scholarly journals Brain injury after 50 h of lung-protective mechanical ventilation in a preclinical model

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Thiago G. Bassi ◽  
Elizabeth C. Rohrs ◽  
Karl C. Fernandez ◽  
Marlena Ornowska ◽  
Michelle Nicholas ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Brain Injury ◽  
Neuronal Damage ◽  
Normal Lung ◽  
Preclinical Model ◽  
Negative Consequences ◽  
Mechanically Ventilated ◽  
Protective Mechanical Ventilation ◽  
Hippocampal Apoptosis ◽  
Lung Protective Mechanical Ventilation

AbstractMechanical ventilation is the cornerstone of the Intensive Care Unit. However, it has been associated with many negative consequences. Recently, ventilator-induced brain injury has been reported in rodents under injurious ventilation settings. Our group wanted to explore the extent of brain injury after 50 h of mechanical ventilation, sedation and physical immobility, quantifying hippocampal apoptosis and inflammation, in a normal-lung porcine study. After 50 h of lung-protective mechanical ventilation, sedation and immobility, greater levels of hippocampal apoptosis and neuroinflammation were clearly observed in the mechanically ventilated group, in comparison to a never-ventilated group. Markers in the serum for astrocyte damage and neuronal damage were also higher in the mechanically ventilated group. Therefore, our study demonstrated that considerable hippocampal insult can be observed after 50 h of lung-protective mechanical ventilation, sedation and physical immobility.

A review of intraoperative lung-protective mechanical ventilation strategy

2020 ◽  
Author(s):  
Trung kien Nguyen ◽  
Duc Hanh Mai ◽  
Anh Nguyet Le ◽  
Quang Huy Nguyen ◽  
Chi Tue Nguyen ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Ventilation Strategy ◽  
Protective Mechanical Ventilation ◽  
Lung Protective Mechanical Ventilation

scholarly journals Neuromonitoring of delirium with quantitative pupillometry In sedated mechanically ventilated critically ill patients

2020 ◽  
Author(s):  
Eva Favre ◽  
Adriano Bernini ◽  
Paola Morelli ◽  
Jerôme Pasquier ◽  
John-Paul Miroz ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Brain Injury ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Potential Utility ◽  
Icu Patients ◽  
Mechanically Ventilated ◽  
Increased Risk ◽  
Infrared Pupillometry ◽  
Icu Delirium

Abstract Background. Intensive care unit (ICU) delirium is a frequent secondary neurological complication in critically ill patients undergoing prolonged mechanical ventilation. Quantitative pupillometry is an emerging modality for the neuromonitoring of primary acute brain injury, but its potential utility in patients at risk of ICU delirium is unknown. Methods. This was an observational cohort study of medical-surgical ICU patients, without acute or known primary brain injury, who underwent sedation and mechanical ventilation for at least 48 hours. Starting at day 3, automated infrared pupillometry – blinded to ICU caregivers – was used for repeated measurement of the pupillary function, including quantitative pupillary light reflex (q-PLR, expressed as % pupil constriction to a standardized light stimulus) and constriction velocity (CV, mm/sec). The relationship between delirium, using the CAM-ICU score, and quantitative pupillary variables was examined. Results. A total of 59/100 patients had ICU delirium, diagnosed at a median 8 (5-13) days from admission. Compared to non-delirious patients, subjects with ICU delirium had lower values of q-PLR (25 [19-31] vs. 20 [15-28] %) and CV (2.5 [1.7-2.8] vs. 1.7 [1.4-2.4] mm/sec) at day 3, and at all additional time-points tested ( p <0.05). After adjusting for the SOFA score and the cumulative dose of analgesia and sedation, lower q-PLR was associated with an increased risk of ICU delirium (OR 1.057 [1.007-1.113] at day 3; p =0.03). Conclusions. Sustained abnormalities of quantitative pupillary variables at the early ICU phase correlate with delirium and precede clinical diagnosis by a median 5 days. These findings suggest a potential utility of quantitative pupillometry in sedated mechanically ventilated ICU patients at high risk of delirium.

scholarly journals LUNG-PROTECTIVE MECHANICAL VENTILATION FOR 50 HOURS INJURES THE HIPPOCAMPUS

CHEST Journal ◽  
2020 ◽  
Vol 158 (4) ◽  
pp. A657-A658
Author(s):  
Thiago Bassi ◽  
Elizabeth Rohrs ◽  
Karl Fernandez ◽  
Marlena Ornowska ◽  
Michelle Nicholas ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Protective Mechanical Ventilation ◽  
Lung Protective Mechanical Ventilation

scholarly journals Heliox Improves Carbon Dioxide Removal during Lung Protective Mechanical Ventilation

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Charlotte J. Beurskens ◽  
Daniel Brevoord ◽  
Wim K. Lagrand ◽  
Walter M. van den Bergh ◽  
Margreeth B. Vroom ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Mechanical Ventilation ◽  
Noble Gas ◽  
Statistical Significance ◽  
Minute Volume ◽  
Lung Mechanics ◽  
Volume Ventilation ◽  
Post Hoc ◽  
Protective Mechanical Ventilation ◽  
Lung Protective Mechanical Ventilation

Introduction. Helium is a noble gas with low density and increased carbon dioxide (CO2) diffusion capacity. This allows lower driving pressures in mechanical ventilation and increased CO2diffusion. We hypothesized that heliox facilitates ventilation in patients during lung-protective mechanical ventilation using low tidal volumes.Methods. This is an observational cohort substudy of a single arm intervention study. Twenty-four ICU patients were included, who were admitted after a cardiac arrest and mechanically ventilated for 3 hours with heliox (50% helium; 50% oxygen). A fixed protective ventilation protocol (6 mL/kg) was used, with prospective observation for changes in lung mechanics and gas exchange. Statistics was by Bonferroni post-hoc correction with statistical significance set atP<0.017.Results. During heliox ventilation, respiratory rate decreased (25±4versus23±5breaths min−1,P=0.010). Minute volume ventilation showed a trend to decrease compared to baseline (11.1±1.9versus9.9±2.1 L min−1,P=0.026), while reducing PaCO2levels (5.0±0.6versus4.5±0.6 kPa,P=0.011) and peak pressures (21.1±3.3versus19.8±3.2 cm H2O,P=0.024).Conclusions. Heliox improved CO2elimination while allowing reduced minute volume ventilation in adult patients during protective mechanical ventilation.

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