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1.
Pediatr Cardiol ; 40(8): 1633-1637, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31468061

RESUMO

We sought to assess acute hemodynamic changes after implementation of negative extrathoracic pressure (NEP) in spontaneously breathing ambulatory Fontan patients with symptomatic heart failure. We hypothesized that application of NEP would result in an acute decrease in pulmonary artery pressure. Ten patients with clinical evidence of Fontan failure underwent baseline hemodynamic catheterization while breathing spontaneously. Hemodynamic measurements were then repeated after 30 min of continuous NEP. After 30 min of continuous NEP, 4/10 patients had a decrease in their Fontan pressure by 2 mmHg and one patient had a decrease by 1 mmHg. There were three patients that had an increase in Fontan pressure by 2 mmHg. In 7/10 patients, indexed pulmonary vascular resistance decreased by an average of 31%. In symptomatic Fontan patients with a favorable hemodynamic response to NEP during catheterization, potential benefit of longer-term NEP to improve clinical status should be explored.


Assuntos
Técnica de Fontan/efeitos adversos , Respiração Artificial/instrumentação , Respiradores de Pressão Negativa , Adolescente , Adulto , Criança , Feminino , Insuficiência Cardíaca/cirurgia , Hemodinâmica/fisiologia , Humanos , Masculino , Projetos Piloto , Adulto Jovem
2.
Microvasc Res ; 122: 71-77, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30481493

RESUMO

Pulmonary alveolar septal capillaries receive their perfusion from a web of larger surrounding acinar vessels. Using 4 µm diam. Latex particles, we showed that positive pressure ventilation narrowed the acinar vessels as evidenced by venous 4 µm particle concentrations and perfusate flows <50% of particle concentrations in negative pressure ventilated lungs. We aimed to understand the effects of positive and negative pressure ventilation on flows of larger particles through the lung. Isolated, ventilated rat lungs (air, transpulmonary pressures of 15/5 cm H2O, 25 breaths/min) were perfused with a hetastarch solution at Ppulm art/PLA pressures of 10/0 cm H2O. Red latex 7 µm (2.5 mg, 4.8 × 106) or 15 µm (2.5 mg, 5.5 × 105) particles were infused into each lung during positive or negative pressure ventilation. An equal number of green particles was infused 20 min later. Flows through lungs infused with 7 µm and 15 µm particles were not different from flows through lungs infused with 4 µm particles (p = 0.811). Venous particle concentrations of 7 µm particles relative to infused particles were lower in positive pressure lungs (0.03 ±â€¯0.03%) compared to negative pressure lungs (0.17 ±â€¯0.12%) (p = 0.041). Venous particle concentrations of 15 µm particles were not different between positive (2.3 ±â€¯1.9%) and negative (3.3 ±â€¯1.8%) pressure ventilation (p = 0.406). Together with our previous study, we conclude that 4 µm and 7 µm particles both enter acinar vessels but that the 7 µm particles are too large to flow through those vessels. In contrast, we conclude that 15 µm particles bypass the acinar vessels, flowing instead through larger intrapulmonary vessels to enter the venous outflow. These findings suggest that intrapulmonary vessels are organized as a web that allows bypass of the acinar vessels by large particles and, that these bypass vessels are not compressed by positive pressure ventilation.


Assuntos
Microcirculação , Microvasos/fisiologia , Respiração com Pressão Positiva , Alvéolos Pulmonares/irrigação sanguínea , Circulação Pulmonar , Respiradores de Pressão Negativa , Animais , Velocidade do Fluxo Sanguíneo , Corantes Fluorescentes/administração & dosagem , Masculino , Microesferas , Tamanho da Partícula , Ratos Sprague-Dawley , Fluxo Sanguíneo Regional , Respiração , Fatores de Tempo
3.
BMC Anesthesiol ; 18(1): 181, 2018 12 03.
Artigo em Inglês | MEDLINE | ID: mdl-30509183

RESUMO

BACKGROUND: Microaspiration past the tracheal tube cuffs causes ventilator-associated pneumonia. The objective of the current study was to evaluate whether creating negative pressure between the tracheal double cuffs could block the fluid passage past the tracheal tube cuffs. METHODS: A new negative pressure system was devised between the double cuffs through a suction hole in the intercuff space. Blue-dyed water was instilled above the cuff at negative suction pressures of - 54, - 68, - 82, - 95, - 109, - 122, and - 136 cmH2O, and the volume leaked was measured in an underlying water trap after 10 min. Leakage tests were also performed during positive pressure ventilation, and using higher-viscosity materials. The actual negative pressures delivered at the hole of double cuffs were obtained by placing microcatheter tip between the intercuff space and the artificial trachea. RESULTS: No leakage occurred past the double cuff at - 136 cmH2O suction pressure at all tracheal tube cuff pressures. The volume leaked decreased significantly as suction pressure increased. When connected to a mechanical ventilator, no leakage was found at - 54 cmH2suction pressure. Volume of the higher-viscosity materials (dynamic viscosity of 63-108 cP and 370-430 cP) leaked was small compared to that of normal saline (0.9-1.1 cP). The pressures measured in the intercuff space corresponded to 3.8-5.9% of those applied. CONCLUSIONS: A new prototype double cuff with negative pressure in the intercuff space completely prevented water leakage. The negative pressure transmitted to the tracheal inner wall was a small percentage of that applied.


Assuntos
Desenho de Equipamento/instrumentação , Intubação Intratraqueal/instrumentação , Respiração com Pressão Positiva/instrumentação , Aspiração Respiratória/prevenção & controle , Respiradores de Pressão Negativa , Desenho de Equipamento/métodos , Humanos , Intubação Intratraqueal/métodos , Respiração com Pressão Positiva/métodos , Pressão
5.
J Physiol ; 596(14): 2853-2864, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29658103

RESUMO

KEY POINTS: Protective reflexes in the throat area (upper airway) are crucial for breathing. Impairment of these reflexes can cause breathing problems during sleep such as obstructive sleep apnoea (OSA). OSA is very common in people with spinal cord injury for unknown reasons. This study shows major changes in protective reflexes that serve to keep the upper airway open in response to suction pressures in people with tetraplegia and OSA. These results help us understand why OSA is so common in people with tetraplegia and provide new insight into how protective upper airway reflexes work more broadly. ABSTRACT: More than 60% of people with tetraplegia have obstructive sleep apnoea (OSA). However, the specific causes are unknown. Genioglossus, the largest upper-airway dilator muscle, is important in maintaining upper-airway patency. Impaired genioglossus muscle function following spinal cord injury may contribute to OSA. This study aimed to determine if genioglossus reflex responses to negative upper-airway pressure are altered in people with OSA and tetraplegia compared to non-neurologically impaired able-bodied individuals with OSA. Genioglossus reflex responses measured via intramuscular electrodes to ∼60 brief (250 ms) pulses of negative upper-airway pressure (∼-15 cmH2 O at the mask) were compared between 13 participants (2 females) with tetraplegia plus OSA and 9 able-bodied controls (2 females) matched for age and OSA severity. The initial short-latency excitatory reflex response was absent in 6/13 people with tetraplegia and 1/9 controls. Genioglossus reflex inhibition in the absence of excitation was observed in three people with tetraplegia and none of the controls. When the excitatory response was present, it was significantly delayed in the tetraplegia group compared to able-bodied controls: excitation onset latency (mean ± SD) was 32 ± 16 vs. 18 ± 9 ms, P = 0.045; peak excitation latency was 48 ± 17 vs. 33 ± 8 ms, P = 0.038. However, when present, amplitude of the excitation response was not different between groups, 195 ± 26 vs. 219 ± 98% at baseline, P = 0.55. There are major differences in genioglossus reflex morphology and timing in response to rapid changes in airway pressure in people with tetraplegia and OSA. Altered genioglossus function may contribute to the increased risk of OSA in people with tetraplegia. The precise mechanisms mediating these differences are unknown.


Assuntos
Músculos Faríngeos/fisiologia , Quadriplegia/fisiopatologia , Reflexo , Apneia Obstrutiva do Sono/fisiopatologia , Respiradores de Pressão Negativa , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
6.
J Heart Lung Transplant ; 37(4): 520-530, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29103845

RESUMO

BACKGROUND: Normothermic ex-vivo lung perfusion (EVLP) using positive pressure ventilation (PPV) and both acellular and red blood cell (RBC)-based perfusate solutions have increased the rate of donor organ utilization. We sought to determine whether a negative pressure ventilation (NPV) strategy would improve donor lung assessment during EVLP. METHODS: Thirty-two pig lungs were perfused ex vivo for 12 hours in a normothermic state, and were allocated equally to 4 groups according to the mode of ventilation (positive pressure ventilation [PPV] vs NPV) and perfusate composition (acellular vs RBC). The impact of ventilation strategy on the preservation of 6 unutilized human donor lungs was also evaluated. Physiologic parameters, cytokine profiles, lung injury, bullae and edema formation were compared between treatment groups. RESULTS: Perfused lungs demonstrated acceptable oxygenation (partial pressure of arterial oxygen/fraction of inspired oxygen ratio >350 mm Hg) and physiologic parameters. However, there was less generation of pro-inflammatory cytokines (tumor necrosis factor-α, interleukin-6 and interleukin-8) in human and pig lungs perfused, irrespective of perfusate solution used, when comparing NPV with PPV (p < 0.05), and a reduction in bullae formation with an NPV modality (p = 0.02). Pig lungs developed less edema with NPV (p < 0.01), and EVLP using an acellular perfusate solution had greater edema formation, irrespective of ventilation strategy (p = 0.01). Interestingly, human lungs perfused with NPV developed negative edema, or "drying" (p < 0.01), and lower composite acute lung injury (p < 0.01). CONCLUSIONS: Utilization of an NPV strategy during extended EVLP is associated with significantly less inflammation, and lung injury, irrespective of perfusate solution composition.


Assuntos
Circulação Extracorpórea/métodos , Transplante de Pulmão , Preservação de Órgãos/métodos , Pneumonia/prevenção & controle , Edema Pulmonar/prevenção & controle , Respiração Artificial/métodos , Adolescente , Adulto , Idoso , Animais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Técnicas de Cultura de Órgãos , Soluções para Preservação de Órgãos , Suínos , Respiradores de Pressão Negativa
7.
Respir Care ; 62(12): 1540-1549, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28860332

RESUMO

BACKGROUND: The objective of this work was to describe the use of negative-pressure ventilation (NPV) in a heterogeneous critically ill, pediatric population. METHODS: A retrospective chart review was conducted of all patients admitted to a pediatric ICU with acute respiratory failure supported with NPV from January 1, 2012 to May 15, 2015. RESULTS: Two hundred thirty-three subjects at a median age of 15.5 months were supported with NPV for various etiologies, most commonly bronchiolitis (70%). Median (interquartile range) duration of support was 18.7 (8.7-34.3) h. The majority were NPV responders (70%), defined as not needing escalation to any form of positive-pressure ventilation. In non-responders, escalation occurred at a median (interquartile range) of 6.9 (3.3-16.6) h. More NPV non-responders had upper-airway obstruction (P = .02), and fewer had bronchiolitis (P = .008) compared with responders. A bedside scoring system developed on these data was 98% specific in predicting NPV failure by 4 h after NPV start (area under the curve 0.759, 95% CI 0.675-0.843, P < .001). Complications from NPV were rare (3%); however, delayed enteral nutrition (33%) and continuous intravenous sedation use (51%) in children while receiving NPV were more frequent. The annual percentage of pediatric ICU admissions requiring intubation declined by 28% in the 3 y after NPV introduction, compared with the 3 y prior. CONCLUSIONS: NPV is a noninvasive respiratory support for pediatric acute respiratory failure from all causes with few complications and a 70% response rate. Children receiving NPV often required intravenous sedation for comfort, and one third received delayed enteral nutrition. Those who required escalation from NPV worsened within 6 h; this may be predictable with a bedside scoring system.


Assuntos
Ventilação não Invasiva/métodos , Insuficiência Respiratória/terapia , Respiradores de Pressão Negativa , Doença Aguda , Estado Terminal , Feminino , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Pediátrica , Masculino , Ventilação não Invasiva/instrumentação , Testes Imediatos , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/fisiopatologia , Estudos Retrospectivos , Resultado do Tratamento
9.
Medicine (Baltimore) ; 95(41): e5119, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27741132

RESUMO

Pulmonary rehabilitation (PR) brings benefits to patients with chronic obstructive pulmonary disease (COPD). Negative pressure ventilation (NPV) increases ventilation and decreases hyperinflation as well as breathing work in COPD. We evaluated the long-term effects of a hospital-based PR program coupled with NPV support in patients with COPD on clinical outcomes.One hundred twenty-nine patients with COPD were followed up for more than 5 years, with the NPV group (n = 63) receiving the support of NPV (20-30 cm H2O delivery pressure for 60 min) and unsupervised home exercise program of 20 to 30 min daily walk, while the control group (n = 6) only received unsupervised home exercise program. Pulmonary function tests and 6 min walk tests (6MWT) were performed every 3 to 6 months. Emergency room (ER) visits and hospitalization with medical costs were recorded.A significant time-by-group interaction in the yearly decline of forced expiratory volume in 1 s in the control group analyzed by mixed-model repeated-measure analysis was found (P = 0.048). The 6MWT distance of the NPV group was significantly increased during the first 4 years, with the interaction of time and group (P = 0.003), the time alone (P = 0.014), and the quadratic time (P < 0.001) being significant between the 2 groups. ER exacerbations and hospitalizations decreased by 66% (P < 0.0001) and 54% (P < 0.0001) in the NPV group, respectively. Patients on PR program coupled with NPV had a significant reduction of annual medical costs (P = 0.022).Our hospital-based multidisciplinary PR coupled with NPV reduced yearly decline of lung function, exacerbations, and hospitalization rates, and improved walking distance and medical costs in patients with COPD during a 5-year observation.


Assuntos
Volume Expiratório Forçado/fisiologia , Custos de Cuidados de Saúde/estatística & dados numéricos , Hospitalização/tendências , Pulmão/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/reabilitação , Respiração Artificial/instrumentação , Respiradores de Pressão Negativa , Idoso , Feminino , Seguimentos , Humanos , Masculino , Doença Pulmonar Obstrutiva Crônica/economia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Testes de Função Respiratória , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
10.
Neumol. pediátr. (En línea) ; 11(4): 151-154, oct. 2016.
Artigo em Espanhol | LILACS | ID: biblio-835073

RESUMO

This review is a short history of mechanical ventilation, from its origins to the present day. This changing history provides the basis for speculation on the future innovations in the ventilatory support.


Se revisa la historia de la ventilación mecánica desde sus orígenes hasta el presente, una historia cambiante que permite especular sobre las futuras innovaciones en el soporte ventilatorio.


Assuntos
História do Século XIX , História do Século XX , Respiração com Pressão Positiva/história , Respiradores de Pressão Negativa/história , Respiração Artificial/história
11.
Sleep Breath ; 20(2): 663-71, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-26483265

RESUMO

PURPOSE: Oral pressure therapy (OPT) has emerged as a novel technique to treat obstructive sleep apnea (OSA) in the past few years. Given this is a relatively new treatment approach, currently, little is known with respect to its clinical utility. The aim of this review was to explore the success rate of OPT when used to treat OSA. METHODS: PubMed, MEDLINE, Scopus, Web of Science, and the Cochrane Library databases were searched for pertinent studies. RESULTS: The OPT treatment success rates varied widely between 25 and 79 % depending on the residual apnea-hypopnea index (AHI) cut off defined for treatment success. When using standard definitions (at least 50 % reduction from the baseline AHI and the post-OPT treatment residual AHI less than or equal to 10), the success rate of OPT treatment varied between 25 and 37 %. CONCLUSIONS: Although there was a significant reduction in AHI with OPT, the baseline AHI was not suppressed in majority of patients to the extent to call these patients as optimally treated. Successful treatment with OPT did not correlate with severity of OSA; however, patients with retro-palatal collapse responded better to treatment. Further research is needed to identify OSA patients who would benefit with this treatment modality.


Assuntos
Desenho de Equipamento , Polissonografia , Apneia Obstrutiva do Sono/terapia , Respiradores de Pressão Negativa , Humanos , Apneia Obstrutiva do Sono/diagnóstico , Vácuo
12.
Rev. med. interna Guatem ; 19(1): 49-51, ene-abr. 2015. ilus
Artigo em Espanhol | LILACS | ID: biblio-982119

RESUMO

El edema pulmonar por presión negativa representa el 0.1% de las complicaciones pulmonares de los pacientes post ­ quirúrgicos, y la condicionante del incremento de dicha incidencia es la existencia de algún tipo de obstrucción de la vía aérea llegando hasta un 11% de casos. Su incidencia y prevalencia no son claras ya que es una entidad con infradiagnóstico. En los reportes de casos se coincide que la mayoría de pacientes son jóvenes con evaluaciones de riesgo quirúrgico bajos previamente sanos y que desarrollan en forma súbita un cuadro de edema agudo de pulmón, casi siempre posterior a la anesthesia, encontrándose ya no orointubados...(AU)


Assuntos
Humanos , Masculino , Apendicite/cirurgia , Edema Pulmonar/diagnóstico , Síndrome do Desconforto Respiratório do Adulto/tratamento farmacológico , Respiradores de Pressão Negativa/estatística & dados numéricos
13.
Curr Opin Pulm Med ; 20(6): 618-22, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25225790

RESUMO

PURPOSE OF REVIEW: The use of noninvasive ventilatory support in patients with cystic fibrosis (CF) has increased exponentially over the past 2 decades. This review examines the current knowledge and considers potential future directions for use of noninvasive ventilation in CF patients. RECENT FINDINGS: Noninvasive ventilation was originally reported as a bridge to transplantation in CF patients with severe respiratory failure but is now used as a long-term treatment modality for patients with respiratory failure independent of transplant status. In 2013 to 2014, over 400 publications on noninvasive ventilation demonstrate its increasing clinical application, however only seven reference CF. Recent technological advances and potential benefits to CF patients are considered. SUMMARY: The role of noninvasive ventilation in CF patients in chronic respiratory failure is established, but future prospective studies are needed to determine further indications and optimal timing of this intervention. Developments in both ventilator and interface design may enhance the efficacy of ventilation in CF patients but require careful individualized assessment and regular review. The implications on treatment burden and quality of life in CF also need to be studied.


Assuntos
Fibrose Cística/terapia , Ventilação não Invasiva , Insuficiência Respiratória/terapia , Músculos Respiratórios/fisiopatologia , Respiradores de Pressão Negativa , Fibrose Cística/complicações , Fibrose Cística/fisiopatologia , Humanos , Transplante de Pulmão , Seleção de Pacientes , Estudos Prospectivos , Qualidade de Vida , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/fisiopatologia , Resultado do Tratamento
15.
Ind Health ; 52(4): 304-12, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24705801

RESUMO

The purpose of this study was to examine the heat stress effects of three protective clothing ensembles: (1) protective apron over cloth coveralls including full face negative pressure respirator (APRON); (2) the apron over cloth coveralls with respirator plus protective pants (APRON+PANTS); and (3) protective coveralls over cloth coveralls with respirator (PROTECTIVE COVERALLS). In addition, there was a no-respirator ensemble (PROTECTIVE COVERALLS-noR), and WORK CLOTHES as a reference ensemble. Four acclimatized male participants completed a full set of five trials, and two of the participants repeated the full set. The progressive heat stress protocol was used to find the critical WBGT (WBGTcrit) and apparent total evaporative resistance (Re,T,a) at the upper limit of thermal equilibrium. The results (WBGTcrit [°C-WBGT] and Re,T,a [kPa m(2) W(-1)]) were WORK CLOTHES (35.5, 0.0115), APRON (31.6, 0.0179), APRON+PANTS (27.7, 0.0244), PROTECTIVE COVERALLS (25.9, 0.0290), and PROTECTIVE COVERALLS-noR (26.2, 0.0296). There were significant differences among the ensembles. Supporting previous studies, there was little evidence to suggest that the respirator contributed to heat stress.


Assuntos
Transtornos de Estresse por Calor/etiologia , Roupa de Proteção/efeitos adversos , Respiradores de Pressão Negativa/efeitos adversos , Metabolismo Basal , Regulação da Temperatura Corporal , Humanos , Masculino , Adulto Jovem
16.
J Neurophysiol ; 111(12): 2656-64, 2014 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-24671536

RESUMO

Unloading of the baroreceptors due to orthostatic stress increases corticospinal excitability. The purpose of this study was to examine the effects of baroreceptor unloading due to orthostatic stress on intracortical excitatory and inhibitory pathways in the motor cortex. With transcranial magnetic stimulation, measures of intracortical excitability for a hand muscle were tested on 2 days in healthy young adults. Lower body negative pressure (LBNP) of 40 mmHg was applied during one of the days and not during the Control day. During application of LBNP heart rate and the low-frequency component of heart rate variability increased, while mean arterial blood pressure was maintained. In the resting state, LBNP decreased short-interval intracortical inhibition (SICI) and had no effect on intracortical facilitation (ICF) or short-interval intracortical facilitation (SICF) compared with the Control day. During isometric contraction, no effects of LBNP were observed on tested measures of intracortical excitability including SICI, SICF, and cortical silent period. It was concluded that baroreceptor unloading due to orthostatic stress results in diminished intracortical inhibition, at least in the resting muscle.


Assuntos
Córtex Motor/fisiologia , Pressorreceptores/fisiologia , Estresse Fisiológico/fisiologia , Pressão Sanguínea/fisiologia , Potencial Evocado Motor , Feminino , Mãos/fisiologia , Frequência Cardíaca/fisiologia , Humanos , Contração Isométrica/fisiologia , Masculino , Músculo Esquelético/fisiologia , Vias Neurais/fisiologia , Tratos Piramidais/fisiologia , Descanso/fisiologia , Estimulação Magnética Transcraniana , Respiradores de Pressão Negativa , Adulto Jovem
17.
Anesthesiology ; 120(4): 943-50, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24270126

RESUMO

BACKGROUND: Recent studies in healthy mice and rats have reported that positive pressure ventilation delivered with physiological tidal volumes at normal end-expiratory volume worsens lung mechanics and induces cytokine release, thus suggesting that detrimental effects are due to positive pressure ventilation per se. The aim of this study in healthy animals is to assess whether these adverse outcomes depend on the mode of mechanical ventilation. METHODS: Rats were subjected to 4 h of spontaneous, positive pressure, and whole-body or thorax-only negative pressure ventilation (N = 8 per group). In all instances the ventilatory pattern was that of spontaneous breathing. Lung mechanics, cytokines concentration in serum and broncho-alveolar lavage fluid, lung wet-to-dry ratio, and histology were assessed. Values from eight animals euthanized shortly after anesthesia served as control. RESULTS: No evidence of mechanical ventilation-dependent lung injury was found in terms of lung mechanics, histology, or wet-to-dry ratio. Relative to control, cytokine levels and recruitment of polymorphonuclear leucocytes increased slightly, and to the same extent with spontaneous, positive pressure, and whole-body negative pressure ventilation. Thorax-only negative pressure ventilation caused marked chest and lung distortion, reversible increase of lung elastance, and higher polymorphonuclear leucocyte count and cytokine levels. CONCLUSION: Both positive and negative pressure ventilation performed with tidal volumes and timing of spontaneous, quiet breathing neither elicit an inflammatory response nor cause morpho-functional alterations in normal animals, thus supporting the notion of the presence of a critical volume threshold above which acute lung injury ensues. Distortion of lung parenchyma can induce an inflammatory response, even in the absence of volotrauma.


Assuntos
Pulmão/fisiologia , Modelos Animais , Respiração Artificial/métodos , Respiração Artificial/veterinária , Mecânica Respiratória/fisiologia , Animais , Líquido da Lavagem Broncoalveolar , Citocinas/sangue , Citocinas/metabolismo , Feminino , Masculino , Respiração com Pressão Positiva , Gravidez , Ratos , Ratos Sprague-Dawley , Valores de Referência , Respiração , Volume de Ventilação Pulmonar/fisiologia , Respiradores de Pressão Negativa
18.
Cochrane Database Syst Rev ; (11): CD003699, 2013 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-24186774

RESUMO

BACKGROUND: Acute hypoxaemic respiratory failure (AHRF) is an important cause of mortality and morbidity in children. Positive pressure ventilation is currently the standard care, however, it does have complications. Continuous negative extrathoracic pressure (CNEP) ventilation or continuous positive airway pressure (CPAP) ventilation delivered via non-invasive approaches (Ni-CPAP) have shown certain beneficial effects in animal and uncontrolled human studies. OBJECTIVES: To assess the effectiveness of CNEP or Ni-CPAP compared to conventional ventilation in children (at least one month old and less than 18 years of age) with AHRF due to non-cardiogenic causes for improving the mortality or morbidity associated with AHRF. SEARCH METHODS: We searched CENTRAL 2013, Issue 6, MEDLINE (January 1966 to June week 3, 2013), EMBASE (1980 to July 2013) and CINAHL (1982 to July 2013). SELECTION CRITERIA: Randomised or quasi-randomised clinical trials of CNEP or Ni-CPAP versus standard therapy (including positive pressure ventilation) involving children (from one month old to less than 18 years at time of randomisation) who met the criteria for diagnosis of AHRF with at least one of the outcomes reported. DATA COLLECTION AND ANALYSIS: We assessed risk of bias of the included studies using allocation concealment, blinding of intervention, completeness of follow-up and blinding of outcome measurements. We abstracted data on relevant outcomes and estimated the effect size by calculating risk ratio (RR) and risk difference (RD) with 95% confidence intervals (CI). MAIN RESULTS: We identified two eligible studies: one of CPAP and one of CNEP (published as an abstract). Both were unblinded studies with mainly unclear risk of bias due to lack of adequate information to assess this. The CPAP study enrolled 37 children to oxygen mask and CPAP and reported improvement in respiratory rate and oxygen saturation in both arms after 30 minutes of application. The CNEP study was published as an abstract and included 33 infants with bronchiolitis. In the CNEP study there was a reduction in the fraction of inspired oxygen (FiO2) (less than 30% within one hour of initiation of therapy) in four participants in the CNEP group compared to none in the control group (RR 10.7, 95% CI 0.6 to 183.9). One infant required CPAP and mechanical ventilation in the control group while all infants in the CNEP group were managed without intubation (RR for both outcomes 0.40, 95% CI 0.02 to 9.06). None of the trials reported on mortality. No adverse events were reported in ether of the included trials. AUTHORS' CONCLUSIONS: There is a lack of well-designed, controlled trials of non-invasive modes of respiratory support in children with AHRF. Studies assessing the outcomes mortality, avoidance of intubation and its associated complications, hospital stay and patient comfort are needed.


Assuntos
Hipóxia/terapia , Respiração Artificial/métodos , Insuficiência Respiratória/terapia , Bronquiolite/terapia , Pressão Positiva Contínua nas Vias Aéreas/métodos , Dengue/complicações , Humanos , Lactente , Recém-Nascido , Respiradores de Pressão Negativa
19.
Expert Rev Respir Med ; 7(6): 615-29, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24175738

RESUMO

Following the classic 'iron lung' non-invasive negative pressure ventilator, non-invasive positive pressure ventilation (NIPPV), particularly used 'nocturnally' has developed a broad role in both the acute hospital setting and domiciliary long-term use for many cardio-respiratory disorders associated with acute and chronic ventilatory failure. This role is based in part upon the perceived relative ease of application and discontinuation of NIPPV, ability to avoid intubation or tracheostomy and their associated morbidities and availability of increasingly portable pressure and volume cycled NIPPV devices. Nevertheless, the many methodologies necessary for optimal NIPPV use are often underappreciated by health care workers and patients alike. This review focuses on the rationale, practice, and future directions for 'nocturnal' use of non-invasive positive pressure ventilation (nNIV) in cardio-respiratory disorders in adults which are commonly associated with sleep-related apnea, hypoventilation and hypoxemia: congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), obesity hypoventilation syndrome (OHS), cystic fibrosis (CF) and neuromuscular disorders.


Assuntos
Ritmo Circadiano , Ventilação não Invasiva/instrumentação , Respiração com Pressão Positiva/instrumentação , Insuficiência Respiratória/terapia , Respiradores de Pressão Negativa , Adulto , Fibrose Cística/terapia , Insuficiência Cardíaca/terapia , Humanos , Síndrome de Hipoventilação por Obesidade/terapia , Doença Pulmonar Obstrutiva Crônica/terapia , Síndromes da Apneia do Sono/terapia
20.
Acta otorrinolaringol. esp ; 64(4): 300-302, jul.-ago. 2013. ilus
Artigo em Espanhol | IBECS | ID: ibc-116632

RESUMO

El edema pulmonar por presión negativa (NPPE) es una complicación anestésica por obstrucción aguda de la vía aérea superior, su principal causa es el laringoespasmo. La fisiopatología radica en una marcada presión negativa intrapleural durante una inspiración contra glotis cerrada, la cual desencadena una presión excesiva en la microvasculatura pulmonar. El diagnóstico puede ser difícil, su reconocimiento ayuda a minimizar la morbimortalidad. En este artículo se presenta un caso de NPPE por laringoespasmo postextubación (AU)


Negative pressure pulmonary oedema (NPPO) is an anaesthetic complication due to acute obstruction of the upper airway, whose main cause is laryngospasm. The pathophysiology involves a strong negative intrapleural pressure during inspiration against a closed glottis, which triggers excessive pressure in the pulmonary microvasculature. Although its diagnosis can be difficult, its recognition helps to minimise morbidity and mortality. This article presents a case of NPPO due to postextubation laryngospasm (AU)


Assuntos
Humanos , Masculino , Adulto , Laringismo/etiologia , Extubação/efeitos adversos , Edema Pulmonar/etiologia , Rinoplastia/efeitos adversos , Respiradores de Pressão Negativa/efeitos adversos , Respiração Artificial/efeitos adversos
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