scholarly journals Drug class effects on respiratory mechanics in animal models: access and applications

2021 ◽  
pp. 153537022199309
Author(s):  
Maria A Oliveira ◽  
Alembert E Lino-Alvarado ◽  
Henrique T Moriya ◽  
Renato L Vitorasso
Keyword(s):  
Respiratory System ◽  
Positive Pressure Ventilation ◽  
Drug Class ◽  
Respiratory Mechanics ◽  
Forced Oscillation ◽  
Basic Research ◽  
Clinical Applications ◽  
Positive Pressure ◽  
Animal Modeling ◽  
The Impact

Assessment of respiratory mechanics extends from basic research and animal modeling to clinical applications in humans. However, to employ the applications in human models, it is desirable and sometimes mandatory to study non-human animals first. To acquire further precise and controlled signals and parameters, the animals studied must be further distant from their spontaneous ventilation. The majority of respiratory mechanics studies use positive pressure ventilation to model the respiratory system. In this scenario, a few drug categories become relevant: anesthetics, muscle blockers, bronchoconstrictors, and bronchodilators. Hence, the main objective of this study is to briefly review and discuss each drug category, and the impact of a drug on the assessment of respiratory mechanics. Before and during the positive pressure ventilation, the experimental animal must be appropriately sedated and anesthetized. The sedation will lower the pain and distress of the studied animal and the plane of anesthesia will prevent the pain. With those drugs, a more controlled procedure is carried out; further, because many anesthetics depress the respiratory system activity, a minimum interference of the animal’s respiration efforts are achieved. The latter phenomenon is related to muscle blockers, which aim to minimize respiratory artifacts that may interfere with forced oscillation techniques. Generally, the respiratory mechanics are studied under appropriate anesthesia and muscle blockage. The application of bronchoconstrictors is prevalent in respiratory mechanics studies. To verify the differences among studied groups, it is often necessary to challenge the respiratory system, for example, by pharmacologically inducing bronchoconstriction. However, the selected bronchoconstrictor, doses, and administration can affect the evaluation of respiratory mechanics. Although not prevalent, studies have applied bronchodilators to return (airway resistance) to the basal state after bronchoconstriction. The drug categories can influence the mathematical modeling of the respiratory system, systemic conditions, and respiratory mechanics outcomes.

scholarly journals Oesophageal balloon positioning by echocardiography to guide positive pressure ventilation

2021 ◽  
Author(s):  
Marco Betello ◽  
Raphael Giraud ◽  
Karim Bendjelid
Keyword(s):  
Lung Injury ◽  
Respiratory System ◽  
Positive Pressure Ventilation ◽  
Respiratory Mechanics ◽  
Lung Compliance ◽  
Technical Note ◽  
Positive Pressure ◽  
Obese Patients ◽  
Correct Position ◽  
Ventilator Induced Lung Injury

AbstractUnderstanding the respiratory mechanics of ARDS patients is crucial to avoid ventilator-induced lung injury (VILI), and this is much more challenging if not only lung compliance is altered but the whole compliance of the respiratory system is abnormal, as in obese patients. We face this problem daily in the ICU, and to optimize ventilation, we estimate respiratory mechanics using an oesophageal balloon. The balloon position is crucial to assess reliable values. In the present technical note, we describe the use of echocardiography to confirm the correct position of this instrument.

Factors Associated with Failure of Non-invasive Positive Pressure Ventilation in a Critical Care Helicopter Emergency Medical Service

2015 ◽  
Vol 30 (3) ◽  
pp. 239-243 ◽  
Author(s):  
James S. Lee ◽  
Domhnall O’Dochartaigh ◽  
Mark MacKenzie ◽  
Darren Hudson ◽  
Stephanie Couperthwaite ◽  
...  
Keyword(s):  
Critical Care ◽  
Emergency Medical Service ◽  
Medical Service ◽  
Positive Pressure Ventilation ◽  
Helicopter Emergency Medical Service ◽  
Positive Pressure ◽  
Factors Associated ◽  
Non Invasive ◽  
Emergency Medical ◽  
The Impact

AbstractIntroductionNon-invasive positive pressure ventilation (NIPPV) is used to treat severe acute respiratory distress. Prehospital NIPPV has been associated with a reduction in both in-hospital mortality and the need for invasive ventilation.Hypothesis/ProblemThe authors of this study examined factors associated with NIPPV failure and evaluated the impact of NIPPV on scene times in a critical care helicopter Emergency Medical Service (HEMS). Non-invasive positive pressure ventilation failure was defined as the need for airway intervention or alternative means of ventilatory support.MethodsA retrospective chart review of consecutive patients where NIPPV was completed in a critical care HEMS was conducted. Factors associated with NIPPV failure in univariate analyses and from published literature were included in a multivariable, logistic regression model.ResultsFrom a total of 44 patients, NIPPV failed in 14 (32%); a Glasgow Coma Scale (GCS) <15 at HEMS arrival was associated independently with NIPPV failure (adjusted odds ratio 13.9; 95% CI, 2.4-80.3; P=.003). Mean scene times were significantly longer in patients who failed NIPPV when compared with patients in whom NIPPV was successful (95 minutes vs 51 minutes; 39.4 minutes longer; 95% CI, 16.2-62.5; P=.001).ConclusionPatients with a decreased level of consciousness were more likely to fail NIPPV. Furthermore, patients who failed NIPPV had significantly longer scene times. The benefits of NIPPV should be balanced against risks of long scene times by HEMS providers. Knowing risk factors of NIPPV failure could assist HEMS providers to make the safest decision for patients on whether to initiate NIPPV or proceed directly to endotracheal intubation prior to transport.LeeJS, O’DochartaighD, MacKenzieM, HudsonD, CouperthwaiteS, Villa-RoelC, RoweBH. Factors associated with failure of non-invasive positive pressure ventilation in a critical care helicopter Emergency Medical Service. Prehosp Disaster Med2015; 30(2): 1–5

scholarly journals The effects of anesthesia induction and positive pressure ventilation on right-ventricular function: An echocardiography-based prospective observational study

2019 ◽  
Author(s):  
Harry Magunia ◽  
Anne Jordanow ◽  
Marius Keller ◽  
Peter Rosenberger ◽  
Martina Nowak-Machen
Keyword(s):  
Right Ventricular ◽  
Ventricular Function ◽  
Right Ventricular Function ◽  
Prospective Observational Study ◽  
Positive Pressure Ventilation ◽  
Right Ventricular Ejection Fraction ◽  
Positive Pressure ◽  
Anesthesia Induction ◽  
Ventricular Ejection Fraction ◽  
The Impact

Abstract Background: General anesthesia induction with the initiation of positive pressure ventilation creates a vulnerable phase for patients. The impact of positive intrathoracic pressure on cardiac performance has been studied but remains controversial. 3D echocardiography is a valid and MRI-validated bed-side tool to evaluate the right ventricle (RV). The aim of this study was to assess the impact of anesthesia induction (using midazolam, sufentanil and rocuronium, followed by sevoflurane) with positive pressure ventilation (PEEP 5, tidal volume 6 – 8 ml/kg) on 2D and 3D echocardiography derived parameters of RV function. Methods: A prospective observational study on fifty-three patients undergoing elective cardiac surgery in a tertiary care university hospital was designed. Transthoracic echocardiography exams were performed before and immediately after anesthesia induction and were recorded together with hemodynamic parameters and ventilator settings. Results: After anesthesia induction TAPSE (mean difference -1.6mm (95% CI -2.6mm to -0.7mm; p=0.0013) as well as the Tissue Doppler derived tricuspid annulus peak velocity (TDITVs’) were significantly reduced (mean difference -1.9% (95% CI: -2.6 to -1.2; p<0.0001), but global right ventricular ejection fraction (RVEF; p=0.1607) and right ventricular stroke volume (RVSV; p=0.1838) did not change. Conclusions: This data shows a preserved right ventricular ejection fraction and right ventricular stroke volume after anesthesia induction and initiation of positive pressure ventilation. However, the baso-apical right ventricular function is significantly reduced. Larger studies are needed in order to determine the clinical impact of these findings especially in patients presenting with impaired right ventricular function before anesthesia induction.

Lung Ventilation: Natural and Mechanical

2017 ◽  
Author(s):  
Yuan Lei
Keyword(s):  
Mechanical Ventilation ◽  
Critical Care ◽  
Respiratory System ◽  
Positive Pressure Ventilation ◽  
Lung Ventilation ◽  
Intermittent Positive Pressure Ventilation ◽  
Artificial Lung ◽  
Positive Pressure ◽  
Anatomy And Physiology ◽  
Artificial Lung Ventilation

‘Lung Ventilation: Natural and Mechanical’ describes the processes of respiration and lung ventilation, focusing on those issues related directly to mechanical ventilation. The chapter starts by discussing the anatomy and physiology of respiration, and the involvement of the lungs and the entire respiratory system. It continues by introducing the three operating principles of mechanical ventilation. It then narrows its focus to intermittent positive pressure ventilation (IPPV), the operating principle of most modern critical care ventilators, explaining the pneumatic process of IPPV. The chapter ends by comparing natural and mechanical/artificial lung ventilation.

scholarly journals Non-invasive positive pressure ventilation offers greater improvement in COPD-related respiratory failure when combined with naloxone

2016 ◽  
Vol 11 (2) ◽  
pp. 359
Author(s):  
Long Zhang ◽  
Wei Zhao ◽  
Qinfu Xu ◽  
Yumiao Zhao ◽  
Junjie Zhao ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Pulmonary Function ◽  
Positive Pressure Ventilation ◽  
Respiratory Mechanics ◽  
Oxygen Metabolism ◽  
Positive Pressure ◽  
Control Group ◽  
Non Invasive ◽  
Copd Patients ◽  
New Treatment

<p class="Abstract">To improve efficacy of non-invasive positive pressure ventilation (NPPV), this study investigated the combination of NPPV with naloxone in COPD patients with respiratory failure. One hundred four patients with COPD-related respiratory failure were enrolled prospectively and randomly divided into a control group treated with NPPV alone (n = 52) and an observation group treated with NPPV combined with 4.0 mg naloxone by continuous infusion (n = 52). At 3 and 5 days after the start of treatment, the respiratory mechanics, pulmonary function, and oxygen metabolism parameters were significantly improved in the NPPV + naloxone group compared to the NPPV alone group (p&lt;0.05). Further, the improvements in the NPPV plus naloxone group were greater at day 5 than at day 3 (p&lt;0.05). These findings indicate that non-invasive positive pressure ventilation combined with naloxone can more effectively improve respiratory mechanics, pulmonary function and oxygen metabolism of COPD patients with respiratory failure than NPPV alone, offering a new treatment approach.</p><p> </p>

scholarly journals Association of Non-Invasive Positive Pressure Ventilation with Short-Term Clinical Outcomes in Patients Hospitalized for Acute Decompensated Heart Failure

2021 ◽  
Vol 10 (21) ◽  
pp. 5092
Author(s):  
Midori Yukino ◽  
Yuji Nagatomo ◽  
Ayumi Goda ◽  
Takashi Kohno ◽  
Makoto Takei ◽  
...  
Keyword(s):  
Heart Failure ◽  
Nutritional Status ◽  
Positive Pressure Ventilation ◽  
Acute Decompensated Heart Failure ◽  
Multivariable Analysis ◽  
Decompensated Heart Failure ◽  
Positive Pressure ◽  
Non Invasive ◽  
The Impact ◽  
Conut Score

The real-world evidence has been sparse on the impact of non-invasive positive pressure ventilation (NPPV) on the outcomes in acute decompensated heart failure (ADHF) patients. We aim to explore this issue in the prospective multicenter WET-HF registry. Among 3927 patients (77 (67–84) years, male 60%), the NPPV was used in 775 patients (19.7%). The association of NPPV use with in-hospital outcome and length of hospital stay (LOS) was examined by two methods, propensity score (PS) matching and multivariable analysis with adjustment for PS. In these analyses the NPPV group exhibited a lower endotracheal intubation (ETI) rate and a comparable in-hospital mortality, but longer LOS compared to the non-NPPV group. In the stratified analysis, the NPPV group exhibited a significantly lower ETI rate in patients with ischemic etiology, systolic blood pressure (sBP) > 140 mmHg and the Controlling Nutritional Status (CONUT) score ≤ 3, indicating better nutritional status. On the contrary, NPPV use was associated with longer LOS in patients with non-ischemic etiology, sBP < 100 mmHg and CONUT score > 3. In conclusion, NPPV use was associated with a lower incidence of ETI. Particularly, patients with ischemic etiology, high sBP, and better nutritional status might benefit from NPPV use.

scholarly journals The effects of anesthesia induction and positive pressure ventilation on right-ventricular function: A 3D echocardiography-based prospective observational study

2019 ◽  
Author(s):  
Harry Magunia ◽  
Anne Jordanow ◽  
Marius Keller ◽  
Peter Rosenberger ◽  
Martina Nowak-Machen
Keyword(s):  
Right Ventricular ◽  
Ventricular Function ◽  
Right Ventricular Function ◽  
Positive Pressure Ventilation ◽  
Right Ventricular Ejection Fraction ◽  
3D Echocardiography ◽  
Positive Pressure ◽  
Anesthesia Induction ◽  
Ventricular Ejection Fraction ◽  
The Impact

Abstract Background: General anesthesia induction with the initiation of positive pressure ventilation creates a vulnerable phase for patients. The impact of positive intrathoracic pressure on cardiac performance has been studied but remains controversial. 3D echocardiography is a valid and MRI-validated bed-side tool to evaluate the right ventricle (RV). The aim of this study was to assess the impact of anesthesia induction (using midazolam, sufentanil and rocuronium, followed by sevoflurane) with positive pressure ventilation (PEEP 5, tidal volume 6 – 8 ml/kg) on 2D and 3D echocardiography derived parameters of RV function. Methods: A prospective observational study on fifty-three patients undergoing elective cardiac surgery in a tertiary care university hospital was designed. Transthoracic echocardiography exams were performed before and immediately after anesthesia induction and were recorded together with hemodynamic parameters and ventilator settings. Results: TAPSE as a parameter reflecting the movement of the lateral tricuspid annulus was significantly reduced (mean difference -1.6mm (95% CI -2.6mm to -0.7mm; p=0.0013). Tissue Doppler derived tricuspid annulus peak velocity was also significantly reduced (mean difference -1.9% (95% CI: -2.6 to -1.2; p<0.0001), but global right ventricular ejection fraction (p=0.1607) and right ventricular stroke volume (p=0.1838) did not change. Conclusions: This data shows a preserved right ventricular ejection fraction and right ventricular stroke volume despite reduced baso-apical right ventricular function after anesthesia induction and initiation of positive pressure ventilation. Because only small changes were seen the clinical impact has yet to be determined. Trial Registration: Retrospecitvely registered, 6th June 2016, ClinicalTrials.gov Identifier NCT02820727. Keywords: Right ventricular function; positive-pressure respiration; anesthesiology; echocardiography, three-dimensional.

scholarly journals The effects of anesthesia induction and positive pressure ventilation on right-ventricular function: An echocardiography-based prospective observational study

2019 ◽  
Author(s):  
Harry Magunia ◽  
Anne Jordanow ◽  
Marius Keller ◽  
Peter Rosenberger ◽  
Martina Nowak-Machen
Keyword(s):  
Right Ventricular ◽  
Ventricular Function ◽  
Right Ventricular Function ◽  
Prospective Observational Study ◽  
Positive Pressure Ventilation ◽  
Right Ventricular Ejection Fraction ◽  
Positive Pressure ◽  
Anesthesia Induction ◽  
Ventricular Ejection Fraction ◽  
The Impact

Abstract Background: General anesthesia induction with the initiation of positive pressure ventilation creates a vulnerable phase for patients. The impact of positive intrathoracic pressure on cardiac performance has been studied but remains controversial. 3D echocardiography is a valid and MRI-validated bed-side tool to evaluate the right ventricle (RV). The aim of this study was to assess the impact of anesthesia induction (using midazolam, sufentanil and rocuronium, followed by sevoflurane) with positive pressure ventilation (PEEP 5, tidal volume 6 – 8 ml/kg) on 2D and 3D echocardiography derived parameters of RV function. Methods: A prospective observational study on fifty-three patients undergoing elective cardiac surgery in a tertiary care university hospital was designed. Transthoracic echocardiography exams were performed before and immediately after anesthesia induction and were recorded together with hemodynamic parameters and ventilator settings. Results: After anesthesia induction TAPSE (mean difference -1.6mm (95% CI -2.6mm to -0.7mm; p=0.0013) as well as the Tissue Doppler derived tricuspid annulus peak velocity (TDITVs’) were significantly reduced (mean difference -1.9% (95% CI: -2.6 to -1.2; p<0.0001), but global right ventricular ejection fraction (RVEF; p=0.1607) and right ventricular stroke volume (RVSV; p=0.1838) did not change. Conclusions: This data shows a preserved right ventricular ejection fraction and right ventricular stroke volume after anesthesia induction and initiation of positive pressure ventilation. However, the baso-apical right ventricular function is significantly reduced. Larger studies are needed in order to determine the clinical impact of these findings especially in patients presenting with impaired right ventricular function before anesthesia induction. Trial registration: Retrospecitvely registered, 6th June 2016, ClinicalTrials.gov Identifier NCT02820727.

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