scholarly journals Neural versus pneumatic control of pressure support in patients with chronic obstructive pulmonary diseases at different levels of positive end expiratory pressure: a physiological study

2021 ◽  
Author(s):  
Ling Liu ◽  
Feiping Xia ◽  
Yi Yang ◽  
Federico Longhini ◽  
Paolo Navalesi ◽  
...  
Keyword(s):  
Airway Pressure ◽  
Pressure Support ◽  
Esophageal Pressure ◽  
Primary Objective ◽  
Chronic Obstructive ◽  
Positive End Expiratory Pressure ◽  
Copd Patients ◽  
Diaphragm Electrical Activity ◽  
The Impact ◽  
Different Levels

Introduction: Intrinsic positive end-expiratory pressure (PEEPi) is a “threshold” load that must be overcome to trigger conventional pneumatically-controlled pressure support (PSP) in chronic obstructive pulmonary disease (COPD). Application of extrinsic PEEP (PEEPe) reduces trigger delays and mechanical inspiratory efforts. Using the diaphragm electrical activity (EAdi), neurally controlled pressure support (PSN) could hypothetically eliminate asynchrony and reduce mechanical inspiratory effort, hence substituting the need for PEEPe. The primary objective of this study was to show that PSN can reduce the need for PEEPe to improve patient-ventilator interaction and to reduce both the “pre-trigger” and “total inspiratory” neural and mechanical efforts in COPD patients with PEEPi. A secondary objective was to evaluate the impact of applying PSN on breathing pattern. <div>Methods: Twelve intubated and mechanically ventilated COPD patients with PEEPi ≥ 5 cm H2O underwent comparisons of PSP and PSN at different levels of PEEPe (at 0 %, 40 %, 80 %, and 120 % of static PEEPi, for 12 minutes at each level on average), at matching peak airway pressure. We measured flow, airway pressure, esophageal pressure, and EAdi, and analyzed neural and mechanical efforts for triggering and total inspiration. Patient-ventilator interaction was analyzed with the NeuroSync index. <div>Results: Mean airway pressure and PEEPe were comparable for PSP and PSN at same target levels. During PSP, the NeuroSync index was 29 % at zero PEEPe and improved to 21 % at optimal PEEPe (P < 0.05). During PSN, the NeuroSync index was lower (<7 %, P < 0.05) regardless of PEEPe. Both pre-trigger (P < 0.05) and total inspiratory mechanical efforts (P < 0.05) were consistently higher during PSP compared to PSN at same PEEPe. The change in total mechanical efforts between PSP at PEEPe0% and PSN at PEEPe0% was not different from the change between PSP at PEEPe0% and PSP at PEEPe80%. <div>Conclusion: PSN abolishes the need for PEEPe in COPD patients, improves patient-ventilator interaction, and reduces the inspiratory mechanical effort to breathe.</div></div></div>

scholarly journals Neural versus pneumatic control of pressure support in patients with chronic obstructive pulmonary diseases at different levels of positive end expiratory pressure: a physiological study

2021 ◽  
Author(s):  
Ling Liu ◽  
Feiping Xia ◽  
Yi Yang ◽  
Federico Longhini ◽  
Paolo Navalesi ◽  
...  
Keyword(s):  
Airway Pressure ◽  
Pressure Support ◽  
Esophageal Pressure ◽  
Primary Objective ◽  
Chronic Obstructive ◽  
Positive End Expiratory Pressure ◽  
Copd Patients ◽  
Diaphragm Electrical Activity ◽  
The Impact ◽  
Different Levels

Introduction: Intrinsic positive end-expiratory pressure (PEEPi) is a “threshold” load that must be overcome to trigger conventional pneumatically-controlled pressure support (PSP) in chronic obstructive pulmonary disease (COPD). Application of extrinsic PEEP (PEEPe) reduces trigger delays and mechanical inspiratory efforts. Using the diaphragm electrical activity (EAdi), neurally controlled pressure support (PSN) could hypothetically eliminate asynchrony and reduce mechanical inspiratory effort, hence substituting the need for PEEPe. The primary objective of this study was to show that PSN can reduce the need for PEEPe to improve patient-ventilator interaction and to reduce both the “pre-trigger” and “total inspiratory” neural and mechanical efforts in COPD patients with PEEPi. A secondary objective was to evaluate the impact of applying PSN on breathing pattern. <div>Methods: Twelve intubated and mechanically ventilated COPD patients with PEEPi ≥ 5 cm H2O underwent comparisons of PSP and PSN at different levels of PEEPe (at 0 %, 40 %, 80 %, and 120 % of static PEEPi, for 12 minutes at each level on average), at matching peak airway pressure. We measured flow, airway pressure, esophageal pressure, and EAdi, and analyzed neural and mechanical efforts for triggering and total inspiration. Patient-ventilator interaction was analyzed with the NeuroSync index. <div>Results: Mean airway pressure and PEEPe were comparable for PSP and PSN at same target levels. During PSP, the NeuroSync index was 29 % at zero PEEPe and improved to 21 % at optimal PEEPe (P < 0.05). During PSN, the NeuroSync index was lower (<7 %, P < 0.05) regardless of PEEPe. Both pre-trigger (P < 0.05) and total inspiratory mechanical efforts (P < 0.05) were consistently higher during PSP compared to PSN at same PEEPe. The change in total mechanical efforts between PSP at PEEPe0% and PSN at PEEPe0% was not different from the change between PSP at PEEPe0% and PSP at PEEPe80%. <div>Conclusion: PSN abolishes the need for PEEPe in COPD patients, improves patient-ventilator interaction, and reduces the inspiratory mechanical effort to breathe.</div></div></div>

Oxidative stress and damage to erythrocytes in patients with chronic obstructive pulmonary disease — changes in ATPase and acetylcholinesterase activity

2015 ◽  
Vol 93 (6) ◽  
pp. 574-580 ◽  
Author(s):  
Bożena Bukowska ◽  
Paulina Sicińska ◽  
Aneta Pająk ◽  
Aneta Koceva-Chyla ◽  
Tadeusz Pietras ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Chronic Obstructive Pulmonary Disease ◽  
Red Blood Cells ◽  
Pulmonary Disease ◽  
Blood Cells ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Membrane Enzymes ◽  
Copd Patients ◽  
The Impact

The study indicates, for the first time, the changes in both ATPase and AChE activities in the membrane of red blood cells of patients diagnosed with COPD. Chronic obstructive pulmonary disease (COPD) is one of the most common and severe lung disorders. We examined the impact of COPD on redox balance and properties of the membrane of red blood cells. The study involved 30 patients with COPD and 18 healthy subjects. An increase in lipid peroxidation products and a decrease in the content of -SH groups in the membrane of red blood cells in patients with COPD were observed. Moreover, an increase in the activity of glutathione peroxidase and a decrease in superoxide dismutase, but not in catalase activity, were found as well. Significant changes in activities of erythrocyte membrane enzymes in COPD patients were also evident demonstrated by a considerably lowered ATPase activity and elevated AChE activity. Changes in the structure and function of red blood cells observed in COPD patients, together with changes in the activity of the key membrane enzymes (ATPases and AChE), can result from the imbalance of redox status of these cells due to extensive oxidative stress induced by COPD disease.

scholarly journals Refractory ineffective triggering during pressure support ventilation: effect of proportional assist ventilation with load-adjustable gain factors

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Anne-Fleur Haudebourg ◽  
Tommaso Maraffi ◽  
Samuel Tuffet ◽  
François Perier ◽  
Nicolas de Prost ◽  
...  
Keyword(s):  
Pressure Support Ventilation ◽  
Pressure Support ◽  
Esophageal Pressure ◽  
Physiological Study ◽  
Observational Assessment ◽  
Proportional Assist Ventilation ◽  
Asynchrony Index ◽  
Support Ventilation ◽  
Academic Medical ◽  
The Impact

Abstract Background Ineffective triggering is frequent during pressure support ventilation (PSV) and may persist despite ventilator adjustment, leading to refractory asynchrony. We aimed to assess the effect of proportional assist ventilation with load-adjustable gain factors (PAV+) on the occurrence of refractory ineffective triggering. Design Observational assessment followed by prospective cross-over physiological study. Setting Academic medical ICU. Patients Ineffective triggering was detected during PSV by a twice-daily inspection of the ventilator’s screen. The impact of pressure support level (PSL) adjustments on the occurrence of asynchrony was recorded. Patients experiencing refractory ineffective triggering, defined as persisting asynchrony at the lowest tolerated PSL, were included in the physiological study. Interventions Physiological study: Flow, airway, and esophageal pressures were continuously recorded during 10 min under PSV with the lowest tolerated PSL, and then under PAV+ with the gain adjusted to target a muscle pressure between 5 and 10 cmH2O. Measurements Primary endpoint was the comparison of asynchrony index between PSV and PAV+ after PSL and gain adjustments. Results Among 36 patients identified having ineffective triggering under PSV, 21 (58%) exhibited refractory ineffective triggering. The lowest tolerated PSL was higher in patients with refractory asynchrony as compared to patients with non-refractory ineffective triggering. Twelve out of the 21 patients with refractory ineffective triggering were included in the physiological study. The median lowest tolerated PSL was 17 cmH2O [12–18] with a PEEP of 7 cmH2O [5–8] and FiO2 of 40% [39–42]. The median gain during PAV+ was 73% [65–80]. The asynchrony index was significantly lower during PAV+ than PSV (2.7% [1.0–5.4] vs. 22.7% [10.3–40.1], p < 0.001) and consistently decreased in every patient with PAV+. Esophageal pressure–time product (PTPes) did not significantly differ between the two modes (107 cmH2O/s/min [79–131] under PSV vs. 149 cmH2O/s/min [129–170] under PAV+, p = 0.092), but the proportion of PTPes lost in ineffective triggering was significantly lower with PAV+ (2 cmH2O/s/min [1–6] vs. 8 cmH2O/s/min [3–30], p = 0.012). Conclusions Among patients with ineffective triggering under PSV, PSL adjustment failed to eliminate asynchrony in 58% of them (21 of 36 patients). In these patients with refractory ineffective triggering, switching from PSV to PAV+ significantly reduced or even suppressed the incidence of asynchrony.

scholarly journals Sensitivity of the COPD assessment test (CAT questionnaire) investigated in a population of 681 consecutive patients referring to a lung clinic: the first Italian specific study

2014 ◽  
Vol 9 ◽  
Author(s):  
Roberto W. Dal Negro ◽  
Luca Bonadiman ◽  
Paola Turco
Keyword(s):  
Lung Function ◽  
Educational Level ◽  
Smoking Habit ◽  
General Medicine ◽  
Therapeutic Monitoring ◽  
Chronic Obstructive ◽  
Difficult Patient ◽  
Copd Assessment Test ◽  
Copd Patients ◽  
The Impact

Background: Chronic Obstructive Pulmonary Disease (COPD) is a major cause of morbidity and mortality at global level even if still underestimated. The insufficient use of specific tools for an objective definition and staging, the inadequate awareness of COPD, but also a difficult patient-to-doctor communication, can contribute to the poor management of COPD. A very simple, short and sensitive questionnaire (the “COPD Assessment Test” - CAT questionnaire) is now available for assessing the impact of COPD on the patient’s health. The present study was designed to provide such evidence using data generated throughout Italy. Methods: The Italian validated version of the CAT questionnaire was distributed to 681 consecutive COPD patients of different severity (males = 480), well matched for age, gender, smoking habit, geographical distribution, BMI, dyspnoea score and educational level. The CAT score variability was investigated vs all anagraphic, and clinical variables, and spirometric indices of lung function (regression). No Italian data are available to our knowledge on the CAT use, neither in General Medicine, nor in the specialist setting. Results: Data of this study confirmed that the CAT questionnaire is a sensitive, simple, and quick tool for assessing the respiratory status of COPD patients. The CAT score proved not conditioned by the patient’s age, gender, body size, geographical origin, and educational level. It was inversely correlated with the spirometric values, even if not uniquely linked to them. Conclusions: The CAT score does not represent a surrogate measurement of lung function: it is an instrument which focuses on different areas of respiratory health in COPD patients, thus providing an useful and objective tool for the long-term clinical and therapeutic monitoring of COPD patients in the specialist outpatient setting.

scholarly journals Study the impact of chronic obstructive pulmonary diseases on bone mineral density of biomass fuel smoke exposed population and its association with hs-CRP in Rural Haryana

2021 ◽  
Vol 12 (11) ◽  
pp. 90-97
Author(s):  
Kamaljeet Singh ◽  
Anand Agrawal ◽  
Sunaina Kharb ◽  
Rishi Rana
Keyword(s):  
Bone Mineral Density ◽  
Lower Limb ◽  
Surrogate Marker ◽  
Chronic Obstructive ◽  
Mineral Density ◽  
T Score ◽  
Copd Patients ◽  
Healthy Control ◽  
Hs Crp ◽  
The Impact

Background: Chronic obstructive pulmonary disease (COPD) has deleterious systemic impact due to spillage of inflammatory mediators in the circulation though its association with highly sensitive C-reactive protein (hs-CRP) considers as surrogate marker of inflammation is not much explored hitherto. Aims and Objectives: This study aims to study the impact of COPD on bone mineral density (BMD) and its association with hs-CRP in rural population of Haryana. Materials and Methods: Tertiary care hospital-based case–control multigroup study conducted in the Department of Respiratory Medicine, BPSGMCW, Khanpur Kalan, Sonepat, Haryana, India. A total of 150 female study subjects included and comprise in three groups, G1: Biomass exposed COPD patients; G2: Biomass smoke exposed non-COPD subjects; and G3: Non-biomass exposed healthy control. Bone density measured using dual-energy X-ray absorptiometry, hs-CRP considers as surrogate marker of inflammation. Statistical software SPSS Version 23 used to measure Chi-square/Fisher’s exact test, Student’s t-test, and Pearson/Spearman’s rank correlation as test of significance, P<0.05 considered as statistically significant. Results: Mean total t-score of COPD subjects was −1.81±1.15, significantly lower than healthy control −0.66±1.69 (P=0.000), however, it is near to biomass exposed non-COPD subjects −1.74±1.14 (P=0.625). Odds ratio for the risk of osteoporosis in the lower limb among COPD group (Lt leg: 7.07; Rt leg: 4.51) was significantly high compare to other study subjects. Mean titer of hs-CRP (7.905±9.60; P<0.001) was significantly high in study group (G1), though its correlation with t-score was very weak (r=−0.024; P=0.867). Conclusion: COPD has significant impact on BMD of affected population predominantly on lower limb compare to other study subjects, however, no significant association was found with inflammatory biomarkers in the decrement of bone density despite high mean titer of hs-CRP among COPD patients.

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