scholarly journals Sedating Mechanically Ventilated COVID-19 Patients with Volatile Anesthetics: Insights on the Last-Minute Potential Weapons

2021 ◽  
Vol 89 (1) ◽  
pp. 6
Author(s):  
Aiman Suleiman ◽  
Abdallah Barjas Qaswal ◽  
Mazen Alnouti ◽  
Moh’d Yousef ◽  
Bayan Suleiman ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Membrane Integrity ◽  
Inflammatory Cells ◽  
Volatile Anesthetics ◽  
Mechanically Ventilated ◽  
Capillary Membrane ◽  
Potential Therapeutic Role ◽  
Late Stages ◽  
Alveolar Capillary

Coronavirus Disease 2019 (COVID-19) has spread globally with the number of cases exceeding seventy million. Although trials on potential treatments of COVID-19 Acute Respiratory Distress Syndrome (ARDS) are promising, the introduction of an effective therapeutic intervention seems elusive. In this review, we explored the potential therapeutic role of volatile anesthetics during mechanical ventilation in the late stages of the disease. COVID-19 is thought to hit the human body via five major mechanisms: direct viral damage, immune overactivation, capillary thrombosis, loss of alveolar capillary membrane integrity, and decreased tissue oxygenation. The overproduction of pro-inflammatory cytokines will eventually lead to the accumulation of inflammatory cells in the lungs, which will lead to ARDS requiring mechanical ventilation. Respiratory failure resulting from ARDS is thought to be the most common cause of death in COVID-19. The literature suggests that these effects could be directly countered by using volatile anesthetics for sedation. These agents possess multiple properties that affect viral replication, immunity, and coagulation. They also have proven benefits at the molecular, cellular, and tissue levels. Based on the comprehensive understanding of the literature, short-term sedation with volatile anesthetics may be beneficial in severe stages of COVID-19 ARDS and trials to study their effects should be encouraged.

scholarly journals FEATURES OF REGULATION OF BREATH

2020 ◽  
Vol 2 (9(78)) ◽  
pp. 31-38
Author(s):  
G. Vasilyev
Keyword(s):  
System Analysis ◽  
Blood Flow Rate ◽  
The Body ◽  
Medical Professionals ◽  
Arterial Blood ◽  
Capillary Membrane ◽  
Volume Blood ◽  
Volume Blood Flow ◽  
Alveolar Capillary

In modern physiology, very simplified perceptions of such an essential system for the body as the respiratory system have taken root. The system analysis showed that at a physical load of more than 50 W, the tissue respiratory subsystem is activated, providing a volume blood flow rate adequate to the amount of oxygen consumed, and in the external respiratory subsystem the regulation on oxygen voltage in arterial blood is activated, and the regulation on carbon dioxide voltage is deactivated. The role of respiratory frequency in increasing the rate of diffusion through the alveolar capillary membrane is shown. For physiologists, medical professionals and trainers.

scholarly journals The Extent of Ventilator-Induced Lung Injury in Mice Partly Depends on Duration of Mechanical Ventilation

2013 ◽  
Vol 2013 ◽  
pp. 1-11 ◽  
Author(s):  
Maria A. Hegeman ◽  
Sabrine N. T. Hemmes ◽  
Maria T. Kuipers ◽  
Lieuwe D. J. Bos ◽  
Geartsje Jongsma ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Lung Injury ◽  
Capillary Permeability ◽  
Statistical Significance ◽  
Lung Compliance ◽  
Alveolar Cell ◽  
Mechanically Ventilated ◽  
Ventilator Induced Lung Injury ◽  
Cell Counts ◽  
Alveolar Capillary

Background. Mechanical ventilation (MV) has the potential to initiate ventilator-induced lung injury (VILI). The pathogenesis of VILI has been primarily studied in animal models using more or less injurious ventilator settings. However, we speculate that duration of MV also influences severity and character of VILI.Methods. Sixty-four healthy C57Bl/6 mice were mechanically ventilated for 5 or 12 hours, using lower tidal volumes with positive end-expiratory pressure (PEEP) or higher tidal volumes without PEEP. Fifteen nonventilated mice served as controls.Results. All animals remained hemodynamically stable and survived MV protocols. In both MV groups, PaO2to FiO2ratios were lower and alveolar cell counts were higher after 12 hours of MV compared to 5 hours. Alveolar-capillary permeability was increased after 12 hours compared to 5 hours, although differences did not reach statistical significance. Lung levels of inflammatory mediators did not further increase over time. Only in mice ventilated with increased strain, lung compliance declined and wet to dry ratio increased after 12 hours of MV compared to 5 hours.Conclusions. Deleterious effects of MV are partly dependent on its duration. Even lower tidal volumes with PEEP may initiate aspects of VILI after 12 hours of MV.

scholarly journals REGULATION OF BREATHING IN THE EXTENDED RANGE

2020 ◽  
Vol 2 (33(60)) ◽  
pp. 4-8
Author(s):  
G. Vasilyev
Keyword(s):  
System Analysis ◽  
Blood Flow Rate ◽  
The Body ◽  
Arterial Blood ◽  
Capillary Membrane ◽  
Extended Range ◽  
Regulation Of Breathing ◽  
Volume Blood ◽  
Alveolar Capillary

In modern physiology, very simplified perceptions of such an essential system for the body as the respiratory system have taken root. The system analysis showed that at a physical load of more than 50 W, the tissue respiratory subsystem is activated, providing a volume blood flow rate adequate to the amount of oxygen consumed, and in the external respiratory subsystem the regulation on oxygen voltage in arterial blood is activated, and the regulation on carbon dioxide voltage is deactivated. The role of respiratory frequency in increasing the rate of diffusion through the alveolar capillary membrane is shown.

scholarly journals Investigating the Role of Subglottic Secretions Suctioning in the Prevention of ‎Ventilator Associated Pneumonia in Patients With Invasive Mechanical ‎Ventilation

2019 ◽  
Vol 11 (6) ◽  
pp. 111
Author(s):  
Iyad Abbas Salman ◽  
Waleed Ibraheem Ali ◽  
Amir Ibrahim Moushib ◽  
Hayder Adnan Fawzi
Keyword(s):  
Mechanical Ventilation ◽  
Endotracheal Tube ◽  
Invasive Mechanical Ventilation ◽  
Tracheal Aspirate ◽  
Ventilator Associated Pneumonia ◽  
Mechanically Ventilated ◽  
Subglottic Secretion ◽  
Radiological Features ◽  
Ventilated Patients

BACKGROUND: development of ventilator associated pneumonia (VAP) leads to ‎prolonged hospital stay, increased health care cost, and mortality rates. Subglottic ‎secretion drainage through a dedicated endotracheal tube has been advocated as a mean ‎to decrease the incidence of VAP and thereby assisting in ‎the decrease of morbidity associated with invasive mechanical ventilation.‎ OBJECTIVE: Investigate the role of subglottic secretion suctioning in the prevention of VAP in mechanically ventilated patients in intensive care unit.‎ METHODS: A cross sectional study done in the intensive care unit of Ghazi Al-Hariri ‎hospital for surgical specialties in medical city complex, 30 patients who ‎are in need for invasive mechanical ventilation were intubated with endotracheal tube ‎that have special port for subglottic secretion suctioning. Daily monitoring of patients ‎clinical and radiological data to detect features of VAP was ‎done, and if there was a suspicion of pneumonia, culture for tracheal aspirate performed ‎to confirm diagnosis.‎ RESULTS: ‎Patient’s age was 37.1 ± ‎‎15.39 years, the highest proportion of study patients was found in ‎age group < 30 and ‎‎30–49 years (40% in ‎each group), most of the patients were males (70%) with a male to female ratio of ‎‎2.33:1‎‏, ‏Subglottic secretion suctioning lead to reduction in VAP by relative risk (95%CI) of ‏‎0.167 (0.045–0.559)‎‏, p-‏value = 0.001. ‏Twenty eight patients didn’t show any sign, symptoms ‎or radiological features suggesting a ‎diagnosis of pneumonia while two patients developed ‎features of pneumonia (suggestive signs and ‎symptoms, radiological features and ‎positive culture of tracheal aspirate).‎ CONCLUSION: the use of endotracheal tube with subglottic ‎secretions suctioning can have a role in the prevention of VAP in mechanically ventilated patients.‎

REGULATION OF BREATHING IN A WIDE RANGE OF PHYSICAL ACTIVITIES

ASJ. ◽  
2021 ◽  
Vol 1 (46) ◽  
pp. 9-17
Author(s):  
G. Vasilyev
Keyword(s):  
System Analysis ◽  
Blood Flow Rate ◽  
The Body ◽  
Arterial Blood ◽  
Capillary Membrane ◽  
Wide Range ◽  
Regulation Of Breathing ◽  
Volume Blood ◽  
Alveolar Capillary

In modern physiology, very simplified perceptions of such an essential system for the body as the respiratory system have taken root. The system analysis showed that at a physical load of more than 50 W, the tissue respiratory subsystem is activated, providing a volume blood flow rate adequate to the amount of oxygen consumed, and in the external respiratory subsystem the regulation on oxygen voltage in arterial blood is activated, and the regulation on carbon dioxide voltage is deactivated. The role of respiratory frequency in increasing the rate of diffusion through the alveolar capillary membrane is shown. For physiologists, medical professionals and trainers.

scholarly journals Heterozygous Tbk1 loss has opposing effects in early and late stages of ALS in mice

2019 ◽  
Vol 216 (2) ◽  
pp. 267-278 ◽  
Author(s):  
David Brenner ◽  
Kirsten Sieverding ◽  
Clara Bruno ◽  
Patrick Lüningschrör ◽  
Eva Buck ◽  
...  
Keyword(s):  
Early Stage ◽  
Inflammatory Cells ◽  
Disease Stage ◽  
Loss Of Function ◽  
Inflammatory Conditions ◽  
Clinical Onset ◽  
Opposing Effects ◽  
Late Stages ◽  
Observation Period

Heterozygous loss-of-function mutations of TANK-binding kinase 1 (TBK1) cause familial ALS, yet downstream mechanisms of TBK1 mutations remained elusive. TBK1 is a pleiotropic kinase involved in the regulation of selective autophagy and inflammation. We show that heterozygous Tbk1 deletion alone does not lead to signs of motoneuron degeneration or disturbed autophagy in mice during a 200-d observation period. Surprisingly, however, hemizygous deletion of Tbk1 inversely modulates early and late disease phases in mice additionally overexpressing ALS-linked SOD1G93A, which represents a “second hit” that induces both neuroinflammation and proteostatic dysregulation. At the early stage, heterozygous Tbk1 deletion impairs autophagy in motoneurons and prepones both the clinical onset and muscular denervation in SOD1G93A/Tbk1+/− mice. At the late disease stage, however, it significantly alleviates microglial neuroinflammation, decelerates disease progression, and extends survival. Our results indicate a profound effect of TBK1 on brain inflammatory cells under pro-inflammatory conditions and point to a complex, two-edged role of TBK1 in SOD1-linked ALS.

scholarly journals Biophysical determinants of alveolar epithelial plasma membrane wounding associated with mechanical ventilation

2013 ◽  
Vol 305 (7) ◽  
pp. L478-L484 ◽  
Author(s):  
Omar Hussein ◽  
Bruce Walters ◽  
Randolph Stroetz ◽  
Paul Valencia ◽  
Deborah McCall ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Plasma Membrane ◽  
Epithelial Cells ◽  
Cell Injury ◽  
Membrane Integrity ◽  
Alveolar Epithelial Cells ◽  
Interfacial Stress ◽  
Interactive Effects ◽  
Mechanically Ventilated ◽  
Alveolar Epithelial

Mechanical ventilation may cause harm by straining lungs at a time they are particularly prone to injury from deforming stress. The objective of this study was to define the relative contributions of alveolar overdistension and cyclic recruitment and “collapse” of unstable lung units to membrane wounding of alveolar epithelial cells. We measured the interactive effects of tidal volume (VT), transpulmonary pressure (PTP), and of airspace liquid on the number of alveolar epithelial cells with plasma membrane wounds in ex vivo mechanically ventilated rat lungs. Plasma membrane integrity was assessed by propidium iodide (PI) exclusion in confocal images of subpleural alveoli. Cyclic inflations of normal lungs from zero end-expiratory pressure to 40 cmH2O produced VT values of 56.9 ± 3.1 ml/kg and were associated with 0.12 ± 0.12 PI-positive cells/alveolus. A preceding tracheal instillation of normal saline (3 ml) reduced VT to 49.1 ± 6 ml/kg but was associated with a significantly greater number of wounded alveolar epithelial cells (0.52 ± 0.16 cells/alveolus; P < 0.01). Mechanical ventilation of completely saline-filled lungs with saline (VT = 52 ml/kg) to pressures between 10 and 15 cmH2O was associated with the least number of wounded epithelial cells (0.02 ± 0.02 cells/alveolus; P < 0.01). In mechanically ventilated, partially saline-filled lungs, the number of wounded cells increased substantially with VT, but, once VT was accounted for, wounding was independent of maximal PTP. We found that interfacial stress associated with the generation and destruction of liquid bridges in airspaces is the primary biophysical cell injury mechanism in mechanically ventilated lungs.

scholarly journals Tocilizumab treatment for COVID-19 patients: a systematic review and meta-analysis

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Qiu Wei ◽  
Hua Lin ◽  
Rong-Guo Wei ◽  
Nian Chen ◽  
Fan He ◽  
...  
Keyword(s):  
Systematic Review ◽  
Mechanical Ventilation ◽  
Meta Analysis ◽  
Good Prognosis ◽  
Care Group ◽  
Risk Of Mortality ◽  
Effective Care ◽  
Potential Therapeutic Role ◽  
Overall Mortality

Abstract Background Coronavirus disease 2019 (COVID-19) has killed over 2.5 million people worldwide, but effective care and therapy have yet to be discovered. We conducted this analysis to better understand tocilizumab treatment for COVID-19 patients. Main text We searched major databases for manuscripts reporting the effects of tocilizumab on COVID-19 patients. A total of 25 publications were analyzed with Revman 5.3 and R for the meta-analysis. Significant better clinical outcomes were found in the tocilizumab treatment group when compared to the standard care group [odds ratio (OR) = 0.70, 95% confidential interval (C): 0.54–0.90, P = 0.007]. Tocilizumab treatment showed a stronger correlation with good prognosis among COVID-19 patients that needed mechanical ventilation (OR = 0.59, 95% CI, 0.37–0.93, P = 0.02). Among stratified analyses, reduction of overall mortality correlates with tocilizumab treatment in patients less than 65 years old (OR = 0.68, 95% CI: 0.60–0.77, P < 0.00001), and with intensive care unit patients (OR = 0.62, 95% CI: 0.55–0.70, P < 0.00001). Pooled estimates of hazard ratio showed that tocilizumab treatment predicts better overall survival in COVID-19 patients (HR = 0.45, 95% CI: 0.24–0.84, P = 0.01), especially in severe cases (HR = 0.58, 95% CI 0.49–0.68, P < 0.00001). Conclusions Our study shows that tocilizumab treatment is associated with a lower risk of mortality and mechanical ventilation requirement among COVID-19 patients. Tocilizumab may have substantial effectiveness in reducing mortality among COVID-19 patients, especially among critical cases. This systematic review provides an up-to-date evidence of potential therapeutic role of tocilizumab in COVID-19 management. Graphical abstract

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