AIRWAY PRESSURES DURING IPPV BEFORE AND AFTER LUNG INJURY

Aim: This study was conducted to assess the effect of ventilators on the lung profile of piglets in the hypovolemic shock before and after the excessive resuscitation of the crystalloid fluid. Materials and Methods: Five male piglets were used in this study as the models of shock, and there are four phases of treatment: Stabilization, shock of bleeding, normovolemic resuscitation, and hypervolemic resuscitation. The application of mechanical ventilation to patients who suspected of having lung injury may worsen the patient's conditions. The purpose of this study was to set the ventilator with the set of positive end-expiratory pressure (PEEP) of 5 cm H2O, the fraction of inspired oxygen (FiO2) of 0.5, and the inspiration: expiration (I: E) ratio of 1:2, which was applied from the stabilization phase. The shock induction was performed by removing the blood until the mean arterial pressure decreasing by 20% from the stabilization. The solution of NaCl 0.9% was used for the normovolemic and hypervolemic resuscitation. The parameter of observation consisted of extravascular lung water index (EVLWI) and pulmonary vascular permeability index (PVPI) on pulse contour cardiac output 2 and exhaled tidal volume (VTE), peak inspiratory pressure (PIP), and respiratory rate (RR) on ventilators. Results: EVLWI does not indicate pulmonary edema. A significant decrease in VTE without any significant alterations in EVLWI, PIP, and RR has indicated the shallow breathing in the shock condition. Therefore, the PVPI parameter cannot be used as a parameter for capillary permeability since its formulation does not reinforce the results of data in the shock condition. The set of the ventilator may prevent the increase of EVLWI, and the uses of ventilators do not worsen the patient's conditions during the crystalloid resuscitation. Conclusion: The use of mechanical ventilator as the support does not worsen the hypovolemic condition and is safe to use as long as the lung profile is not indicated to have lung injury.

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Endotracheal suctioning: ventilator vs manual delivery of hyperoxygenation breaths

American Journal of Critical Care ◽

10.4037/ajcc1996.5.3.192 ◽

1996 ◽

Vol 5 (3) ◽

pp. 192-197 ◽

Cited By ~ 5

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.

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Aging Influences the Metabolic and Inflammatory Phenotype in an Experimental Mouse Model of Acute Lung Injury

The Journals of Gerontology Series A ◽

10.1093/gerona/glaa248 ◽

2020 ◽

Author(s):

Kevin W Gibbs ◽

Chia-Chi Chuang Key ◽

Lanazha Belfield ◽

Jennifer Krall ◽

Lina Purcell ◽

...

Keyword(s):

Acute Lung Injury ◽

Fatty Acid ◽

Lung Injury ◽

Whole Body ◽

Acid Oxidation ◽

Aged Mice ◽

Protein Levels ◽

Adult Mice ◽

Age Related ◽

Before And After

Abstract Increased age is a risk factor for poor outcomes from respiratory failure and acute respiratory distress syndrome (ARDS). In this study, we sought to define age-related differences in lung inflammation, muscle injury, and metabolism after intratracheal lipopolysaccharide (IT-LPS) acute lung injury (ALI) in adult (6 months) and aged (18–20 months) male C57BL/6 mice. We also investigated age-related changes in muscle fatty acid oxidation (FAO) and the consequences of systemic FAO inhibition with the drug etomoxir. Aged mice had a distinct lung injury course characterized by prolonged alveolar neutrophilia and lack of response to therapeutic exercise. To assess the metabolic consequences of ALI, aged and adult mice underwent whole body metabolic phenotyping before and after IT-LPS. Aged mice had prolonged anorexia and decreased respiratory exchange ratio, indicating increased reliance on FAO. Etomoxir increased mortality in aged but not adult ALI mice, confirming the importance of FAO on survival from acute severe stress and suggesting that adult mice have increased resilience to FAO inhibition. Skeletal muscles from aged ALI mice had increased transcription of key fatty acid metabolizing enzymes, CPT-1b, LCAD, MCAD, FATP1 and UCP3. Additionally, aged mice had increased protein levels of CPT-1b at baseline and after lung injury. Surprisingly, CPT-1b in isolated skeletal muscle mitochondria had decreased activity in aged mice compared to adults. The distinct phenotype of aged ALI mice has similar characteristics to the adverse age-related outcomes of ARDS. This model may be useful to examine and augment immunologic and metabolic abnormalities unique to the critically ill aged population.

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Alveolar deflation dynamics before and after lung injury assessed by synchrotron radiation computed tomography

Intensive Care Medicine Experimental ◽

10.1186/2197-425x-3-s1-a567 ◽

2015 ◽

Vol 3 (S1) ◽

Author(s):

G Perchiazzi ◽

JB Borges ◽

G Hedenstierna ◽

L Porra ◽

L Broche ◽

...

Keyword(s):

Computed Tomography ◽

Synchrotron Radiation ◽

Lung Injury ◽

Before And After

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Intra-Abdominal Pressures in Acute Lung Injury — Impact on Pleural and Airway Pressures.

10.1164/ajrccm-conference.2009.179.1_meetingabstracts.a4680 ◽

2009 ◽

Author(s):

D Talmor ◽

T Sarge ◽

A Malhotra ◽

CR O'Donnell ◽

R Ritz ◽

...

Keyword(s):

Acute Lung Injury ◽

Lung Injury ◽

Airway Pressures

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Distal effects of tracheal gas insufflation: changes with catheter position and oleic acid lung injury

Journal of Applied Physiology ◽

10.1152/jappl.1996.81.3.1121 ◽

1996 ◽

Vol 81 (3) ◽

pp. 1121-1127 ◽

Cited By ~ 16

Author(s):

A. Nahum ◽

S. A. Ravenscraft ◽

A. B. Adams ◽

J. J. Marini

Keyword(s):

Oleic Acid ◽

Lung Injury ◽

Dead Space ◽

Minute Ventilation ◽

Catheter Position ◽

Tracheal Gas Insufflation ◽

Before And After ◽

Dead Space Volume ◽

Catheter Tip ◽

Conducting Airways

We separated distal (turbulence-related) and proximal (dead space washout-related) effects of tracheal gas insufflation (TGI) by comparing the effects of straight and inverted catheters. We reasoned that the inverted catheter was unlikely to remove CO2 from conducting airways distal to its orifice. In six normal dogs during TGI at 10 l/min, advancing the catheters from 10 to 1 cm above the main carina decreased dead space volume by 29 +/- 12 and 12 +/- 6 ml (P < 0.04) with the straight and inverted catheters, respectively. By comparison, the tracheal volume between 10 and 1 cm above the carina was 15 +/- 2 ml. In another set of dogs (n = 5), we examined the distal effects of TGI before and after oleic acid-induced lung injury. During TGI at 10 l/min before and after oleic acid injury, the differences in arterial PCO2 between the straight and inverted catheters were 5 +/- and 9 +/- 6 Torr (P < 0.18), respectively. Our data suggest that distal effects of TGI become more pronounced as the catheter tip is positioned closer to the main carina. The distal effects of TGI were not diminished after oleic acid injury when minute ventilation was maintained constant.

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Effect of Thoracentesis on Intubated Patients with Acute Lung Injury

The American Surgeon ◽

10.1177/000313481608200321 ◽

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.

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