Effect of Thoracentesis on Intubated Patients with Acute Lung Injury

2016 ◽  
Vol 82 (3) ◽  
pp. 266-270
Author(s):  
Matthew B. Bloom ◽  
Derek Serna-Gallegos ◽  
Mark Ault ◽  
Ahsan Khan ◽  
Rex Chung ◽  
...  
Keyword(s):  
Acute Lung Injury ◽  
Lung Injury ◽  
Blood Gases ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Mechanically Ventilated ◽  
Arterial Blood ◽  
Tertiary Center ◽  
Before And After ◽  
The Impact

Pleural effusions occur frequently in mechanically ventilated patients, but no consensus exists regarding the clinical benefit of effusion drainage. We sought to determine the impact of thoracentesis on gas exchange in patients with differing severities of acute lung injury (ALI). A retrospective analysis was conducted on therapeutic thoracenteses performed on intubated patients in an adult surgical intensive care unit of a tertiary center. Effusions judged by ultrasound to be 400 mL or larger were drained. Subjects were divided into groups based on their initial P:F ratios: normal >300, ALI 200 to 300, and acute respiratory distress syndrome (ARDS) <200. Baseline characteristics, physiologic variables, arterial blood gases, and ventilator settings before and after the intervention were analyzed. The primary end point was the change in measures of oxygenation. Significant improvements in P:F ratios (mean ± SD) were seen only in patients with ARDS (50.4 ± 38.5, P = 0.001) and ALI (90.6 ± 161.7, P = 0.022). Statistically significant improvement was observed in the pO2 (31.1, P = 0.005) and O2 saturation (4.1, P < 0.001) of the ARDS group. The volume of effusion removed did not correlate with changes in individual patient's oxygenation. These data support the role of therapeutic thoracentesis for intubated patients with abnormal P:F ratios.

Endotracheal suctioning: ventilator vs manual delivery of hyperoxygenation breaths

1996 ◽  
Vol 5 (3) ◽  
pp. 192-197 ◽  
Author(s):  
MJ Grap ◽  
C Glass ◽  
M Corley ◽  
T Parks
Keyword(s):  
Clinical Practice ◽  
Lung Injury ◽  
Arterial Pressure ◽  
Oxygen Saturation ◽  
Arterial Oxygen ◽  
Suction Catheter ◽  
Endotracheal Suctioning ◽  
Arterial Blood ◽  
Before And After ◽  
The Impact

BACKGROUND: Despite a large number of studies on endotracheal suctioning, there is little data on the impact of clinically practical hyperoxygenation techniques on physiologic parameters in critically ill patients. OBJECTIVE: To compare the manual and mechanical delivery of hyperoxygenation before and after endotracheal suctioning using methods commonly employed in clinical practice. METHODS: A quasi-experimental design was used, with twenty-nine ventilated patients with a lung injury index of 1.54 (mild-moderate lung injury). Three breaths were given before and after each of two suction catheter passes using both the manual resuscitation bag and the ventilator. Arterial pressure, capillary oxygen saturation, heart rate, and cardiac rhythm were monitored for 1 minute prior to the intervention to obtain a baseline, continuously throughout the procedure, and for 3 minutes afterward. Arterial blood gases were collected immediately prior to the suctioning intervention, immediately after, and at 30, 60, 120, and 180 seconds after the intervention. Data were analyzed with repeated measures analysis of variance. RESULTS: Arterial oxygen partial pressures were significantly higher using the ventilator method. Peak inspiratory pressures during hyperoxygenation were significantly higher with the manual resuscitation bag method. Significant increases were observed in mean arterial pressure during and after suctioning, with both delivery methods, with no difference between methods. Maximal increases in arterial oxygen partial pressure and arterial oxygen saturation occurred 30 seconds after hyperoxygenation, falling to baseline values at 3 minutes for both methods. CONCLUSION: Using techniques currently employed in clinical practice, these findings support the use of the patient's ventilator for hyperoxygenation during suctioning.

scholarly journals A Diagnostic Stewardship Intervention To Improve Blood Culture Use among Adult Nonneutropenic Inpatients: the DISTRIBUTE Study

2020 ◽  
Vol 58 (10) ◽  
Author(s):  
Valeria Fabre ◽  
Eili Klein ◽  
Alejandra B. Salinas ◽  
George Jones ◽  
Karen C. Carroll ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Blood Culture ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Control Units ◽  
Stewardship Program ◽  
Academic Center ◽  
Before And After ◽  
The Impact

ABSTRACT Interventions to optimize blood culture (BCx) practices in adult inpatients are limited. We conducted a before-after study evaluating the impact of a diagnostic stewardship program that aimed to optimize BCx use in a medical intensive care unit (MICU) and five medicine units at a large academic center. The program included implementation of an evidence-based algorithm detailing indications for BCx use and education and feedback to providers about BCx rates and indication inappropriateness. Neutropenic patients were excluded. BCx rates from contemporary control units were obtained for comparison. The primary outcome was the change in BCxs ordered with the intervention. Secondary outcomes included proportion of inappropriate BCx, solitary BCx, and positive BCx. Balancing metrics included compliance with the Centers for Medicare and Medicaid Services (CMS) SEP-1 BCx component, 30-day readmission, and all-cause in-hospital and 30-day mortality. After the intervention, BCx rates decreased from 27.7 to 22.8 BCx/100 patient-days (PDs) in the MICU (P = 0.001) and from 10.9 to 7.7 BCx/100 PD for the 5 medicine units combined (P < 0.001). BCx rates in the control units did not decrease significantly (surgical intensive care unit [ICU], P = 0.06; surgical units, P = 0.15). The proportion of inappropriate BCxs did not significantly change with the intervention (30% in the MICU and 50% in medicine units). BCx positivity increased in the MICU (from 8% to 11%, P < 0.001). Solitary BCxs decreased by 21% in the medicine units (P < 0.001). Balancing metrics were similar before and after the intervention. BCx use can be optimized with clinician education and practice guidance without affecting sepsis quality metrics or mortality.

Potentiation of hypoxic pulmonary vasoconstriction by ethyl alcohol in dogs

1978 ◽  
Vol 44 (1) ◽  
pp. 76-80 ◽  
Author(s):  
R. C. Doekel ◽  
E. K. Weir ◽  
R. Looga ◽  
R. F. Grover ◽  
J. T. Reeves
Keyword(s):  
Pressor Response ◽  
Hypoxic Pulmonary Vasoconstriction ◽  
Blood Gases ◽  
Adrenergic Blockade ◽  
Mechanically Ventilated ◽  
Pulmonary Vasoconstriction ◽  
Arterial Blood ◽  
Before And After ◽  
Pressor Activity ◽  
Inhibition Of Prostaglandin Synthesis

Pulmonary and systemic hemodynamics and arterial blood gases were measured in anesthetized and mechanically ventilated dogs before and after oral or intravenous administration of ethanol. Increases in mean pulmonary artery pressure and pulmonary vascular resistance occurred. Platelet antiserum-induced thrombocytopenia inhibition of prostaglandin synthesis with meclofenamate, or alpha-adrenergic blockade did not alter the pulmonary pressor response to ethanol. However, the increase in resistance following ethanol was abolished by hyperoxia and potentiated by hypoxia. Thus, it appears that the effect of ethanol is to augment hypoxic pulmonary vasoconstriction, whereas ethanol per se has no independent pulmonary pressor activity.

scholarly journals Somatostatin Reduces the Acute Lung Injury of Mice via Increasing the Affinity of Glucocorticoid Receptor

2016 ◽  
Vol 38 (4) ◽  
pp. 1354-1364 ◽  
Author(s):  
Yan Zhao ◽  
Min Zhang ◽  
Ren-Ping Xiong ◽  
Xing-Yun Chen ◽  
Ping Li ◽  
...  
Keyword(s):  
Acute Lung Injury ◽  
Lung Injury ◽  
Glucocorticoid Receptor ◽  
Binding Capacity ◽  
Blood Gases ◽  
Protective Role ◽  
Lung Water ◽  
Beneficial Effects ◽  
Arterial Blood ◽  
Lung Injuries

Background/Aims: Although it has been reported that somatostatin (SOM) upregulated the level of 90-kD heat shock protein (Hsp90), which participates in the inflammatory regulation by its client proteins, such as glucocorticoid receptor (GR), it remains unclear if it has a protective role against acute lung injury (ALI). Methods: ALI model was established by the injection of oleic acid (OA) into the tail vein of mice. Lung injury was assessed by histological analysis, lung water content and arterial blood gases. The levels of Hsp90 and GR, the binding capacity and the affinity of GR were examined. Results: It was showed that pretreatment with SOM significantly increased Hsp90 levels and alleviated lung injuries in OA-injected mice. Furthermore, SOM increased the GR expression and improved the affinity of the GR in animals with lung injury. However, little alteration was found in the maximum binding capacity of the GR in mice with or without SOM. Conclusion: The data indicate SOM exerts a protective effect by increasing Hsp90 abundant and further enhancing the affinity of the GR. The beneficial effects of SOM treatment provide a new strategy for modulation of GR efficiency and alleviation of acute lung injury.

scholarly journals Incidence and outcomes of acute lung injury in the surgical intensive care unit of a tertiary care hospital in Bangkok, Thailand

2017 ◽  
Vol 10 (4) ◽  
pp. 379-385
Author(s):  
Onuma Chaiwat ◽  
Worawan Suwannasri ◽  
Jedsadayoot Sak-aroonchai ◽  
Sawita Kanavitoon ◽  
Annop Piriyapathsom ◽  
...  
Keyword(s):  
Intensive Care ◽  
Acute Lung Injury ◽  
Mortality Rate ◽  
Lung Injury ◽  
Tertiary Care ◽  
Ventilatory Support ◽  
Surgical Intensive Care Unit ◽  
Apache Ii Score ◽  
Care Hospital ◽  
Surgical Intensive Care

Abstract Background Although the pathophysiology and treatment of acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are well established, the incidence and outcomes of ALI have not been extensively reported. Variations in healthcare systems, demographics, socioeconomics, and levels of intensive care units (ICU) may explain remarkable differences in outcomes reported. Objectives To evaluate the incidence and outcomes of ALI/ARDS at the surgical ICU (SICU) at Siriraj Hospital of Mahidol University, Bangkok. Methods We included patients aged ≥18 years admitted to the general SICU between June 1, 2010 and May 31, 2013 in this prospective, cohort observational study. All patients required ≥24 h of ventilatory support. The study outcomes were the incidence of ALI/ARDS, SICU length of stay, and mortality rate. Results Of 2523 patients admitted to the SICU, 495 (20%) required ≥24 h ventilatory support, and 15 (3%) developed ALI/ARDS. ALI/ARDS occurred on day 2 of ventilatory support. ARDS was caused by sepsis and pneumonia. The patients who developed ALI/ARDS had a higher APACHE II score (P = 0.001) and end-stage renal disease (P = 0.01). Pneumonia and acute kidney injury were more severe in patients with ALI and ARDS (40% vs 9%, P = 0.002; 33% vs 10%, P = 0.02, respectively). Ventilatory support duration, SICU lengths of stay and hospital mortality were higher in the ALI/ARDS group. Conclusions The incidence of ALI/ARDS in the SICU was low, but the mortality rate was high. A larger sample size is necessary to identify independent risk factors for ALI/ARDS.

scholarly journals Ventilator „Chirana Aura V“ In Two Models Of Neonatal Acute Lung Injury - A Pilot Study

2014 ◽  
Vol 14 (1) ◽  
pp. 20-26
Author(s):  
L. Tomclkova ◽  
D. Mokra ◽  
H. Plstekova ◽  
M. Petraskova ◽  
K. Javorka ◽  
...  
Keyword(s):  
Acute Lung Injury ◽  
Lung Injury ◽  
Pediatric Patients ◽  
Clinical Investigation ◽  
Intratracheal Instillation ◽  
Blood Gases ◽  
Efficiency Index ◽  
Lung Compliance ◽  
Acid Base Balance ◽  
Arterial Blood

Abstract In severe respiratory insufficiency, neonatal and pediatric patients should be ventilated artificially by a ventilator. Aim of this experimental study was to evaluate whether the newly developed ventilator Chirana Aura V may effectively ventilate the lungs of animals with two different models of acute lung injury: acute respiratory distress syndrome (ARDS) induced by repetitive saline lavage and meconium aspiration syndrome (MAS) induced by intratracheal instillation of neonatal meconium. The experiments were performed on 10 adult rabbits (New Zealand white). In ARDS group (n=5), the lungs were repetitively lavaged with saline (30 ml/kg) until partial pressure of oxygen (PaO2) in arterial blood was under 26.7 kPa at inspiratory fraction of oxygen FiO2=1.0. In MAS group (n=5), animals were instilled 4 ml/kg of suspension of human meconium (25 mg/ml). When the model of acute lung injury was developed, animals were ventilated for additional 2 hours with pressure control ventilation (PCV) regime by ventilator Chirana Aura V. Ventilatory parameters, blood gases, acid-base balance, end-tidal CO2, O2 saturation of hemoglobin, oxygenation indexes, ventilation efficiency index, dynamic lung compliance, and right-to-left pulmonary shunts were measured and calculated in regular time intervals. In both experimental groups, used ventilatory settings provided acceptable gas exchange within the period of observation. Thus, the results indicate that ventilator Chirana Aura V might be suitable for ventilation of animal models of acute lung injury. However, further pre-clinical investigation is needed before its use may be recommended in neonatal and/or pediatric patients with acute lung injury.

Select dietary fatty acids attenuate cardiopulmonary dysfunction during acute lung injury in pigs

1995 ◽  
Vol 269 (6) ◽  
pp. H2090-H2099 ◽  
Author(s):  
M. J. Murray ◽  
M. Kumar ◽  
T. J. Gregory ◽  
P. L. Banks ◽  
H. D. Tazelaar ◽  
...  
Keyword(s):  
Acute Lung Injury ◽  
Lung Injury ◽  
Pulmonary Vascular Resistance ◽  
Vascular Resistance ◽  
Blood Gases ◽  
Dietary Fatty Acids ◽  
Arterial Blood ◽  
Pulmonary Arterial ◽  
O2 Delivery ◽  
Arterial Po2

We examined the effect of substituting linoleic acid (LA) with eicosapentaenoic acid (EPA) and gamma-linolenic acid (gamma-LA), precursors of trienoic and monoenoic eicosanoids, respectively, on acute lung injury (ALI). Three groups (n = 8/group) of pigs were fed enteral diets containing LA (diet A), EPA (diet B), or EPA+gamma-LA (diet C) for 8 days. ALI was then induced with a 0.1 mg/kg bolus of Escherichia coli endotoxin followed by a continuous infusion for 4 h (0.075 mg.kg-1.h-1). Pulmonary arterial and capillary wedge pressures, cardiac index (CI), arterial blood gases, arterial O2 content, and plasma thromboxane B2 (TxB2) were measured. Arterial PO2 decreased at 20 min in animals fed diet A. This change was attenuated with diets B and C. The EPA- and EPA + gamma-LA-enriched diets attenuated the fall in O2 delivery at 20 min, an improvement that was sustained throughout the 4-h study period with the EPA+gamma-LA-enriched diet only. This improvement in O2 delivery was due not only to the improved arterial PO2, but also to the maintenance of CI at 20 min in animals fed diets B and C and throughout the 4-h study period in animals fed diet C. At 4 h, TxB2 increased 10-fold over baseline in animals fed diet A, whereas in animals fed diets B and C the increase was only 3-fold. These decreased TxB2 levels in animals fed diets B and C correlate with an attenuation in the increase in pulmonary vascular resistance that was observed at 20 min after endotoxin infusion in animals fed diet A. These data suggest that specialized enteral diets enriched in EPA+gamma-LA improve gas exchange and O2 delivery, presumably in part through a modification of TxB2 production with a decrease in pulmonary vascular resistance and an increase in CI, during ALI.

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