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Extracorporeal Membrane Oxygenation
Published in Stephen M. Cohn, Alan Lisbon, Stephen Heard, 50 Landmark Papers, 2021
Ronny Munoz-Acuna, Ameeka Pannu
Despite multiple investigations into therapeutic interventions, decreasing ventilator-induced lung injury (VILI) remains the mainstay of ARDS management. Decreasing VILI includes mitigating the risk of volutrauma, barotrauma, atelectrauma, and biotrauma during mechanical ventilation, thus adopting a “lung-protective” ventilation strategy [5]. Given the results of these landmark trials, there has also been investigation into other gas exchange methods that may further protect diseased lung.
Rehabilitation in the intensive care unit
Published in Claudio F. Donner, Nicolino Ambrosino, Roger S. Goldstein, Pulmonary Rehabilitation, 2020
Piero Ceriana, Nicolino Ambrosino
For many years, based on a ‘conservative’ paradigm, mobilization and physiotherapy of critically ill patients was considered unsafe and was postponed until after discharge from the ICU. Patients were considered too sick for any form of physical activity (PA) and there was also concern that activity might dislodge intracavitary tubes and intravascular lines. Support for the viewpoint came from observations such as: Bed rest requiring a lower muscle oxygen consumption results in more availability to repair vital organs.Lower ventilatory requirements diminish the risk of ventilator-induced lung injury, allowing lower tidal volumes and a lower inspired oxygen fraction.The supine position could facilitate blood flow to the brain, reduce the risk of falls and reduce pain to injured parts of the body.Lower blood pressure and oxygen consumption could mean less cardiac workload and a lower risk of arrhytmias and ischaemia.
3D In Vitro/Ex Vivo Systems
Published in Anthony J. Hickey, Sandro R.P. da Rocha, Pharmaceutical Inhalation Aerosol Technology, 2019
Bethany M. Young, Alexandria Ritchie, Laleh Golshahi, Rebecca L. Heise
EVPLs have advantages and disadvantages over in vivo or in vitro models. EVPLs are seen as a highly translatable testing system that can be continuously monitored in a way that would be considered invasive in vivo. Compared to in vitro methods, they can analyze the behavior of multiple tissues and cell types that perform normal physiological functions such as bronchoconstriction and vasoconstriction (Ewing et al. 2010). While this is a very promising tool for aerosol testing, there are aspects of the system that may be problematic. Inflammatory mediators within the lung during removal can cause substantial inflammation and cause damage to the tissue. There can also be an injury caused by the chosen protocol as well, including, but not limited to, compromised blood supply (Tanaka et al. 2015; Tane et al. 2017) and complications caused by ventilator-induced lung injury that is seen with any lung placed on a ventilator for a prolonged amount of time. EVPL is recommended for only deposition and initial lung function assessments because of the decrease in lung viability after only several hours. Even with these substantial limitations for the EVPL, this is a suitable predictive model that closely correlates to in vivo results when concerning kinetics and deposition (Sakagami 2006; Selg et al. 2012).
Critical care
Published in Canadian Journal of Respiratory, Critical Care, and Sleep Medicine, 2021
Ricardo Teijeiro Paradis, Ghislaine Douflé, John Granton
Mechanical ventilation is a double edged sword. The Lung Safe study results provided valuable insight into gaps in the recognition and subsequent management of patients suffering from ARDS. Despite evidence of harm caused by ventilator-induced lung injury, ARDS remained underdiagnosed and adherence to lung-protective ventilation principles was inconsistent.2 Gaps in the recognition of ARDS and inadequate implementation of lung-protective ventilation raises significant concerns. In the retrospective analysis by Urner and colleagues, exposure to high driving pressure and mechanical power even for a short duration, was associated with higher mortality.3 This study supports the notion that limiting the intensity of mechanical ventilation early and throughout ventilatory support may be beneficial.
COMPARATIVE STUDY BETWEEN THE EFFECT OF VOLUME-CONTROLLED VENTILATION AND PRESSURE CONTROLLED VENTILATION VOLUME GUARANTEED ON GAS EXCHANGE AND RESPIRATORY DYNAMICS DURING ONE-LUNG VENTILATION
Published in Egyptian Journal of Anaesthesia, 2021
Ahmed A. Ammar, Abdelkader Z. Abdelkader, Sherif M. Elhady, Ahmed G. Yacout
The present study shows that increased TNFα level immediately after surgery is directly correlated with increased peak airway pressure (Pearson correlation coefficient is 0.400) and inversely correlated with dynamic compliance (Pearson correlation coefficient is −0.433). Many experimental studies have reported the effect of peak inspiratory flow on ventilator-induced lung injury (VILI). For our current knowledge, this is the first human study reporting correlation between peak airway pressure and lung injury. In an experimental study on rabbits, Yoshiko Maeda et al. studied injurious effects of high peak airway pressure on development of ventilator-induced lung injury and concluded that when an injurious TV delivered at a higher peak flow, the deterioration in lung histology appears to be more marked than when it is delivered at a lower peak flow in an animal model [22].
Effect of extracorporeal membrane oxygenation transport on short- and long-term survival in patients with acute respiratory distress syndrome
Published in Baylor University Medical Center Proceedings, 2020
Desiree A. Steimer, Omar Hernandez, Gerald Ogola, David P. Mason, Gary S. Schwartz
Despite similar lengths of stay, ECMO-related complications, and survival, the duration of ECMO was significantly different between the two cohorts (Table 3). Patients are only separated from ECMO when they demonstrate pulmonary recovery and therefore the duration of ECMO support is a reflection of the severity of ARDS. Other established surrogate markers of respiratory failure such as PaO2/FiO2 ratio, Acute Physiology and Chronic Health Evaluation score, and Respiratory ECMO Survival Prediction score provide a static assessment at the time of cannulation and are not true markers of ongoing pathophysiology. Duration of ECMO support is a continuous measurement that represents the dynamic nature of ARDS recovery. We believe that ECMO duration can be influenced by the timing of cannulation. Patients cannulated early experience less ventilator-induced lung injury as a secondary insult and therefore may have accelerated pulmonary recovery.18