Renal Nerves Are Not Involved in Sodium and Water Retention during Mechanical Ventilation in Awake Dogs 

1998 ◽  
Vol 89 (4) ◽  
pp. 942-953 ◽  
Author(s):  
Willehad Boemke ◽  
Martin O. Krebs ◽  
Kourosh Djalali ◽  
Harald Bunger ◽  
Gabriele Kaczmarczyk
Keyword(s):  
Mechanical Ventilation ◽  
Continuous Positive Airway Pressure ◽  
Antidiuretic Hormone ◽  
Airway Pressure ◽  
Water Retention ◽  
Positive Airway Pressure ◽  
Surgical Stress ◽  
Urine Volume ◽  
Plasma Renin ◽  
Renal Nerves

Background The role of renal nerves during positive end-expiratory pressure ventilation (PEEP) has only been investigated in surgically stressed, anesthetized, unilaterally denervated dogs. Anesthesia, sedation, and surgical stress, however, decrease urine volume and sodium excretion and increase renal sympathetic nerve activity independent of PEEP. This study investigated in awake dogs the participation of renal nerves in mediating volume and water retention during PEEP. Methods Eight tracheotomized, trained, awake dogs were used. The protocol consisted of 60 min of spontaneous breathing at a continuous positive airway pressure of 4 cm H2O, followed by 120 min of controlled mechanical ventilation with a mean PEEP of 15-17 cm H2O (PEEP), and 60 min of continuous positive airway pressure. Two protocols were performed on intact dogs, in which volume expansion had (hypervolemic; electrolyte solution, 0.5 ml x kg(-1) x min(-1)) and had not (normovolemic) been instituted. This was repeated on the same dogs 2 or 3 weeks after bilateral renal denervation. Results Hypervolemic dogs excreted more sodium and water than did normovolemic dogs. There was no difference between intact and renal-denervated dogs. Arterial pressure did not decrease when continuous positive airway pressure was switched to PEEP. Plasma renin activity, aldosterone, and antidiuretic hormone concentrations were greater in normovolemic dogs. The PEEP increased aldosterone and antidiuretic hormone concentrations only in normovolemic dogs. Conclusions In conscious dogs, renal nerves have no appreciable contribution to sodium and water retention during PEEP. Retention in normovolemic dogs seems to be primarily caused by an activation of the renin-angiotensin system and an increase in the antidiuretic hormone. Excretion rates depended on the volume status of the dogs.

scholarly journals Non-invasive duo positive airway pressure ventilation versus nasal continuous positive airway pressure in preterm infants with respiratory distress syndrome: a randomized controlled trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Arash Malakian ◽  
Mohammad Reza Aramesh ◽  
Mina Agahin ◽  
Masoud Dehdashtian
Keyword(s):  
Mechanical Ventilation ◽  
Continuous Positive Airway Pressure ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Airway Pressure ◽  
Distress Syndrome ◽  
Positive Airway Pressure ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation

Abstract Background The most common cause of respiratory failure in premature infants is respiratory distress syndrome. Historically, respiratory distress syndrome has been treated by intratracheal surfactant injection followed by mechanical ventilation. In view of the risk of pulmonary injury associated with mechanical ventilation and subsequent chronic pulmonary lung disease, less invasive treatment modalities have been suggested to reduce pulmonary complications. Methods 148 neonates (with gestational age of 28 to 34 weeks) with respiratory distress syndrome admitted to Imam Khomeini Hospital in Ahwaz in 2018 were enrolled in this clinical trial study. 74 neonates were assigned to duo positive airway pressure (NDUOPAP) group and 74 neonates to nasal continuous positive airway pressure (NCPAP) group. The primary outcome in this study was failure of N-DUOPAP and NCPAP treatments within the first 72 h after birth and secondary outcomes included treatment complications. Results there was not significant difference between DUOPAP (4.1 %) and NCPAP (8.1 %) in treatment failure at the first 72 h of birth (p = 0.494), but non-invasive ventilation time was less in the DUOPAP group (p = 0.004). There were not significant differences in the frequency of patent ductus arteriosus (PDA), pneumothorax, intraventricular hemorrhage (IVH) and bronchopulmonary dysplasia (BPD), apnea and mortality between the two groups. Need for repeated doses of surfactant (p = 0.042) in the NDUOPAP group was significantly lower than that of the NCPAP group. The duration of oxygen therapy in the NDUOPAP group was significantly lower than that of the NCPAP group (p = 0.034). Also, the duration of hospitalization in the NDUOPAP group was shorter than that of the NCPAP group (p = 0.002). Conclusions In the present study, DUOPAP compared to NCPAP did not reduce the need for mechanical ventilation during the first 72 h of birth, but the duration of non-invasive ventilation and oxygen demand, the need for multiple doses of surfactant and length of stay in the DUOPAP group were less than those in the CPAP group. Trial registration IRCT20180821040847N1, Approved on 2018-09-10.

scholarly journals Mapleson D continuous positive airway pressure system for weaning of mechanical ventilation in pediatric patients: In response

Lung India ◽  
2017 ◽  
Vol 34 (2) ◽  
pp. 216
Author(s):  
MiguelAngel Palomero Rodriguez ◽  
HéctorChozas de Arteaga ◽  
YolandaLaporta Báez ◽  
Jesúsde Vicente Sánchez ◽  
AntonioPérez Ferrer
Keyword(s):  
Mechanical Ventilation ◽  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Pediatric Patients ◽  
Positive Airway Pressure ◽  
Pressure System

scholarly journals The role of Continuous Positive Airway Pressure (CPAP) in Delaying or Avoiding Mechanical Ventilation in COVID-19 Respiratory Failure: A Retrospective Cohort Study

2021 ◽  
Author(s):  
Allan Cameron ◽  
Sharif Fattah ◽  
Laura Knox ◽  
Pauline Grose
Keyword(s):  
Mechanical Ventilation ◽  
Cohort Study ◽  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Invasive Mechanical Ventilation ◽  
Respiratory Support ◽  
Royal Infirmary ◽  
High Dependency ◽  
Number Of Patients

Abstract Background - During the winter of 2020-2021, the second wave of the COVID19 pandemic in the United Kingdom caused increased demand for intensive care unit (ICU) beds, and in particular, for invasive mechanical ventilation (IMV). To alleviate some of this pressure, some centres offered non-invasive continuous positive airway pressure (CPAP), delivered on specialised COVID high dependency units (cHDUs). However, this practice was based largely on anecdotal reports, and it is not clear from the literature how effective CPAP is at delaying or preventing IMV. Methods - This was a retrospective observational cohort study of consecutive patients admitted to a specialised cHDU at Glasgow Royal Infirmary between November 2020 and February 2021. Each patient had a continuous record of the level of respiratory support required, and was followed up to hospital discharge or death. We examined patient outcomes according to age, sex and maximum level of respiratory support, using logistic regression and time-to-event analysis. The number of patients who could not be oxygenated by standard oxygen facemask but could be oxygenated by CPAP was counted and compared to the number of patients admitted to ICU for IMV over the same period.Results - There were 152 admissions to cHDU over the study period. Of these, 125 received CPAP treatment. Of the patients who received support in cHDU, the overall mortality rate was 37.9% (95% CI 30.3% - 46.1%)). Odds of mortality were closely correlated with increasing age and oxygen requirement. Of the 152 patients, 44 patients (28.8%, 95% CI 22.0 – 36.9%) went on to require IMV in ICU. This represents 77.2% of the 57 COVID-19 admissions to ICU during the same period. However, there were also 41 patients who received levels of respiratory support on cHDU which would normally necessitate ICU admission but who never went to ICU, potentially reducing ICU admissions by 41.8% (95% CI 32.1 – 52.2%).Conclusion - Providing respiratory support in cHDU reduced the number of potential ICU admissions by 41.8%, as well as delaying IMV for over 75% of ICU admissions. This represents a significant sparing of ICU capacity at a time when IMV beds were in high demand.

ARTIFICIAL VENTILATION IN HYALINE MEMBRANE DISEASE: THE USE OF POSITIVE END-EXPIRATORY PRESSURE AND CONTINUOUS POSITIVE AIRWAY PRESSURE

PEDIATRICS ◽  
1973 ◽  
Vol 51 (4) ◽  
pp. 629-640
Author(s):  
Niloufer Cumarasamy ◽  
Rosmarie Nüssli ◽  
Dieter Vischer ◽  
Peter H. Dangel ◽  
Gabriel V. Duc
Keyword(s):  
Mechanical Ventilation ◽  
Survival Rate ◽  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Artificial Ventilation ◽  
Controlled Trial ◽  
Hyaline Membrane Disease ◽  
Positive End Expiratory Pressure ◽  
Hyaline Membrane

During the years 1969, 1970, and 1971, 120 infants with hyaline membrane disease were studied, of whom 71 were treated with artificial ventilation. Among other changes in 1971, positive end-expiratory pressure was applied during mechanical ventilation and continuous positive airway pressure maintained during the weaning period. The survival rate of the ventilated babies increased from 23% in the preceding two years to 70% in 1971. As this study is not a controlled trial, the observed increase in survival cannot be ascribed to the application of increased airway pressure alone. The data presented, though necessarily inconclusive, may be useful for continuing comparisons with other pediatric centers.

Thoracic Transillumination: Aid in the Diagnosis and Treatment of Pneumopericardium

PEDIATRICS ◽  
1979 ◽  
Vol 64 (6) ◽  
pp. 958-960 ◽  
Author(s):  
Eresvita E. Cabatu ◽  
Edwin G. Brown
Keyword(s):  
Mechanical Ventilation ◽  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Hyaline Membrane Disease ◽  
Pericardial Tamponade ◽  
Review Of The Literature ◽  
Air Leak ◽  
Hyaline Membrane ◽  
Life Threatening

A frequent complication of continuous positive airway pressure and mechanical ventilation used to treat neonates who have hyaline membrane disease and other forms of respiratory distress is an air leak from alveolar rupture. Pneumothorax and pneumomediastinum are common. Pneumopericardium does not occur often, but it can be life-threatening if it produces acute cardiac tamponade. In a review of the literature, Brans and associates1 found that pneumopericardium in neonates was treated by pericardiocentesis in one half of the published cases; 79% of them survived or they ultimately died of complications unrelated to pericardial tamponade. However, only 32% of the infants treated conservatively survived.

Hemodynamic Changes During Discontinuation of Mechanical Ventilation in Medical Intensive Care Unit Patients

2006 ◽  
Vol 15 (6) ◽  
pp. 580-593 ◽  
Author(s):  
Susan K. Frazier ◽  
Kathleen S. Stone ◽  
Debra Moser ◽  
Rebecca Schlanger ◽  
Carolyn Carle ◽  
...  
Keyword(s):  
Heart Rate ◽  
Mechanical Ventilation ◽  
Cardiac Output ◽  
Continuous Positive Airway Pressure ◽  
Stroke Volume ◽  
Cardiac Dysfunction ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Plasma Catecholamine ◽  
Medical Intensive Care

• Background Cardiac dysfunction can prevent successful discontinuation of mechanical ventilation. Critically ill patients may have undetected cardiac disease, and cardiac dysfunction can be produced or exacerbated by underlying pathophysiology. • Objective To describe and compare hemodynamic function and cardiac rhythm during baseline mechanical ventilation with function and rhythm during a trial of continuous positive airway pressure in medical intensive care patients. • Methods A convenience sample of 43 patients (53% men; mean age 51.1 years) who required mechanical ventilation were recruited for this pilot study. Cardiac output, stroke volume, arterial blood pressure, heart rate, cardiac rhythm, and plasma catecholamine levels were measured during mechanical ventilation and during a trial of continuous positive airway pressure. • Results One third of the patients had difficulty discontinuing mechanical ventilation. Successful patients had significantly increased cardiac output and stroke volume without changes in heart rate or arterial pressure during the trial of continuous positive airway pressure. Unsuccessful patients had no significant changes in cardiac output, stroke volume, or heart rate but had a significant increase in mean arterial pressure. The 2 groups of patients also had different patterns in ectopy. Concurrently, catecholamine concentrations decreased in the successful patients and significantly increased in the unsuccessful patients during the trial. • Conclusions Patterns of cardiac function and plasma catecholamine levels differed between patients who did or did not achieve spontaneous ventilation with a trial of continuous positive airway pressure. Cardiac function must be systematically considered before and during the return to spontaneous ventilation to optimize the likelihood of success.

Sign in / Sign up

Export Citation Format

Share Document