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[PMID]: 27741132 [Au] Autor: Huang HY; Chou PC; Joa WC; Chen LF; Sheng TF; Lin HC; Yang LY; Pan YB; Chung FT; Wang CH; Kuo HP [Ad] Endereço: aDepartment of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei bBiostatistics Unit, Clinical Trial Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan. [Ti] Título: Pulmonary rehabilitation coupled with negative pressure ventilation decreases decline in lung function, hospitalizations, and medical cost in COPD: A 5-year study. [So] Source: Medicine (Baltimore);95(41):e5119, 2016 Oct. [Is] ISSN: 1536-5964 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: Pulmonary rehabilitation (PR) brings benefits to patients with chronic obstructive pulmonary disease (COPD). Negative pressure ventilation (NPV) increases ventilation and decreases hyperinflation as well as breathing work in COPD. We evaluated the long-term effects of a hospital-based PR program coupled with NPV support in patients with COPD on clinical outcomes.One hundred twenty-nine patients with COPD were followed up for more than 5 years, with the NPV group (n = 63) receiving the support of NPV (20-30 cm H2O delivery pressure for 60 min) and unsupervised home exercise program of 20 to 30 min daily walk, while the control group (n = 6) only received unsupervised home exercise program. Pulmonary function tests and 6 min walk tests (6MWT) were performed every 3 to 6 months. Emergency room (ER) visits and hospitalization with medical costs were recorded.A significant time-by-group interaction in the yearly decline of forced expiratory volume in 1 s in the control group analyzed by mixed-model repeated-measure analysis was found (P = 0.048). The 6MWT distance of the NPV group was significantly increased during the first 4 years, with the interaction of time and group (P = 0.003), the time alone (P = 0.014), and the quadratic time (P < 0.001) being significant between the 2 groups. ER exacerbations and hospitalizations decreased by 66% (P < 0.0001) and 54% (P < 0.0001) in the NPV group, respectively. Patients on PR program coupled with NPV had a significant reduction of annual medical costs (P = 0.022).Our hospital-based multidisciplinary PR coupled with NPV reduced yearly decline of lung function, exacerbations, and hospitalization rates, and improved walking distance and medical costs in patients with COPD during a 5-year observation. [Mh] Termos MeSH primário: Volume Expiratório Forçado/fisiologia Custos de Cuidados de Saúde/estatística & dados numéricos Hospitalização/tendências Pulmão/fisiopatologia Doença Pulmonar Obstrutiva Crônica/reabilitação Respiração Artificial/instrumentação Respiradores de Pressão Negativa [Mh] Termos MeSH secundário: Idoso Feminino Seguimentos Seres Humanos Masculino Doença Pulmonar Obstrutiva Crônica/economia Doença Pulmonar Obstrutiva Crônica/fisiopatologia Testes de Função Respiratória Estudos Retrospectivos Fatores de Tempo Resultado do Tratamento [Pt] Tipo de publicação: JOURNAL ARTICLE; OBSERVATIONAL STUDY [Em] Mês de entrada: 1702 [Cu] Atualização por classe: 170224 [Lr] Data última revisão: 170224 [Sb] Subgrupo de revista: AIM; IM [Da] Data de entrada para processamento: 161015 [St] Status: MEDLINE

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[PMID]: 26483265 [Au] Autor: Nigam G; Pathak C; Riaz M [Ad] Endereço: Sleep Disorders Center, University of Michigan Health System, C728 Med Inn Bldg. 1500 E. Medical Center Drive, Ann Arbor, MI, 48109-5845, USA. dr.nigamgaurav@gmail.com. [Ti] Título: Effectiveness of oral pressure therapy in obstructive sleep apnea: a systematic analysis. [So] Source: Sleep Breath;20(2):663-71, 2016 May. [Is] ISSN: 1522-1709 [Cp] País de publicação: Germany [La] Idioma: eng [Ab] Resumo: PURPOSE: Oral pressure therapy (OPT) has emerged as a novel technique to treat obstructive sleep apnea (OSA) in the past few years. Given this is a relatively new treatment approach, currently, little is known with respect to its clinical utility. The aim of this review was to explore the success rate of OPT when used to treat OSA. METHODS: PubMed, MEDLINE, Scopus, Web of Science, and the Cochrane Library databases were searched for pertinent studies. RESULTS: The OPT treatment success rates varied widely between 25 and 79 % depending on the residual apnea-hypopnea index (AHI) cut off defined for treatment success. When using standard definitions (at least 50 % reduction from the baseline AHI and the post-OPT treatment residual AHI less than or equal to 10), the success rate of OPT treatment varied between 25 and 37 %. CONCLUSIONS: Although there was a significant reduction in AHI with OPT, the baseline AHI was not suppressed in majority of patients to the extent to call these patients as optimally treated. Successful treatment with OPT did not correlate with severity of OSA; however, patients with retro-palatal collapse responded better to treatment. Further research is needed to identify OSA patients who would benefit with this treatment modality. [Mh] Termos MeSH primário: Desenho de Equipamento Polissonografia Apneia Obstrutiva do Sono/terapia Respiradores de Pressão Negativa [Mh] Termos MeSH secundário: Seres Humanos Apneia Obstrutiva do Sono/diagnóstico Vácuo [Pt] Tipo de publicação: JOURNAL ARTICLE; META-ANALYSIS; REVIEW [Em] Mês de entrada: 1703 [Cu] Atualização por classe: 171102 [Lr] Data última revisão: 171102 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 151021 [St] Status: MEDLINE [do] DOI: 10.1007/s11325-015-1270-3

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[PMID]: 25225790 [Au] Autor: Bright-Thomas RJ; Johnson SC [Ad] Endereço: aManchester Adult Cystic Fibrosis Centre, North West Lung Centre, University Hospital of South Manchester bRespiratory Research Group, Institute of Inflammation and Repair, University of Manchester, Manchester, UK. [Ti] Título: What is the role of noninvasive ventilation in cystic fibrosis? [So] Source: Curr Opin Pulm Med;20(6):618-22, 2014 Nov. [Is] ISSN: 1531-6971 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: PURPOSE OF REVIEW: The use of noninvasive ventilatory support in patients with cystic fibrosis (CF) has increased exponentially over the past 2 decades. This review examines the current knowledge and considers potential future directions for use of noninvasive ventilation in CF patients. RECENT FINDINGS: Noninvasive ventilation was originally reported as a bridge to transplantation in CF patients with severe respiratory failure but is now used as a long-term treatment modality for patients with respiratory failure independent of transplant status. In 2013 to 2014, over 400 publications on noninvasive ventilation demonstrate its increasing clinical application, however only seven reference CF. Recent technological advances and potential benefits to CF patients are considered. SUMMARY: The role of noninvasive ventilation in CF patients in chronic respiratory failure is established, but future prospective studies are needed to determine further indications and optimal timing of this intervention. Developments in both ventilator and interface design may enhance the efficacy of ventilation in CF patients but require careful individualized assessment and regular review. The implications on treatment burden and quality of life in CF also need to be studied. [Mh] Termos MeSH primário: Fibrose Cística/terapia Ventilação não Invasiva Insuficiência Respiratória/terapia Músculos Respiratórios/fisiopatologia Respiradores de Pressão Negativa [Mh] Termos MeSH secundário: Fibrose Cística/complicações Fibrose Cística/fisiopatologia Seres Humanos Transplante de Pulmão Seleção de Pacientes Estudos Prospectivos Qualidade de Vida Insuficiência Respiratória/etiologia Insuficiência Respiratória/fisiopatologia Resultado do Tratamento [Pt] Tipo de publicação: JOURNAL ARTICLE; REVIEW [Em] Mês de entrada: 1506 [Cu] Atualização por classe: 140924 [Lr] Data última revisão: 140924 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 140917 [St] Status: MEDLINE [do] DOI: 10.1097/MCP.0000000000000105

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[PMID]: 24857748 [Au] Autor: Akkermans R [Ti] Título: Philip Drinker. [So] Source: Lancet Respir Med;2(7):525-6, 2014 Jul. [Is] ISSN: 2213-2619 [Cp] País de publicação: England [La] Idioma: eng [Mh] Termos MeSH primário: Exposição Ocupacional/história Poliomielite/história Respiradores de Pressão Negativa/história [Mh] Termos MeSH secundário: Asfixia/etiologia Asfixia/história Asfixia/terapia Poeira Gases História do Século XX Invenções/história Poliomielite/complicações Estados Unidos [Pt] Tipo de publicação: BIOGRAPHY; HISTORICAL ARTICLE; JOURNAL ARTICLE; PORTRAITS [Ps] Nome de pessoa como assunto: Drinker P [Nm] Nome de substância: 0 (Dust); 0 (Gases) [Em] Mês de entrada: 1503 [Cu] Atualização por classe: 140710 [Lr] Data última revisão: 140710 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 140527 [St] Status: MEDLINE

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[PMID]: 24705801 [Au] Autor: Fletcher OM; Guerrina R; Ashley CD; Bernard TE [Ad] Endereço: College of Public Health, University of South Florida, USA. [Ti] Título: Heat stress evaluation of two-layer chemical demilitarization ensembles with a full face negative pressure respirator. [So] Source: Ind Health;52(4):304-12, 2014. [Is] ISSN: 1880-8026 [Cp] País de publicação: Japan [La] Idioma: eng [Ab] Resumo: The purpose of this study was to examine the heat stress effects of three protective clothing ensembles: (1) protective apron over cloth coveralls including full face negative pressure respirator (APRON); (2) the apron over cloth coveralls with respirator plus protective pants (APRON+PANTS); and (3) protective coveralls over cloth coveralls with respirator (PROTECTIVE COVERALLS). In addition, there was a no-respirator ensemble (PROTECTIVE COVERALLS-noR), and WORK CLOTHES as a reference ensemble. Four acclimatized male participants completed a full set of five trials, and two of the participants repeated the full set. The progressive heat stress protocol was used to find the critical WBGT (WBGTcrit) and apparent total evaporative resistance (Re,T,a) at the upper limit of thermal equilibrium. The results (WBGTcrit [°C-WBGT] and Re,T,a [kPa m(2) W(-1)]) were WORK CLOTHES (35.5, 0.0115), APRON (31.6, 0.0179), APRON+PANTS (27.7, 0.0244), PROTECTIVE COVERALLS (25.9, 0.0290), and PROTECTIVE COVERALLS-noR (26.2, 0.0296). There were significant differences among the ensembles. Supporting previous studies, there was little evidence to suggest that the respirator contributed to heat stress. [Mh] Termos MeSH primário: Transtornos de Estresse por Calor/etiologia Roupa de Proteção/efeitos adversos Respiradores de Pressão Negativa/efeitos adversos [Mh] Termos MeSH secundário: Metabolismo Basal Regulação da Temperatura Corporal Seres Humanos Masculino Adulto Jovem [Pt] Tipo de publicação: JOURNAL ARTICLE; RESEARCH SUPPORT, N.I.H., EXTRAMURAL; RESEARCH SUPPORT, U.S. GOV'T, NON-P.H.S. [Em] Mês de entrada: 1608 [Cu] Atualização por classe: 161019 [Lr] Data última revisão: 161019 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 140408 [St] Status: MEDLINE

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[PMID]: 24671536 [Au] Autor: Buharin VE; Butler AJ; Shinohara M [Ad] Endereço: School of Applied Physiology, Georgia Institute of Technology, Atlanta, Georgia; [Ti] Título: Motor cortical disinhibition with baroreceptor unloading induced by orthostatic stress. [So] Source: J Neurophysiol;111(12):2656-64, 2014 Jun 15. [Is] ISSN: 1522-1598 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: Unloading of the baroreceptors due to orthostatic stress increases corticospinal excitability. The purpose of this study was to examine the effects of baroreceptor unloading due to orthostatic stress on intracortical excitatory and inhibitory pathways in the motor cortex. With transcranial magnetic stimulation, measures of intracortical excitability for a hand muscle were tested on 2 days in healthy young adults. Lower body negative pressure (LBNP) of 40 mmHg was applied during one of the days and not during the Control day. During application of LBNP heart rate and the low-frequency component of heart rate variability increased, while mean arterial blood pressure was maintained. In the resting state, LBNP decreased short-interval intracortical inhibition (SICI) and had no effect on intracortical facilitation (ICF) or short-interval intracortical facilitation (SICF) compared with the Control day. During isometric contraction, no effects of LBNP were observed on tested measures of intracortical excitability including SICI, SICF, and cortical silent period. It was concluded that baroreceptor unloading due to orthostatic stress results in diminished intracortical inhibition, at least in the resting muscle. [Mh] Termos MeSH primário: Córtex Motor/fisiologia Pressorreceptores/fisiologia Estresse Fisiológico/fisiologia [Mh] Termos MeSH secundário: Pressão Sanguínea/fisiologia Potencial Evocado Motor Feminino Mãos/fisiologia Frequência Cardíaca/fisiologia Seres Humanos Contração Isométrica/fisiologia Masculino Músculo Esquelético/fisiologia Vias Neurais/fisiologia Tratos Piramidais/fisiologia Descanso/fisiologia Estimulação Magnética Transcraniana Respiradores de Pressão Negativa Adulto Jovem [Pt] Tipo de publicação: JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T; RESEARCH SUPPORT, U.S. GOV'T, NON-P.H.S. [Em] Mês de entrada: 1501 [Cu] Atualização por classe: 140616 [Lr] Data última revisão: 140616 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 140328 [St] Status: MEDLINE [do] DOI: 10.1152/jn.00778.2013

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[PMID]: 24270126 [Au] Autor: Pecchiari M; Monaco A; Koutsoukou A; Della Valle P; Gentile G; D'Angelo E [Ad] Endereço: From the Dipartimento di Fisiopatologia Medico-chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy (M.P., A.M., and E.D.); 1st Department of Respiratory Medicine, Sotiria Hospital, University of Athens Medical School, Athens, Greece (A.K.); Servizio di Coagulazione e Unità di Ricerca sulla Trombosi, Istituto di Ricovero e Cura a Carattere Scientifico, San Raffaele, Milan, Italy (P.D.V.); and Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy (G.G.). [Ti] Título: Effects of various modes of mechanical ventilation in normal rats. [So] Source: Anesthesiology;120(4):943-50, 2014 Apr. [Is] ISSN: 1528-1175 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: BACKGROUND: Recent studies in healthy mice and rats have reported that positive pressure ventilation delivered with physiological tidal volumes at normal end-expiratory volume worsens lung mechanics and induces cytokine release, thus suggesting that detrimental effects are due to positive pressure ventilation per se. The aim of this study in healthy animals is to assess whether these adverse outcomes depend on the mode of mechanical ventilation. METHODS: Rats were subjected to 4 h of spontaneous, positive pressure, and whole-body or thorax-only negative pressure ventilation (N = 8 per group). In all instances the ventilatory pattern was that of spontaneous breathing. Lung mechanics, cytokines concentration in serum and broncho-alveolar lavage fluid, lung wet-to-dry ratio, and histology were assessed. Values from eight animals euthanized shortly after anesthesia served as control. RESULTS: No evidence of mechanical ventilation-dependent lung injury was found in terms of lung mechanics, histology, or wet-to-dry ratio. Relative to control, cytokine levels and recruitment of polymorphonuclear leucocytes increased slightly, and to the same extent with spontaneous, positive pressure, and whole-body negative pressure ventilation. Thorax-only negative pressure ventilation caused marked chest and lung distortion, reversible increase of lung elastance, and higher polymorphonuclear leucocyte count and cytokine levels. CONCLUSION: Both positive and negative pressure ventilation performed with tidal volumes and timing of spontaneous, quiet breathing neither elicit an inflammatory response nor cause morpho-functional alterations in normal animals, thus supporting the notion of the presence of a critical volume threshold above which acute lung injury ensues. Distortion of lung parenchyma can induce an inflammatory response, even in the absence of volotrauma. [Mh] Termos MeSH primário: Pulmão/fisiologia Modelos Animais Respiração Artificial/métodos Respiração Artificial/veterinária Mecânica Respiratória/fisiologia [Mh] Termos MeSH secundário: Animais Líquido da Lavagem Broncoalveolar Citocinas/sangue Citocinas/metabolismo Feminino Masculino Respiração com Pressão Positiva Gravidez Ratos Ratos Sprague-Dawley Valores de Referência Respiração Volume de Ventilação Pulmonar/fisiologia Respiradores de Pressão Negativa [Pt] Tipo de publicação: JOURNAL ARTICLE [Nm] Nome de substância: 0 (Cytokines) [Em] Mês de entrada: 1406 [Cu] Atualização por classe: 140403 [Lr] Data última revisão: 140403 [Sb] Subgrupo de revista: AIM; IM [Da] Data de entrada para processamento: 131126 [St] Status: MEDLINE [do] DOI: 10.1097/ALN.0000000000000075

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[PMID]: 24186774 [Au] Autor: Shah PS; Ohlsson A; Shah JP [Ad] Endereço: Department of Paediatrics and Health Policy, Management and Evaluation, University of Toronto Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario, Canada, M5G 1XB. [Ti] Título: Continuous negative extrathoracic pressure or continuous positive airway pressure compared to conventional ventilation for acute hypoxaemic respiratory failure in children. [So] Source: Cochrane Database Syst Rev;(11):CD003699, 2013 Nov 04. [Is] ISSN: 1469-493X [Cp] País de publicação: England [La] Idioma: eng [Ab] Resumo: BACKGROUND: Acute hypoxaemic respiratory failure (AHRF) is an important cause of mortality and morbidity in children. Positive pressure ventilation is currently the standard care, however, it does have complications. Continuous negative extrathoracic pressure (CNEP) ventilation or continuous positive airway pressure (CPAP) ventilation delivered via non-invasive approaches (Ni-CPAP) have shown certain beneficial effects in animal and uncontrolled human studies. OBJECTIVES: To assess the effectiveness of CNEP or Ni-CPAP compared to conventional ventilation in children (at least one month old and less than 18 years of age) with AHRF due to non-cardiogenic causes for improving the mortality or morbidity associated with AHRF. SEARCH METHODS: We searched CENTRAL 2013, Issue 6, MEDLINE (January 1966 to June week 3, 2013), EMBASE (1980 to July 2013) and CINAHL (1982 to July 2013). SELECTION CRITERIA: Randomised or quasi-randomised clinical trials of CNEP or Ni-CPAP versus standard therapy (including positive pressure ventilation) involving children (from one month old to less than 18 years at time of randomisation) who met the criteria for diagnosis of AHRF with at least one of the outcomes reported. DATA COLLECTION AND ANALYSIS: We assessed risk of bias of the included studies using allocation concealment, blinding of intervention, completeness of follow-up and blinding of outcome measurements. We abstracted data on relevant outcomes and estimated the effect size by calculating risk ratio (RR) and risk difference (RD) with 95% confidence intervals (CI). MAIN RESULTS: We identified two eligible studies: one of CPAP and one of CNEP (published as an abstract). Both were unblinded studies with mainly unclear risk of bias due to lack of adequate information to assess this. The CPAP study enrolled 37 children to oxygen mask and CPAP and reported improvement in respiratory rate and oxygen saturation in both arms after 30 minutes of application. The CNEP study was published as an abstract and included 33 infants with bronchiolitis. In the CNEP study there was a reduction in the fraction of inspired oxygen (FiO2) (less than 30% within one hour of initiation of therapy) in four participants in the CNEP group compared to none in the control group (RR 10.7, 95% CI 0.6 to 183.9). One infant required CPAP and mechanical ventilation in the control group while all infants in the CNEP group were managed without intubation (RR for both outcomes 0.40, 95% CI 0.02 to 9.06). None of the trials reported on mortality. No adverse events were reported in ether of the included trials. AUTHORS' CONCLUSIONS: There is a lack of well-designed, controlled trials of non-invasive modes of respiratory support in children with AHRF. Studies assessing the outcomes mortality, avoidance of intubation and its associated complications, hospital stay and patient comfort are needed. [Mh] Termos MeSH primário: Hipóxia/terapia Respiração Artificial/métodos Insuficiência Respiratória/terapia [Mh] Termos MeSH secundário: Bronquiolite/terapia Pressão Positiva Contínua nas Vias Aéreas/métodos Dengue/complicações Seres Humanos Lactente Recém-Nascido Respiradores de Pressão Negativa [Pt] Tipo de publicação: JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T; REVIEW [Em] Mês de entrada: 1405 [Cu] Atualização por classe: 161128 [Lr] Data última revisão: 161128 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 131105 [St] Status: MEDLINE [do] DOI: 10.1002/14651858.CD003699.pub4

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[PMID]: 24175738 [Au] Autor: Wahab R; Basner RC [Ad] Endereço: Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University College of Physicians and Surgeons, 622 West 168th Street, NY 10032, USA. [Ti] Título: Nocturnal non-invasive ventilation for cardio-respiratory disorders in adults. [So] Source: Expert Rev Respir Med;7(6):615-29, 2013 Dec. [Is] ISSN: 1747-6356 [Cp] País de publicação: England [La] Idioma: eng [Ab] Resumo: Following the classic 'iron lung' non-invasive negative pressure ventilator, non-invasive positive pressure ventilation (NIPPV), particularly used 'nocturnally' has developed a broad role in both the acute hospital setting and domiciliary long-term use for many cardio-respiratory disorders associated with acute and chronic ventilatory failure. This role is based in part upon the perceived relative ease of application and discontinuation of NIPPV, ability to avoid intubation or tracheostomy and their associated morbidities and availability of increasingly portable pressure and volume cycled NIPPV devices. Nevertheless, the many methodologies necessary for optimal NIPPV use are often underappreciated by health care workers and patients alike. This review focuses on the rationale, practice, and future directions for 'nocturnal' use of non-invasive positive pressure ventilation (nNIV) in cardio-respiratory disorders in adults which are commonly associated with sleep-related apnea, hypoventilation and hypoxemia: congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), obesity hypoventilation syndrome (OHS), cystic fibrosis (CF) and neuromuscular disorders. [Mh] Termos MeSH primário: Ritmo Circadiano Ventilação não Invasiva/instrumentação Respiração com Pressão Positiva/instrumentação Insuficiência Respiratória/terapia Respiradores de Pressão Negativa [Mh] Termos MeSH secundário: Adulto Fibrose Cística/terapia Insuficiência Cardíaca/terapia Seres Humanos Síndrome de Hipoventilação por Obesidade/terapia Doença Pulmonar Obstrutiva Crônica/terapia Síndromes da Apneia do Sono/terapia [Pt] Tipo de publicação: JOURNAL ARTICLE; RESEARCH SUPPORT, N.I.H., EXTRAMURAL; REVIEW [Em] Mês de entrada: 1407 [Cu] Atualização por classe: 131114 [Lr] Data última revisão: 131114 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 131102 [St] Status: MEDLINE [do] DOI: 10.1586/17476348.2013.839246

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[PMID]: 23838714 [Au] Autor: Bruells CS; Smuder AJ; Reiss LK; Hudson MB; Nelson WB; Wiggs MP; Sollanek KJ; Rossaint R; Uhlig S; Powers SK [Ad] Endereço: Department of Anesthesiology, Medical Faculty of Rhenish-Westphalian Technical University Aachen University, Aachen, Germany. cbruells@ukaachen.de [Ti] Título: Negative pressure ventilation and positive pressure ventilation promote comparable levels of ventilator-induced diaphragmatic dysfunction in rats. [So] Source: Anesthesiology;119(3):652-62, 2013 Sep. [Is] ISSN: 1528-1175 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: BACKGROUND: Mechanical ventilation is a life-saving intervention for patients with respiratory failure. Unfortunately, a major complication associated with prolonged mechanical ventilation is ventilator-induced diaphragmatic atrophy and contractile dysfunction, termed ventilator-induced diaphragmatic dysfunction (VIDD). Emerging evidence suggests that positive pressure ventilation (PPV) promotes lung damage (ventilator-induced lung injury [VILI]), resulting in the release of signaling molecules that foster atrophic signaling in the diaphragm and the resultant VIDD. Although a recent report suggests that negative pressure ventilation (NPV) results in less VILI than PPV, it is unknown whether NPV can protect against VIDD. Therefore, the authors tested the hypothesis that compared with PPV, NPV will result in a lower level of VIDD. METHODS: Adult rats were randomly assigned to one of three experimental groups (n = 8 each): (1) acutely anesthetized control (CON), (2) 12 h of PPV, and (3) 12 h of NPV. Dependent measures included indices of VILI, diaphragmatic muscle fiber cross-sectional area, diaphragm contractile properties, and the activity of key proteases in the diaphragm. RESULTS: Our results reveal that no differences existed in the degree of VILI between PPV and NPV animals as evidenced by VILI histological scores (CON = 0.082 ± 0.001; PPV = 0.22 ± 0.04; NPV = 0.25 ± 0.02; mean ± SEM). Both PPV and NPV resulted in VIDD. Importantly, no differences existed between PPV and NPV animals in diaphragmatic fiber cross-sectional area, contractile properties, and the activation of proteases. CONCLUSION: These results demonstrate that NPV and PPV result in similar levels of VILI and that NPV and PPV promote comparable levels of VIDD in rats. [Mh] Termos MeSH primário: Diafragma/fisiopatologia Respiração com Pressão Positiva/efeitos adversos Lesão Pulmonar Induzida por Ventilação Mecânica/etiologia Respiradores de Pressão Negativa/efeitos adversos [Mh] Termos MeSH secundário: Animais Atrofia Citocinas/análise Diafragma/patologia Feminino Pulmão/patologia Estresse Oxidativo Ratos Ratos Sprague-Dawley [Pt] Tipo de publicação: COMPARATIVE STUDY; JOURNAL ARTICLE; RESEARCH SUPPORT, N.I.H., EXTRAMURAL; RESEARCH SUPPORT, NON-U.S. GOV'T [Nm] Nome de substância: 0 (Cytokines) [Em] Mês de entrada: 1311 [Cu] Atualização por classe: 161019 [Lr] Data última revisão: 161019 [Sb] Subgrupo de revista: AIM; IM [Da] Data de entrada para processamento: 130711 [St] Status: MEDLINE [do] DOI: 10.1097/ALN.0b013e31829b3692

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