
Ressuscitação/efeitos adversos
Ressuscitação/instrumentação
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170602
[Lr] Data última revisão:
170602
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:160825
[St] Status:MEDLINE
[do] DOI:10.1136/archdischild-2016-310577


  9 / 1876 MEDLINE  
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[PMID]:27743000
[Au] Autor:Kida Y; Ohshimo S; Shime N
[Ad] Endereço:Department of Emergency and Critical Care Medicine, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
[Ti] Título:Potential covariates that affect post-extubation breathing effort in children.
[So] Source:Intensive Care Med;42(12):2127-2128, 2016 Dec.
[Is] ISSN:1432-1238
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Extubação
Desmame do Respirador
[Mh] Termos MeSH secundário: Criança
Seres Humanos
Trabalho Respiratório
[Pt] Tipo de publicação:LETTER
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171126
[Lr] Data última revisão:
171126
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161016
[St] Status:MEDLINE
[do] DOI:10.1007/s00134-016-4538-6


  10 / 1876 MEDLINE  
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[PMID]:27499619
[Au] Autor:Loverdos K; Toumpanakis D; Litsiou E; Karavana V; Glynos C; Magkou C; Theocharis S; Vassilakopoulos T
[Ad] Endereço:Department of Critical Care, Pulmonary Unit and Marianthi Simou Applied Biomedical Research and Training Center, Evangelismos General Hospital, University of Athens Medical School.
[Ti] Título:The differential effects of inspiratory, expiratory, and combined resistive breathing on healthy lung.
[So] Source:Int J Chron Obstruct Pulmon Dis;11:1623-38, 2016.
[Is] ISSN:1178-2005
[Cp] País de publicação:New Zealand
[La] Idioma:eng
[Ab] Resumo:Combined resistive breathing (CRB) is the hallmark of obstructive airway disease pathophysiology. We have previously shown that severe inspiratory resistive breathing (IRB) induces acute lung injury in healthy rats. The role of expiratory resistance is unknown. The possibility of a load-dependent type of resistive breathing-induced lung injury also remains elusive. Our aim was to investigate the differential effects of IRB, expiratory resistive breathing (ERB), and CRB on healthy rat lung and establish the lowest loads required to induce injury. Anesthetized tracheostomized rats breathed through a two-way valve. Varying resistances were connected to the inspiratory, expiratory, or both ports, so that the peak inspiratory pressure (IRB) was 20%-40% or peak expiratory (ERB) was 40%-70% of maximum. CRB was assessed in inspiratory/expiratory pressures of 30%/50%, 40%/50%, and 40%/60% of maximum. Quietly breathing animals served as controls. At 6 hours, respiratory system mechanics were measured, and bronchoalveolar lavage was performed for measurement of cell and protein concentration. Lung tissue interleukin-6 and interleukin-1ß levels were estimated, and a lung injury histological score was determined. ERB produced significant, load-independent neutrophilia, without mechanical or permeability derangements. IRB 30% was the lowest inspiratory load that provoked lung injury. CRB increased tissue elasticity, bronchoalveolar lavage total cell, macrophage and neutrophil counts, protein and cytokine levels, and lung injury score in a dose-dependent manner. In conclusion, CRB load dependently deranges mechanics, increases permeability, and induces inflammation in healthy rats. ERB is a putative inflammatory stimulus for the lung.
[Mh] Termos MeSH primário: Lesão Pulmonar Aguda/etiologia
Resistência das Vias Respiratórias
Expiração
Inalação
Pulmão/fisiopatologia
[Mh] Termos MeSH secundário: Lesão Pulmonar Aguda/metabolismo
Lesão Pulmonar Aguda/patologia
Lesão Pulmonar Aguda/fisiopatologia
Animais
Líquido da Lavagem Broncoalveolar/química
Líquido da Lavagem Broncoalveolar/citologia
Água Extravascular Pulmonar/metabolismo
Feminino
Mediadores da Inflamação/metabolismo
Interleucina-1beta/metabolismo
Interleucina-6/metabolismo
Pulmão/metabolismo
Pulmão/patologia
Peroxidase/metabolismo
Pneumonia/etiologia
Pneumonia/fisiopatologia
Edema Pulmonar/etiologia
Edema Pulmonar/fisiopatologia
Ratos Wistar
Fatores de Tempo
Trabalho Respiratório
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (IL1B protein, rat); 0 (Inflammation Mediators); 0 (Interleukin-1beta); 0 (Interleukin-6); EC 1.11.1.7 (Peroxidase)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170817
[Lr] Data última revisão:
170817
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160809
[St] Status:MEDLINE
[do] DOI:10.2147/COPD.S106337



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