LUNG PROTECTIVE STRATEGY DURING MECHANICAL VENTILATION OF PEDIATRIC PATIETNS WITH ARDS IS ASSOCIATED WITH REDUCED INCIDENCE OF CHEST TUBES INSERTION FOR PNEUMOTHORACES BUT WITH INCREASED INCIDENCE OF CHEST TUBES INSERTION FOR PLEURAL EFFUSIONS

CHEST Journal ◽  
2005 ◽  
Vol 128 (4) ◽  
pp. 356S
Author(s):  
Michael P. Miller ◽  
Mayer Sagy
Keyword(s):  
Mechanical Ventilation ◽  
Pleural Effusions ◽  
Chest Tubes ◽  
Lung Protective Strategy ◽  
Protective Strategy

scholarly journals Covid-19 pneumonia: Timing of pneumomediastinum and pneumothorax in 11 patients

2021 ◽  
Vol 8 (2) ◽  
pp. 1
Author(s):  
Mostafa Al Turk ◽  
Maria Mitri ◽  
Kawthar Jarrah ◽  
Joanna Abi Chebl ◽  
Georges Juvelekian
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Case Series ◽  
Plateau Pressure ◽  
Acceptable Range ◽  
Lung Protective Strategy ◽  
Protective Strategy ◽  
Acute Event ◽  
Shed Light

Purpose: As the pandemic continues, many complications, previously recognized as rare, are now being reported as more than frequent complications of Covid-19 pneumonia. Of those, pneumomediastinum and pneumothorax are gaining attention. Their mechanism of occurrence/trigger is not fully understood, but the timing at which they occur is unclear.Methods: This is a case series of 11 Covid-19 patients with pneumomediastinum; retrospectively, we shed light on some of the patients’ characteristics, the role of mechanical ventilation, and the timing of pneumomediastinum after initiation of mechanical ventilation.Results: We found that despite following the lung-protective strategy and despite keeping a plateau pressure at an acceptable range, most of our patients had an acute event around the same timing of mechanical ventilation.Conclusions: The similar timing raises questions about other risk factors that remain unknown. Timing and steroids can contribute to the higher incidence of these complications.

Chest Tube Drainage of Transudative Pleural Effusions Hastens Liberation From Mechanical Ventilation

CHEST Journal ◽  
2011 ◽  
Vol 139 (3) ◽  
pp. 519-523 ◽  
Author(s):  
Yizhak Kupfer ◽  
Chanaka Seneviratne ◽  
Kabu Chawla ◽  
Kavan Ramachandran ◽  
Sidney Tessler
Keyword(s):  
Mechanical Ventilation ◽  
Chest Tube ◽  
Chest Tube Drainage ◽  
Pleural Effusions ◽  
Tube Drainage

Conventional Mechanical Ventilation Is Associated with Bronchoalveolar Lavage-induced Activation of Polymorphonuclear Leukocytes

2002 ◽  
Vol 97 (6) ◽  
pp. 1426-1433 ◽  
Author(s):  
Haibo Zhang ◽  
Gregory P. Downey ◽  
Peter M. Suter ◽  
Arthur S. Slutsky ◽  
V. Marco Ranieri
Keyword(s):  
Mechanical Ventilation ◽  
Bronchoalveolar Lavage ◽  
Polymorphonuclear Leukocytes ◽  
Bronchoalveolar Lavage Fluid ◽  
Distress Syndrome ◽  
Lavage Fluid ◽  
Surface Expression ◽  
Multiple Organ ◽  
Protective Strategy ◽  
Oxidant Production

Background Protective ventilatory strategies have resulted in a decreased mortality rate in acute respiratory distress syndrome, but the underlying mechanisms remain unclear. The authors hypothesized that (1) mechanical ventilation modulates activation of polymorphonuclear leukocytes (PMNs), (2) the consequent release of proteinases is correlated with a systemic inflammatory response and with multiple organ dysfunction, and (3) these deleterious effects can be minimized by a protective ventilatory strategy. Methods Human PMNs were incubated with bronchoalveolar lavage fluid obtained from patients at entry or 36 h after randomization to ventilation with either a conventional (control) or a lung-protective strategy. PMN oxidant production and surface expression of adhesion molecules and granule markers, including CD18, CD63, and L-selectin, were measured by flow cytometry. Extracellular elastase activity was quantified using a fluorescent substrate. Results Bronchoalveolar lavage obtained from both groups of patients at entry showed similar effects on PMN oxidant production and expression of surface markers. At 36 h, exposure of PMNs to bronchoalveolar lavage fluid from the control group resulted in increased PMN activation as manifested by a significant increase in oxidant production, CD18, and CD63 surface expression, and shedding of L-selectin. By contrast, these variables were unchanged at 36 h in the lung-protective group. There was a significant correlation between the changes of the variables and changes in interleukin-6 level and the number of failing organs. Conclusions Polymorphonuclear leukocytes can be activated by mechanical ventilation, and the consequent release of elastase was correlated with the degree of systemic inflammatory response and multiple organ failure. This result may possibly explain the decreased mortality in acute respiratory distress syndrome patients treated with a lung-protective strategy.

Influence of perfluorocarbons on Carbamazepine and Benzodiazepine for a neuro-lung protective strategy

2017 ◽  
Vol 43 ◽  
pp. 82-88 ◽  
Author(s):  
V. Natchimuthu ◽  
Sabu Thomas ◽  
Murugan Ramalingam ◽  
S. Ravi
Keyword(s):  
Lung Protective Strategy ◽  
Protective Strategy

Pleural Effusion Outcomes in Intensive Care: Analysis of a Large Clinical Database

2019 ◽  
Vol 35 (1) ◽  
pp. 48-54
Author(s):  
Marjorie Bateman ◽  
Ala Alkhatib ◽  
Thomas John ◽  
Malhar Parikh ◽  
Fayez Kheir
Keyword(s):  
Mechanical Ventilation ◽  
Intensive Care ◽  
Pleural Effusion ◽  
Hospital Stay ◽  
Disease Severity ◽  
Pleural Fluid ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Pleural Effusions ◽  
Icu Stay

Background: Pleural effusions are common in critically ill patients. However, the management of pleural fluid on relevant clinical outcomes is poorly studied. We evaluated the impact of pleural effusion in the intensive care unit (ICU). Methods: A large observational ICU database Multiparameter Intelligent Monitoring in Intensive Care III was utilized. Analyses used matched patients with the same admission diagnosis, age, gender, and disease severity. Results: Of 50 765, 3897 (7.7%) of critically ill adult patients had pleural effusions. Compared to patients without effusion, patients with effusion had higher in-hospital (38.7% vs 31.3%, P < .0001), 1-month (43.1% vs 36.1%, P < .0001), 6-month (63.6% vs 55.7%, P < .0001), and 1-year mortality (73.8% vs 66.1%, P < .0001), as well as increased length of hospital stay (17.6 vs 12.7 days, P < .0001), ICU stay (7.3 vs 5.1 days, P < .0001), need for mechanical ventilation (63.1% vs 55.7%, P < .0001), and duration of mechanical ventilation (8.7 vs 6.3 days, P < .0001). A total of 1503 patients (38.6%) underwent pleural fluid drainage. Patients in the drainage group had higher in-hospital (43.9% vs 35.4%, P = .0002), 1-month (47.7% vs 39.7%, P = .0005), 6-month (67.1% vs 61.8%, P = .0161), and 1-year mortality (77.1% vs 72.1%, P = .0147), as well as increased lengths of hospital stay (22.1 vs 16.0 days, P < .0001), ICU stay (9.2d vs 6.4 days, P < .0001), and duration of mechanical ventilation (11.7 vs 7.1 days, P < .0001). Conclusions: The presence of a pleural effusion was associated with increased mortality in critically ill patients regardless of disease severity. Drainage of pleural effusion was associated with worse outcomes in a large, heterogeneous cohort of ICU patients.

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