Early Extubation to Noninvasive Respiratory Support of Former Preterm Lambs Improves Long-Term Respiratory Outcomes

2021 ◽  
Author(s):  
Mar Janna Dahl ◽  
Chiara Veneroni ◽  
Anna Lavizzari ◽  
Sydney Bowen ◽  
Haleigh Emerson ◽  
...  
Keyword(s):  
Smooth Muscle ◽  
Preterm Birth ◽  
Respiratory System ◽  
Invasive Mechanical Ventilation ◽  
Peripheral Resistance ◽  
Respiratory Support ◽  
Postnatal Life ◽  
Forced Oscillation Technique ◽  
Respiratory System Mechanics

Invasive mechanical ventilation (IMV) and exposure to oxygen-rich gas during early postnatal life are contributing factors to long-term pulmonary morbidities faced by survivors of preterm birth and bronchopulmonary dysplasia. The duration of IMV that leads to long-term pulmonary morbidities is unknown. We compared two durations of IMV (3h versus 6d) during the first 6-7d of postnatal life in preterm lambs to test the hypothesis that minimizing the duration of IMV will improve long-term respiratory system mechanics and structural outcomes later in life. Moderately preterm (~85% gestation) lambs were supported by IMV for either 3h or 6d before weaning from all respiratory support to become former preterm lambs. Respiratory system mechanics and airway reactivity were assessed monthly from 1 to 6 months of chronological postnatal age by the forced oscillation technique. Quantitative morphological measurements were made for smooth muscle accumulation around terminal bronchioles and indices of alveolar formation. Minimizing IMV to 3h led to significantly better (p<0.05) baseline respiratory system mechanics and less reactivity to methacholine in the first 3 months of chronological age (2 months corrected age), significantly less (p<0.05) accumulation of smooth muscle around peripheral resistance airways (terminal bronchioles), and significantly better (p<0.05) alveolarization at the end of 5 months corrected age compared to continuous IMV for 6d. We conclude that limiting the duration of IMV following preterm birth of fetal lambs leads to better respiratory system mechanics and structural outcomes later in life.

Respiratory outcomes in children with congenital myotonic dystrophy

2021 ◽  
pp. 1-5
Author(s):  
Jaclyn C. Omura ◽  
Maida Chen ◽  
Miriam Haviland ◽  
Susan Apkon
Keyword(s):  
Respiratory Distress ◽  
Myotonic Dystrophy ◽  
Invasive Mechanical Ventilation ◽  
Retrospective Chart Review ◽  
Mortality Rates ◽  
Respiratory Support ◽  
Non Invasive ◽  
Congenital Myotonic Dystrophy ◽  
Respiratory Outcomes

PURPOSE: Congenital myotonic dystrophy (CDM) results in hypotonia and acute respiratory distress at birth. Previous studies show that prolonged periods of intubation (>4 weeks) correlate with increased mortality rates. The objective is to describe the use and duration of respiratory support in newborns with CDM and how these relate to mortality. METHODS: A retrospective chart review was performed at a tertiary pediatric hospital among children with confirmed diagnosis of CDM. The main outcome measures were: mortality, duration of invasive mechanical ventilation (IMV) and non-invasive partial pressure ventilation (NIPPV), along with long-term use of respiratory support and equipment. RESULTS: A total of 18 subjects met inclusion criteria, 83%.f which had documented respiratory distress at birth, 39%.equired NIPPV, and 50%.equired intubation in the neonatal period. The earliest NIPPV was initiated at day one of life, and the latest extubation to NIPPV was at 17 days of life. CONCLUSION: This cohort required IMV for shorter periods with earlier transitions to NIPPV which suggests a possible change in practice and earlier transition to NIPPV recently. Further data are needed to determine if there is a possible correlation between the need for NIPPV/IMV and mortality rates.

scholarly journals Evaluation of Respiratory System Mechanics in Mice using the Forced Oscillation Technique

10.3791/50172 ◽  
2013 ◽  
Author(s):  
Toby K. McGovern ◽  
Annette Robichaud ◽  
Liah Fereydoonzad ◽  
Thomas F. Schuessler ◽  
James G. Martin
Keyword(s):  
Respiratory System ◽  
Forced Oscillation ◽  
Forced Oscillation Technique ◽  
Respiratory System Mechanics

scholarly journals Respiratory Care in Children with COVID-19

2021 ◽  
Author(s):  
Shalu Gupta ◽  
Suresh K. Angurana ◽  
Virendra Kumar
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Distress ◽  
Health Care Providers ◽  
Respiratory System ◽  
Oxygen Delivery ◽  
Invasive Mechanical Ventilation ◽  
Respiratory Support ◽  
Critically Ill Children ◽  
Care Providers ◽  
Novel Coronavirus

AbstractThe novel coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) is causing significant morbidity and mortality worldwide. The common presentations in children include involvement of respiratory system leading to pneumonia and acute respiratory distress syndrome, as well as multiorgan dysfunction syndrome and multisystem inflammatory syndrome in children (MIS-C). Pediatric COVID-19 is a milder disease as compared with the adults. Also, there is rise in MIS-C cases which is a hyperinflammatory condition temporally associated with SARS-CoV-2. Since respiratory system is predominantly involved, few of these critically ill children often require respiratory support which can range from simple oxygen delivery devices, high-flow nasal cannula (HFNC), noninvasive ventilation (NIV), invasive mechanical ventilation, and extracorporeal membrane oxygenation (ECMO). Most of the oxygen delivery devices and respiratory interventions generate aerosols and pose risk of transmission of virus to health care providers (HCPs). The use of HFNC and NIV should be limited to children with mild respiratory distress preferably in negative pressure rooms and with adequate personnel protective equipments (PPEs). However, there should be low thresholds for intubation and invasive mechanical ventilation in the event of clinical deterioration while on any respiratory support. The principle of providing respiratory support requires special droplet and air-borne precautions to limit exposure or transmission of virus to HCPs and at the same time ensuring safety of the patient.

scholarly journals Long-term effects of recurrent intermittent hypoxia and hyperoxia on respiratory system mechanics in neonatal mice

2016 ◽  
Vol 81 (4) ◽  
pp. 565-571 ◽  
Author(s):  
Andrew M. Dylag ◽  
Catherine A. Mayer ◽  
Thomas M. Raffay ◽  
Richard J. Martin ◽  
Anjum Jafri ◽  
...  
Keyword(s):  
Respiratory System ◽  
Intermittent Hypoxia ◽  
Long Term Effects ◽  
Respiratory System Mechanics ◽  
Neonatal Mice

scholarly journals Hourly Analysis of Mechanical Ventilation Parameters in Critically Ill Adult Covid-19 Patients: Association with Mortality

2021 ◽  
Author(s):  
Tomás F. Fariña-González ◽  
Antonio Núñez-Reiz ◽  
Julieta Latorre ◽  
Maria Calle-Romero ◽  
Viktor Yordanov-Zlatkov ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory System ◽  
Time Course ◽  
Respiratory Mechanics ◽  
Invasive Mechanical Ventilation ◽  
Lung Mechanics ◽  
Icu Admission ◽  
Respiratory System Mechanics ◽  
Renal Replacement Therapies ◽  
Pressure Controlled

Abstract Objective: there exists controversy about the pathophysiology and lung mechanics of COVID-19 associated ARDS, because some report severe hypoxemia with preserved respiratory system mechanics, contrasting with “classic” ARDS. We performed a detailed hourly analysis of the characteristics and time course of lung mechanics and biochemical analysis of patients requiring invasive mechanical ventilation for COVID-19-associated ARDS, comparing survivors and non-survivors.Methods and measurements: retrospective analysis of the data stored in the ICU information system of patients admitted in our hospital ICU that required invasive mechanical ventilation due to confirmed SARS-CoV-2 pneumonia between March 5th and April 30th, 2020. We compare respiratory system mechanics and gas exchange during the first ten days of IMV, discriminating volume and pressure controlled modes, between ICU survivors and non-survivors.Results: 140 patients were analyzed, analyzing 11,138 respiratory mechanics recordings. Global mortality was 38.6%. Multivariate analysis showed that age (OR 1,092, 95% (CI 1,014-1,176)), previous use of ACEI/ARBs (OR 4,612, (95% CI 1,19-17,84)) and need of renal replacement therapies (OR 10,15, (95% CI 1,58-65,11)) were associated with higher mortality. Respiratory variables start to diverge significantly between survivors and non-survivors after the 96 to 120 hours from mechanical ventilation initiation, particularly respiratory system compliance. In non survivors, mechanical power at 24 and 96 hs was higher regardless ventilatory mode. Conclusions: in patients admitted for SARS-CoV-2 pneumonia and requiring mechanical ventilation, non survivors have different respiratory system mechanics than survivors in the first 10 days of ICU admission. We propose a checkpoint at 96-120 hs to assess patients` improvement or worsening in order to consider escalating to extracorporeal therapies.“TAKE HOME MESSAGE”: assessing respiratory mechanics in the first 96-120 hs from ICU admission could predict the outcome of Covid-19 patients under mechanical ventilation.

Long-Term Effects of Recurrent Intermittent Hypoxia/Hyperoxia on Respiratory System Mechanics in Neonatal Mice

PEDIATRICS ◽  
2016 ◽  
Vol 137 (Supplement 3) ◽  
pp. 509A-509A
Author(s):  
Andrew M. Dylag ◽  
Catherine A. Mayer ◽  
Richard Martin ◽  
Peter M. MacFarlane
Keyword(s):  
Respiratory System ◽  
Intermittent Hypoxia ◽  
Long Term Effects ◽  
Respiratory System Mechanics ◽  
Neonatal Mice

PGE2 release by bradykinin in human airway smooth muscle cells: involvement of cyclooxygenase-2 induction

1997 ◽  
Vol 273 (6) ◽  
pp. L1132-L1140 ◽  
Author(s):  
Linhua Pang ◽  
Alan J. Knox
Keyword(s):  
Arachidonic Acid ◽  
Smooth Muscle ◽  
Airway Smooth Muscle ◽  
Arachidonic Acid Release ◽  
Human Airway Smooth Muscle ◽  
Short Term ◽  
Human Airway ◽  
Acid Release ◽  
Cox 2

Prostanoids may be involved in bradykinin (BK)-induced bronchoconstriction in asthma. We investigated whether cyclooxygenase (COX)-2 induction was involved in prostaglandin (PG) E2 release by BK in cultured human airway smooth muscle (ASM) cells and analyzed the BK receptor subtypes responsible. BK stimulated PGE2release, COX activity, and COX-2 induction in a concentration- and time-dependent manner. It also time dependently enhanced arachidonic acid release. In short-term (15-min) experiments, BK stimulated PGE2 generation but did not increase COX activity or induce COX-2. In long-term (4-h) experiments, BK enhanced PGE2 release and COX activity and induced COX-2. The long-term responses were inhibited by the protein synthesis inhibitors cycloheximide and actinomycin D and the steroid dexamethasone. The effects of BK were mimicked by the B2-receptor agonist [Tyr(Me)8]BK, whereas the B1 agonist des-Arg9-BK was weakly effective at high concentrations. The B2antagonist HOE-140 potently inhibited all the effects, but the B1 antagonist des-Arg9,(Leu8)-BK was inactive. This study is the first to demonstrate that BK can induce COX-2. Conversion of increased arachidonic acid release to PGE2 by COX-1 is mainly involved in the short-term effect, whereas B2 receptor-related COX-2 induction is important in the long-term PGE2 release.

Gestational exposure to Δ9-THC impacts ovarian follicular dynamics and angiogenesis in adulthood in Wistar rats

2021 ◽  
pp. 1-5
Author(s):  
Annia A. Martínez-Peña ◽  
Kendrick Lee ◽  
James J. Petrik ◽  
Daniel B. Hardy ◽  
Alison C. Holloway
Keyword(s):  
Reproductive Health ◽  
Cannabis Sativa ◽  
Follicular Development ◽  
Angiogenic Factor ◽  
Postnatal Life ◽  
Adult Rat ◽  
Female Reproductive Health ◽  
Gestational Exposure ◽  
Follicular Dynamics

Abstract With the legalization of marijuana (Cannabis sativa) and increasing use during pregnancy, it is important to understand its impact on exposed offspring. Specifically, the effects of Δ-9-tetrahydrocannabinol (Δ9-THC), the major psychoactive component of cannabis, on fetal ovarian development and long-term reproductive health are not fully understood. The aim of this study was to assess the effect of prenatal exposure to Δ9-THC on ovarian health in adult rat offspring. At 6 months of age, Δ9-THC-exposed offspring had accelerated folliculogenesis with apparent follicular development arrest, but no persistent effects on circulating steroid levels. Ovaries from Δ9-THC-exposed offspring had reduced blood vessel density in association with decreased expression of the pro-angiogenic factor VEGF and its receptor VEGFR-2, as well as an increase in the anti-angiogenic factor thrombospondin 1 (TSP-1). Collectively, these data suggest that exposure to Δ9-THC during pregnancy alters follicular dynamics during postnatal life, which may have long-lasting detrimental effects on female reproductive health.

Sign in / Sign up

Export Citation Format

Share Document