WorldWideScience

Sample records for airway pressure release

  1. Comparison of Airway Pressure Release Ventilation to Conventional Mechanical Ventilation in the Early Management of Smoke Inhalation Injury in Swine

    Science.gov (United States)

    2011-01-01

    acute respiratory distress syndrome developed ( PaO2 /FIO2 ratio ), plateau pressures were limited to ន cm H2O. Six uninjured pigs received...conventional mechanical ventilation for 48 hrs and served as time controls. Changes in PaO2 /FIO2 ratio, tidal volume, respiratory rate, mean airway pressure...plateau pressure, and hemody- namic variables were recorded. Survival was assessed using Kaplan- Meier analysis. PaO2 /FIO2 ratio was lower in airway

  2. Nasal continuous positive airway pressure

    DEFF Research Database (Denmark)

    Scholze, Alexandra; Lamwers, Stephanie; Tepel, Martin;

    2012-01-01

    Obstructive sleep apnoea (OSA) is linked to increased cardiovascular risk. This risk can be reduced by nasal continuous positive airway pressure (nCPAP) treatment. As OSA is associated with an increase of several vasoconstrictive factors, we investigated whether nCPAP influences the digital volum...

  3. [A case of respiratory insufficiency after resection of the aortic aneurysm and replacement with a synthetic conduit which recovered by airway pressure release ventilation].

    Science.gov (United States)

    Shimoyama, Yuichiro; Majima, Nozomi; Kadono, Noriko; Ito, Masayuki; Agui, Tomoyuki; Umegaki, Osamu; Minami, Toshiaki

    2011-04-01

    We experienced a patient with respiratory insufficiency after resection of the aortic aneurysm and replacement with a synthetic conduit which recovered by airway pressure release ventilation (APRV) dramatically. A 44-year-old man diagnosed as aortic aneurysm of the descending thoracic aorta was admitted to our hospital and an operation was scheduled. The operation lasted for 19 hours and the time of general anesthesia was 23 hours. The immediate post-operative chest x-ray showed atelectasis of the right upper lobe, elevated right diaphragm and poor aeration of the lungs. A volume-limited mechanical ventilation was used for this patient postoperatively in ICU. But accumulation of carbon dioxide and poor oxygenation were observed. We started APRV by Bennet 840 (Tyco Healthcare, Tokyo). Specifically, we used Bilevel mode (PEEP 20/3 cmH20/3, inspiratory time 3.2 seconds, respiratory rate 15 times per minute, pressure support 20 cm H2O, FI(O2) 1.0). Promptly accumulation of carbon dioxide was improved and atelectasis of the right upper lobe vanished. Additionally, oxygenation was improved. He was weaned from a ventilator on postoperative day 5. We have demonstrated that APRV is an important tool that should be used to improve severe respiratory insufficiency.

  4. Ventilación con liberación de presión en la vía aérea, en neonatos con insuficiencia respiratoria aguda Airway pressure release ventilation in newborns

    Directory of Open Access Journals (Sweden)

    Emmanuel Jiménez-Castro

    2013-06-01

    Full Text Available La ventilación con liberación de presión en la vía aérea (APRVes una modalidad ventilatoria que utiliza presión positiva controlada en la vía aérea, con el fin de maximizar el reclutamiento alveolar, con tiempos inspiratorios prolongados, permitiendo la respiración espontánea durante ambas fases del ciclo respiratorio. Los autores describen su experiencia en una serie de 12 casos con pacientes neonatales con insuficiencia respiratoria aguda, que fueron tratados con la APRV ventilación con liberación de presión en la vía aérea, cuando la oxigenación no mejoró con la ventilación de control de presión. La edad media de los pacientes fue de 13± 16,5 días. La fracción inspirada de oxígeno disminuyó de 62,9±23,6 cm H2O para la ventilación de control de presión, a 44±14,0 cm H2O, para la APRV. El promedio de presión parcial de oxígenoaumentó de 54,6 ± 11,9mmHg a 92±32mmH; el promedio de presión parcial de CO2 disminuyó de 53,2±15,6 mmHg a 43,1±10mmHg, y la presión pico de la vía aérea se redujo de 16,8±5,9cm H2O a 16,6±5,3 cm de H2O, respectivamente. La ventilación con liberación de presión en la vía aérea, puede mejorar la oxigenación en pacientes pediátricos con insuficiencia respiratoria aguda, cuando la ventilación mecánica convencional falla.Airway pressure release ventilation is a mechanical ventilation method that uses a controlled positive airway pressure in order to maximize alveolar recruitment, with prolonged inspiratory times, therefore allowing spontaneous breathing during both phases of the respiratory cycle. The authors describe their experience in twelve cases of newborn patients with acute respiratory failure treated with airway pressure release ventilation when oxygenation did not improve with pressure control ventilation. The mean age of patients was 13 ± 16.5 days. The fractional concentration of oxygen (FiO2 decreased from 62.9 ± 23.6 cmH2O for pressure control ventilation to 44

  5. Continuous positive airway pressure therapy: new generations.

    LENUS (Irish Health Repository)

    Garvey, John F

    2012-02-01

    Continuous positive airway pressure (CPAP) is the treatment of choice for obstructive sleep apnoea syndrome (OSAS). However, CPAP is not tolerated by all patients with OSAS and alternative modes of pressure delivery have been developed to overcome pressure intolerance, thereby improving patient comfort and adherence. Auto-adjustable positive airway pressure (APAP) devices may be utilised for the long-term management of OSAS and may also assist in the initial diagnosis of OSAS and titration of conventional CPAP therapy. Newer modalities such as C-Flex and A-Flex also show promise as treatment options in the future. However, the evidence supporting the use of these alternative modalities remains scant, in particular with regard to long-term cardiovascular outcomes. In addition, not all APAP devices use the same technological algorithms and data supporting individual APAP devices cannot be extrapolated to support all. Further studies are required to validate the roles of APAP, C-Flex and A-Flex. In the interim, standard CPAP therapy should continue as the mainstay of OSAS management.

  6. Continuous positive airway pressure therapy: new generations.

    LENUS (Irish Health Repository)

    Garvey, John F

    2010-02-01

    Continuous positive airway pressure (CPAP) is the treatment of choice for obstructive sleep apnoea syndrome (OSAS). However, CPAP is not tolerated by all patients with OSAS and alternative modes of pressure delivery have been developed to overcome pressure intolerance, thereby improving patient comfort and adherence. Auto-adjustable positive airway pressure (APAP) devices may be utilised for the long-term management of OSAS and may also assist in the initial diagnosis of OSAS and titration of conventional CPAP therapy. Newer modalities such as C-Flex and A-Flex also show promise as treatment options in the future. However, the evidence supporting the use of these alternative modalities remains scant, in particular with regard to long-term cardiovascular outcomes. In addition, not all APAP devices use the same technological algorithms and data supporting individual APAP devices cannot be extrapolated to support all. Further studies are required to validate the roles of APAP, C-Flex and A-Flex. In the interim, standard CPAP therapy should continue as the mainstay of OSAS management.

  7. Release of beryllium into artificial airway epithelial lining fluid.

    Science.gov (United States)

    Stefaniak, Aleksandr B; Virji, M Abbas; Day, Gregory A

    2012-01-01

    Inhaled beryllium particles that deposit in the lung airway lining fluid may dissolve and interact with immune-competent cells resulting in sensitization. As such, solubilization of 17 beryllium-containing materials (ore, hydroxide, metal, oxide, alloys, and process intermediates) was investigated using artificial human airway epithelial lining fluid. The maximum beryllium release in 7 days was 11.78% (from a beryl ore melter dust), although release from most materials was beryllium ions may be released in the respiratory tract via dissolution in airway lining fluid. Beryllium-containing particles that deposit in the respiratory tract dissolve in artificial lung epithelial lining fluid, thereby providing ions for absorption in the lung and interaction with immune-competent cells in the respiratory tract.

  8. Acrolein stimulates eicosanoid release from bovine airway epithelial cells

    Energy Technology Data Exchange (ETDEWEB)

    Doupnik, C.A.; Leikauf, G.D. (Univ. of Cincinnati College of Medicine, OH (USA))

    1990-10-01

    Injury to the airway mucosa after exposure to environmental irritants is associated with pulmonary inflammation and bronchial hyperresponsiveness. To better understand the relationships between mediator release and airway epithelial cell injury during irritant exposures, we studied the effects of acrolein, a low-molecular-weight aldehyde found in cigarette smoke, on arachidonic acid metabolism in cultured bovine tracheal epithelial cells. Confluent airway epithelial cell monolayers, prelabeled with (3H)arachidonic acid, released significant levels of 3H activity when exposed (20 min) to 100 microM acrolein. (3H)arachidonic acid products were resolved using reverse-phase high-performance liquid chromatography. Under control conditions the released 3H activity coeluted predominantly with the cyclooxygenase product, prostaglandin (PG) E2. After exposure to acrolein, significant peaks in 3H activity coeluted with the lipoxygenase products 12-hydroxyeicosatetraenoic acid (HETE) and 15-HETE, as well as with PGE2, PGF2 alpha, and 6-keto-PGF1 alpha. Dose-response relationships for acrolein-induced release of immunoreactive PGF2 alpha and PGE2 from unlabeled epithelial monolayers demonstrated 30 microM acrolein as the threshold dose, with 100 microM acrolein inducing nearly a fivefold increase in both PGF2 alpha and PGE2. Cellular viability after exposure to 100 microM acrolein, determined by released lactate dehydrogenase activity, was not affected until exposure periods were greater than or equal to 2 h. These results implicate the airway epithelial cell as a possible source of eicosanoids after exposure to acrolein.

  9. Walking with continuous positive airway pressure

    NARCIS (Netherlands)

    Dieperink, W.; Goorhuis, JF; de Weerd, W; Hazenberg, A; Zijistra, JG; Nijsten, MWN

    2006-01-01

    A ventilator-dependent child had been in the paediatric intensive care unit (PICU) ever since birth. As a result, she had fallen behind considerably in her development. After 18 months, continuous positive airway tracheostomy tube with a novel lightweight device device, the child was discharged home

  10. Genioglossus muscle responses to upper airway pressure changes: afferent pathways.

    Science.gov (United States)

    Mathew, O P; Abu-Osba, Y K; Thach, B T

    1982-02-01

    The afferent pathway of an upper airway reflex in which genioglossus muscle electromyographic (GG EMG) activity is influenced by pharyngeal pressure changes was investigated in 20 anesthetized rabbits. We took advantage of the fact that the upper airway was separated into two compartments by pharyngeal closure occurring when the animals breathe through a tracheostomy. This allowed pressure to be delivered selectively either to the nose and nasopharynx or to the larynx and hypopharynx. Midcervical vagotomy did not eliminate the GG EMG response to pressure stimuli. On the other hand high cervical vagotomy or superior laryngeal nerve section eliminated the response in the laryngeal compartment, but not in the nasopharyngeal compartment. Topical anesthesia of the mucosa of the nose, pharynx, and larynx abolished the response in both compartments. Therefore we conclude that more than one afferent pathway exists for this upper airway pressure reflex; the primary afferent pathway from the laryngeal compartment is the superior laryngeal branch of the vagus nerve, whereas the primary afferent pathway for the nasopharynx is nonvagal. Trigeminal nerve, glossopharyngeal nerve, and/or nervus intermedius carry nonvagal afferents from the nasopharynx and nose. The topical anesthetic and nerve section studies suggest that superficial receptors mediate this response. The occurrence of swallowing in response to upper airway pressure changes and its elimination by topical anesthesia or superior mechanoreceptors may mediate both genioglossus respiratory responses and swallowing responses.

  11. Multiple applications of the Boussignac continuous positive airway pressure system

    NARCIS (Netherlands)

    Dieperink, Willem

    2008-01-01

    Continuous positive airway pressure, (CPAP) is a form of treatment to support patients with dyspnea. For the application of CPAP a mechanical ventilator or complex CPAP apparatus is mostly used. The Boussignac CPAP (BCPAP) system developed by George Boussignac does not need such apparatus. The BCPAP

  12. Continuous Positive Airway Pressure Strategies with Bubble Nasal Continuous Positive Airway Pressure: Not All Bubbling Is the Same: The Seattle Positive Airway Pressure System.

    Science.gov (United States)

    Welty, Stephen E

    2016-12-01

    Premature neonates are predisposed to complications, including bronchopulmonary dysplasia (BPD). BPD is associated with long-term pulmonary and neurodevelopmental consequences. Noninvasive respiratory support with nasal continuous positive airway pressure (CPAP) has been recommended strongly by the American Academy of Pediatrics. However, CPAP implementation has shown at least a 50% failure rate. Enhancing nasal CPAP effectiveness may decrease the need for mechanical ventilation and reduce the incidence of BPD. Bubble nasal CPAP is better than nasal CPAP using mechanical devices and the bubbling provides air exchange in distal respiratory units. The Seattle PAP system reduces parameters that assess work of breathing.

  13. Comparison of Efficacy and Tolerance of Automatic Continuous Positive Airway Pressure Devices With the Optimum Continuous Positive Airway Pressure.

    Science.gov (United States)

    Tommi, George; Aronow, Wilbert S; Sheehan, John C; McCleay, Matthew T; Meyers, Patrick G

    Patients diagnosed with obstructive sleep apnea syndrome were randomly placed on automatic continuous positive airway pressure (ACPAP) for 2 hours followed by manual titration for the rest of the night. One hundred sixty-one patients entered the study, with at least 50 patients titrated with each of 3 ACPAP devices. The optimum continuous positive airway pressure (CPAP) was defined as the lowest pressure with an apnea-hypoxia index of ≤5/hr, which ranged from 4 cm to 18 cm. Success with ACPAP was approximately 60%-80% when the optimum CPAP was 4-6 cm but fell to below 30% if the optimum CPAP was ≥8 cm (P = 0.001). Average ACPAP ranged from 2 to 10 cm below the optimum level if the optimum CPAP was ≥8 cm. Patients who responded to a low CPAP but deteriorated on higher pressures failed to respond to any of the automatic devices. We recommend that CPAP titration be performed manually before initiation of ACPAP in patients with obstructive sleep apnea. The basal pressure for ACPAP should be the optimum pressure obtained by manual titration. Limits on the upper level of ACPAP may be necessary for patients who deteriorate on higher positive pressures.

  14. ATP induced MUC5AC release from human airways in vitro

    Directory of Open Access Journals (Sweden)

    Patricia Roger

    2000-01-01

    Full Text Available Background: Chronic airway diseases are often associated with marked mucus production, however, little is known about the regulation of secretory activity by locally released endogenous mediators.

  15. Bronchoconstriction Induces TGF-β Release and Airway Remodelling in Guinea Pig Lung Slices.

    Directory of Open Access Journals (Sweden)

    Tjitske A Oenema

    Full Text Available Airway remodelling, including smooth muscle remodelling, is a primary cause of airflow limitation in asthma. Recent evidence links bronchoconstriction to airway remodelling in asthma. The mechanisms involved are poorly understood. A possible player is the multifunctional cytokine TGF-β, which plays an important role in airway remodelling. Guinea pig lung slices were used as an in vitro model to investigate mechanisms involved in bronchoconstriction-induced airway remodelling. To address this aim, mechanical effects of bronchoconstricting stimuli on contractile protein expression and TGF-β release were investigated. Lung slices were viable for at least 48 h. Both methacholine and TGF-β1 augmented the expression of contractile proteins (sm-α-actin, sm-myosin, calponin after 48 h. Confocal fluorescence microscopy showed that increased sm-myosin expression was enhanced in the peripheral airways and the central airways. Mechanistic studies demonstrated that methacholine-induced bronchoconstriction mediated the release of biologically active TGF-β, which caused the increased contractile protein expression, as inhibition of actin polymerization (latrunculin A or TGF-β receptor kinase (SB431542 prevented the methacholine effects, whereas other bronchoconstricting agents (histamine and KCl mimicked the effects of methacholine. Collectively, bronchoconstriction promotes the release of TGF-β, which induces airway smooth muscle remodelling. This study shows that lung slices are a useful in vitro model to study mechanisms involved in airway remodelling.

  16. Validation of airway resistance models for predicting pressure loss through anatomically realistic conducting airway replicas of adults and children.

    Science.gov (United States)

    Borojeni, Azadeh A T; Noga, Michelle L; Martin, Andrew R; Finlay, Warren H

    2015-07-16

    This work describes in vitro measurement of the total pressure loss at varying flow rate through anatomically realistic conducting airway replicas of 10 children, 4 to 8 years old, and 5 adults. Experimental results were compared with analytical predictions made using published airway resistance models. For the adult replicas, the model proposed by van Ertbruggen et al. (2005. J. Appl. Physiol. 98, 970-980) most accurately predicted central conducting airway resistance for inspiratory flow rates ranging from 15 to 90 L/min. Models proposed by Pedley et al. (1970. J. Respir. Physiol. 9, 371-386) and by Katz et al. (2011. J. Biomech. 44, 1137-1143) also provided reasonable estimates, but with a tendency to over predict measured pressure loss for both models. For child replicas, the Pedley and Katz models both provided good estimation of measured pressure loss at flow rates representative of resting tidal breathing, but under predicted measured values at high inspiratory flow rate (60 L/min). The van Ertbruggen model, developed based on flow simulations performed in an adult airway model, tended to under predict measured pressure loss through the child replicas across the range of flow rates studied (2 to 60 L/min). These results are intended to provide guidance for selection of analytical pressure loss models for use in predicting airway resistance and ventilation distribution in adults and children.

  17. Toll-Like Receptor 4 Engagement Mediates Prolyl Endopeptidase Release from Airway Epithelia via Exosomes.

    Science.gov (United States)

    Szul, Tomasz; Bratcher, Preston E; Fraser, Kyle B; Kong, Michele; Tirouvanziam, Rabindra; Ingersoll, Sarah; Sztul, Elizabeth; Rangarajan, Sunil; Blalock, J Edwin; Xu, Xin; Gaggar, Amit

    2016-03-01

    Proteases are important regulators of pulmonary remodeling and airway inflammation. Recently, we have characterized the enzyme prolyl endopeptidase (PE), a serine peptidase, as a critical protease in the generation of the neutrophil chemoattractant tripeptide Pro-Gly-Pro (PGP) from collagen. However, PE has been characterized as a cytosolic enzyme, and the mechanism mediating PE release extracellularly remains unknown. We examined the role of exosomes derived from airway epithelia as a mechanism for PE release and the potential extracellular signals that regulate the release of these exosomes. We demonstrate a specific regulatory pathway of exosome release from airway epithelia and identify PE as novel exosome cargo. LPS stimulation of airway epithelial cells induces release of PE-containing exosomes, which is significantly attenuated by small interfering RNA depletion of Toll-like receptor 4 (TLR4). These differences were recapitulated upon intratracheal LPS administration in mice competent versus deficient for TLR4 signaling. Finally, sputum samples from subjects with cystic fibrosis colonized with Pseudomonas aeruginosa demonstrate elevated exosome content and increased PE levels. This TLR4-based mechanism highlights the first report of nonstochastic release of exosomes in the lung and couples TLR4 activation with matrikine generation. The increased quantity of these proteolytic exosomes in the airways of subjects with chronic lung disease highlights a new mechanism of injury and inflammation in the pathogenesis of pulmonary disorders.

  18. Early nasal continuous positive airway pressure in a cohort of the smallest infants in Denmark

    DEFF Research Database (Denmark)

    Hansen, Bo M; Esbjørn, Barbara Hoff; Greisen, G

    2004-01-01

    To evaluate neurodevelopmental outcome at age 5 y of age in a cohort of preterm children treated mainly with nasal continuous positive airway pressure (CPAP) in the neonatal period.......To evaluate neurodevelopmental outcome at age 5 y of age in a cohort of preterm children treated mainly with nasal continuous positive airway pressure (CPAP) in the neonatal period....

  19. [Effects of once-daily low-dose administration of sustained-release theophylline on airway inflammation and airway hyperresponsiveness in patients with asthma].

    Science.gov (United States)

    Terao, Ichiro

    2002-04-01

    Bronchial asthma is eosinophilic airway inflammation with enhanced airway responsiveness induced by eosinophilic granule proteins such as eosinophilic cationic protein (ECP) that are released from eosinophils. In the present study using 30 outpatients with mild to moderate asthma who had no history of treatment with steroid inhalation, we examined the effects of 4-week low-dose (200 mg/day) treatment with Uniphyl Tablets, a sustained-release theophylline formulated for once-daily dosing, on airway inflammation and airway hyperresponsiveness, as well as on respiratory function. Uniphyl Tablets significantly (p statistically significant (p V50 also showed statistically significant (p < 0.05) improvement. Mean blood theophylline concentration at the time the improvements were seen was 3.95 mg/mL. These results suggest that low-dose administration of Uniphyl Tablets has anti-airway inflammatory and anti-airway hyperresponsiveness effects in mild to moderate asthmatic patients.

  20. Comparative evaluation of intraocular pressure changes subsequent to insertion of laryngeal mask airway and endotracheal tube.

    Directory of Open Access Journals (Sweden)

    Ghai B

    2001-07-01

    Full Text Available AIMS: To evaluate the intraocular pressure and haemodynamic changes subsequent to insertion of laryngeal mask airway and endotracheal tube. SUBJECTS AND METHODS: The study was conducted in 50 adult patients. A standard general anaesthesia was administered to all the patients. After 3 minutes of induction of anaesthesia baseline measurements of heart rate, non-invasive blood pressure and intraocular pressure were taken following which patients were divided into two groups: laryngeal mask airway was inserted in group 1 and tracheal tube in group 2. These measurements were repeated at 15-30 second, every minute thereafter up to 5 minutes after airway instrumentation. RESULTS: A statistically significant rise in heart rate, systolic blood pressure, diastolic blood pressure and intraocular pressure was seen in both the groups subsequent to insertion of laryngeal mask airway or endotracheal tube. Mean maximum increase was statistically more after endotracheal intubation than after laryngeal mask airway insertion. The duration of statistically significant pressure responses was also longer after endotracheal intubation. CONCLUSION: Laryngeal mask airway is an acceptable alternative technique for ocular surgeries, offering advantages in terms of intraocular pressure and cardiovascular stability compared to tracheal intubation.

  1. Cigarette smoke-induced necroptosis and DAMP release trigger neutrophilic airway inflammation in mice

    NARCIS (Netherlands)

    Pouwels, Simon D; van der Toorn, Marco; Hesse, Laura; Gras, Renee; Ten Hacken, Nick H T; Krysko, Dmitri V; Vandenabeele, Peter; de Vries, Maaike; van Oosterhout, Antoon J M; Heijink, Irene H; Nawijn, Martijn C

    2015-01-01

    Recent data indicate a role for airway epithelial necroptosis, a regulated form of necrosis, and the associated release of damage associated molecular patterns (DAMPs) in the development of COPD. DAMPs can activate pattern recognition receptors (PRRs), triggering innate immune responses. We hypothes

  2. Randomized trial of prongs or mask for nasal continuous positive airway pressure in preterm infants.

    LENUS (Irish Health Repository)

    Kieran, Emily A

    2012-11-01

    To determine whether nasal continuous positive airway pressure (NCPAP) given with nasal prongs compared with nasal mask reduces the rate of intubation and mechanical ventilation in preterm infants within 72 hours of starting therapy.

  3. Negative Pressure Pulmonary Edema Following use of Laryngeal Mask Airway (LMA

    Directory of Open Access Journals (Sweden)

    Yesim Bayraktar

    2013-06-01

    Full Text Available Negative pressure pulmonary edema (NPPE following upper airway obstruction is a non-cardiogenic pulmonary edema. The first cause in the etiology of NPPE is developed laryngospasm after intubation or extubation, while the other causes are epiglotitis, croup, hiccups, foreign body aspiration, pharyngeal hematoma and oropharyngeal tumors.The Late diagnosis and treatment causes high morbidity and mortality. The protection of the airway and maintainance of arterial oxygenation will be life saving.In this article we aimed to report  a case of negative pressure pulmonary edema, resolved succesfully after treatment, following use of laryngeal mask airway (LMA.

  4. Neutrophil recruitment by human IL-17 via C-X-C chemokine release in the airways.

    Science.gov (United States)

    Laan, M; Cui, Z H; Hoshino, H; Lötvall, J; Sjöstrand, M; Gruenert, D C; Skoogh, B E; Lindén, A

    1999-02-15

    IL-17 is a recently discovered cytokine that can be released from activated human CD4+ T lymphocytes. This study assessed the proinflammatory effects of human (h) IL-17 in the airways. In vitro, hIL-17 increased the release of IL-8 in human bronchial epithelial and venous endothelial cells, in a time- and concentration-dependent fashion. This effect of hIL-17 was inhibited by cotreatment with an anti-hIL-17 Ab and was potentiated by hTNF-alpha. In addition, hIL-17 increased the expression of hIL-8 mRNA in bronchial epithelial cells. Conditioned medium from hIL-17-treated bronchial epithelial cells increased human neutrophil migration in vitro. This effect was blocked by an anti-hIL-8 Ab. In vivo, intratracheal instillation of hIL-17 selectively recruited neutrophils into rat airways. This recruitment of neutrophils into the airways was inhibited by an anti-hIL-17 Ab and accompanied by increased levels of rat macrophage inflammatory protein-2 (rMIP-2) in bronchoalveolar lavage (BAL) fluid. The BAL neutrophilia was also blocked by an anti-rMIP-2 Ab. The effect of hIL-17 on the release of hIL-8 and rMIP-2 was also inhibited by glucocorticoids, in vitro and in vivo, respectively. These data demonstrate that hIL-17 can specifically and selectively recruit neutrophils into the airways via the release of C-X-C chemokines from bronchial epithelial cells and suggest a novel mechanism linking the activation of T-lymphocytes to recruitment of neutrophils into the airways.

  5. Nitric oxide gas phase release in human small airway epithelial cells

    Directory of Open Access Journals (Sweden)

    Suresh Vinod

    2009-01-01

    Full Text Available Abstract Background Asthma is a chronic airway inflammatory disease characterized by an imbalance in both Th1 and Th2 cytokines. Exhaled nitric oxide (NO is elevated in asthma, and is a potentially useful non-invasive marker of airway inflammation. However, the origin and underlying mechanisms of intersubject variability of exhaled NO are not yet fully understood. We have previously described NO gas phase release from normal human bronchial epithelial cells (NHBEs, tracheal origin. However, smaller airways are the major site of morbidity in asthma. We hypothesized that IL-13 or cytomix (IL-1β, TNF-α, and IFN-γ stimulation of differentiated small airway epithelial cells (SAECs, generation 10–12 and A549 cells (model cell line of alveolar type II cells in culture would enhance NO gas phase release. Methods Confluent monolayers of SAECs and A549 cells were cultured in Transwell plates and SAECs were allowed to differentiate into ciliated and mucus producing cells at an air-liquid interface. The cells were then stimulated with IL-13 (10 ng/mL or cytomix (10 ng/mL for each cytokine. Gas phase NO release in the headspace air over the cells was measured for 48 hours using a chemiluminescence analyzer. Results In contrast to our previous result in NHBE, baseline NO release from SAECs and A549 is negligible. However, NO release is significantly increased by cytomix (0.51 ± 0.18 and 0.29 ± 0.20 pl.s-1.cm-2, respectively reaching a peak at approximately 10 hours. iNOS protein expression increases in a consistent pattern both temporally and in magnitude. In contrast, IL-13 only modestly increases NO release in SAECs reaching a peak (0.06 ± 0.03 pl.s-1.cm-2 more slowly (30 to 48 hours, and does not alter NO release in A549 cells. Conclusion We conclude that the airway epithelium is a probable source of NO in the exhaled breath, and intersubject variability may be due, in part, to variability in the type (Th1 vs Th2 and location (large vs small airway

  6. Neuropeptide release from airways of young and fully-grown rabbits.

    Science.gov (United States)

    Larsen, Gary L; Fratelli, Cori; Loader, Joan; Kang, June-Ku Brian; Dakhama, Azzeddine

    2006-12-01

    Nerve growth factor (NGF), a neurotrophin that regulates neuronal development, enhances production of neuropeptides that control airway caliber including substance P (SP). Little is known about the developmental interplay between neurotrophins and neuropeptides. Our goal was to assess release of NGF, SP, and vasoactive intestinal peptide (VIP) from tracheal segments of young (2-week-old) and fully-grown (13-week-old) rabbits, and ascertain location of neuropeptides in airways with mechanical denudation of epithelium and immunohistochemistry. After electrical field stimulation of nerves, bath solutions were collected and immunoassays performed to quantify NGF, SP, and VIP release. There were significant decreases in NGF, SP, and VIP release from airways in 13- versus 2-week-old rabbits. There were also significant decreases in SP and VIP release from denuded versus normal tissues at 2 weeks of age. A similar pattern for SP was seen in 13-week-old rabbits. Immunohistochemistry demonstrated increased neuropeptides in airways from younger rabbits. Although SP was seen in the epithelium and submucosal nerves in the younger group, it was localized to the latter location in fully-grown rabbits. VIP was seen in only submucosal nerves at both ages. Thus, release of NGF, SP, and VIP with neural stimulation decreases in rabbit tracheal segments with age. Decreases in SP with maturation and epithelial denudation appear related in part to decreases in epithelial SP with growth. However, decreases in VIP that occur normally and with epithelial denudation are not explained by location of VIP within the epithelium. The epithelium may be a source of factors that inhibit release of neuropeptides.

  7. Negative Pressure Pulmonary Edema Following use of Laryngeal Mask Airway (LMA)

    OpenAIRE

    2013-01-01

    Negative pressure pulmonary edema (NPPE) following upper airway obstruction is a non-cardiogenic pulmonary edema. The first cause in the etiology of NPPE is developed laryngospasm after intubation or extubation, while the other causes are epiglotitis, croup, hiccups, foreign body aspiration, pharyngeal hematoma and oropharyngeal tumors.The Late diagnosis and treatment causes high morbidity and mortality. The protection of the airway and maintainance of arterial oxygenation will be life saving...

  8. Effect of Continuous Positive Airway Pressure on Airway Inflammation and Oxidative Stress in Patients with Obstructive Sleep Apnea

    Directory of Open Access Journals (Sweden)

    Promsrisuk Tichanon

    2016-01-01

    Full Text Available Background. Airway inflammation and oxidative stress may be linked in obstructive sleep apnea (OSA patients. We determined the effectiveness of continuous positive airway pressure (CPAP therapy in reducing fractional exhaled nitric oxide (FeNO and malondialdehyde (MDA levels in OSA patients. Methods. Thirteen patients with OSA and 13 normal controls were recruited. FeNO and MDA levels were measured in the controls and in OSA patients before and after three months of CPAP therapy. Results. FeNO and MDA levels were higher in the patients compared to the age and gender matched controls (FeNO: 25.9 ± 5.0 versus 17.5 ± 5.9 ppb, P<0.001; MDA: 14.6 ± 7.8 versus 2.1 ± 0.3 μmol/L, P<0.001. FeNO and MDA levels were lower post-CPAP compared to pre-CPAP (FeNO: 25.9 ± 5.0 versus 17.0 ± 2.3 ppb, P<0.001; MDA: 14.6 ± 7.8 versus 10.0 ± 6.4 μmol/L, P<0.01. Apnea-hypopnea index (15.9 ± 6.6 versus 4.1 ± 2.1/h, P<0.001 and mean arterial pressure (P<0.01 decreased following CPAP treatment. Daytime mean SpO2 (P<0.05 increased. Conclusion. Our study demonstrates that CPAP therapy yields clinical benefits by reducing upper airway inflammation and oxidative stress in OSA patients.

  9. Inhibition by salmeterol and cilomilast of fluticasone-enhanced IP-10 release in airway epithelial cells.

    Science.gov (United States)

    Reddy, P J; Aksoy, Mark O; Yang, Yi; Li, Xiu Xia; Ji, Rong; Kelsen, Steven G

    2008-02-01

    The CXC chemokines, IP-10/CXCL10 and IL-8/CXCL8, play a role in obstructive lung disease by attracting Th1/Tc1 lymphocytes and neutrophils, respectively. Inhaled corticosteroids (ICS) and long acting beta 2-agonists (LABA) are widely used. However, their effect(s) on the release of IP-10 and IL-8 by airway epithelial cells are poorly understood. This study examined the effects of fluticasone, salmeterol, and agents which raise intracellular cAMP (cilomilast and db-cAMP) on the expression of IP-10 and IL-8 protein and mRNA. Studies were performed in cultured human airway epithelial cells during cytokine-stimulated IP-10 and IL-8 release. Cytokine treatment (TNF-alpha, IL-1beta and IFN-gamma) increased IP-10 and IL-8 protein and mRNA levels. Fluticasone (0.1 nM to 1 microM) increased IP-10 but reduced IL-8 protein release without changing IP-10 mRNA levels assessed by real time RT-PCR. The combination of salmeterol (1 micro M) and cilomilast (1-10 mu M) reduced IP-10 but had no effect on IL-8 protein. Salmeterol alone (1 micro M) and db-cAMP alone (1 mM) antagonised the effects of fluticasone on IP-10 but not IL-8 protein. In human airway epithelial cells, inhibition by salmeterol of fluticasone-enhanced IP-10 release may be an important therapeutic effect of the LABA/ICS combination not present when the two drugs are used separately.

  10. Nap-titration : An effective alternative for continuous positive airway pressure titration

    NARCIS (Netherlands)

    Hoekema, A; Stegenga, B; Meinesz, AF; van der Hoeven, JH; Wijkstra, PJ

    2006-01-01

    When treating Obstructive Steep Apnea-Hypopnea Syndrome (OSAHS) several alternatives for standard (manual) continuous positive airway pressure (CPAP) titration are feasible. A practical alternative is titration without polysomnography during an afternoon nap (Nap-titration). The aim of the present s

  11. Motivational Interviewing (MINT) Improves Continuous Positive Airway Pressure (CPAP) Acceptance and Adherence: A Randomized Controlled Trial

    Science.gov (United States)

    Olsen, Sara; Smith, Simon S.; Oei, Tian P. S.; Douglas, James

    2012-01-01

    Objective: Adherence to continuous positive airway pressure (CPAP) therapy for obstructive sleep apnoea (OSA) is poor. We assessed the effectiveness of a motivational interviewing intervention (motivational interview nurse therapy [MINT]) in addition to best practice standard care to improve acceptance and adherence to CPAP therapy in people with…

  12. Cardiovascular risk in patients with sleep apnoea with or without continuous positive airway pressure therapy

    DEFF Research Database (Denmark)

    Lamberts, Morten; Nielsen, O W; Lip, G Y H;

    2014-01-01

    BACKGROUND: The prognostic significance of age and continuous positive airway pressure (CPAP) therapy on cardiovascular disease in patients with sleep apnoea has not been assessed previously. METHODS: Using nationwide databases, the entire Danish population was followed from 2000 until 2011. Firs...

  13. Implementation of Boussignac continuous positive airway pressure in the coronary care unit : Experiences and attitudes

    NARCIS (Netherlands)

    Dieperink, Willem; Nijsten, Maarten W. N.; van de Stadt, Mark; van der Horst, Iwan C. C.; Aarts, Leon P. H. J.; Zijlstra, Felix; Jaarsma, Tiny

    2008-01-01

    OBJECTIVE: Boussignac continuous positive airway pressure (BCPAP) delivered by face mask is useful for patients with acute cardiogenic Pulmonary edema (ACPE). Although BCPAP is medically effective, we observed that not 611 suitable patients received it. In this descriptive, prospective, cohort study

  14. Selective indication for positive airway pressure (PAP in sleep-related breathing disorders with obstruction

    Directory of Open Access Journals (Sweden)

    Stasche, Norbert

    2006-10-01

    Full Text Available Positive airway pressure (PAP is the therapy of choice for most sleep-related breathing disorders (SRBD. A variety of PAP devices using positive airway pressure (CPAP, BiPAP, APAP, ASV must be carefully considered before application. This overview aims to provide criteria for choosing the optimal PAP device according to severity and type of sleep-related breathing disorder. In addition, the range of therapeutic applications, constraints and side effects as well as alternative methods to PAP will be discussed. This review is based on an analysis of current literature and clinical experience. The data is presented from an ENT-sleep-laboratory perspective and is designed to help the ENT practitioner initiate treatment and provide support. Different titration methods, current devices and possible applications will be described. In addition to constant pressure devices (CPAP, most commonly used for symptomatic obstructive sleep apnoea (OSA without complicating conditions, BiPAP models will be introduced. These allow two different positive pressure settings and are thus especially suitable for patients with cardiopulmonary diseases or patients with pressure intolerance, increasing compliance in this subgroup considerably. Compliance can also be increased in patients during first night of therapy, patients with highly variable pressure demands or position-dependent OSA, by using self-regulating Auto-adjust PAP devices (Automatic positive airway pressure, APAP. Patients with Cheyne-Stokes breathing, a subtype of central sleep apnoea, benefit from adaptive servo-ventilation (ASV, which analyzes breathing patterns continually and adjusts the actual ventilation pressure accordingly. This not only reduces daytime sleepiness, but can also influence heart disease positively. Therapy with positive airway pressure is very effective in eliminating obstruction-related sleep diseases and symptoms. However, because therapy is generally applied for life, the optimal

  15. The use of nasal dilator strips as a placebo for trials evaluating continuous positive airway pressure

    Directory of Open Access Journals (Sweden)

    Aline C.S. Amaro

    2012-01-01

    Full Text Available OBJECTIVES: The aim of the current study was to compare the objective and subjective effects of continuous positive airway pressure to the use of nasal dilator strips in patients with acromegaly and moderate to severe obstructive sleep apnea. METHODS: We studied 12 patients with acromegaly and moderate to severe obstructive sleep apnea (male/ females = 8/4, age = 52±8 ys, body mass index = 33.5±4.6 Kg/m², apnea-hypopnea index = 38±14 events/h who had been included in a randomized, crossover study to receive three months of treatment with continuous positive airway pressure and nasal dilator strips. All patients were evaluated at study entry and at the end of each treatment by polysomnography, and Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index and treatment satisfaction questionnaires. ClinicalTrials.gov: NCT01265121 RESULTS: The apnea-hypopnea index values decreased significantly with continuous positive airway pressure treatment but did not change with the use of nasal dilator strips. All of the subjective symptoms improved with both treatments, but these improvements were significantly greater with continuous positive airway pressure than with the nasal dilator strips CONCLUSION: The use of nasal dilator strips had a much smaller effect on the severity of obstructive sleep apnea in patients with acromegaly and moderate to severe obstructive sleep apnea in comparison to the use of continuous positive airway pressure. Moreover, the improvement in several subjective parameters without any significant objective improvement in obstructive sleep apnea resulting from the use of nasal dilator strips is compatible with a placebo effect.

  16. Oscillating Positive Airway Pressure Versus CPAP for the Treatment of Obstructive Sleep Apnea

    Science.gov (United States)

    Haba-Rubio, José; Petitpierre, Nicolas Julien; Cornette, Françoise; Tobback, Nadia; Vat, Sopharat; Giallourou, Theresia; Al-Jumaily, Ahmed; Heinzer, Raphael

    2015-01-01

    Although continuous positive airway pressure (CPAP) is the most effective therapy for obstructive sleep apnea (OSA), it is not always well tolerated by the patients. Previous physiological studies showed that pressure oscillations applied to the pharynx could activate upper airway muscles, but it is not clear whether these pressure oscillations could be tolerated during sleep in OSA patients. The aim of this study was to assess the tolerance of oscillating positive airway pressure (O-PAP) (a CPAP device delivering high-frequency pressure oscillations to the upper airway) compared to CPAP. Fourteen OSA patients currently on CPAP [age 59.9 ± 10.1 years old, BMI 34.8 ± 7.2 kg/m2, initial apnea–hypopnea index (AHI): 58.7 ± 25.2 events/h] used O-PAP or CPAP on two consecutive nights under polysomnography, in a single-blind randomized crossover design to assess sleep quality. A subtherapeutic pressure (70% of the optimal titrated pressure) was applied in both conditions and the residual AHI with each technique was also compared. There was no difference in measured or perceived sleep quality between the two treatment modalities (sleep efficiency 90.0% versus 88.1%, p = 0.54). Despite the small sample, we also found a trend toward a decrease in residual respiratory events with O-PAP compared to CPAP (median AHI 14.3 versus 20.5/h, p = 0.194). The good tolerance of O-PAP and the positive trend toward a reduction in residual AHI should stimulate further research on the effects of O-PAP in OSA patients. PMID:26029694

  17. Comparison of upper airway respiratory resistance measurements with the esophageal pressure/airflow relationship during sleep.

    Science.gov (United States)

    Morgenstern, C; Schwaibold, M; Randerath, W; Bolz, A; Jané, R

    2011-01-01

    Measurement of upper airway resistance is of interest in sleep disordered breathing to estimate upper airway patency. Resistance is calculated with the airflow and respiratory effort signals. However, there is no consensus on a standard for upper airway resistance measurement. This study proposes a new benchmarking method to objectively compare different upper airway resistance measurement methods by objectively differentiating between breaths with inspiratory flow limitation (high resistance) and non-limited breaths (low resistance). Resistance was measured at peak-Pes, at peak-flow, at the linear portion of a polynomial equation, as an area comparative and as average resistance for an inspiration. A total of 20 patients with systematic, gold-standard esophageal pressure and nasal airflow acquisition were analyzed and 109,955 breaths were automatically extracted and evaluated. Relative resistance values in relationship to a reference resistance value obtained during wakefulness were also analyzed. The peak-Pes measurement method obtained the highest separation index with significant (p < 0.001) differences to the other methods, followed by the area comparative and the peak-flow methods. As expected, average resistances were significantly (p < 0.001) lower for the non-IFL than for the IFL group. Hence, we recommend employing the peak-Pes for accurate upper airway resistance estimation.

  18. Oxygen therapy, continuous positive airway pressure, or noninvasive bilevel positive pressure ventilation in the treatment of acute cardiogenic pulmonary edema

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    Park Marcelo

    2001-01-01

    Full Text Available OBJECTIVE: To compare the effects of 3 types of noninvasive respiratory support systems in the treatment of acute pulmonary edema: oxygen therapy (O2, continuous positive airway pressure, and bilevel positive pressure ventilation. METHODS: We studied prospectively 26 patients with acute pulmonary edema, who were randomized into 1 of 3 types of respiratory support groups. Age was 69±7 years. Ten patients were treated with oxygen, 9 with continuous positive airway pressure, and 7 with noninvasive bilevel positive pressure ventilation. All patients received medicamentous therapy according to the Advanced Cardiac Life Support protocol. Our primary aim was to assess the need for orotracheal intubation. We also assessed the following: heart and respiration rates, blood pressure, PaO2, PaCO2, and pH at begining, and at 10 and 60 minutes after starting the protocol. RESULTS: At 10 minutes, the patients in the bilevel positive pressure ventilation group had the highest PaO2 and the lowest respiration rates; the patients in the O2 group had the highest PaCO2 and the lowest pH (p<0.05. Four patients in the O2 group, 3 patients in the continuous positive pressure group, and none in the bilevel positive pressure ventilation group were intubated (p<0.05. CONCLUSION: Noninvasive bilevel positive pressure ventilation was effective in the treatment of acute cardiogenic pulmonary edema, accelerated the recovery of vital signs and blood gas data, and avoided intubation.

  19. Cost-Effectiveness of Continuous Positive Airway Pressure Therapy in Patients with Obstructive Sleep Apnea-Hypopnea in British Columbia

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    MCY Tan

    2008-01-01

    Full Text Available BACKGROUND: Obstructive sleep apnea-hypopnea (OSAH is a common disorder characterized by recurrent collapse of the upper airway during sleep. Patients experience a reduced quality of life and an increased risk of motor vehicle crashes (MVCs. Continuous positive airway pressure (CPAP, which is the first-line therapy for OSAH, improves sleepiness, vigilance and quality of life.

  20. Maxillomandibular Advancement Surgery as Alternative to Continuous Positive Airway Pressure in Morbidly Severe Obstructive Sleep Apnea : A Case Report

    NARCIS (Netherlands)

    Doff, Michiel H. J.; Jansma, Johan; Schepers, Rutger H.; Hoekema, Aamoud

    2013-01-01

    Obstructive sleep apnea syndrome (OSAS) is a sleep-related breathing disorder, characterized by disrupted snoring and repetitive upper airway obstructions. Oral appliance therapy is an effective alternative to continuous positive airway pressure (CPAP) and is especially effective in mild and moderat

  1. Effects of continuous positive airway pressure on upper airway inspiratory dynamics in awake patients with sleep-disordered breathing.

    Science.gov (United States)

    Vérin, E; Similowski, T; Sériès, F

    2003-01-01

    Continuous positive airway pressure (CPAP) is the main treatment of the obstructive sleep apnoea syndrome (OSAS). We assessed its effects on the upper airway (UA) dynamics in response to bilateral anterior magnetic phrenic nerve stimulation (BAMPS) in 17 awake untreated OSAS patients (15 males; 52 +/- 7 years) whose effective CPAP (P(eff)) had been determined beforehand by a conventional titration sleep study. All twitch-related inspirations were flow-limited, flow first rising to a maximum (V(Imax)), then decreasing to a minimum (V(Imin)), and then increasing again (M-shaped pattern). Up to V(Imin), the relationship between driving pressure (P(d)) and flow (V) could adequately be fitted to a polynomial regression model (V = k(1)P(d) + k(2)P(d)(2); r(2) = 0.71-0.98, P < 0.0001). At atmospheric pressure V(Imax) was 700 +/- 377 ml s(-1), V(Imin) was 458 +/- 306 ml s(-1), k(1) was 154.5 +/- 63.9 ml s(-1) (cmH(2)O)(-1), and k(2) was 10.7 +/- 7.3 ml s(-1) (cmH(2)O)(-1). CPAP significantly increased V(Imax) and V(Imin) (peak values 1007 +/- 332 ml and 837 +/- 264 ml s(-1), respectively) as well as k(1) and k(2) (peak values 300.9 +/- 178.2 ml s(-1) (cmH(2)O)(-1) and 55.2 +/- 65.3 ml s(-1) (cmH(2)O)(-1), respectively). With increasing CPAP, k(1)/k(2) increased up to a peak value before decreasing. We defined as P(eff,stim) the CPAP value corresponding to the highest k(1)/k(2) value. P(eff,stim) was correlated with P(eff) (P(eff) = 7.0 +/- 2.0; P(eff,stim) = 6.4 +/- 2.6 cmH(2)O; r = 0.886; 95 % CI 0.696-0.960, P < 0.001). We conclude that CPAP improves UA dynamics in OSAS and that the therapeutic CPAP to apply can be predicted during wakefulness using BAMPS.

  2. Altered diaphragmatic contractile properties after high airway pressure controlled mechanical ventilation

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    @@ Acute respiratory failure is the most frequent indication for the application of mechanical ventilation. 1 As commonly used in clinical settings, lung protective strategies and recruitment manoeuvres are applications of higher than normal airway pressure to open the collapsed alveoli and prevent lung atelectasis caused by minimal vital ventilation. Under those conditions, we pay more attention to the lung injury and circulatory failure, and less attention to the diaphragmatic structure and function.

  3. The NOFLO trial: low-flow nasal prongs therapy in weaning nasal continuous positive airway pressure in preterm infants.

    LENUS (Irish Health Repository)

    O'Donnell, Sinéad M

    2013-07-01

    To determine if low-flow nasal prongs therapy with room air, compared with no treatment, facilitates weaning from nasal continuous positive airway pressure (NCPAP) in very low birth weight (VLBW, birth weight <1500 g) infants.

  4. Short-term effects of positive expiratory airway pressure in patients being weaned from mechanical ventilation

    Directory of Open Access Journals (Sweden)

    Marcelo de Mello Rieder

    2009-05-01

    Full Text Available OBJECTIVE: To investigate the feasibility and the cardiorespiratory effects of using positive expiratory airway pressure, a physiotherapeutic tool, in comparison with a T-tube, to wean patients from mechanical ventilation. METHODS/DESIGN: A prospective, randomized, cross-over study. SETTING: Two intensive care units. PATIENTS AND INTERVENTIONS: We evaluated forty patients who met weaning criteria and had been mechanically-ventilated for more than 48 hours, mean age 59 years, including 23 males. All patients were submitted to the T-tube and Expiratory Positive Airway Pressure devices, at 7 cm H2O, during a 30-minute period. Cardiorespiratory variables including work of breathing, respiratory rate (rr, peripheral oxygen saturation (SpO2, heart rate (hr, systolic, diastolic and mean arterial pressures (SAP, DAP, MAP were measured in the first and thirtieth minutes. The condition was analyzed as an entire sample set (n=40 and was also divided into subconditions: chronic obstructive pulmonary disease (n=14 and non-chronic obstructive pulmonary disease (non- chronic obstructive pulmonary disease (n=26 categories. Comparisons were made using a t-test and Analysis of Variance. The level of significance was p < 0.05. RESULTS: Our data showed an increase in work of breathing in the first and thirtieth minutes in the EPAP condition (0.86+ 0.43 and 1.02+1.3 as compared with the T-tube condition (0.25+0.26 and 0.26+0.35 (p<0.05, verified by the flow-sensor monitor (values in J/L. No statistical differences were observed when comparing the Expiratory Positive Airway Pressure and T-tube conditions with regard to cardiorespiratory measurements. The same result was observed for both chronic obstructive pulmonary disease and non- chronic obstructive pulmonary disease subconditions. CONCLUSIONS: Our study demonstrated that, in weaning patients from mechanical ventilation, the use of a fixed level of Expiratory Positive Airway Pressure caused an increase in work of

  5. 气道压力释放通气应用于急性肺损伤/急性呼吸窘迫综合征患者的临床研究%The clinical effect of airway pressure release ventilation for acute lung injury/acute respiratory distress syndrome

    Institute of Scientific and Technical Information of China (English)

    宋邵华; 田惠玉; 杨秀芬; 胡振杰

    2016-01-01

    Objective To evaluate the effect of airway pressure release ventilation (APRV) in patients with acute lung injury/acute respiratory distress syndrome (ALI/ARDS), to evaluate the extent of ventilator-induced lung injury (VILI), and to explore its possible mechanism. Methods A prospective study was conducted in the Department of Critical Care Medicine of the First Hospital of Hebei Medical University from December 2010 to February 2012. The patients with ALI/ARDS were enrolled. They were randomly divided into two groups. The patients in APRV group were given APRV pattern, while those in control group were given lung protection ventilation, synchronized intermittent mandatory ventilation with positive end-expiratory pressure (SIMV+PEEP). All patients were treated with AVEA ventilator. The parameters such as airway peak pressure (Ppeak), mean airway pressure (Pmean), pulse oxygen saturation (SpO2), mean arterial pressure (MAP), heart rate (HR), central venous pressure (CVP), arterial blood gas, urine output (UO), the usage of sedation and muscle relaxation drugs were recorded. AVEA ventilator "turning point (Pflex) operation" was used to describe the quasi-static pressure volume curve (P-V curve). High and low inflection point (UIP, LIP) and triangular Pflex volume (Vdelta) were automatically measured and calculated. The ventilation parameters were set, and the 24-hour P-V curve was recorded again in order to be compared with subsequent results. Venous blood was collected before treatment, 24 hours and 48 hours after ventilation to measure lung surfactant protein D (SP-D) and large molecular mucus in saliva (KL-6) by enzyme linked immunosorbent assay (ELISA), and the correlation between the above two parameters and prognosis on 28 days was analyzed by multinomial logistic regression. Results Twenty-six patients with ALI/ARDS were enrolled, and 22 of them completed the test with 10 in APRV group and 12 in control group. The basic parameters and P-V curves between two

  6. Use of Biphasic Continuous Positive Airway Pressure in Premature Infant with Cleft Lip–Cleft Palate

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    Lovya George

    2015-10-01

    Full Text Available Preterm infants (PIs often require respiratory support due to surfactant deficiency. Early weaning from mechanical ventilation to noninvasive respiratory support decreases ventilation-associated irreversible lung damage. This wean is particularly challenging in PIs with cleft lip and cleft palate due to anatomical difficulties encountered in maintaining an adequate seal for positive pressure ventilation. PI with a cleft lip and palate often fail noninvasive respiratory support and require continued intubation and mechanical ventilation. We are presenting the first case report of a PI with cleft lip and palate who was managed by biphasic nasal continuous positive airway pressure.

  7. Real-time imaging of ATP release induced by mechanical stretch in human airway smooth muscle cells.

    Science.gov (United States)

    Takahara, Norihiro; Ito, Satoru; Furuya, Kishio; Naruse, Keiji; Aso, Hiromichi; Kondo, Masashi; Sokabe, Masahiro; Hasegawa, Yoshinori

    2014-12-01

    Airway smooth muscle (ASM) cells within the airway walls are continually exposed to mechanical stimuli, and exhibit various functions in response to these mechanical stresses. ATP acts as an extracellular mediator in the airway. Moreover, extracellular ATP is considered to play an important role in the pathophysiology of asthma and chronic obstructive pulmonary disease. However, it is not known whether ASM cells are cellular sources of ATP secretion in the airway. We therefore investigated whether mechanical stretch induces ATP release from ASM cells. Mechanical stretch was applied to primary human ASM cells cultured on a silicone chamber coated with type I collagen using a stretching apparatus. Concentrations of ATP in cell culture supernatants measured by luciferin-luciferase bioluminescence were significantly elevated by cyclic stretch (12 and 20% strain). We further visualized the stretch-induced ATP release from the cells in real time using a luminescence imaging system, while acquiring differential interference contrast cell images with infrared optics. Immediately after a single uniaxial stretch for 1 second, strong ATP signals were produced by a certain population of cells and spread to surrounding spaces. The cyclic stretch-induced ATP release was significantly reduced by inhibitors of Ca(2+)-dependent vesicular exocytosis, 1,2-bis(o-aminophenoxy)ethane-N,N,N',N'-tetraacetic acid tetraacetoxymethyl ester, monensin, N-ethylmaleimide, and bafilomycin. In contrast, the stretch-induced ATP release was not inhibited by a hemichannel blocker, carbenoxolone, or blockade of transient receptor potential vanilloid 4 by short interfering RNA transfection or ruthenium red. These findings reveal a novel property of ASM cells: mechanically induced ATP release may be a cellular source of ATP in the airway.

  8. Measurement of Pressure between Upper Airway Tract and Laryngoscope Blade during Orotracheal Intubation with Film of Microcapsules

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    Shigehiro Hashimoto

    2014-04-01

    Full Text Available The measurement system for the pressure between the blade of a laryngoscope and the upper airway tract during orotracheal intubation has been investigated with a film of microcapsules. Two types of the laryngoscope were used in the study: Wis-Foregger and Mac-Intosh. The film is attached on the surface of the blade of the laryngoscope. The measurement was applied to 20 cases of the orotracheal intubation. In the pressed part of the film, the microcapsules burst and release chemicals, which react with chemicals out of microcapsules and show a red color. The color density was photoelectrically measured, and converted to the pressure value in three regions on the blade; the epiglottis, the tongue, and the upper incisor. The results show that the pressures are 1.2±0.6 MPa on the epiglottis, 0.8±0.4 MPa on the tongue, and (11±3×10 MPa on the upper incisor, and that the pressures on the epiglottis are 2.0±0.3 MPa in bled cases, and 0.8±0.4 MPa in non-bled cases.

  9. Upflow bioreactor with septum and pressure release mechanism

    Science.gov (United States)

    Hansen, Conly L.; Hansen, Carl S.; Pack, Kevin; Milligan, John; Benefiel, Bradley C.; Tolman, C. Wayne; Tolman, Kenneth W.

    2010-04-20

    An upflow bioreactor includes a vessel having an inlet and an outlet configured for upflow operation. A septum is positioned within the vessel and defines a lower chamber and an upper chamber. The septum includes an aperture that provides fluid communication between the upper chamber and lower chamber. The bioreactor also includes means for releasing pressure buildup in the lower chamber. In one configuration, the septum includes a releasable portion having an open position and a closed position. The releasable portion is configured to move to the open position in response to pressure buildup in the lower chamber. In the open position fluid communication between the lower chamber and the upper chamber is increased. Alternatively the lower chamber can include a pressure release line that is selectively actuated by pressure buildup. The pressure release mechanism can prevent the bioreactor from plugging and/or prevent catastrophic damage to the bioreactor caused by high pressures.

  10. Diastolic function and functional capacity after a single session of continuous positive airway pressure in patients with compensated heart failure

    Directory of Open Access Journals (Sweden)

    Marjory Fernanda Bussoni

    2014-01-01

    Full Text Available OBJECTIVE: The effects of acute continuous positive airway pressure therapy on left ventricular diastolic function and functional capacity in patients with compensated systolic heart failure remain unclear. METHODS: This randomized, double-blind, placebo-controlled clinical trial included 43 patients with heart failure and a left ventricular ejection fraction <0.50 who were in functional classes I-III according to the New York Heart Association criteria. Twenty-three patients were assigned to continuous positive airway pressure therapy (10 cmH2O, while 20 patients received placebo with null pressure for 30 minutes. All patients underwent a 6-minute walk test (6MWT and Doppler echocardiography before and immediately after intervention. Clinicaltrials.gov: NCT01088854. RESULTS: The groups had similar clinical and echocardiographic baseline variables. Variation in the diastolic function index (e′ after intervention was associated with differences in the distance walked in both groups. However, in the continuous positive airway pressure group, this difference was greater (continuous positive airway pressure group: Δ6MWT = 9.44+16.05×Δe′, p = 0.002; sham group: Δ6MWT = 7.49+5.38×Δe′; p = 0.015. There was a statistically significant interaction between e′ index variation and continuous positive airway pressure for the improvement of functional capacity (p = 0.020. CONCLUSIONS: Continuous positive airway pressure does not acurately change the echocardiographic indexes of left ventricle systolic or diastolic function in patients with compensated systolic heart failure. However, 30-minute continuous positive airway pressure therapy appears to have an effect on left ventricular diastolic function by increasing functional capacity.

  11. Noninvasive respiratory support of juvenile rabbits by high-amplitude bubble continuous positive airway pressure.

    Science.gov (United States)

    Diblasi, Robert M; Zignego, Jay C; Tang, Dennis M; Hildebrandt, Jack; Smith, Charles V; Hansen, Thomas N; Richardson, C Peter

    2010-06-01

    Bubble continuous positive airway pressure (B-CPAP) applies small-amplitude, high-frequency oscillations in airway pressure (DeltaPaw) that may improve gas exchange in infants with respiratory disease. We developed a device, high-amplitude B-CPAP (HAB-CPAP), which provides greater DeltaPaw than B-CPAP provides. We studied the effects of different operational parameters on DeltaPaw and volumes of gas delivered to a mechanical infant lung model. In vivo studies tested the hypothesis that HAB-CPAP provides noninvasive respiratory support greater than that provided by B-CPAP. Lavaged juvenile rabbits were stabilized on ventilator nasal CPAP. The animals were then supported at the same mean airway pressure, bias flow, and fraction of inspired oxygen (FiO2) required for stabilization, whereas the bubbler angle was varied in a randomized crossover design at exit angles, relative to vertical, of 0 (HAB-CPAP0; equivalent to conventional B-CPAP), 90 (HAB-CPAP90), and 135 degrees (HAB-CPAP135). Arterial blood gases and pressure-rate product (PRP) were measured after 15 min at each bubbler angle. Pao2 levels were higher (p<0.007) with HAB-CPAP135 than with conventional B-CPAP. PaCO2 levels did not differ (p=0.073) among the three bubbler configurations. PRP with HAB-CPAP135 were half of the PRP with HAB-CPAP0 or HAB-CPAP90 (p=0.001). These results indicate that HAB-CPAP135 provides greater respiratory support than conventional B-CPAP does.

  12. Residual Daytime Sleepiness in Obstructive Sleep Apnea After Continuous Positive Airway Pressure Optimization: Causes and Management.

    Science.gov (United States)

    Chapman, Julia L; Serinel, Yasmina; Marshall, Nathaniel S; Grunstein, Ronald R

    2016-09-01

    Excessive daytime sleepiness (EDS) is common in obstructive sleep apnea (OSA), but it is also common in the general population. When sleepiness remains after continuous positive airway pressure (CPAP) treatment of OSA, comorbid conditions or permanent brain injury before CPAP therapy may be the cause of the residual sleepiness. There is currently no broad approach to treating residual EDS in patients with OSA. Individual assessment must be made of comorbid conditions and medications, and of lifestyle factors that may be contributing to the sleepiness. Modafinil and armodafinil are the only pharmacologic agents indicated for residual sleepiness in these patients.

  13. Pressure-morphology relationship of a released carpal tunnel.

    Science.gov (United States)

    Kim, Dong Hee; Marquardt, Tamara L; Gabra, Joseph N; Shen, Zhilei Liu; Evans, Peter J; Seitz, William H; Li, Zong-Ming

    2013-04-01

    We investigated morphological changes of a released carpal tunnel in response to variations of carpal tunnel pressure. Pressure within the carpal tunnel is known to be elevated in patients with carpal tunnel syndrome and dependent on wrist posture. Previously, increased carpal tunnel pressure was shown to affect the morphology of the carpal tunnel with an intact transverse carpal ligament (TCL). However, the pressure-morphology relationship of the carpal tunnel after release of the TCL has not been investigated. Carpal tunnel release (CTR) was performed endoscopically on cadaveric hands and the carpal tunnel pressure was dynamically increased from 10 to 120 mmHg. Simultaneously, carpal tunnel cross-sectional images were captured by an ultrasound system, and pressure measurements were recorded by a pressure transducer. Carpal tunnel pressure significantly affected carpal arch area (p 62 mm(2) at 120 mmHg. Carpal arch height, length, and width also significantly changed with carpal tunnel pressure (p carpal tunnel pressure increased, carpal arch height and length increased, but the carpal arch width decreased. Analyses of the pressure-morphology relationship for a released carpal tunnel revealed a nine times greater compliance than that previously reported for a carpal tunnel with an intact TCL. This change of structural properties as a result of transecting the TCL helps explain the reduction of carpal tunnel pressure and relief of symptoms for patients after CTR surgery.

  14. Unidirectional Expiratory Valve Method to Assess Maximal Inspiratory Pressure in Individuals without Artificial Airway.

    Directory of Open Access Journals (Sweden)

    Samantha Torres Grams

    Full Text Available Maximal Inspiratory Pressure (MIP is considered an effective method to estimate strength of inspiratory muscles, but still leads to false positive diagnosis. Although MIP assessment with unidirectional expiratory valve method has been used in patients undergoing mechanical ventilation, no previous studies investigated the application of this method in subjects without artificial airway.This study aimed to compare the MIP values assessed by standard method (MIPsta and by unidirectional expiratory valve method (MIPuni in subjects with spontaneous breathing without artificial airway. MIPuni reproducibility was also evaluated.This was a crossover design study, and 31 subjects performed MIPsta and MIPuni in a random order. MIPsta measured MIP maintaining negative pressure for at least one second after forceful expiration. MIPuni evaluated MIP using a unidirectional expiratory valve attached to a face mask and was conducted by two evaluators (A and B at two moments (Tests 1 and 2 to determine interobserver and intraobserver reproducibility of MIP values. Intraclass correlation coefficient (ICC[2,1] was used to determine intraobserver and interobserver reproducibility.The mean values for MIPuni were 14.3% higher (-117.3 ± 24.8 cmH2O than the mean values for MIPsta (-102.5 ± 23.9 cmH2O (p<0.001. Interobserver reproducibility assessment showed very high correlation for Test 1 (ICC[2,1] = 0.91, and high correlation for Test 2 (ICC[2,1] = 0.88. The assessment of the intraobserver reproducibility showed high correlation for evaluator A (ICC[2,1] = 0.86 and evaluator B (ICC[2,1] = 0.77.MIPuni presented higher values when compared with MIPsta and proved to be reproducible in subjects with spontaneous breathing without artificial airway.

  15. Unidirectional Expiratory Valve Method to Assess Maximal Inspiratory Pressure in Individuals without Artificial Airway

    Science.gov (United States)

    Grams, Samantha Torres; Kimoto, Karen Yumi Mota; Azevedo, Elen Moda de Oliveira; Lança, Marina; de Albuquerque, André Luis Pereira; de Brito, Christina May Moran; Yamaguti, Wellington Pereira

    2015-01-01

    Introduction Maximal Inspiratory Pressure (MIP) is considered an effective method to estimate strength of inspiratory muscles, but still leads to false positive diagnosis. Although MIP assessment with unidirectional expiratory valve method has been used in patients undergoing mechanical ventilation, no previous studies investigated the application of this method in subjects without artificial airway. Objectives This study aimed to compare the MIP values assessed by standard method (MIPsta) and by unidirectional expiratory valve method (MIPuni) in subjects with spontaneous breathing without artificial airway. MIPuni reproducibility was also evaluated. Methods This was a crossover design study, and 31 subjects performed MIPsta and MIPuni in a random order. MIPsta measured MIP maintaining negative pressure for at least one second after forceful expiration. MIPuni evaluated MIP using a unidirectional expiratory valve attached to a face mask and was conducted by two evaluators (A and B) at two moments (Tests 1 and 2) to determine interobserver and intraobserver reproducibility of MIP values. Intraclass correlation coefficient (ICC[2,1]) was used to determine intraobserver and interobserver reproducibility. Results The mean values for MIPuni were 14.3% higher (-117.3 ± 24.8 cmH2O) than the mean values for MIPsta (-102.5 ± 23.9 cmH2O) (p<0.001). Interobserver reproducibility assessment showed very high correlation for Test 1 (ICC[2,1] = 0.91), and high correlation for Test 2 (ICC[2,1] = 0.88). The assessment of the intraobserver reproducibility showed high correlation for evaluator A (ICC[2,1] = 0.86) and evaluator B (ICC[2,1] = 0.77). Conclusions MIPuni presented higher values when compared with MIPsta and proved to be reproducible in subjects with spontaneous breathing without artificial airway. PMID:26360255

  16. Upper airway collapsibility evaluated by a negative expiratory pressure test in severe obstructive sleep apnea

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    Salvatore Romano

    2011-01-01

    Full Text Available OBJECTIVES: To investigate the usefulness of measuring upper airway collapsibility with a negative expiratory pressure application as a screening test for severe obstructive sleep apnea (OSA. INTRODUCTION: OSA is a risk factor for cardiovascular disease, and it may have serious consequences. Its recognition may have important implications during the perioperative period. Increased upper airway collapsibility is one of the main determinants of OSA, and its evaluation could be useful for identifying this condition. METHODS: Severe OSA and normal subjects (24 in each group were matched by body mass index and referred to our sleep laboratory. The subjects were enrolled in an overnight sleep study, and a diurnal negative expiratory pressure test was performed. Flow drop (DV and expiratory volume were measured in the first 0.2 s (V02 of the negative expiratory pressure test. RESULTS: DV (% and V02 (% values were statistically different between normal and OSA subjects. OSA patients showed a greater decrease in flow than normal subjects. In addition, severely OSA patients exhaled during the first 0.2 s of the negative expiratory pressure application was an average of only 11.2% of the inspired volume compared to 34.2% for the normal subjects. Analysis of the receiver operating characteristics showed that V02 (% and DV (% could accurately identify severe OSA in subjects with sensitivities of 95.8% and 91.7%, respectively, and specificities of 95.8% and 91.7%, respectively. CONCLUSIONS: V02 (% and DV (% are highly accurate parameters for detecting severe OSA. The pharyngeal collapsibility measurement, which uses negative expiratory pressure during wakefulness, is predictive of collapsibility during sleep.

  17. Successful treatment of laryngomalacia and bilateral vocal cord paralysis with continuous positive airway pressure

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    Sovtić Aleksandar

    2010-01-01

    Full Text Available Introduction Laryngomalacia is the most frequent congenital anomaly of airways, and it may cause obstructive sleep apneas. The associated vocal cord paralysis may aggravate the symptoms of upper airway obstruction. Case report In a 14 month old boy severe laryngomalacia and bilateral vocal cord paralysis were diagnosed by flexible bronchoscopy. A sleep study showed a severe obstructive sleep apnoea (OSA. The patient was ventilated at home via the face mask with non invasive mechanical ventilation (CPAP for a year. The level of pressure had to be set at 7cm H2O to correct desaturation with an improvement in mean SpO2. On the follow up bronchoscopic examination laryngomalatia was improved, vocal cord paralysis persisted and sleep study revealed significant improvement. Discussion In the patient with severe laryngomalatia and bilateral vocal cord paralysis with OSA conservative treatment with CPAP was used instead of a surgical intervention. Non invasive ventilation was used every night, for at least 6 hours, without adverse events. Invasive measurement of transdiaphragmatic pressure is the best way of titrating of CPAP level. This case report suggests the efficacy of noninvasive titrating of CPAP level by the hemoglobin oxygen saturation trend measurement. Conclusion In case of severe laryngomalatia and associated vocal cord paralysis, followed by OSA non invasive ventilation by nasal CPAP represents an effective and safe alternative to surgery.

  18. Continuous positive airway pressure ameliorated severe pulmonary hypertension associated with obstructive sleep apnea.

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    Ogawa,Aiko

    2006-06-01

    Full Text Available

    A 52-year-old obese woman was admitted to our institution for evaluation of dyspnea and pulmonary hypertension (PH. Polysomnography revealed severe obstructive sleep apnea (OSA with an apnea hypopnea index of 99.8. Treatment with nocturnal continuous positive airway pressure (CPAP resulted in correction of daytime hypoxemia, hypercapnia, and near-normalization of pulmonary artery pressure. To our knowledge, this is the most severe case of OSA-associated PH (approximately70 mmHg reported to date, and it was successfully treated with nocturnal CPAP. This case demonstrates that OSA should be considered and polysomnography performed in all patients with PH, irrespective of severity, and that nocturnal CPAP has therapeutic effects on both OSA and daytime PH.

  19. Effects of Altered Intra-abdominal Pressure on the Upper Airway Collapsibility in a Porcine Model

    Institute of Scientific and Technical Information of China (English)

    Shu-Lin Ren; Yan-Ru Li; Ji-Xiang Wu; Jing-Ying Ye; Rachel Jen

    2015-01-01

    Background: Obstructive sleep apnea is strongly associated with obesity, particularly abdominal obesity common in centrally obese males.Previous studies have demonstrated that intra-abdominal pressure (IAP) is increased in morbid obesity, and tracheal traction forces may influence pharyngeal airway collapsibility.This study aimed to investigate that whether IAP plays a role in the mechanism of upper airway (UA) collapsibility via IAP-related caudal tracheal traction.Methods: An abdominal wall lifting (AWL) system and graded CO2 pneumoperitoneum pressure was applied to four supine, anesthetized Guizhou miniature pigs and its effects on tracheal displacement (TD) and airflow dynamics of UA were studied.Individual run data in 3 min obtained before and after AWL and obtained before and after graded pneumoperitoneum pressure were analyzed.Differences between baseline and AWL/graded pneumoperitoneum pressure data of each pig were examined using a Student's t-test or analysis of variance.Results: Application of AWL resulted in decreased IAP and significant caudal TD.The average displacement amplitude was 0.44 mm (P < 0.001).There were three subjects showed increased tidal volume (TV) (P < 0.0l) and peak inspiratory airflow (P < 0.01);however, the change of flow limitation inspiratory UA resistance (Rua) was not significant.Experimental increased IAP by pneumoperitoneum resulted in significant cranial TD.The average displacement amplitude was 1.07 mm (P < 0.001) when IAP was 25 cmH20 compared to baseline.There were three subjects showed reduced Rua while the TV increased (P < 0.01).There was one subject had decreased TV and elevated Rua (P < 0.001).Conclusions: Decreased IAP significantly increased caudal TD, and elevated IAP significantly increased cranial TD.However, the mechanism of UA collapsibility appears primarily mediated by changes in lung volume rather than tracheal traction effect.TV plays an independent role in the mechanism of UA collapsibility.

  20. Distending Pressure Did Not Activate Acute Phase or Inflammatory Responses in the Airways and Lungs of Fetal, Preterm Lambs.

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    Rebecca Y Petersen

    Full Text Available Mechanical ventilation at birth causes airway injury and lung inflammation in preterm sheep. Continuous positive airway pressure (CPAP is being increasingly used clinically to transition preterm infants at birth.To test if distending pressures will activate acute phase reactants and inflammatory changes in the airways of fetal, preterm lambs.The head and chest of fetal lambs at 128±1 day GA were surgically exteriorized. With placental circulation intact, fetal lambs were then randomized to one of five 15 minute interventions: PEEP of 0, 4, 8, 12, or 16 cmH2O. Recruitment volumes were recorded. Fetal lambs remained on placental support for 30 min after the intervention. The twins of each 0 cmH2O animal served as controls. Fetal lung fluid (FLF, bronchoalveolar lavage fluid (BAL, right mainstem bronchi and peripheral lung tissue were evaluated for inflammation.Recruitment volume increased from 0.4±0.04 mL/kg at 4 cmH2O to 2.4±0.3 mL/kg at 16 cmH2O. The lambs were surfactant deficient, and all pressures were below the opening inflection pressure on pressure-volume curve. mRNA expression of early response genes and pro-inflammatory cytokines did not increase in airway tissue or lung tissue at any pressure compared to controls. FLF and BAL also did not have increases in early response proteins. No histologic changes or Egr-1 activation was present at the pressures used.Distending pressures as high as 16 cmH2O did not recruit lung volume at birth and did not increase markers of injury in the lung or airways in non-breathing preterm fetal sheep.

  1. Liberação de pressão de vias aéreas em pacientes pediátricos submetidos à cirurgia cardíaca Airway pressure release ventilation in post operative cardiac surgery in pediatric patients

    Directory of Open Access Journals (Sweden)

    W. B. de Carvalho

    2000-06-01

    positive end expiratory pressure (IMV+PEEP, APRV and continuous positive airway pressure (CPAP in children during cardiac surgery post operative with pulmonary hypertension and mild or moderate pulmonary lesion. METHODS: Ten patients were studied with respiratory monitoring (Bear Neonatal Volume Monitor-1Ò in MV with a continuos flow, time cycled and pressure limited ventilator. The cardiocirculatory variables analyzed were central venous pressure (CVP, oxygen extraction ratio, cardiac rate, systolic arterial pressure, and arterial- mixed venous CO2 difference. Friedman's test (non-parametric was used to compare the variables in three modalities of ventilation and the Wilcoxon test was used for the variables obtained in two of the modalities. RESULTS: The mean airway pressure (MAP showed a significant increasing during APRV compared to IMV+PEEP (p=0,012. The positive inspiratory pressure (PIP, the minute volume and the ratio of oxygen arterial pressure to oxygen inspired fraction (PaO2/FiO2 didn't show statistical difference. During APRV there was a significant decrease in respiratory rate (p= 0,004 and an increase in tidal volume (p=0,045 when compared to CPAP and IMV+PEEP. In the cardiocirculatory system only CVP showed a significant increased (p=0,019 during APRV. CONCLUSION: Due to the methodology utilized MAP was higher with APRV resulting in an increased tidal volume without respiratory or cardiocirculatory adverse effects when the three modes were compared. Our results suggest that APRV is a simple and safe method of ventilation.

  2. Nasal continuous positive airway pressure (CPAP) for the respiratory care of the newborn infant.

    Science.gov (United States)

    Diblasi, Robert M

    2009-09-01

    Nasal continuous positive airway pressure (CPAP) is a noninvasive form of respiratory assistance that has been used to support spontaneously breathing infants with lung disease for nearly 40 years. Following reports that mechanical ventilation contributes to pulmonary growth arrest and the development of chronic lung disease, there is a renewed interest in using CPAP as the prevailing method for supporting newborn infants. Animal and human research has shown that CPAP is less injurious to the lungs than is mechanical ventilation. The major concepts that embrace lung protection during CPAP are the application of spontaneous breathing at a constant distending pressure and avoidance of intubation and positive-pressure inflations. A major topic for current research focuses on whether premature infants should be supported initially with CPAP following delivery, or after the infant has been extubated following prophylactic surfactant administration. Clinical trials have shown that CPAP reduces the need for intubation/mechanical ventilation and surfactant administration, but it is still unclear whether CPAP reduces chronic lung disease and mortality, compared to modern lung-protective ventilation techniques. Despite the successes, little is known about how best to manage patients using CPAP. It is also unclear whether different strategies or devices used to maintain CPAP play a role in improving outcomes in infants. Nasal CPAP technology has evolved over the last 10 years, and bench and clinical research has evaluated differences in physiologic effects related to these new devices. Ultimately, clinicians' abilities to perceive changes in the pathophysiologic conditions of infants receiving CPAP and the quality of airway care provided are likely to be the most influential factors in determining patient outcomes.

  3. Obstructive sleep apnea syndrome, continuous positive airway pressure and treatment of hypertension.

    Science.gov (United States)

    Floras, John S

    2015-09-15

    Obstructive sleep apnea (OSA), present in ~15% of the general population, increases the risks of stroke, heart failure, and premature death. Importantly, individuals with cardiovascular disease have a higher prevalence yet they often have few symptoms to alert clinicians to its presence. OSA with an apnea-hypopnea index (AHI) ≥15 events/hour is present in ≥30% of patients with primary hypertension and in up to 80% of those with drug resistant hypertension, suggesting that the neural, hormonal, inflammatory and vascular cascades triggered by OSA may elevate blood pressure chronically. The purpose of this review is to summarize: (1) the epidemiology of OSA and its relation to cardiovascular risk; (2) potential mechanisms by which OSA could promote conditions known to increase the risk of hypertension or contribute to its development and progression; (3) evidence for and against a pro-hypertensive effect of OSA; and, (4) the impact of treatment with continuous positive airway pressure (CPAP) on blood pressure and blood pressure-related morbidities. The prevailing view that the effect of treatment on blood pressure is modest arises from the inability of most contemporary technology to measure accurately the true impact of CPAP on OSA-entrained surges in nocturnal blood pressure. Moreover the exclusive focus on blood pressure, as if this is the principal determinant of cardiovascular event rates in this population, is naïve. The capacity to reduce cardiovascular risk by treating OSA with CPAP likely transcends a simple blood pressure effect; formal testing of this hypothesis will require adequately powered randomized clinical trials.

  4. Efficacy of Home Single-Channel Nasal Pressure for Recommending Continuous Positive Airway Pressure Treatment in Sleep Apnea

    Science.gov (United States)

    Masa, Juan F.; Duran-Cantolla, Joaquin; Capote, Francisco; Cabello, Marta; Abad, Jorge; Garcia-Rio, Francisco; Ferrer, Antoni; Fortuna, Ana M.; Gonzalez-Mangado, Nicolas; de la Peña, Monica; Aizpuru, Felipe; Barbe, Ferran; Montserrat, Jose M.; Larrateguy, Luis D.; de Castro, Jorge Rey; Garcia-Ledesma, Estefania; Corral, Jaime; Martin-Vicente, Maria J.; Martinez-Null, Cristina; Egea, Carlos; Cancelo, Laura; García-Díaz, Emilio; Carmona-Bernal, Carmen; Sánchez-Armengol, Ángeles; Mayos, Merche; Miralda, Rosa M; Troncoso, Maria F.; Gonzalez, Monica; Martinez-Martinez, Marian; Cantalejo, Olga; Piérola, Javier; Vigil, Laura; Embid, Cristina; del Mar Centelles, Mireia; Prieto, Teresa Ramírez; Rojo, Blas; Lores, Vanesa

    2015-01-01

    Introduction: Unlike other prevalent diseases, obstructive sleep apnea (OSA) has no simple tool for diagnosis and therapeutic decision-making in primary healthcare. Home single-channel nasal pressure (HNP) may be an alternative to polysomnography for diagnosis but its use in therapeutic decisions has yet to be explored. Objectives: To ascertain whether an automatically scored HNP apnea-hypopnea index (AHI), used alone to recommend continuous positive airway pressure (CPAP) treatment, agrees with decisions made by a specialist using polysomnography and several clinical variables. Methods: Patients referred by primary care physicians for OSA suspicion underwent randomized polysomnography and HNP. We analyzed the total sample and both more and less symptomatic subgroups for Bland and Altman plots to explore AHI agreement; receiver operating characteristic curves to establish area under the curve (AUC) measurements for CPAP recommendation; and therapeutic decision efficacy for several HNP AHI cutoff points. Results: Of the 787 randomized patients, 35 (4%) were lost, 378 (48%) formed the more symptomatic and 374 (48%) the less symptomatic subgroups. AHI bias and agreement limits were 5.8 ± 39.6 for the total sample, 5.3 ± 38.7 for the more symptomatic, and 6 ± 40.2 for the less symptomatic subgroups. The AUC were 0.826 for the total sample, 0.903 for the more symptomatic, and 0.772 for the less symptomatic subgroups. In the more symptomatic subgroup, 70% of patients could be correctly treated with CPAP. Conclusion: Automatic home single-channel nasal pressure scoring can correctly recommend CPAP treatment in most of more symptomatic patients with OSA suspicion. Our results suggest that this device may be an interesting tool in initial OSA management for primary care physicians, although future studies in a primary care setting are necessary. Clinical Trials Information: Clinicaltrial.gov identifier: NCT01347398. Citation: Masa JF, Duran-Cantolla J, Capote F, Cabello

  5. Continuous positive airway pressure and noninvasive ventilation in prehospital treatment of patients with acute respiratory failure

    DEFF Research Database (Denmark)

    Bakke, Skule A; Bøtker, Morten Thingemann; Riddervold, Ingunn S;

    2014-01-01

    Continuous positive airway pressure (CPAP) and noninvasive ventilation (NIV) are frequently used inhospital for treating respiratory failure, especially in treatment of acute cardiogenic pulmonary edema and exacerbation of chronic obstructive pulmonary disease. Early initiation of treatment...... is important for success and introduction already in the prehospital setting may be beneficial. Our goal was to assess the evidence for an effect of prehospital CPAP or NIV as a supplement to standard medical treatment alone on the following outcome measures; mortality, hospital length of stay, intensive care...... examine prehospital CPAP. Of these, only one small, randomized controlled trial shows a reduced mortality rate and a reduced intubation rate with supplemental CPAP. The other three studies have neutral findings, but in two of these a trend toward lower intubation rate is found. The effect of supplemental...

  6. Continuous positive airway pressure breathing increases cranial spread of sensory blockade after cervicothoracic epidural injection of lidocaine.

    NARCIS (Netherlands)

    Visser, W.A.; Eerd, M.J. van; Seventer, R. van; Gielen, M.J.M.; Giele, J.L.P.; Scheffer, G.J.

    2007-01-01

    BACKGROUND: Continuous positive airway pressure (CPAP) increases the caudad spread of sensory blockade after low-thoracic epidural injection of lidocaine. We hypothesized that CPAP would increase cephalad spread of blockade after cervicothoracic epidural injection. METHODS: Twenty patients with an e

  7. Simulated driving in obstructive sleep apnoea-hypopnoea : effects of oral appliances and continuous positive airway pressure

    NARCIS (Netherlands)

    Hoekema, Aarnoud; Stegenga, Boudewijn; Bakker, Marije; Brouwer, Wiebo H.; de Bont, Lambert G. M.; Wijkstra, Peter J.; van der Hoeven, Johannes H.

    2007-01-01

    Impaired simulated driving performance has been demonstrated in obstructive sleep apnoea-hypopnoea syndrome (OSAHS) patients. Although continuous positive airway pressure (CPAP) generally improves simulated driving performance, the effects of oral-appliance (OA) therapy are unknown. The aims of this

  8. Infants with severe respiratory syncytial virus needed less ventilator time with nasal continuous airways pressure then invasive mechanical ventilation

    NARCIS (Netherlands)

    Borckink, Ilse; Essouri, Sandrine; Laurent, Marie; Albers, Marcel J. I. J.; Burgerhof, Johannes G. M.; Tissieres, Pierre; Kneyber, Martin C. J.

    2014-01-01

    AIM: Nasal continuous positive airway pressure (NCPAP) has been proposed as an early first-line support for infants with severe respiratory syncytial virus (RSV) infection. We hypothesised that infants <6 months with severe RSV would require shorter ventilator support on NCPAP than invasive mechanic

  9. Safety and Effectiveness of Bubble Continuous Positive Airway Pressure in Neonates With Respiratory Distress and Its Failure Factors

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    Ajay Sethi

    2015-09-01

    Conclusion: Bubble Continuous Positive Airway Pressure is safe, efficacious and easy to use in preterm and term neonates with mild to moderate respiratory distress. The major failure factors in our study were sepsis, recurrent apnea, and shock. The survival rate in our study was 60%. [Natl J Med Res 2015; 5(3.000: 202-206

  10. A Randomized Trial of Low-Flow Oxygen versus Nasal Continuous Positive Airway Pressure in Preterm Infants

    DEFF Research Database (Denmark)

    Heiring, Christian; Steensberg, Jesper; Bjerager, Mia

    2015-01-01

    BACKGROUND: Nasal continuous positive airway pressure (nCPAP) stabilizes the residual volume and may decrease the risk of 'atelectotrauma', potentially promoting lung development in neonates. OBJECTIVES: To assess whether replacing nCPAP by low-flow O2 by nasal cannula affects lung function expre...

  11. Otic Barotrauma Resulting from Continuous Positive Airway Pressure: Case Report and Literature Review

    Science.gov (United States)

    McCormick, Justin P.; Hildrew, Douglas M.; Lawlor, Claire M.; Guittard, Jesse A.; Worley, N. Knight

    2016-01-01

    Background: Obstructive sleep apnea (OSA) is a growing problem affecting millions of people in the United States. The prevalence of OSA has risen drastically in the past few decades concurrently with the increasing prevalence of obesity. Subsequently, there has been an ever-increasing rise in the use of continuous positive airway pressure (CPAP) devices. While using CPAP devices may lead to many adverse effects, the majority of these effects are described as relatively benign. Case Report: We describe the detailed clinical course and outcome for a patient with otic barotrauma as a result of excessive self-titration of CPAP therapy in an in-home setting. We also discuss the pathophysiology of otic barotrauma and present a review of current literature on the topic. Conclusion: While the benefits of CPAP are clear, we must take into account the rare but possible effects on ear structure and function. Many studies describe an increase in middle ear pressure with the use of CPAP, but few describe the effects of this increased pressure on the middle ear, such as the otic barotrauma described in this case. Given the increased prevalence of OSA, it is important to understand the risks associated with CPAP therapy. PMID:27303224

  12. Type of mask may impact on continuous positive airway pressure adherence in apneic patients.

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    Jean Christian Borel

    Full Text Available RATIONALE: In obstructive sleep apnea patients (OSA, continuous positive airway pressure (CPAP adherence is crucial to improve symptoms and cardiometabolic outcomes. The choice of mask may influence CPAP adherence but this issue has never been addressed properly. OBJECTIVE: To evaluate the impact of nasal pillows, nasal and oronasal masks on CPAP adherence in a cohort of OSA. METHODS: Newly CPAP treated OSA participating in "Observatoire Sommeil de la Fédération de Pneumologie", a French national prospective cohort, were included between March 2009 and December 2011. Anthropometric data, medical history, OSA severity, sleepiness, depressive status, treatment modalities (auto-CPAP versus fixed pressure, pressure level, interface type, use of humidifiers and CPAP-related side effects were included in multivariate analysis to determine independent variables associated with CPAP adherence. RESULTS: 2311 OSA (age = 57(12 years, apnea+hypopnea index = 41(21/h, 29% female were included. Nasal masks, oronasal masks and nasal pillows were used by 62.4, 26.2 and 11.4% of the patients, respectively. In univariate analysis, oronasal masks and nasal pillows were associated with higher risk of CPAP non-adherence. CPAP non-adherence was also associated with younger age, female gender, mild OSA, gastroesophageal reflux, depression status, low effective pressure and CPAP-related side effects. In multivariate analysis, CPAP non-adherence was associated with the use of oronasal masks (OR = 2.0; 95%CI = 1.6; 2.5, depression, low effective pressure, and side effects. CONCLUSION: As oronasal masks negatively impact on CPAP adherence, a nasal mask should be preferred as the first option. Patients on oronasal masks should be carefully followed.

  13. Lung pressures and gas transport during high-frequency airway and chest wall oscillation.

    Science.gov (United States)

    Khoo, M C; Ye, T H; Tran, N H

    1989-09-01

    The major goal of this study was to compare gas exchange, tidal volume (VT), and dynamic lung pressures resulting from high-frequency airway oscillation (HFAO) with the corresponding effects in high-frequency chest wall oscillation (HFCWO). Eight anesthetized paralyzed dogs were maintained eucapnic with HFAO and HFCWO at frequencies ranging from 1 to 16 Hz in the former and 0.5 to 8 Hz in the latter. Tracheal (delta Ptr) and esophageal (delta Pes) pressure swings, VT, and arterial blood gases were measured in addition to respiratory impedance and static pressure-volume curves. Mean positive pressure (25-30 cmH2O) in the chest cuff associated with HFCWO generation decreased lung volume by approximately 200 ml and increased pulmonary impedance significantly. Aside from this decrease in functional residual capacity (FRC), no change in lung volume occurred as a result of dynamic factors during the course of HFCWO application. With HFAO, a small degree of hyperinflation occurred only at 16 Hz. Arterial PO2 decreased by 5 Torr on average during HFCWO. VT decreased with increasing frequency in both cases, but VT during HFCWO was smaller over the range of frequencies compared with HFAO. delta Pes and delta Ptr between 1 and 8 Hz were lower than the corresponding pressure swings obtained with conventional mechanical ventilation (CMV) applied at 0.25 Hz. delta Pes was minimized at 1 Hz during HFCWO; however, delta Ptr decreased continuously with decreasing frequency and, below 2 Hz, became progressively smaller than the corresponding values obtained with HFAO and CMV.

  14. Effect of Nasal Obstruction on Continuous Positive Airway Pressure Treatment: Computational Fluid Dynamics Analyses.

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    Tadashi Wakayama

    Full Text Available Nasal obstruction is a common problem in continuous positive airway pressure (CPAP therapy for obstructive sleep apnea and limits treatment compliance. The purpose of this study is to model the effects of nasal obstruction on airflow parameters under CPAP using computational fluid dynamics (CFD, and to clarify quantitatively the relation between airflow velocity and pressure loss coefficient in subjects with and without nasal obstruction.We conducted an observational cross-sectional study of 16 Japanese adult subjects, of whom 9 had nasal obstruction and 7 did not (control group. Three-dimensional reconstructed models of the nasal cavity and nasopharynx with a CPAP mask fitted to the nostrils were created from each subject's CT scans. The digital models were meshed with tetrahedral cells and stereolithography formats were created. CPAP airflow simulations were conducted using CFD software. Airflow streamlines and velocity contours in the nasal cavities and nasopharynx were compared between groups. Simulation models were confirmed to agree with actual measurements of nasal flow rate and with pressure and flow rate in the CPAP machine.Under 10 cmH2O CPAP, average maximum airflow velocity during inspiration was 17.6 ± 5.6 m/s in the nasal obstruction group but only 11.8 ± 1.4 m/s in the control group. The average pressure drop in the nasopharynx relative to inlet static pressure was 2.44 ± 1.41 cmH2O in the nasal obstruction group but only 1.17 ± 0.29 cmH2O in the control group. The nasal obstruction and control groups were clearly separated by a velocity threshold of 13.5 m/s, and pressure loss coefficient threshold of approximately 10.0. In contrast, there was no significant difference in expiratory pressure in the nasopharynx between the groups.This is the first CFD analysis of the effect of nasal obstruction on CPAP treatment. A strong correlation between the inspiratory pressure loss coefficient and maximum airflow velocity was found.

  15. Mathematical Equations to Predict Positive Airway Pressures for Obstructive Sleep Apnea: A Systematic Review

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    Macario Camacho

    2015-01-01

    Full Text Available Objective. To systematically review the international literature for mathematical equations used to predict effective pressures for positive airway pressure (PAP devices. Methods. Google Scholar, PubMed, Scopus, Embase, Web of Science, CINAHL, and The Cochrane Library were searched through June 27, 2015. The PRISMA statement was followed. There was no language limitation. Results. 709 articles were screened, fifty were downloaded, and twenty-six studies presented equations that met the inclusion and exclusion criteria. In total, there were 4,436 patients in the development phases and 3,489 patients in the validation phases. Studies performed multiple linear regressions analyses as part of the equation(s development and included the following variables: physical characteristics, polysomnography data, behavioral characteristics, and miscellaneous characteristics, which were all predictive to a variable extent. Of the published variables, body mass index (BMI and mean oxygen saturation are the most heavily weighted, while BMI (eighteen studies, apnea-hypopnea index (seventeen studies, and neck circumference (eleven studies were the variables most frequently used in the mathematical equations. Ten studies were from Asian countries and sixteen were from non-Asian countries. Conclusion. This systematic review identified twenty-six unique studies reporting mathematical equations which are summarized. Overall, BMI and mean oxygen saturation are the most heavily weighted.

  16. Mathematical Equations to Predict Positive Airway Pressures for Obstructive Sleep Apnea: A Systematic Review

    Science.gov (United States)

    Camacho, Macario; Riaz, Muhammad; Tahoori, Armin; Certal, Victor; Kushida, Clete A.

    2015-01-01

    Objective. To systematically review the international literature for mathematical equations used to predict effective pressures for positive airway pressure (PAP) devices. Methods. Google Scholar, PubMed, Scopus, Embase, Web of Science, CINAHL, and The Cochrane Library were searched through June 27, 2015. The PRISMA statement was followed. There was no language limitation. Results. 709 articles were screened, fifty were downloaded, and twenty-six studies presented equations that met the inclusion and exclusion criteria. In total, there were 4,436 patients in the development phases and 3,489 patients in the validation phases. Studies performed multiple linear regressions analyses as part of the equation(s) development and included the following variables: physical characteristics, polysomnography data, behavioral characteristics, and miscellaneous characteristics, which were all predictive to a variable extent. Of the published variables, body mass index (BMI) and mean oxygen saturation are the most heavily weighted, while BMI (eighteen studies), apnea-hypopnea index (seventeen studies), and neck circumference (eleven studies) were the variables most frequently used in the mathematical equations. Ten studies were from Asian countries and sixteen were from non-Asian countries. Conclusion. This systematic review identified twenty-six unique studies reporting mathematical equations which are summarized. Overall, BMI and mean oxygen saturation are the most heavily weighted. PMID:26294977

  17. TRPC3 Regulates Release of Brain-Derived Neurotrophic Factor From Human Airway Smooth Muscle

    OpenAIRE

    Vohra, Pawan K.; Thompson, Michael A.; Sathish, Venkatachalem; Kiel, Alexander; Jerde, Calvin; Pabelick, Christina M.; Singh, Brij B.; Prakash, Y. S.

    2013-01-01

    Exogenous brain-derived neurotrophic factor (BDNF) enhances Ca2+ signaling and cell proliferation in human airway smooth muscle (ASM), especially with inflammation. Human ASM also expresses BDNF, raising the potential for autocrine/paracrine effects. The mechanisms by which ASM BDNF secretion occurs are not known. Transient receptor potential channels (TRPCs) regulate a variety of intracellular processes including store-operated Ca2+ entry (SOCE; including in ASM) and secretion of factors suc...

  18. Effects of nasal continuous positive airway pressure therapy on partners' sexual lives.

    Science.gov (United States)

    Acar, Mustafa; Kaya, Coskun; Catli, Tolgahan; Hancı, Deniz; Bolluk, Ozge; Aydin, Yunus

    2016-01-01

    To assess sexual functioning in male and female partners before and after nasal continuous positive airway pressure (CPAP) therapy in men with obstructive sleep apnea (OSA). Twenty-one male patients with moderate to severe OSA and erectile dysfunction, and their female partner, were recruited into this prospective study. Males diagnosed with OSA were treated with nasal CPAP therapy for 12 weeks. Women were assessed for sexual functioning using the Female Sexual Function Index (FSFI), and for mood status using the Beck Depression Inventory (BDI), before and after their male partner underwent nasal CPAP therapy. Sexual functioning was assessed in men using the International Index of Erectile Function (IIEF), before and after nasal CPAP therapy. After nasal CPAP therapy for OSA in men, IIEF scores were significantly higher than pre-treatment scores. Total pre- and post-treatment IIEF scores (mean ± standard deviation) were 50.28 ± 15.88 and 65.42 ± 7.47, respectively, P sexual functioning in both the male and female partners. Moreover, our findings indicate that improved sexual function in women after their male partner underwent nasal CPAP also had psychological benefits.

  19. Noninvasive Positive Airway Pressure Treatment in Children Less Than 12 Months of Age

    Directory of Open Access Journals (Sweden)

    Adetayo Adeleye

    2016-01-01

    Full Text Available Study Objectives. We identified the associated conditions of patients less than 12 months of age who were referred for polysomnogram (PSG studies. We collated PSG findings and physician interpretation. We determined the correlation between the recommended treatment by the PSG interpreting physician and actual prescribed treatment by the referring or subjects’ physician. We determined adherence with noninvasive positive airway pressure (PAP treatment. Methods. This was a retrospective cohort study. Participants included children less than 12 months of age referred for PSG studies between 2007 and 2012. Results. 92 patients under the age of 12 months were included in the study analysis. Mean (standard deviation, SD age in days at time of the PSG study was 208.5 (101.2. 35 (38% patients had a diagnosis of Trisomy 21. Seven (8% patients had no prior diagnosis. Median (Q1, Q3 apnea hypopnea index (AHI was 22.5 (11.3–37.0. Agreement between the PSG interpreting physician’s recommendation and actual prescribed treatment by the referring or subjects’ physician was 85.9% [95% CI 77.1–91.6]. Mean (SD percentage days with PAP therapy usage more than 4 hours was 25.2% (32. Conclusions. In our experience, despite consistent physician messaging to families, adherence with noninvasive PAP treatment is low.

  20. Continuous Positive Airway Pressure Device Time to Procurement in a Disadvantaged Population

    Directory of Open Access Journals (Sweden)

    Lourdes M. DelRosso

    2015-01-01

    Full Text Available Introduction. The management of obstructive sleep apnea (OSA in patients who cannot afford a continuous positive airway pressure (CPAP device is challenging. In this study we compare time to CPAP procurement in three groups of patients diagnosed with OSA: uninsured subsidized by a humanitarian grant (Group 1, uninsured unsubsidized (Group 2, and those with Medicare or Medicaid (Group 3. We evaluate follow-up and adherence in Group 1. We hypothesize that additional factors, rather than just the ability to obtain CPAP, may uniquely affect follow-up and adherence in uninsured patients. Methods. 30 patients were in Groups 1 and 2, respectively. 12 patients were in Group 3. Time of CPAP procurement from OSA diagnosis to CPAP initiation was assessed in all groups. CPAP adherence data was collected for Group 1 patients at 1, 3, 6, and 9 months. Results. There were no significant differences between groups in gender, age, body mass index, or apnea hypopnea index. The mean time to procurement in Group 1 was shorter compared to Group 2 but not significant. Compared to both Group 1 and Group 2, Group 3 patients had significantly shorter times to device procurement. Conclusion. Time to procurement of CPAP was significantly shorter in those with Medicaid/Medicare insurance compared to the uninsured.

  1. Effects of continuous positive airway pressure on energy balance regulation: a systematic review

    Science.gov (United States)

    Shechter, Ari

    2016-01-01

    Obesity is both a cause and a possible consequence of obstructive sleep apnoea (OSA), as OSA seems to affect parameters involved in energy balance regulation, including food intake, hormonal regulation of hunger/satiety, energy metabolism and physical activity. It is known that weight loss improves OSA, yet it remains unclear why continuous positive airway pressure (CPAP) often results in weight gain. The goal of this systematic review is to explore if and how CPAP affects the behaviour and/or metabolism involved in regulating energy balance. CPAP appears to correct for a hormonal profile characterised by abnormally high leptin and ghrelin levels in OSA, by reducing the circulating levels of each. This is expected to reduce excess food intake. However, reliable measures of food intake are lacking, and not yet sufficient to make conclusions. Although studies are limited and inconsistent, CPAP may alter energy metabolism, with reports of reductions in resting metabolic rate or sleeping metabolic rate. CPAP appears to not have an appreciable effect on altering physical activity levels. More work is needed to characterise how CPAP affects energy balance regulation. It is clear that promoting CPAP in conjunction with other weight loss approaches should be used to encourage optimal outcomes in OSA patients. PMID:27824596

  2. Positive airway pressure improves nocturnal beat-to-beat blood pressure surges in obesity hypoventilation syndrome with obstructive sleep apnea.

    Science.gov (United States)

    Carter, Jason R; Fonkoue, Ida T; Grimaldi, Daniela; Emami, Leila; Gozal, David; Sullivan, Colin E; Mokhlesi, Babak

    2016-04-01

    Positive airway pressure (PAP) treatment has been shown to have a modest effect on ambulatory blood pressure (BP) in patients with obstructive sleep apnea (OSA). However, there is a paucity of data on the effect of PAP therapy on rapid, yet significant, BP swings during sleep, particularly in obesity hypoventilation syndrome (OHS). The present study hypothesizes that PAP therapy will improve nocturnal BP on the first treatment night (titration PAP) in OHS patients with underlying OSA, and that these improvements will become more significant with 6 wk of PAP therapy. Seventeen adults (7 men, 10 women; age 50.4 ± 10.7 years, BMI 49.3 ± 2.4 kg/m(2)) with OHS and clinically diagnosed OSA participated in three overnight laboratory visits that included polysomnography and beat-to-beat BP monitoring via finger plethysmography. Six weeks of PAP therapy, but not titration PAP, lowered mean nocturnal BP. In contrast, when nocturnal beat-to-beat BPs were aggregated into bins consisting of at least three consecutive cardiac cycles with a >10 mmHg BP surge (i.e., Δ10-20, Δ20-30, Δ30-40, and Δ>40 mmHg), titration, and 6-wk PAP reduced the number of BP surges per hour (time × bin, P < 0.05). PAP adherence over the 6-wk period was significantly correlated to reductions in nocturnal systolic (r = 0.713, P = 0.001) and diastolic (r = 0.497, P = 0.043) BP surges. Despite these PAP-induced improvements in nocturnal beat-to-beat BP surges, 6 wk of PAP therapy did not alter daytime BP. In conclusion, PAP treatment reduces nocturnal beat-to-beat BP surges in OHS patients with underlying OSA, and this improvement in nocturnal BP regulation was greater in patients with higher PAP adherence.

  3. Long-Term Effects of Continuous Positive Airway Pressure Treatment on Sexuality in Female Patients with Obstructive Sleep Apnea

    OpenAIRE

    Petersen, Marian; Kristensen, Ellids; Berg, Søren; Midgren, Bengt

    2013-01-01

    Introduction Results from a previous study showed that sexuality was negatively affected in females with untreated obstructive sleep apnea (OSA). Data are sparse on the long-term effects of nocturnal continuous positive airway pressure (CPAP) treatment on sexual difficulties and sexual distress in female patients with OSA. Aim The aim of the present study was to investigate the effects after 1 year of CPAP treatment on sexual difficulties, sexual distress, and manifest sexual dysfunction in f...

  4. Effect of adjuvant nasal continuous positive airway pressure therapy on immune response and organ injury in children with severe pneumonia

    Institute of Scientific and Technical Information of China (English)

    Ni-Na Huang; Yu-Dan Zhang

    2016-01-01

    Objective:To analyze the effect of adjuvant nasal continuous positive airway pressure therapy on immune response and organ injury in children with severe pneumonia.Methods:A total of 90 children with severe pneumonia were randomly divided into observation group and control group (n=45), control group received conventional therapy, observation group accepted regular + adjuvant nasal continuous positive airway pressure therapy, and then differences in immune globulin, Th1/Th2 indexes, blood coagulation indexes, echocardiography parameters and so on were compared between two groups of children.Results:IgG2, IgG3, IgA and IgM content in peripheral blood of observation group were higher than those of control group; Th1/Th2 indexes IL-4 and IFN-γ content in serum as well as IL-4/IFN-γ level were lower than those of control group; blood coagulation indexes PT, TT, APTT and D-D levels were lower than those of control group while FIB and PLT levels were higher than those of control group; echocardiography parameters PVAT and AVAT levels were higher than those of control group while PFVMA level was lower than that of control group.Conclusions: Adjuvant nasal continuous positive airway pressure therapy helps to enhance the immune response and optimize blood coagulation function and cardiac function in children with severe pneumonia.

  5. A pilot study of the effect of pressure-driven lidocaine spray on airway topical anesthesia for conscious sedation intubation

    Institute of Scientific and Technical Information of China (English)

    JIANG Hai; MIAO Hai-sheng; JIN San-qing; CHEN Li-hong; TIAN Jing-ling

    2011-01-01

    Background Difficult airway remains not only a challenge to the anesthesiologists,but also a life-threatening event to the patients.Awake intubation is the principal choice to deal with difficult airway,and a key point for awake intubation is airway topical anesthesia.Yet,so far there is no ideal topical anesthesia approach for awake intubation.This study aimed at evaluating the effect of pressure-driven (by 10 L/min oxygen flow) lidocaine spray on airway topical anesthesia in order to find a powerful and convenient method for airway topical anesthesia for conscious sedation intubation.Methods Thirty adult patients referred for elective surgery under general anesthesia,aged 18-60 years and Mallampati class Ⅰ or Ⅱ,were recruited for the study.Before topical anesthesia,the observer's assessment of alert and sedation (OAA/S) scale was controlled between 3 and 4 by intravenous midazolam (0.03 mg/kg),propofol (2 mg.kg1·h-1) andremifentanil (0.05 μg.kg-1·min-1).Ten minutes after sedation,topical anesthesia was performed with the pressure-driven lidocaine spray; the driving pressure was achieved by an oxygen flow of 10 L/min.After topical anesthesia,tracheal intubation was performed and the intubation condition was assessed with modified the Erhan's intubation condition score by an experienced anesthesiologist,and a score of less than 10 was considered to be satisfactory.Attempts to intubate the patient were recorded,and the complications such as local anesthetic toxicity,mucosa injury,and respiration depression were also recorded.The mean arterial blood pressure (MAP),heart rate (HR) and pulse oxygen saturation (SpO2) were recorded at different time points before and after intubation.Patients were asked 24 hours after the operation whether they could recall the events during intubation.Results All patients were intubated at the first attempt,the average intubation condition score was 7.0±1.1,from 6 to 10,satisfied intubation condition.MAP and HR increased

  6. Efficacy of the addition of positive airway pressure to conventional chest physiotherapy in resolution of pleural effusion after drainage: protocol for a randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Elinaldo da Conceição dos Santos

    2015-04-01

    Discussion: Conventional chest physiotherapy and intermittent positive airway pressure breathing are widely indicated for people with pleural effusion and chest drains; however, no studies have evaluated the real benefit of this type of treatment. Our hypothesis is that optimised lung expansion achieved through the application of intermittent positive airway pressure will accelerate the reabsorption of pleural effusion, decrease the duration of chest drainage and respiratory system impairment, reduce the length of hospital stay, and reduce the incidence of pulmonary complications.

  7. Pathogenic bacteria colonizing the airways in asymptomatic neonates stimulates topical inflammatory mediator release

    DEFF Research Database (Denmark)

    Følsgaard, Nilofar Vahman; Schjørring, Susanne; Chawes, Bo Lund Krogsgaard

    2013-01-01

    by a multivariate approach for pattern identification. Measurements and Main Results: Colonization with M. catarrhalis and H. influenzae induced a mixed T helper cell (Th) type 1/Th2/Th17 response with high levels of IL-1 beta (M. catarrhalis, P = 2.2 x 10(-12); H. influenzae, P = 7.1 X 10(-10)), TNF-alpha (M...... colonization was not significantly associated with any of the mediators. Conclusions: M. catarrhalis and H. influenzae colonization of the airways of asymptomatic neonates is associated with an inflammatory immune response of the airway mucosa, which may result in chronic inflammation........ catarrhalis, P = 1.5 x 10(-9); H. influenzae, P = 5.9 x 10(-7)), and macrophage inflammatory protein-1 beta (M. catarrhalis, P = 1.6 X 10(-11); H. influenzae, P = 2.7 x 10(-7)). S. aureus colonization demonstrated a Th17-promoting profile with elevated IL-17 levels (P = 1.6 x 10(-24)). S. pneumoniae...

  8. Physiological Correlation of Airway Pressure and Transpulmonary Pressure Stress Index on Respiratory Mechanics in Acute Respiratory Failure

    Institute of Scientific and Technical Information of China (English)

    Chun Pan; Lu Chen; Yun-Hang Zhang; Wei Liu; Rosario Urbino; V Marco Ranieri; Hai-Bo Qiu

    2016-01-01

    Background:Stress index at post-recruitment maneuvers could be a method of positive end-expiratory pressure (PEEP) titration in acute respiratory distress syndrome (ARDS) patients.However,airway pressure (Paw) stress index may not reflect lung mechanics in the patients with high chest wall elastance.This study was to evaluate the Paw stress index on lung mechanics and the correlation between Paw stress index and transpulmonary pressure (PL) stress index in acute respiratory failure (ARF) patients.Methods:Twenty-four ARF patients with mechanical ventilation (MV) were consecutively recruited from July 2011 to April 2013 in Zhongda Hospital,Nanjing,China and Ospedale S.Giovanni Battista-Molinette Hospital,Turin,Italy.All patients underwent MV with volume control (tidal volume 6 ml/kg) for 20 min.PEEP was set according to the ARDSnet study protocol.The patients were divided into two groups according to the chest wall elastance/respiratory system elastance ratio.The high elastance group (H group,n =14) had a ratio ≥30%,and the low elastance group (L group,n =10) had a ratio <30%.Respiratory elastance,gas-exchange,Paw stress index,and PL stress index were measured.Student's t-test,regression analysis,and Bland-Altman analysis were used for statistical analysis.Results:Pneumonia was the major cause of respiratory failure (71.0%).Compared with the L group,PEEP was lower in the H group (5.7 ± 1.7 cmH2O vs.9.0 ± 2.3 cm2O,P < 0.01).Compared with the H group,lung elastance was higher (20.0 ± 7.8 cmH2O/L vs.11.6 ± 3.6 cmH2O/L,P < 0.01),and stress was higher in the L group (7.0 ± 1.9 vs.4.9 ± 1.9,P =0.02).A linear relationship was observed between the Paw stress index and the PL stress index in H group (R2 =0.56,P < 0.01) and L group (R2 =0.85,P < 0.01).Conclusion:In the ARF patients with MV,Paw stress index can substitute for PL to guide ventilator settings.

  9. Prostaglandins but not leukotrienes alter extracellular matrix protein deposition and cytokine release in primary human airway smooth muscle cells and fibroblasts

    NARCIS (Netherlands)

    Van Ly, David; Burgess, Janette K.; Brock, Thomas G.; Lee, Tak H.; Black, Judith L.; Oliver, Brian G. G.

    2012-01-01

    Van Ly D, Burgess JK, Brock TG, Lee TH, Black JL, Oliver BG. Prostaglandins but not leukotrienes alter extracellular matrix protein deposition and cytokine release in primary human airway smooth muscle cells and fibroblasts. Am J Physiol Lung Cell Mol Physiol 303: L239-L250, 2012. First published Ma

  10. PKA and Epac cooperate to augment bradykinin-induced interleukin-8 release from human airway smooth muscle cells

    Directory of Open Access Journals (Sweden)

    Halayko Andrew J

    2009-09-01

    Full Text Available Abstract Background Airway smooth muscle contributes to the pathogenesis of pulmonary diseases by secreting inflammatory mediators such as interleukin-8 (IL-8. IL-8 production is in part regulated via activation of Gq-and Gs-coupled receptors. Here we study the role of the cyclic AMP (cAMP effectors protein kinase A (PKA and exchange proteins directly activated by cAMP (Epac1 and Epac2 in the bradykinin-induced IL-8 release from a human airway smooth muscle cell line and the underlying molecular mechanisms of this response. Methods IL-8 release was assessed via ELISA under basal condition and after stimulation with bradykinin alone or in combination with fenoterol, the Epac activators 8-pCPT-2'-O-Me-cAMP and Sp-8-pCPT-2'-O-Me-cAMPS, the PKA activator 6-Bnz-cAMP and the cGMP analog 8-pCPT-2'-O-Me-cGMP. Where indicated, cells were pre-incubated with the pharmacological inhibitors Clostridium difficile toxin B-1470 (GTPases, U0126 (extracellular signal-regulated kinases ERK1/2 and Rp-8-CPT-cAMPS (PKA. The specificity of the cyclic nucleotide analogs was confirmed by measuring phosphorylation of the PKA substrate vasodilator-stimulated phosphoprotein. GTP-loading of Rap1 and Rap2 was evaluated via pull-down technique. Expression of Rap1, Rap2, Epac1 and Epac2 was assessed via western blot. Downregulation of Epac protein expression was achieved by siRNA. Unpaired or paired two-tailed Student's t test was used. Results The β2-agonist fenoterol augmented release of IL-8 by bradykinin. The PKA activator 6-Bnz-cAMP and the Epac activator 8-pCPT-2'-O-Me-cAMP significantly increased bradykinin-induced IL-8 release. The hydrolysis-resistant Epac activator Sp-8-pCPT-2'-O-Me-cAMPS mimicked the effects of 8-pCPT-2'-O-Me-cAMP, whereas the negative control 8-pCPT-2'-O-Me-cGMP did not. Fenoterol, forskolin and 6-Bnz-cAMP induced VASP phosphorylation, which was diminished by the PKA inhibitor Rp-8-CPT-cAMPS. 6-Bnz-cAMP and 8-pCPT-2'-O-Me-cAMP induced GTP

  11. Nasal Expiratory Positive Airway Pressure Devices (Provent) for OSA: A Systematic Review and Meta-Analysis

    Science.gov (United States)

    Riaz, Muhammad; Certal, Victor; Nigam, Gaurav; Abdullatif, Jose; Zaghi, Soroush; Kushida, Clete A.; Camacho, Macario

    2015-01-01

    Objective. To quantify the effectiveness of nasal expiratory positive airway pressure (nasal EPAP) devices or Provent as treatment for obstructive sleep apnea (OSA). Methods. PubMed and six other databases were searched through November 15, 2015, without language limitations. Results. Eighteen studies (920 patients) were included. Pre- and post-nasal EPAP means ± standard deviations (M ± SD) for apnea-hypopnea index (AHI) in 345 patients decreased from 27.32 ± 22.24 to 12.78 ± 16.89 events/hr (relative reduction = 53.2%). Random effects modeling mean difference (MD) was −14.78 events/hr [95% CI −19.12, −10.45], p value < 0.00001. Oxygen desaturation index (ODI) in 247 patients decreased from 21.2 ± 19.3 to 12.4 ± 14.1 events/hr (relative reduction = 41.5%, p value < 0.00001). Lowest oxygen saturation (LSAT) M ± SD improved in 146 patients from 83.2 ± 6.8% to 86.2 ± 11.1%, MD 3 oxygen saturation points [95% CI 0.57, 5.63]. Epworth Sleepiness Scale (ESS) M ± SD improved (359 patients) from 9.9 ± 5.3 to 7.4 ± 5.0, MD −2.5 [95% CI −3.2, −1.8], p value < 0.0001. Conclusion. Nasal EPAP (Provent) reduced AHI by 53.2%, ODI by 41.5% and improved LSAT by 3 oxygen saturation points. Generally, there were no clear characteristics (demographic factors, medical history, and/or physical exam finding) that predicted favorable response to these devices. However, limited evidence suggests that high nasal resistance could be associated with treatment failure. Additional studies are needed to identify demographic and polysomnographic characteristics that would predict therapeutic success with nasal EPAP (Provent). PMID:26798519

  12. Accuracy of Positive Airway Pressure Device—Measured Apneas and Hypopneas: Role in Treatment Followup

    Directory of Open Access Journals (Sweden)

    Carl Stepnowsky

    2013-01-01

    Full Text Available Improved data transmission technologies have facilitated data collected from positive airway pressure (PAP devices in the home environment. Although clinicians’ treatment decisions increasingly rely on autoscoring of respiratory events by the PAP device, few studies have specifically examined the accuracy of autoscored respiratory events in the home environment in ongoing PAP use. “PAP efficacy” studies were conducted in which participants wore PAP simultaneously with an Embletta sleep system (Embla, Inc., Broomfield, CO, which was directly connected to the ResMed AutoSet S8 (ResMed, Inc., San Diego, CA via a specialized cable. Mean PAP-scored Apnea-Hypopnea Index (AHI was 14.2 ± 11.8 (median: 11.7; range: 3.9–46.3 and mean manual-scored AHI was 9.4 ± 10.2 (median: 7.7; range: 1.2–39.3. Ratios between the mean indices were calculated. PAP-scored HI was 2.0 times higher than the manual-scored HI. PAP-scored AHI was 1.5 times higher than the manual-scored AHI, and PAP-scored AI was 1.04 of manual-scored AI. In this sample, PAP-scored HI was on average double the manual-scored HI. Given the importance of PAP efficacy data in tracking treatment progress, it is important to recognize the possible bias of PAP algorithms in overreporting hypopneas. The most likely cause of this discrepancy is the use of desaturations in manual hypopnea scoring.

  13. Nasal Expiratory Positive Airway Pressure Devices (Provent for OSA: A Systematic Review and Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Muhammad Riaz

    2015-01-01

    Full Text Available Objective. To quantify the effectiveness of nasal expiratory positive airway pressure (nasal EPAP devices or Provent as treatment for obstructive sleep apnea (OSA. Methods. PubMed and six other databases were searched through November 15, 2015, without language limitations. Results. Eighteen studies (920 patients were included. Pre- and post-nasal EPAP means ± standard deviations (M ± SD for apnea-hypopnea index (AHI in 345 patients decreased from 27.32±22.24 to 12.78±16.89 events/hr (relative reduction = 53.2%. Random effects modeling mean difference (MD was −14.78 events/hr [95% CI −19.12, −10.45], p value < 0.00001. Oxygen desaturation index (ODI in 247 patients decreased from 21.2±19.3 to 12.4±14.1 events/hr (relative reduction = 41.5%, p value < 0.00001. Lowest oxygen saturation (LSAT M ± SD improved in 146 patients from 83.2±6.8% to 86.2±11.1%, MD 3 oxygen saturation points [95% CI 0.57, 5.63]. Epworth Sleepiness Scale (ESS M ± SD improved (359 patients from 9.9±5.3 to 7.4±5.0, MD −2.5 [95% CI −3.2, −1.8], p value < 0.0001. Conclusion. Nasal EPAP (Provent reduced AHI by 53.2%, ODI by 41.5% and improved LSAT by 3 oxygen saturation points. Generally, there were no clear characteristics (demographic factors, medical history, and/or physical exam finding that predicted favorable response to these devices. However, limited evidence suggests that high nasal resistance could be associated with treatment failure. Additional studies are needed to identify demographic and polysomnographic characteristics that would predict therapeutic success with nasal EPAP (Provent.

  14. TRPC3 regulates release of brain-derived neurotrophic factor from human airway smooth muscle.

    Science.gov (United States)

    Vohra, Pawan K; Thompson, Michael A; Sathish, Venkatachalem; Kiel, Alexander; Jerde, Calvin; Pabelick, Christina M; Singh, Brij B; Prakash, Y S

    2013-12-01

    Exogenous brain-derived neurotrophic factor (BDNF) enhances Ca(2+) signaling and cell proliferation in human airway smooth muscle (ASM), especially with inflammation. Human ASM also expresses BDNF, raising the potential for autocrine/paracrine effects. The mechanisms by which ASM BDNF secretion occurs are not known. Transient receptor potential channels (TRPCs) regulate a variety of intracellular processes including store-operated Ca(2+) entry (SOCE; including in ASM) and secretion of factors such as cytokines. In human ASM, we tested the hypothesis that TRPC3 regulates BDNF secretion. At baseline, intracellular BDNF was present, and BDNF secretion was detectable by enzyme linked immunosorbent assay (ELISA) of cell supernatants or by real-time fluorescence imaging of cells transfected with GFP-BDNF vector. Exposure to the pro-inflammatory cytokine tumor necrosis factor-alpha (TNFα) (20ng/ml, 48h) or a mixture of allergens (ovalbumin, house dust mite, Alternaria, and Aspergillus extracts) significantly enhanced BDNF secretion and increased TRPC3 expression. TRPC3 knockdown (siRNA or inhibitor Pyr3; 10μM) blunted BDNF secretion, and prevented inflammation effects. Chelation of extracellular Ca(2+) (EGTA; 1mM) or intracellular Ca(2+) (BAPTA; 5μM) significantly reduced secreted BDNF, as did the knockdown of SOCE proteins STIM1 and Orai1 or plasma membrane caveolin-1. Functionally, secreted BDNF had autocrine effects suggested by phosphorylation of high-affinity tropomyosin-related kinase TrkB receptor, prevented by chelating extracellular BDNF with chimeric TrkB-Fc. These data emphasize the role of TRPC3 and Ca(2+) influx in the regulation of BDNF secretion by human ASM and the enhancing effects of inflammation. Given the BDNF effects on Ca(2+) and cell proliferation, BDNF secretion may contribute to altered airway structure and function in diseases such as asthma.

  15. Significance of depression in obstructive sleep apnea patients and the relationship between the comorbidity and continuous positive airway pressure treatment

    Institute of Scientific and Technical Information of China (English)

    FENG Jing; CHEN Bao-yuan; Ambrose An-Po Chiang

    2010-01-01

    Obstructive sleep apnea (OSA), which is the most common sleep-related breathing disorder and characterized by recurrent collapse of the upper airway,causes repeated arousals from sleep, decreased oxygen saturation of the blood, and excessive daytime sleepiness.Patients with OSA are at increased risk of cardiovascular and cerebrovascular disease, type 2 diabetes, cognitive impairment, and depression.1,2 Currently, continuous positive airway pressure (CPAP) had been identified as the standard treatment for patients with OSA. CPAP shows significant improvements in objective and subjective sleepiness and several quality3 of life assessments, cognitive function and depression.3 However,reports of non-adherence to CPAP therapy range from 29% to 83%, and one of the reasons of non-adherence is the comorbidity of depression.4

  16. Repeated allergen exposure reduce early phase airway response and leukotriene release despite upregulation of 5-lipoxygenase pathways

    Directory of Open Access Journals (Sweden)

    Cui Zhi-Hua

    2012-03-01

    Full Text Available Abstract Background Allergen induced early phase airway response and airway plasma exudation are predominantly mediated by inflammatory mast cell mediators including histamine, cysteinyl leukotrienes (cysLTs and thromboxane A2 (TXA2. The aim of the present study was to evaluate whether repeated allergen exposure affects early phase airway response to allergen challenge. Methods A trimellitic anhydride (TMA sensitized guinea pig model was used to investigate the effects of low dose repeated allergen exposure on cholinergic airway responsiveness, early phase airway response and plasma exudation, as well as local airway production of mast cell derived cysteinyl leukotrienes and thromboxane B2 (TXB2 after allergen challenge. Results Repeated low dose allergen exposure increased cholinergic airway responsiveness. In contrast, early phase airway response and plasma exudation in response to a high-dose allergen challenge were strongly attenuated after repeated low dose allergen exposure. Inhibition of the airway response was unspecific to exposed allergen and independent of histamine receptor blocking. Furthermore, a significant reduction of cysteinyl leukotrienes and TXB2 was found in the airways of animals repeatedly exposed to a low dose allergen. However, in vitro stimulation of airway tissue from animals repeatedly exposed to a low dose allergen with arachidonic acid and calcium ionophore (A23187 induced production of cysteinyl leukotrienes and TXB2, suggesting enhanced activity of 5-lipoxygenase and cyclooxygenase pathways. Conclusions The inhibition of the early phase airway response, cysteinyl leukotriene and TXB2 production after repeated allergen exposure may result from unresponsive effector cells.

  17. ADAM10 mediates the house dust mite-induced release of chemokine ligand CCL20 by airway epithelium

    NARCIS (Netherlands)

    Post, S.; Rozeveld, D.; Jonker, M. R.; Bischoff, R.; van Oosterhout, A. J.; Heijink, I. H.

    2015-01-01

    Background: House dust mite (HDM) acts on the airway epithelium to induce airway inflammation in asthma. We previously showed that the ability of HDM to induce allergic sensitization in mice is related to airway epithelial CCL20 secretion. Objective: As a disintegrin and metalloprotease (ADAM)s have

  18. Continuous Positive Airway Pressure Therapy for Obstructive Sleep Apnea: Maximizing Adherence Including Using Novel Information Technology-based Systems.

    Science.gov (United States)

    Hevener, Bretton; Hevener, William

    2016-09-01

    Sleep apnea is a form of sleep-disordered breathing that is associated with an increase in disease comorbidities, mortality risks, health care costs, and traffic accidents. Sleep apnea is most commonly treated with positive airway pressure (PAP). PAP can be difficult for patients to tolerate. This leads to initial and long-term noncompliance. Most insurance companies require compliance with PAP treatment to cover ongoing reimbursements for the device and related disposable supplies. Therefore, there are both clinical and financial incentives to a sleep apneic patient's compliance with PAP therapy.

  19. Efficacy of the New Perilaryngeal Airway (CobraPLA™) Versus the Laryngeal Mask Airway (LMA™) to Improve Oropharyngeal Leak Pressure in Obese and Overweight Patients

    NARCIS (Netherlands)

    Yaghoobi, Siamak; Abootorabi, Seyed Mohamadreza; Kayalha, Hamid; Van Zundert, Tom C; Pakpour, Amir H

    2015-01-01

    BACKGROUND: This study aimed to evaluate the applicability of Cobra perilaryngeal airway (Cobra PLA™) for obese patients under general anesthesia and also to compare the results with those of classic laryngeal mask airway (LMA™). MATERIALS AND METHODS: Seventy-three overweight and obese patients wer

  20. Alternaria-induced release of IL-18 from damaged airway epithelial cells: an NF-κB dependent mechanism of Th2 differentiation?

    Directory of Open Access Journals (Sweden)

    Hiroki Murai

    Full Text Available BACKGROUND: A series of epidemiologic studies have identified the fungus Alternaria as a major risk factor for asthma. The airway epithelium plays a critical role in the pathogenesis of allergic asthma. These reports suggest that activated airway epithelial cells can produce cytokines such as IL-25, TSLP and IL-33 that induce Th2 phenotype. However the epithelium-derived products that mediate the pro-asthma effects of Alternaria are not well characterized. We hypothesized that exposure of the airway epithelium to Alternaria releasing cytokines that can induce Th2 differentiation. METHODOLOGY/PRINCIPAL FINDING: We used ELISA to measure human and mouse cytokines. Alternaria extract (ALT-E induced rapid release of IL-18, but not IL-4, IL-9, IL-13, IL-25, IL-33, or TSLP from cultured normal human bronchial epithelial cells; and in the BAL fluids of naïve mice after challenge with ALT-E. Both microscopic and FACS indicated that this release was associated with necrosis of epithelial cells. ALT-E induced much greater IL-18 release compared to 19 major outdoor allergens. Culture of naïve CD4 cells with rmIL-18 induced Th2 differentiation in the absence of IL-4 and STAT6, and this effect was abrogated by disrupting NF- κB p50 or with a NEMO binding peptide inhibitor. CONCLUSION/SIGNIFICANCE: Rapid and specific release of IL-18 from Alternaria-exposed damaged airway epithelial cells can directly initiate Th2 differentiation of naïve CD4(+ T-cells via a unique NF-κB dependent pathway.

  1. Role of growth hormone-releasing hormone in sleep and growth impairments induced by upper airway obstruction in rats.

    Science.gov (United States)

    Tarasiuk, A; Berdugo-Boura, N; Troib, A; Segev, Y

    2011-10-01

    Upper airway obstruction (UAO) can lead to abnormal growth hormone (GH) homeostasis and growth retardation but the mechanisms are unclear. We explored the effect of UAO on hypothalamic GH-releasing hormone (GHRH), which has a role in both sleep and GH regulation. The tracheae of 22-day-old rats were narrowed; UAO and sham-operated animals were sacrificed 16 days post-surgery. To stimulate slow-wave sleep (SWS) and GH secretion, rats were treated with ritanserin (5-HT(2) receptor antagonist). Sleep was measured with a telemetric system. Hypothalamic GHRH, hypothalamic GHRH receptor (GHRHR) and GH receptor, and orexin were analysed using ELISA, real-time PCR and Western blot. UAO decreased hypothalamic GHRH, GHRHR and GH receptor levels, while orexin mRNA increased (psleep and slow-wave activity was reduced (pgrowth impairment (pgrowth retardation in UAO is associated with a reduction in hypothalamic GHRH content. Our findings show that abnormalities in the GHRH/GH axis underlie both growth retardation and SWS-disorder UAO.

  2. EXTUBATE: A randomised controlled trial of nasal biphasic positive airway pressure vs. nasal continuous positive airway pressure following extubation in infants less than 30 weeks' gestation: study protocol for a randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Victor Suresh

    2011-12-01

    Full Text Available Abstract Background Respiratory distress syndrome remains a significant problem among premature infants. Mechanical ventilation through an endotracheal tube remains the mainstay of respiratory support but may be associated with lung injury and the development of chronic lung disease of prematurity. Efforts are needed to reduce the duration of mechanical ventilation in favour of less invasive forms of respiratory support and to improve rates of successful extubation. Non-invasive respiratory support has been demonstrated to be less injurious to the premature lung. Standard practice is to use nasal continuous positive airway pressure (n-CPAP following extubation to support the baby's breathing. Many clinicians also use nasal biphasic positive airway pressure (n-BiPAP in efforts to improve rates of successful extubation. However, there is currently no evidence that this confers any advantage over conventional nasal continuous positive airway pressure. Methods We propose an unblinded multi-centre randomised trial comparing n-CPAP with n-BiPAP in babies born before 30 weeks' gestation and less than two weeks old. Babies with congenital abnormalities and severe intra-ventricular haemorrhage will be excluded. 540 babies admitted to neonatal centres in England will be randomised at the time of first extubation attempt. The primary aim of this study is to compare the rate of extubation failure within 48 hours following the first attempt at extubation. The secondary aims are to compare the effect of n-BiPAP and n-CPAP on the following outcomes: 1. Maintenance of successful extubation for 7 days post extubation 2. Oxygen requirement at 28 days of age and at 36 weeks' corrected gestational age 3. Total days on ventilator, n-CPAP/n-BiPAP 4. Number of ventilator days following first extubation attempt 5. pH and partial pressure of carbon dioxide in the first post extubation blood gas 6. Duration of hospital stay 7. Rate of abdominal distension requiring

  3. Retrospective, nonrandomized controlled study on autoadjusting, dual-pressure positive airway pressure therapy for a consecutive series of complex insomnia disorder patients

    Science.gov (United States)

    Krakow, Barry; McIver, Natalia D; Ulibarri, Victor A; Nadorff, Michael R

    2017-01-01

    Purpose Emerging evidence shows that positive airway pressure (PAP) treatment of obstructive sleep apnea (OSA) and upper airway resistance syndrome (UARS) in chronic insomnia patients (proposed “complex insomnia” disorder) leads to substantial decreases in insomnia severity. Although continuous PAP (CPAP) is the pressure mode most widely researched, intolerance to fixed pressurized air is rarely investigated or described in comorbidity patients. This retrospective study examined dual pressure, autoadjusting PAP modes in chronic, complex insomnia disorder patients. Patients and methods Chronic insomnia disorder patients (mean [SD] insomnia severity index [ISI] =19.11 [3.34]) objectively diagnosed with OSA or UARS and using either autobilevel PAP device or adaptive servoventilation (ASV) device after failing CPAP therapy (frequently due to intolerance to pressurized air, poor outcomes, or emergence of CSA) were divided into PAP users (≥20 h/wk) and partial users (insomnia patients, PAP users (n=246) averaged 6.10 (1.78) nightly hours and 42.71 (12.48) weekly hours and partial users (n=56) averaged 1.67 (0.76) nightly hours and 11.70 (5.31) weekly hours. For mean (SD) decreases in total ISI scores, a significant (group × time) interaction was observed (F[1,300]=13.566; Pinsomnia symptoms (r=−0.256, PInsomnia severity significantly decreased in patients using autoadjusting PAP devices, but the study design restricts interpretation to an association. Future research must elucidate the interaction between insomnia and OSA/UARS as well as the adverse influence of pressure intolerance on PAP adaptation in complex insomnia patients. Randomized controlled studies must determine whether advanced PAP modes provide benefits over standard CPAP modes in these comorbidity patients. PMID:28331381

  4. Unilateral pulmonary oedema due to lung re-expansion following pleurocentesis for spontaneous pneumothorax. The role of non-invasive continuous positive airway pressure ventilation.

    Science.gov (United States)

    Papakonstantinou, Dimitrios K; Gatzioufas, Zisis I; Tzegas, Georgios I; Stergiopoulos, Panagiotis I; Tsokantaridis, Christos G; Chalikias, Georgios K; Tziakas, Dimitrios N

    2007-01-18

    Re-expansion pulmonary oedema represents a rare complication of treatment of spontaneous pneumothorax with only a few cases documented in the current literature. We present the case of a 47-year-old male who presented a right-sided spontaneous pneumothorax and developed respiratory failure after chest tube drainage. The diagnosis of re-expansion pulmonary oedema was made and he was successfully treated with non-invasive continuous positive airway pressure ventilation. Since pathogenesis of re-expansion unilateral pulmonary oedema differs significantly from that of cardiogenic pulmonary oedema, the role of non-invasive continuous positive airway pressure ventilation is discussed as an additional therapeutic option.

  5. Inhibitory effects of cryptoporus polysaccharide on airway constriction, eosinophil release, and chemotaxis in guinea pigs

    Institute of Scientific and Technical Information of China (English)

    Xiao-yan ZHAO; Qiang-min XIE; Ji-qiang CHEN; Chuan-kui KE

    2004-01-01

    AIM: To study effects of cryptoporus polysaccharide (CP) on antigen-induced bronchoconstriction, eosinophil peroxidase (EPO) release in vivo, and on platelet activating factor (PAF)-induced eosinophil chemotaxis in vitro in guinea pig. METHODS: The asthma model of guinea pig was formed with ovalbumin (OVA). The changes of lung resistance (RL) and dynamic lung compliance (Cdyn), EPO level in bronchoalveolar lavage fluids (BALF) and eosinophil migration were determined. RESULTS: Pretreatment of CP at doses of 3, 9, and 27 mg/kg by intragastric gavage (ig), qd for 10 d, inhibited early asthma response in a dose-dependent manner. Inhibitory rates of mean increase value from 1 to 30 min of RL were 34.8 %, 74.4 % (P<0.05), and 79.6 % (P<0.05), respectively. Inhibitory rate of mean reduction value of Cdyn were 22.9 %, 40.5 % (P<0.01), and 66.5 % (P<0.01), respectively.Pretreatment of CP at doses of 3, 9, and 27 mg/kg also inhibited late asthma response, and the reduction of EPO level in BALF were 3.1%, 16.9 % (P<0.01), and 20.1% (P<0.01), respectively. The inhibitory rates of CP at concentrations of 0.13, 1.3, 13, 130 nmol/L to eosinophil migration induced by PAF were 6.8 %, 17.2 % (P<0.05),29.6 % (P<0.01), and 35.9 % (P<0.01). CONCLUSION: CP protects lung against increase of RL and reduction of Cdyn, decreases EPO level in the asthma model, and inhibits eosinophil chemotaxis induced by PAF. The results suggest that CP may be a novel antiinflammatory agent for the treatment of asthma and allergic diseases.

  6. Airway epithelium is a predominant source of endogenous airway GABA and contributes to relaxation of airway smooth muscle tone

    OpenAIRE

    Gallos, George; Townsend, Elizabeth; Yim, Peter; Virag, Laszlo; Zhang, Yi; Xu, Dingbang; Bacchetta, Matthew; Emala, Charles W.

    2012-01-01

    Chronic obstructive pulmonary disease and asthma are characterized by hyperreactive airway responses that predispose patients to episodes of acute airway constriction. Recent studies suggest a complex paradigm of GABAergic signaling in airways that involves GABA-mediated relaxation of airway smooth muscle. However, the cellular source of airway GABA and mechanisms regulating its release remain unknown. We questioned whether epithelium is a major source of GABA in the airway and whether the ab...

  7. [Continuous positive airway pressure and high-frequency independent lung ventilation in patients with chronic obstructive lung diseases].

    Science.gov (United States)

    Fedorova, E A; Vyzhigina, M A; Gal'perin, Iu S; Zhukova, S G; Titov, V A; Godin, A V

    2004-01-01

    The original hypoxemia, hypercapnia, high pulmonary hypertension, high resistance of microcirculation vessels, right volumetric ventricular overload, persistent sub-edema of pulmonary intersticium as well as disparity of ventilation and perfusion between both lungs are the main problems in patients with chronic obstructive disease of the lungs (CODL). Such patients are, as a rule, intolerant to the independent lung collaboration or artificial single-stage ventilation (ASV). Patients with respiratory insufficiency, stages 2 and 3, and with a pronounced impaired type of ventilation have originally a deranged blood gas composition, like hypoxemia or hypercapnia. The application of volume-controllable bi-pulmonary ASV in such patients maintains an adequate gas exchange hemodynamics. However, ASV is accompanied by a significantly reduced gas-exchange function of the single ventilated lung and by essentially worsened intrapulmonary hemodynamics. Therefore, what is needed is to use alternative methods of independent lung ventilation in order to eliminate the gas-exchange impairments and to enable surgical interventions at thoracic organs in such patients (who are intolerant to ASV). A choice of a method and means of oxygen supply to the independent lung is of great importance. The possibility to avoid a high pressure in the airways, while maintaining, simultaneously, an adequate gas exchange, makes the method related with maintaining a constant positive pressure in the airways (CPPA) a priority one in case of CODL patients. The use of constant high-frequency ventilation in the independent lung in patients with obstructive pulmonary lesions does not improve the gas exchange or hemodynamics. Simultaneously, a growing total pulmonary resistance and an increasing pressure in the pulmonary artery are observed. Consequently, the discussed method must not be used for the ventilation support of the independent lung in patients with the obstructive type of the impaired external

  8. The Effect of Nasal Surgery on Continuous Positive Airway Pressure Device Use and Therapeutic Treatment Pressures: A Systematic Review and Meta-Analysis

    Science.gov (United States)

    Camacho, Macario; Riaz, Muhammad; Capasso, Robson; Ruoff, Chad M.; Guilleminault, Christian; Kushida, Clete A.; Certal, Victor

    2015-01-01

    Background: The relationship between nasal surgery and its effect on continuous positive airway pressure (CPAP) device therapeutic treatment pressures and CPAP device use has not been previously systematically examined. Study Objectives: To conduct a systematic review and meta-analysis evaluating the effect of isolated nasal surgery on therapeutic CPAP device pressures and use in adults with obstructive sleep apnea. Methods: MEDLINE, Scopus, Web of Science, and The Cochrane Library were searched through July 15, 2014. The MOOSE consensus statement and PRISMA statement were followed. Results: Eighteen studies (279 patients) reported CPAP data after isolated nasal surgery. Seven studies (82 patients) reported preoperative and postoperative mean therapeutic CPAP device pressures and standard deviations, which reduced from 11.6 ± 2.2 to 9.5 ± 2.0 centimeters of water pressure (cwp) after nasal surgery. Pooled random effects analysis demonstrated a statistically significant pressure reduction, with a mean difference of −2.66 cwp (95% confidence intervals, −3.65 to −1.67); P < 0.00001. Eleven studies (153 patients) described subjective, self-reported data for CPAP use; and a subgroup analysis demonstrated that 89.1% (57 of 64 patients) who were not using CPAP prior to nasal surgery subsequently accepted, adhered to, or tolerated it after nasal surgery. Objective, device meter-based hours of use increased in 33 patients from 3.0 ± 3.1 to 5.5 ± 2.0 h in the short term (< 6 mo of follow-up). Conclusion: Isolated nasal surgery in patients with obstructive sleep apnea and nasal obstruction reduces therapeutic CPAP device pressures and the currently published literature's objective and subjective data consistently suggest that it also increases CPAP use in select patients. Citation: Camacho M, Riaz M, Capasso R, Ruoff CM, Guilleminault C, Kushida CA, Certal V. The effect of nasal surgery on continuous positive airway pressure device use and therapeutic treatment

  9. Indirect airway challenges

    NARCIS (Netherlands)

    Joos, GF; O'Connor, B; Anderson, SD; Chung, F; Cockcroft, DW; Dahlen, B; DiMaria, G; Foresi, A; Hargreave, FE; Holgate, ST; Inman, M; Lotvall, J; Magnussen, H; Polosa, R; Postma, DS; Riedler, J

    2003-01-01

    Indirect challenges act by causing the release of endogenous mediators that cause the airway smooth muscle to contract. This is in contrast to the direct challenges where agonists such as methacholine or histamine cause airflow limitation predominantly via a direct effect on airway smooth muscle. Di

  10. Dynamic Characteristics of Mechanical Ventilation System of Double Lungs with Bi-Level Positive Airway Pressure Model

    Directory of Open Access Journals (Sweden)

    Dongkai Shen

    2016-01-01

    Full Text Available In recent studies on the dynamic characteristics of ventilation system, it was considered that human had only one lung, and the coupling effect of double lungs on the air flow can not be illustrated, which has been in regard to be vital to life support of patients. In this article, to illustrate coupling effect of double lungs on flow dynamics of mechanical ventilation system, a mathematical model of a mechanical ventilation system, which consists of double lungs and a bi-level positive airway pressure (BIPAP controlled ventilator, was proposed. To verify the mathematical model, a prototype of BIPAP system with a double-lung simulators and a BIPAP ventilator was set up for experimental study. Lastly, the study on the influences of key parameters of BIPAP system on dynamic characteristics was carried out. The study can be referred to in the development of research on BIPAP ventilation treatment and real respiratory diagnostics.

  11. The Efficacy of a Protocolized Nursing Care on Nasal Skin Breakdown in Preterm Neonates Receiving Nasal Continuous Positive Airway Pressure

    Directory of Open Access Journals (Sweden)

    Mahnaz Jabraeili

    2017-01-01

    Full Text Available Background: Nasal continuous positive airway pressure (NCPAP is an effective method of ventilation in newborns with respiratory distress syndrome (RDS. Using an appropriate nasal skin care protocol is identical to prevention or reduction of nasal skin breakdown in those who receive NCPAP. This study aimed to investigate the effectiveness of an evidence-based clinical care protocol on nasal skin integrity in preterm newborns who receive NCPAP.Materials and Methods: A Randomized Controlled Trial was used to conduct the study. A cohort of 110 preterm newborns with a gestational age (GA of 25 to 36 weeks, receiving nasal continuous positive airway pressure (NCPAP for RDS in the neonatal intensive care unit of a university teaching hospital were selected to perform the study. They were randomly assigned to a protocolized nasal skin care (group A or to a group receiving the routine care (group B. Nasal skin integrity of the preterm neonates, were measured on a daily basis for 10 days using the Neonatal Skin Condition Scale (NSCS 24 hours after placement of NCPAPs in both groups.Results: Each intervention and control group included 55 neonates. 65.50% of neonates in the control group and 47.30% of neonates in the intervention group were male. Repeated measures analysis showed thatNSCS scores were significantly lower in intervention group receiving nasal skin care in accordance with the protocol than the control group receiving the routine nasal skin care (P=0.000. Conclusion: In this study, the protocolized care reduced nasal skin breakdown in the preterm newborns receiving NCPAP. Therefore, it can be used as an effective method in nasal skin care in neonates who are treated by NCPAP.

  12. Release of copper-amended particles from micronized copper-pressure-treated wood during mechanical abrasion

    OpenAIRE

    Civardi, Chiara; Schlagenhauf, Lukas; Kaiser, Jean-Pierre; Hirsch, Cordula; Mucchino, Claudio; Wichser, Adrian; Wick, Peter; Schwarze, Francis W. M. R.

    2016-01-01

    Background We investigated the particles released due to abrasion of wood surfaces pressure-treated with micronized copper azole (MCA) wood preservative and we gathered preliminary data on its in vitro cytotoxicity for lung cells. The data were compared with particles released after abrasion of untreated, water (0% MCA)-pressure-treated, chromated copper (CC)-pressure-treated wood, and varnished wood. Size, morphology, and composition of the released particles were analyzed. Results Our resul...

  13. Sexual function and obstructive sleep apnea-hypopnea : A randomized clinical trial evaluating the effects of oral-appliance and continuous positive airway pressure therapy

    NARCIS (Netherlands)

    Hoekema, Aarnoud; Stel, Anna-Lucia; Stegenga, Boudewijn; van der Hoeven, Johannes H.; Wijkstra, Peter J.; van Driel, Mels F.; de Bont, Lambert G. M.

    2007-01-01

    Introduction. The obstructive sleep apnea-hypopnea syndrome (OSAHS) is associated with sexual dysfunction. Although successful treatment with continuous positive airway pressure (CPAP) has been demonstrated to improve sexual function, the effects of oral-appliance therapy are unknown. Aim. The aims

  14. Effect of Positive Airway Pressure on Cardiovascular Outcomes in Coronary Artery Disease Patients with Non-Sleepy Obstructive Sleep Apnea : The RICCADSA Randomized Controlled Trial

    NARCIS (Netherlands)

    Peker, Yüksel; Glantz, Helena; Eulenburg, Christine; Wegscheider, Karl; Herlitz, Johan; Thunström, Erik

    2016-01-01

    RATIONALE: Obstructive sleep apnea is common in patients with coronary artery disease, many of whom do not report daytime sleepiness. First-line treatment for symptomatic obstructive sleep apnea is continuous positive airway pressure, but its value in patients without daytime sleepiness is uncertain

  15. A 64-year old man who sustained many episodes of acute cardiogenic pulmonary edema successfully treated with Boussignac continuous positive airway pressure : A case report

    NARCIS (Netherlands)

    Dieperink, Willem; van der Horst, Iwan C. C.; Nannenberg-Koops, Jaqueline W.; Brouwer, Henk W.; Jaarsma, T.; Nieuwland, Wybe; Zijlstra, Felix; Nijsten, Maarten W. N.

    2007-01-01

    Continuous positive airway pressure (CPAP) is standard treatment for patients with acute cardiogenic pulmonary edema. We describe a patient who had 21 episodes of acute cardiogenic pulmonary edema due to very poor patient compliance. This 64-year old man had end-stage congestive heart failure based

  16. Effect of continuous positive airway pressure treatment on pulmonary artery pressure in patients with isolated obstructive sleep apnea: a meta-analysis.

    Science.gov (United States)

    Imran, Tasnim F; Ghazipura, Marya; Liu, Spencer; Hossain, Tanzib; Ashtyani, Hormoz; Kim, Bernard; Michael Gaziano, J; Djoussé, Luc

    2016-09-01

    Pulmonary hypertension (PH) can occur in patients with obstructive sleep apnea (OSA) in the absence of cardiac or lung disease. Data on the development and severity of PH, and the effect of continuous positive airway pressure (CPAP) therapy on pulmonary artery (PA) pressures in these patients have been inconsistent in the literature. We sought to determine whether CPAP therapy affects PA pressures in patients with isolated OSA in this meta-analysis. We searched PubMed, Medline, EMBASE and other databases from January 1980 to August 2015. Studies of patients with OSA, defined as an apnea-hypopnea index >10 events/h, and PH, defined as PA pressure >25 mmHg were included. Two reviewers independently extracted data and assessed risk of bias. A total of 222 patients from seven studies (341.53 person-years) had reported PA pressures before and after treatment with CPAP therapy. 77 % of participants were men, with a mean age of 52.5 years, a mean apnea-hypopnea index of 58 events/h, and mean PA pressure of 39.3 ± 6.3 mmHg. CPAP treatment duration ranged from 3 to 70 months. Using fixed effects meta-analysis, CPAP therapy was associated with a decrease in PA pressure of 13.3 mmHg (95 % CI 12.7-14.0) in our study population. This meta-analysis found that CPAP therapy is associated with a significantly lower PA pressure in patients with isolated OSA and PH.

  17. Inductance plethysmography: an alternative signal to servocontrol the airway pressure during proportional assist ventilation in small animals.

    Science.gov (United States)

    Schulze, A; Suguihara, C; Gerhardt, T; Schaller, P; Claure, N; Everett, R; Devia, C; Hehre, D; Bancalari, E

    2001-02-01

    During proportional assist ventilation (PAV), the ventilator pressure is servocontrolled throughout each spontaneous inspiration such that it instantaneously increases in proportion to the airflow (resistive unloading mode), or inspired volume (elastic unloading mode), or both (combined unloading mode). The PAV pressure changes are generated in a closed-loop feedback circuitry commonly using a pneumotachographic signal. In neonates, however, a pneumotachograph increases dead space ventilation, and its signal may include a substantial endotracheal tube leak component. We hypothesized that respiratory inductive plethysmography (RIP) can replace pneumotachography to drive the ventilator during PAV without untoward effects on ventilation or respiratory gas exchange. Ten piglets and five rabbits were supported for 10-min (normal lungs) or 20-min (meconium injured lungs) periods by each of the three PAV modes. In each mode, three test periods were applied in random order with the ventilator driven by the pneumotachograph signal, or the RIP abdominal band signal, or the RIP sum signal of rib cage and abdomen. Interchanging the three input signals did not affect the regularity of spontaneous breathing, and gas exchange was achieved with similar peak and mean airway pressures (ANOVA). However, the RIP sum signal worked adequately only when the relative gains of rib cage and abdominal band signal were calibrated. We conclude that an RIP abdominal band signal can be used to generate PAV, avoiding increased dead space and endotracheal tube leak problems.

  18. Does Airway Pressure Release Ventilation Mode Make Difference in Cardiopulmonary Function of ICU Patients?

    Directory of Open Access Journals (Sweden)

    Maziar Mahjoubifard

    2015-11-01

    Full Text Available Introduction: Tuberculosis (TB, with different types of respiratory tract involvements, has a high rate of mortality all around the world. Endobronchial involvement, which is a slightly common tuberculous infection, requires special attention due to its severe complications such as bronchostenosis. Aim of study of this study was describes, one type of pulmonary tuberculosis with less diagnosed and delayed treatment. High suspicious needs to diagnose and may be need bronchoscopy for confirmed the diagnosis. It can be associated with sever complication and early diagnosis and treatment are necessary for prevention of adverse effect. Materials and Methods: This retrospective study was conducted in a teaching hospital during 2005-2010. Patients diagnosed with endobronchial tuberculosis through bronchoscopic biopsy were included in the study. Diagnosis was confirmed by observation of caseous necrosis, bronchial lavage fluid or positive acid-fast staining in tissue samples obtained through bronchial biopsy. Moreover, demographic information, endobronchial view, lab tests, as well as clinical and radiographic findings were reviewed and evaluated retrospectively. Results: A total of 20 cases were confirmed with endobronchial tuberculosis, 75% of whom were female with the mean age of 60 years. The results showed that the most common clinical symptom was cough (80%, the most common finding in the chest X-ray was consolidation (75%, and the most common bronchoscopic feature was anthracosis (55%. Conclusion: TB is still a major concern, particularly in the developing countries. Thus, in order for early diagnosis and prevention of this disease, we need to pay meticulous attention to its clinical manifestations and bronchoscopic features.

  19. Opposing effects of narcotic gases and pressure on the striatal dopamine release in rats.

    Science.gov (United States)

    Balon, Norbert; Kriem, Badreddine; Dousset, Erick; Weiss, Michel; Rostain, Jean-Claude

    2002-08-30

    Nitrogen-oxygen breathing mixtures, for pressures higher than 0.5 MPa, decrease the release of dopamine in the rat striatum, due to the narcotic potency of nitrogen. In contrast, high pressures of helium-oxygen breathing mixtures of more than 1-2 MPa induce an increase of the striatal dopamine release and an enhancement of motor activity, referred to as the high pressure nervous syndrome (HPNS), and attributed to the effect of pressure per se. It has been demonstrated that the effect of pressure could be antagonized by narcotic gas in a ternary mixture, but most of the narcotic gas studies measuring DA release were executed below the threshold for pressure effect. To examine the effect of narcotic gases at pressure on the rat striatal dopamine release, we have used two gases, with different narcotic potency, at sublethargic pressure, nitrogen at 3 MPa and argon at 2 MPa. In addition, to dissociate the effect of the pressure, we have used nitrous oxide at 0.1 MPa to induce narcosis at very low pressure, and helium at 8 MPa to study the effect of pressure per se. In all the narcotic conditions we have recorded a decrease of the striatal dopamine release. In contrast, helium pressure induced an increase of DA release. For the pressures used, the results suggest that the decrease of dopamine release was independent of such an effect of the pressure. However, for the same narcotic gas, the measurements of the extracellular DA performed in the striatum seem to reflect an opposing effect of pressure, since the decrease in DA release is lower with increasing pressure.

  20. A comparison of intraocular pressure and hemodynamic responses to insertion of laryngeal mask airway or endotracheal tube using anesthesia with propofol and remifentanil in cataract surgery

    Directory of Open Access Journals (Sweden)

    Mohsen Ziyaeifard

    2012-01-01

    Full Text Available Background: The aim of this study was to evaluate intraocular pressure (IOP and hemodynamic responses following insertion of laryngeal mask airway (LMA or endotracheal tube (ETT after anesthesia induction with propofol and remifentanil in cataract surgery. Materials and Methods: In a randomized controlled study, 50 adults scheduled for elective cataract extraction procedure under general anesthesia were allocated to LMA insertion (n = 25 or ETT (n = 25 groups. IOP, systolic blood pressure (SBP, diastolic blood pressure (DBP, and heart rate (HR were measured after insertion of the airway device every minute up to 5 min. Results: There were no significant differences between LMA and ETT groups in SBP, DBP, HR, and IOP immediately after airway instrumentation up to 5 min, except in 4th min in DBP, 2nd min in HR, and 5th min in IOP (7.9 ± 2.3 mmHg in LMA and 9.4 ± 2.5 mmHg in ETT group; P = 0.030. There was good surgeon satisfaction for providing acceptable surgical field in both groups (88% in LMA and 80% in ETT group; P = 0.702. Conclusion: Propofol combined with remifentanil provides good and excellent conditions for insertion of LMA or ETT with minimal hemodynamic disturbances in cataract surgery. Considering LMA insertion is less traumatic than ETT, using LMA may be better than ETT for airway securing in these patients.

  1. Effect of ethanol on the efficacy of nasal continuous positive airway pressure as a treatment for obstructive sleep apnea.

    Science.gov (United States)

    Berry, R B; Desa, M M; Light, R W

    1991-02-01

    The effect of ethanol ingestion on the efficacy of nasal continuous positive airway pressure (nasal CPAP) as a treatment for the obstructive sleep apnea (OSA) syndrome was studied in ten obese male subjects undergoing this therapy. On the first night of polysomnography, the lowest level of CPAP that maintained airway patency was determined (critical level). On the second (control) night (C), subjects slept the entire night on this level of CPAP. On the third night (E), subjects ingested either 1.5 ml/kg (part A, N = 6) or 2.0 ml/kg (part B, N = 4) of 50 percent ethanol (100 proof vodka) over one half-hour starting 1 h before bedtime. A serum ethanol level was obtained at bedtime (part A: 63.7 +/- 17.3 mg/dl; part B: 108.6 +/- 20.6 mg/dl), and subjects were monitored on the critical level of CPAP. Comparison of nights C and E for parts A + B showed no difference in total sleep time (TST) or the amount of different sleep stages as an absolute time or a percentage of TST except that there was more stage 2 (as a percent of TST) on E nights. The apnea + hypopnea index and C and E nights did not differ and was quite low (3.6 +/- 3.7/h vs 1.9 +/- 2.7/h). Similarly, ethanol ingestion did not increase the number of desaturations to at or below 90 and 85 percent, or lower the mean arterial oxygen saturation in NREM or REM sleep. Analysis of parts A and B separately also showed no differences with respect to the apnea + hypopnea index or the number of desaturations on control and ethanol nights. We conclude that acute moderate ethanol ingestion does not decrease the efficacy of an optimum level of nasal CPAP.

  2. Effect of continuous positive airway pressure therapy on hypothalamic-pituitary-adrenal axis function and 24-h blood pressure profile in obese men with obstructive sleep apnea syndrome.

    Science.gov (United States)

    Carneiro, Gláucia; Togeiro, Sônia Maria; Hayashi, Lílian F; Ribeiro-Filho, Fernando Flexa; Ribeiro, Artur Beltrame; Tufik, Sérgio; Zanella, Maria Teresa

    2008-08-01

    Obstructive sleep apnea syndrome (OSAS) increases the risk of cardiovascular events. Sympathetic nervous system and hypothalamic-pituitary-adrenal (HPA) axis activation may be the mechanism of this relationship. The aim of this study was to evaluate HPA axis and ambulatory blood pressure monitoring in obese men with and without OSAS and to determine whether nasal continuous positive airway pressure therapy (nCPAP) influenced responses. Twenty-four-hour ambulatory blood pressure monitoring and overnight cortisol suppression test with 0.25 mg of dexamethasone were performed in 16 obese men with OSAS and 13 obese men controls. Nine men with severe apnea were reevaluated 3 mo after nCPAP therapy. Body mass index and blood pressure of OSAS patients and obese controls were similar. In OSAS patients, the percentage of fall in systolic blood pressure at night (P = 0.027) and salivary cortisol suppression postdexamethasone (P = 0.038) were lower, whereas heart rate (P = 0.022) was higher compared with obese controls. After nCPAP therapy, patients showed a reduction in heart rate (P = 0.036) and a greater cortisol suppression after dexamethasone (P = 0.001). No difference in arterial blood pressure (P = 0.183) was observed after 3 mo of nCPAP therapy. Improvement in cortisol suppression was positively correlated with an improvement in apnea-hypopnea index during nCPAP therapy (r = 0.799, P = 0.010). In conclusion, men with OSAS present increased postdexamethasone cortisol levels and heart rate, which were recovered by nCPAP.

  3. Nasal pillows as an alternative interface in patients with obstructive sleep apnoea syndrome initiating continuous positive airway pressure therapy.

    LENUS (Irish Health Repository)

    Ryan, Silke

    2012-02-01

    Side-effects directly due to the nasal mask are common in patients with obstructive sleep apnoea syndrome (OSAS) commencing continuous positive airway pressure (CPAP). Recently, nasal pillows have been designed to overcome these issues. Limited evidence exists of the benefits and effectiveness of these devices. Twenty-one patients (19 male, 49+\\/-10years) with the established diagnosis of OSAS [apnoea\\/hypopnoea index (AHI): 52+\\/-22] and who had a successful CPAP titration were commenced on CPAP therapy (10+\\/-2cmH2O), and randomized to 4weeks of a nasal pillow (P) and a standard nasal mask (M) in a crossover design. Outcome measures were objective compliance, AHI, quality of life, Epworth Sleepiness Score (ESS) and CPAP side-effects. There was no difference in compliance (M versus P: 5.1+\\/-1.9h versus 5.0+\\/-1.7h; P=0.701) and AHI (2.6+\\/-2.7 versus 3.0+\\/-2.9; P=0.509). Quality of life and ESS improved with CPAP, but there was no difference in the extent of improvement between both devices. Usage of nasal pillows resulted in less reported pressure on the face and more subjects found the nasal pillow the more comfortable device. However, there was no clear overall preference for either device at the end of the study (mask=57%, pillow=43%; P=0.513). The applied CPAP pressure did not correlate with compliance, AHI and ESS. Furthermore, no differences in outcome parameters were noted comparing groups with CPAP pressure <10 and >\\/=10cm H(2) O. Nasal pillows are equally effective in CPAP therapy, but do not generally lead to improved compliance.

  4. Effect of continuous positive airway pressure treatment on serum adiponectin level and mean arterial pressure in male patients with obstructive sleep apnea syndrome

    Institute of Scientific and Technical Information of China (English)

    ZHANG Xi-long; YIN Kai-sheng; LI Chong; JIA En-zhi; LI Yan-qun; GAO Zhao-fang

    2007-01-01

    Background Recent research suggested that obstructive sleep apnea syndrome (OSAS) might be independently associated with hypoadiponectinemia, which was linked to some complications of OSAS, such as hypertension, diabetes,etc. This study was conducted to investigate the effect of continuous positive airway pressure (CPAP) treatment on changes of both serum adiponectin levels and mean arterial pressure and their possible links in male OSAS patients.Methods Twenty-three adult male patients with moderate-to-severe OSAS but without obesity, coronary heart disease and diabetes were recruited. Their blood sampleswere collected and moming mean arterial pressure (MAP) was measured before CPAP treatment and on day 3, 7, 14 of CPAP treatment respectively. The serum adiponectin concentration was tested with radioimmunoassay.Results Compared with the serum adiponectin level before CPAP treatment, no significant change was found in OSAS patients on day 3 and day 7 of CPAP treatment (P>0.05). It was not until day 14 of CPAP treatment did a significant elevation in serum adiponectin level occur (P<0.01). Meanwhile, the MAP showed no statistically significant difference among its levels before CPAP, on day 3 and day 7 of CPAP treatment (P>0.05). However, on day 14 of CPAP treatment,a significantly lower MAP than that obtained before treatment was observed (P<0.05).Conclusions CPAP treatment can gradually reverse hypoadiponectinemia and reduce MAP in OSAS patients.Hypoadiponectinemia might be involved in the pathogenesis of OSAS-mediated hypertension.

  5. Proteases from Aspergillus fumigatus induce release of proinflammatory cytokines and cell detachment in airway epithelial cell lines

    NARCIS (Netherlands)

    Tomee, JFC; Hiemstra, PS; Kauffman, HF

    1997-01-01

    Aspergillus fumigatus is a pathogen causing; diverse respiratory disorders, Several studies have suggested that fungal proteases may play a role in the pathogenicity of fungi, Since the airways are the most common route for entry of. A, fumigatus, this study focused on the ability of fungal protease

  6. Development and evaluation of a self-efficacy instrument for Japanese sleep apnea patients receiving continuous positive airway pressure treatment

    Directory of Open Access Journals (Sweden)

    Saito A

    2015-01-01

    Full Text Available Ayako Saito,1 Shigeko Kojima,2 Fumihiko Sasaki,3 Masamichi Hayashi,4 Yuki Mieno,4 Hiroki Sakakibara,5 Shuji Hashimoto1 1Department of Hygiene, School of Medicine, Fujita Health University, Toyoake, Japan; 2Department of Rehabilitation, Faculty of Health Sciences, Nihon Fukushi University, Handa, Japan; 3SDB Research Laboratory, Takaoka Clinic, Nagoya, Japan; 4Department of Internal Medicine, Division of Respiratory Medicine and Clinical Allergy, Fujita Health University, Toyoake, Japan; 5Tokushige Kokyuki Clinic, Nagoya, Japan Abstract: The purpose of this study was to develop and evaluate a self-efficacy instrument for Japanese obstructive sleep apnea (OSA patients treated with continuous positive airway pressure (CPAP. Analyzed subjects were 653 Japanese OSA patients (619 males and 34 females treated with CPAP at a sleep laboratory in a respiratory clinic in a Japanese city. Based on Bandura's social cognitive theory, the CPAP Self-Efficacy Questionnaire for Sleep Apnea in Japanese (CSESA-J was developed by a focus group of experts, using a group interview of OSA patients for the items of two previous self-efficacy scales for Western sleep apnea patients receiving CPAP treatment. CSESA-J has two subscales, one for self-efficacy and the other for outcome expectancy, and consists of a total of 15 items. Content validity was confirmed by the focus group. Confirmatory factor analysis showed that the factor loadings of self-efficacy and outcome expectancy were 0.47–0.76 and 0.41–0.92, respectively, for the corresponding items. CSESA-J had a significant but weak positive association with the General Self-Efficacy Scale, and a strong positive association with “Self-efficacy scale on health behavior in patients with chronic disease.” Cronbach’s alpha coefficient was 0.85 for the self-efficacy subscale and 0.89 for the outcome expectancy subscale. The intraclass correlation coefficient using data from the first and second measurements with

  7. Cystic fibrosis airway secretions exhibit mucin hyperconcentration and increased osmotic pressure

    Science.gov (United States)

    Henderson, Ashley G.; Ehre, Camille; Button, Brian; Abdullah, Lubna H.; Cai, Li-Heng; Leigh, Margaret W.; DeMaria, Genevieve C.; Matsui, Hiro; Donaldson, Scott H.; Davis, C. William; Sheehan, John K.; Boucher, Richard C.; Kesimer, Mehmet

    2014-01-01

    The pathogenesis of mucoinfective lung disease in cystic fibrosis (CF) patients likely involves poor mucus clearance. A recent model of mucus clearance predicts that mucus flow depends on the relative mucin concentration of the mucus layer compared with that of the periciliary layer; however, mucin concentrations have been difficult to measure in CF secretions. Here, we have shown that the concentration of mucin in CF sputum is low when measured by immunologically based techniques, and mass spectrometric analyses of CF mucins revealed mucin cleavage at antibody recognition sites. Using physical size exclusion chromatography/differential refractometry (SEC/dRI) techniques, we determined that mucin concentrations in CF secretions were higher than those in normal secretions. Measurements of partial osmotic pressures revealed that the partial osmotic pressure of CF sputum and the retained mucus in excised CF lungs were substantially greater than the partial osmotic pressure of normal secretions. Our data reveal that mucin concentration cannot be accurately measured immunologically in proteolytically active CF secretions; mucins are hyperconcentrated in CF secretions; and CF secretion osmotic pressures predict mucus layer–dependent osmotic compression of the periciliary liquid layer in CF lungs. Consequently, mucin hypersecretion likely produces mucus stasis, which contributes to key infectious and inflammatory components of CF lung disease. PMID:24892808

  8. Effects of continuous positive airway pressure treatment on clinic and ambulatory blood pressures in patients with obstructive sleep apnea and resistant hypertension: a randomized controlled trial.

    Science.gov (United States)

    Muxfeldt, Elizabeth S; Margallo, Victor; Costa, Leonardo M S; Guimarães, Gleison; Cavalcante, Aline H; Azevedo, João C M; de Souza, Fabio; Cardoso, Claudia R L; Salles, Gil F

    2015-04-01

    The effect of continuous positive airway pressure (CPAP) on blood pressures (BPs) in patients with resistant hypertension and obstructive sleep apnea is not established. We aimed to evaluate it in a randomized controlled clinical trial, with blinded assessment of outcomes. Four hundred thirty-four resistant hypertensive patients were screened and 117 patients with moderate/severe obstructive sleep apnea, defined by an apnea-hypopnea index ≥15 per hour, were randomized to 6-month CPAP treatment (57 patients) or no therapy (60 patients), while maintaining antihypertensive treatment. Clinic and 24-hour ambulatory BPs were obtained before and after 6-month treatment. Primary outcomes were changes in clinic and ambulatory BPs and in nocturnal BP fall patterns. Intention-to-treat and per-protocol (limited to those with uncontrolled ambulatory BPs) analyses were performed. Patients had mean (SD) 24-hour BP of 129(16)/75(12) mm Hg, and 59% had uncontrolled ambulatory BPs. Mean apnea-hypopnea index was 41 per hour and 58.5% had severe obstructive sleep apnea. On intention-to-treat analysis, there was no significant difference in any BP change, neither in nocturnal BP fall, between CPAP and control groups. The best effect of CPAP was on night-time systolic blood pressure in per-protocol analysis, with greater reduction of 4.7 mm Hg (95% confidence interval, -11.3 to +3.1 mm Hg; P=0.24) and an increase in nocturnal BP fall of 2.2% (95% confidence interval, -1.6% to +5.8%; P=0.25), in comparison with control group. In conclusion, CPAP treatment had no significant effect on clinic and ambulatory BPs in patients with resistant hypertension and moderate/severe obstructive sleep apnea, although a beneficial effect on night-time systolic blood pressure and on nocturnal BP fall might exist in patients with uncontrolled ambulatory BP levels.

  9. MUC5AC mucin release from human airways in vitro: Effects of indomethacin and Bay X1005

    Directory of Open Access Journals (Sweden)

    Patricia Roger

    2001-01-01

    Full Text Available Background: Increased secretion of mucus is a hallmark of many respiratory diseases and contributes significantly to the airflow limitation experienced by many patients. While the current pharmacological approach to reducing mucus and sputum production in patients is limited, clinical studies have suggested that drugs which inhibit the cyclooxygenase and/or 5-lipoxygenase enzymatic pathways may reduce secretory activity in patients with airway disease.

  10. Sleep apnoea and the hypothalamic-pituitary-adrenal axis in men and women: effects of continuous positive airway pressure.

    Science.gov (United States)

    Kritikou, Ilia; Basta, Maria; Vgontzas, Alexandros N; Pejovic, Slobodanka; Fernandez-Mendoza, Julio; Liao, Duanping; Bixler, Edward O; Gaines, Jordan; Chrousos, George P

    2016-02-01

    Previous findings on the association of obstructive sleep apnoea (OSA) and the hypothalamic-pituitary-adrenal (HPA) axis are inconsistent, partly due to the confounding effect of obesity and infrequent sampling. Our goal was to examine whether in a relatively nonobese population, OSA is associated with elevated cortisol levels and to assess the effects of a 2-month placebo-controlled continuous positive airway pressure (sham-CPAP) use.72 subjects (35 middle-aged males and post-menopausal females with OSA, and 37 male and female controls) were studied in the sleep laboratory for four nights. 24-h blood sampling was performed every hour on the fourth day and night in the sleep laboratory at baseline, after sham-CPAP and after CPAP treatment.In both apnoeic men and women, OSA was associated with significantly higher 24-h cortisol levels compared with controls, whereas CPAP lowered cortisol levels significantly, close to those of controls.These results suggest that OSA in nonobese men and slightly obese women is associated with HPA axis activation, similar albeit stronger compared with obese individuals with sleep apnoea. Short-term CPAP use decreased cortisol levels significantly compared with baseline, indicating that CPAP may have a protective effect against comorbidities frequently associated with chronic activation of the HPA axis, e.g. hypertension.

  11. Effects of 12 months continuous positive airway pressure on sympathetic activity related brainstem function and structure in obstructive sleep apnea.

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    Luke Anthony Henderson

    2016-03-01

    Full Text Available Muscle sympathetic nerve activity (MSNA is greatly elevated in patients with obstructive sleep apnoea (OSA during normoxic daytime wakefulness. Increased MSNA is a precursor to hypertension and elevated cardiovascular morbidity and mortality. However, the mechanisms underlying the high MSNA in OSA are not well understood. In this study we used concurrent microneurography and magnetic resonance imaging to explore MSNA-related brainstem activity changes and anatomical changes in 15 control and 15 subjects with OSA prior to and following 6 and 12 months of continuous positive airway pressure (CPAP treatment. We found that 6 and 12 months of CPAP treatment significantly reduced the elevated resting MSNA in individuals with OSA. Furthermore, this MSNA reduction was associated with restoration of MSNA-related activity and structural changes in the medullary raphe, rostral ventrolateral medulla, dorsolateral pons and ventral midbrain. This restoration occurred after 6 months of CPAP treatment and was maintained following 12 months CPAP. These findings show that continual CPAP treatment is an effective long-term treatment for elevated MNSA likely due to its effects on restoring brainstem structure and function.

  12. Effect of Continuous Positive Airway Pressure on Adiponectin in Patients with Obstructive Sleep Apnea: A Meta-Analysis.

    Directory of Open Access Journals (Sweden)

    Li-Da Chen

    Full Text Available Obstructive sleep apnea (OSA has been suggested to be associated with low levels of adiponectin. Continuous positive airway pressure (CPAP is the gold standard treatment for OSA; however, previous studies assessing the effect of CPAP on adiponectin in patients with OSA yielded conflicting results. The present meta-analysis was performed to determine whether CPAP therapy could increase adiponectin levels.Two reviewers independently searched PubMed, Cochrane library, Embase and Web of Science before February 2015. Information on characteristics of subjects, study design and pre- and post-CPAP treatment of serum adiponectin was extracted for analysis. Standardized mean difference (SMD was used to analyze the summary estimates for CPAP therapy.Eleven studies involving 240 patients were included in this meta-analysis, including ten observational studies and one randomized controlled study. The meta-analysis showed that there was no change of adiponectin levels before and after CPAP treatment in OSA patients (SMD = 0.059, 95% confidence interval (CI = -0.250 to 0.368, z = 0.37, p = 0.710. Subgroup analyses indicated that the results were not affected by age, baseline body mass index, severity of OSA, CPAP therapy duration, sample size and racial differences.This meta-analysis suggested that CPAP therapy has no impact on adiponectin in OSA patients, without significant changes in body weight. Further large-scale, well-designed long-term interventional investigations are needed to clarify this issue.

  13. Influence of upper body position on middle cerebral artery blood velocity during continuous positive airway pressure breathing

    DEFF Research Database (Denmark)

    Højlund Rasmussen, J; Mantoni, T; Belhage, B;

    2007-01-01

    in 11 healthy subjects during CPAP at different body positions (15 degrees head-down tilt, supine, 15 degrees, 30 degrees and 45 degrees upper body elevation). In the supine position, 10 cmH(2)O of CPAP reduced MCA V(mean) by 9 +/- 3% and increased cHbT by 4 +/- 2 micromol/L (mean +/- SEM); (P ....05). In the head-down position, CPAP increased cHbT to 13 +/- 2 micromol/L but left MCA V(mean) unchanged. Upper body elevation by 15 degrees attenuated the CPAP associated reduction in MCA V(mean) (-7 +/- 2%), while cHbT returned to baseline (1 +/- 2 micromol/L). With larger elevation of the upper body MCA V......Continuous positive airway pressure (CPAP) is a treatment modality for pulmonary oxygenation difficulties. CPAP impairs venous return to the heart and, in turn, affects cerebral blood flow (CBF) and augments cerebral blood volume (CBV). We considered that during CPAP, elevation of the upper body...

  14. Heart rate variability in non-apneic snorers and controls before and after continuous positive airway pressure

    Directory of Open Access Journals (Sweden)

    Mateika Jason H

    2005-07-01

    Full Text Available Abstract Background We hypothesized that sympathetic nervous system activity (SNSA is increased and parasympathetic nervous system activity (PNSA is decreased during non-rapid eye movement (NREM sleep in non-apneic, otherwise healthy, snoring individuals compared to control. Moreover, we hypothesized that these alterations in snoring individuals would be more evident during non-snoring than snoring when compared to control. Methods To test these hypotheses, heart rate variability was used to measure PNSA and SNSA in 11 normotensive non-apneic snorers and 12 control subjects before and 7-days after adapting to nasal continuous positive airway pressure (nCPAP. Results Our results showed that SNSA was increased and PNSA was decreased in non-apneic snorers during NREM compared to control. However, these changes were only evident during the study in which snoring was eliminated with nCPAP. Conversely, during periods of snoring SNSA and PNSA were similar to measures obtained from the control group. Additionally, within the control group, SNSA and PNSA did not vary before and after nCPAP application. Conclusion Our findings suggest that long-lasting alterations in autonomic function may exist in snoring subjects that are otherwise healthy. Moreover, we speculate that because of competing inputs (i.e. inhibitory versus excitatory inputs to the autonomic nervous system during snoring, the full impact of snoring on autonomic function is most evident during non-snoring periods.

  15. Extreme REM Rebound during Continuous Positive Airway Pressure Titration for Obstructive Sleep Apnea in a Depressed Patient

    Directory of Open Access Journals (Sweden)

    Anna Lo Bue

    2014-01-01

    Full Text Available A 20% increase in REM sleep duration has been proposed as a threshold to identify REM rebound in patients with obstructive sleep apnea (OSA who start continuous positive airway pressure (CPAP treatment. We describe the case of one patient with OSA who showed an unexpectedly high degree of REM rebound during titration of CPAP. A 34-year-old man was diagnosed with OSA. He remained untreated for many years, during which he developed systemic hypertension, depression, and severe daytime somnolence. When he was reevaluated sixteen years later, his Epworth sleepiness score was 18, and his OSA had greatly worsened (apnea/hypopnea index: 47, lowest nocturnal saturation: 57%. He underwent a successful CPAP titration during nocturnal polysomnography. Electroencephalographic analysis of the sleep recording revealed a huge amount of REM sleep, accounting for 72% of the total sleep time. When asked, the patient referred that he had suddenly interrupted paroxetine assumption three days before the polysomnography. The very large REM rebound observed in this patient could be due to additional effects of initiation of CPAP therapy and suspension of antidepressive treatment. This case does not report any dangerous consequence, but sudden antidepressive withdrawal could be dangerous for patients with OSA who develop hypoventilation during REM sleep with CPAP application.

  16. Oxidative stress mediated arterial dysfunction in patients with obstructive sleep apnoea and the effect of continuous positive airway pressure treatment

    Directory of Open Access Journals (Sweden)

    Del Ben Maria

    2012-07-01

    Full Text Available Abstract Background Several studies suggest an increase of oxidative stress and a reduction of endothelial function in obstructive sleep apnoea syndrome (OSAS. We assessed the association between OSAS, endothelial dysfunction and oxidative stress. Further aim was to evaluate the effect of nasal continuous positive airway pressure (nCPAP on oxidative stress and arterial dysfunction. Methods We studied 138 consecutive patients with heavy snoring and possible OSAS. Patients underwent unattended overnight home polysomnography. Ten patients with severe OSAS were revaluated after 6 months of nCPAP therapy. To assess oxidative stress in vivo, we measured urinary 8-iso-PGF2α and serum levels of soluble NOX2-derived peptide (sNOX2-dp. Serum levels of nitrite/nitrate (NOx were also determined. Flow-mediated brachial artery dilation (FMD was measured to asses endothelial function. Results Patients with severe OSAS had higher urinary 8-iso-PGF2α (p Conclusions The results of our study indicate that patients with OSAS and cardiometabolic comorbidities have increased oxidative stress and arterial dysfunction that are partially reversed by nCPAP treatment.

  17. All-cause mortality from obstructive sleep apnea in male and female patients with and without continuous positive airway pressure treatment

    DEFF Research Database (Denmark)

    Jennum, Poul; Tønnesen, Philip; Ibsen, Rikke;

    2015-01-01

    BACKGROUND: More information is needed about the effect on mortality of continuous positive airway pressure (CPAP) in patients with obstructive sleep apnea (OSA), especially in women. METHODS: We employed a historical cohort study design, using data from 25,389 patients with a diagnosis of OSA......, irrespective of whether they received CPAP treatment. CPAP treatment improved survival, as illustrated by the hazard ratio of 0.62 (P

  18. Hypoxemia during bilevel positive airway pressure treatment in patients with obstructive sleep apnea syndrome and chronic respiratory insufficiency.

    Science.gov (United States)

    Brzecka, Anna; Piesiak, Pawel; Kosacka, Monika; Jankowska, Renata

    2013-01-01

    In patients with obstructive sleep apnea (OSA) syndrome and chronic respiratory insufficiency one of the options of treatment is bilevel positive airway pressure (BPAP) during sleep. The aim of the study was to find out what are the factors influencing the early results of BPAP treatment in such OSA patients. The study was carried out in 55 adult obese patients (mean body mass index 45 ± 7 kg/m(2)), severe OSA syndrome (mean apnea/hypopnea index 62 ± 19), and chronic respiratory insufficiency (mean PaCO(2) 54 ± 5.7 torr) who underwent polysomnography during BPAP treatment. In 31 patients (56%) the mean SaO(2) during sleep was <88% despite the optimal BPAP and oxygen titration: 83 ± 4% during NREM and 81 ± 7% during REM sleep vs. 91 ± 2% and 90 ± 3%, respectively, in the remaining 24 patients (p < 0.001). The patients with advanced hypoxemia during sleep and BPAP treatment had lower forced vital capacity (2.2 ± 0.9 vs. 2.7 ± 0.8 l, p < 0.05), lower diurnal PaO(2) (49 ± 8 vs. 54 ± 7 torr), higher diurnal PaCO(2) (57 ± 5 vs. 52 ± 5 torr, p < 0.01), and higher PaCO(2) during sleep (75 ± 13 vs. 59.5 ± 7.5 torr). In conclusion, in obese patients with severe OSA syndrome and chronic alveolar hypoventilation there is a risk of sleep hypoxemia during BPAP treatment, despite optimal pressure titration.

  19. Airway management and morbid obesity

    DEFF Research Database (Denmark)

    Kristensen, Michael S

    2010-01-01

    airway and the function of the lungs (decreased residual capacity and aggravated ventilation perfusion mismatch) worse than in lean patients. Proper planning and preparation of airway management is essential, including elevation of the patient's upper body, head and neck. Preoxygenation is mandatory...... solely on whether morbid obesity is present or not. It is important to ensure sufficient depth of anaesthesia before initiating manipulation of the airway because inadequate anaesthesia depth predisposes to aspiration if airway management becomes difficult. The intubating laryngeal mask airway is more...... pressure, noninvasive ventilation and physiotherapy....

  20. Ignition during hydrogen release from high pressure into the atmosphere

    Science.gov (United States)

    Oleszczak, P.; Wolanski, P.

    2010-12-01

    The first investigations concerned with a problem of hydrogen jet ignition, during outflow from a high-pressure vessel were carried out nearly 40 years ago by Wolanski and Wojcicki. The research resulted from a dramatic accident in the Chorzow Chemical Plant Azoty, where the explosion of a synthesis gas made up of a mixture composed of three moles of hydrogen per mole of nitrogen, at 300°C and 30 MPa killed four people. Initial investigation had excluded potential external ignition sources and the main aim of the research was to determine the cause of ignition. Hydrogen is currently considered as a potential fuel for various vehicles such as cars, trucks, buses, etc. Crucial safety issues are of potential concern, associated with the storage of hydrogen at a very high pressure. Indeed, the evidence obtained nearly 40 years ago shows that sudden rupture of a high-pressure hydrogen storage tank or other component can result in ignition and potentially explosion. The aim of the present research is identification of the conditions under which hydrogen ignition occurs as a result of compression and heating of the air by the shock wave generated by discharge of high-pressure hydrogen. Experiments have been conducted using a facility constructed in the Combustion Laboratory of the Institute of Heat Engineering, Warsaw University of Technology. Tests under various configurations have been performed to determine critical conditions for occurrence of high-pressure hydrogen ignition. The results show that a critical pressure exists, leading to ignition, which depends mainly on the geometric configuration of the outflow system, such as tube diameter, and on the presence of obstacles.

  1. Modified drug release using atmospheric pressure plasma deposited siloxane coatings

    Science.gov (United States)

    Dowling, D. P.; Maher, S.; Law, V. J.; Ardhaoui, M.; Stallard, C.; Keenan, A.

    2016-09-01

    This pilot study evaluates the potential of atmospheric plasma polymerised coatings to modify the rate of drug release from polymeric substrates. The antibiotic rifampicin was deposited in a prototype multi-layer drug delivery system, consisting of a nebulized layer of active drug between a base layer of TEOS deposited on a plastic substrate (polystyrene) and an overlying layer of plasma polymerised PDMS. The polymerised TEOS and PDMS layers were deposited using a helium atmospheric plasma jet system. Elution of rifampicin was measured using UV-VIS spectroscopy, in addition to a antimicrobial well diffusion assay with an established indicator organism. The multi-layered plasma deposited coatings significantly extended the duration of release of the rifampicin from 24 h for the uncoated polymer to 144 h for the coated polymer.

  2. Effects of continuous positive airway pressure on blood pressure in patients with resistant hypertension and obstructive sleep apnea: a meta-analysis

    Science.gov (United States)

    Iftikhar, Imran H.; Valentine, Christopher W.; Bittencourt, Lia R.A.; Cohen, Debbie L.; Fedson, Annette C.; Gíslason, Thorarinn; Penzel, Thomas; Phillips, Craig L.; Yu-sheng, Lin; Pack, Allan I.; Magalang, Ulysses J.

    2015-01-01

    Objective To systematically analyze the studies that have examined the effect of continuous positive airway pressure (CPAP) on blood pressure (BP) in patients with resistant hypertension and obstructive sleep apnea (OSA). Methods Design – meta-analysis of observational studies and randomized controlled trials (RCTs) indexed in PubMed and Ovid (All Journals@Ovid). participants: individuals with resistant hypertension and OSA; interventions – CPAP treatment. Results A total of six studies met the inclusion criteria for preintervention to postintervention analyses. The pooled estimates of mean changes after CPAP treatment for the ambulatory (24-h) SBP and DBP from six studies were −7.21 mmHg [95% confidence interval (CI): −9.04 to −5.38; P <0.001; I2 58%) and −4.99 mmHg (95% CI: −6.01 to −3.96; P <0.001; I2 31%), respectively. The pooled estimate of the ambulatory SBP and DBP from the four RCTs showed a mean net change of −6.74 mmHg [95% CI: −9.98 to −3.49; P <0.001; I2 61%] and −5.94 mmHg (95% CI: −9.40 to −2.47; P =0.001; I2 76%), respectively, in favor of the CPAP group. Conclusion The pooled estimate shows a favorable reduction of BP with CPAP treatment in patients with resistant hypertension and OSA. The effects sizes are larger than those previously reported in patients with OSA without resistant hypertension. PMID:25243523

  3. Randomized controlled trial comparing nasal intermittent positive pressure ventilation and nasal continuous positive airway pressure in premature infants after tracheal extubation

    Directory of Open Access Journals (Sweden)

    Daniela Franco Rizzo Komatsu

    Full Text Available Summary Objective: To analyze the frequency of extubation failure in premature infants using conventional mechanical ventilation (MV after extubation in groups subjected to nasal intermittent positive pressure ventilation (nIPPV and continuous positive airway pressure (nCPAP. Method: Seventy-two premature infants with respiratory failure were studied, with a gestational age (GA ≤ 36 weeks and birth weight (BW > 750 g, who required tracheal intubation and mechanical ventilation. The study was controlled and randomized in order to ensure that the members of the groups used in the research were chosen at random. Randomization was performed at the time of extubation using sealed envelopes. Extubation failure was defined as the need for re-intubation and mechanical ventilation during the first 72 hours after extubation. Results: Among the 36 premature infants randomized to nIPPV, six (16.6% presented extubation failure in comparison to 11 (30.5% of the 36 premature infants randomized to nCPAP. There was no statistical difference between the two study groups regarding BW, GA, classification of the premature infant, and MV time. The main cause of extubation failure was the occurrence of apnea. Gastrointestinal and neurological complications did not occur in the premature infants participating in the study. Conclusion: We found that, despite the extubation failure of the group of premature infants submitted to nIPPV being numerically smaller than in premature infants submitted to nCPAP, there was no statistically significant difference between the two modes of ventilatory support after extubation.

  4. Effectiveness of continuous positive airway pressure in lowering blood pressure in patients with obstructive sleep apnea: a critical review of the literature

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    Fatureto-Borges F

    2016-03-01

    Full Text Available Fernanda Fatureto-Borges,1 Geraldo Lorenzi-Filho,2 Luciano F Drager1,3 1Hypertension Unit, Heart Institute (InCor, 2Sleep Laboratory, Pulmonary Division, 3Hypertension Unit, Renal Division, University of Sao Paulo Medical School, Sao Paulo, Brazil Abstract: Obstructive sleep apnea (OSA is an extremely common comorbid condition in patients with hypertension, with a prevalence of ~50%. There is growing evidence suggesting that OSA is a secondary cause of hypertension, associated with both poor blood pressure (BP control and target organ damage in patients with hypertension. The application of continuous positive airway pressure (CPAP during sleep is the gold standard treatment of moderate- to-severe OSA and very effective in abolishing obstructive respiratory events. However, several meta-analyses showed that the overall impact of CPAP on BP is modest (~2 mmHg. There are several potential reasons for this disappointing finding, including the heterogeneity of patients studied (normotensive patients, controlled, and uncontrolled patients with hypertension, nonideal CPAP compliance, clinical presentation (there is some evidence that the positive impact of CPAP on lowering BP is more evident in sleepy patients, and the multifactorial nature of hypertension. In this review, we performed a critical analysis of the literature evaluating the impact of CPAP on BP in several subgroups of patients. We finally discussed perspectives in this important research area, including the urgent need to identify predictors of BP response to CPAP and the importance of precision medicine in this scenario. Keywords: cardiovascular disease, CPAP, hypertension, sleep apnea, treatment

  5. Sleep-related breathing disorders. 5. Nasal continuous positive airway pressure treatment for obstructive sleep apnoea.

    Science.gov (United States)

    Grunstein, R R

    1995-10-01

    CPAP should be considered the first line of treatment in patients with moderate to severe obstructive sleep apnoea. In our centre in Sydney this generally means patients with more than 20 apnoea/hypopnoeas per hour with repeated dips in oxyhaemoglobin saturation and usually some symptomatology. Despite this first line role of nasal CPAP, recent objective studies question whether earlier enthusiastic reports on adherence to CPAP are correct. The role of technical innovations in new CPAP machines in improving usage remains to be tested. The "drop out" rate from physician selection for a CPAP trial to highly compliant user is certainly more than 50% of patients. What happens to these patients? Data from some studies suggest that surgical treatments are used, at least in the USA, but in all probability many of these patients remain untreated. The challenge in the next decade is either to improve CPAP devices to increase usage in this group or to develop other treatment options. The role of intensive inhospital "acclimatisation" to CPAP also has yet to be objectively tested. It is unclear whether "intelligent" CPAP will make huge inroads in increasing the number of patients who accept CPAP trials, prescriptions, or compliance. It will have minimal impact on patients with mask problems or claustrophobia or those who feel that CPAP is inconvenient. There is a high likelihood that it will reduce technologist workload during CPAP titration studies. "Intelligent" CPAP may help to reduce total overnight mouth leakage and therefore reduce nasal side effects. The current expense of developing such devices will mean that they are unlikely to supersede much cheaper standard "one pressure" CPAP machines in the next few years.

  6. Obstructive sleep apnea in Type 2 diabetes and impact of continuous positive airway pressure therapy on glycemic control

    Directory of Open Access Journals (Sweden)

    Javid Ahmad Malik

    2017-01-01

    Full Text Available Background: Obstructive sleep apnea (OSA and type 2 diabetes mellitus (T2DM are two interacting epidemics both with high prevalence and morbidity. Both epidemiologic and clinical studies suggest that the majority of patients with T2DM also have OSA and untreated OSA in these patients results in poor glycemic control leading to acceleration of diabetes-related complications. Objectives: To assess the prevalence and severity of OSA in T2DM patients and to assess the impact of OSA treatment on presenting symptoms and hemoglobin A1c (HbA1c. Methods: We performed polysomnography (PSG studies and measured HbA1c in 62 consecutive patients with T2DM that were referred from various subspecialty clinics from July 2011 to August 2013. Results: In our 62 diabetic patients, 59 (95.2% had abnormal PSG. Based on Apnea–Hypopnea Index (AHI score, 3 (5.1% patients had mild, 28 (47.5% had moderate, and 28 (47.5% had severe OSA. The mean AHI of diabetic patients was significantly more than nondiabetic patients, i.e., 25.7 versus 19.7 (P = 0.001. Variables that significantly correlated with the presence of OSA include age, gender, body mass index (BMI, hypertension, diabetes, and cardiovascular disease (P < 0.05; however, on logistic regression only BMI, hypertension, and nocturia correlated with OSA. Overall, 59% of diabetic patients showed improvement in their glycemic control as measured by HbA1c with continuous positive airway pressure (CPAP treatment. Significant, moderate, and mild categories of treatment response were respectively observed in 7%, 20%, and 32% of patients. Conclusion: Treatment of OSA with CPAP reduces HbA1c in a significant number of diabetics.

  7. Obstructive sleep apnea in Type 2 diabetes and impact of continuous positive airway pressure therapy on glycemic control

    Science.gov (United States)

    Malik, Javid Ahmad; Masoodi, Shariq Rashid; Shoib, Sheikh

    2017-01-01

    Background: Obstructive sleep apnea (OSA) and type 2 diabetes mellitus (T2DM) are two interacting epidemics both with high prevalence and morbidity. Both epidemiologic and clinical studies suggest that the majority of patients with T2DM also have OSA and untreated OSA in these patients results in poor glycemic control leading to acceleration of diabetes-related complications. Objectives: To assess the prevalence and severity of OSA in T2DM patients and to assess the impact of OSA treatment on presenting symptoms and hemoglobin A1c (HbA1c). Methods: We performed polysomnography (PSG) studies and measured HbA1c in 62 consecutive patients with T2DM that were referred from various subspecialty clinics from July 2011 to August 2013. Results: In our 62 diabetic patients, 59 (95.2%) had abnormal PSG. Based on Apnea–Hypopnea Index (AHI) score, 3 (5.1%) patients had mild, 28 (47.5%) had moderate, and 28 (47.5%) had severe OSA. The mean AHI of diabetic patients was significantly more than nondiabetic patients, i.e., 25.7 versus 19.7 (P = 0.001). Variables that significantly correlated with the presence of OSA include age, gender, body mass index (BMI), hypertension, diabetes, and cardiovascular disease (P < 0.05); however, on logistic regression only BMI, hypertension, and nocturia correlated with OSA. Overall, 59% of diabetic patients showed improvement in their glycemic control as measured by HbA1c with continuous positive airway pressure (CPAP) treatment. Significant, moderate, and mild categories of treatment response were respectively observed in 7%, 20%, and 32% of patients. Conclusion: Treatment of OSA with CPAP reduces HbA1c in a significant number of diabetics. PMID:28217508

  8. Effect of preoperative continuous positive airway pressure duration on outcomes after maxillofacial surgery for obstructive sleep apnoea.

    Science.gov (United States)

    Islam, Shofiq; Taylor, Christopher; Ormiston, Ian W

    2015-02-01

    Continuous positive airway pressure (CPAP) remains the first-line treatment for obstructive sleep apnoea (OSA), and is known to result in various physiological changes. The objective of this study was to evaluate the association between duration of preoperative CPAP therapy and outcome after maxillomandibular advancement (MMA) for OSA. We retrospectively analysed consecutive patients treated at our institution, and divided them into 2 groups based on duration of treatment with CPAP: short-term (up to 12 months) and long-term use (12 months or more). We controlled for baseline demographic and clinical characteristics. We compared postoperative scores for the apnoea/hypopnoea index (AHI) and the Epworth sleepiness scale (ESS), and lowest recorded oxygen saturation between groups. In 43 patients data were available on the preoperative use of CPAP, and in 37 of them preoperative and postoperative polysomnographic data were also available for inclusion. Most had bimaxillary advancement with genioplasty. Differences between the groups in mean reduction in the AHI and lowest oxygen saturation were not significant, and operative success rates were comparable. After operation, the reduction in ESS scores was significantly greater in the long-term group than in the short-term group (mean (SD) 8(3) compared with 2 (2), respectively, p<0.001). Our results suggest that the duration of use of CPAP preoperatively does not significantly influence objective outcome measures. The reduction in AHI scores after MMA was equivalent in both groups. The long-term group seemed to fare better than the short-term group on subjective outcome measures.

  9. Effect of continuous positive airway pressure treatment on elderly Chinese patients with obstructive sleep apnea in the prethrombotic state

    Institute of Scientific and Technical Information of China (English)

    张希龙; 殷凯生; 王虹; 苏梅; 杨玉

    2003-01-01

    Objectives To characterize the prethrombotic state (PTS) in elderly Chinese patients with obstructive sleep apnea hypopnea syndrome (OSAHS) and the effect of nasal continuous positive airway pressure (nCPAP) ventilation on their PTS.Methods Forty-one elderly patients with moderate and severe OSAHS were enrolled into the OSAHS group and underwent nCPAP treatment. Their blood samples were drawn at 6:00 am and 4:00 pm before and during nCPAP treatment, respectively, to test hemocrit, platelet aggregation (PAG), whole blood viscosity (WBV), plasma fibrinogen (fng), prothrombin time (PT) and activated partial thromboplastin time (APTT). All blood factors were also tested in a control group consisting of 32 healthy elderly Chinese with neither OSAHS nor cerebrocardiac vascular disease. Results In the OSAHS group there was a significantly higher hemocrit, WBV, fng, and a significantly shorter PT and APTT at 6:00 am compared to 4:00 pm before nCPAP treatment, while there was no significant difference among all blood test factors between 6:00 am and 4:00 pm on day 30 of the nCPAP treatment. In the OSAHS group, the hemocrit, WBV, PAG and plasma fng were significantly lower and the PT and APTT were significantly longer at 6:00 am on day 30 of the nCPAP treatment compared to 6:00 am before the nCPAP treatment. A significantly lower hemocrit, but a much longer PT and APTT were observed at 4:00 pm on day 30 of the treatment, compared with 4:00 pm before the treatment. No significant difference among the blood test factors was found between 6:00 am and 4:00 pm blood in the control group or between the control and OSAHS groups after 30 days of nCPAP treatment.Conclusion In elderly Chinese OSAHS patients, PTS could be effectively eliminated by nCPAP treatment.

  10. Elective nasal continuous positive airway pressure to support respiration after prolonged ventilation in infants after congenital cardiac surgery

    Science.gov (United States)

    Gandhi, Hemang; Mishra, Amit; Thosani, Rajesh; Acharya, Himanshu; Shah, Ritesh; Surti, Jigar; Sarvaia, Alpesh

    2017-01-01

    Background: We sought to compare the effectiveness of oxygen (O2) treatment administered by an O2 mask and nasal continuous positive airway pressure (NCPAP) in infants after congenital cardiac surgery. Methods: In this retrospective observational study, 54 infants undergoing corrective cardiac surgery were enrolled. According to the anesthesiologist's preference, the patients ventilated for more than 48 h were either put on NCPAP or O2 mask immediately after extubation. From pre-extubation to 24 h after treatment, arterial blood gas and hemodynamic data were measured. Results: After 24 h of NCPAP institution, the patients showed a significant improvement in oxygenation compared to O2 mask group. Respiratory rate (per minute) decreased from 31.67 ± 4.55 to 24.31 ± 3.69 (P < 0.0001), PO2 (mmHg) increased from 112.12 ± 22.83 to 185.74 ± 14.81 (P < 0.0001), and PCO2 (mmHg) decreased from 42.88 ± 5.01 to 37.00 ± 7.22 (P < 0.0076) in patients on NCPAP. In this group, mean pediatric cardiac surgical Intensive Care Unit (PCSICU) stay was 4.72 ± 1.60 days, with only 2 (11.11%) patients requiring re-intubation. Conclusion: NCPAP can be used safely and effectively in infants undergoing congenital cardiac surgery to improve oxygenation/ventilation. It also reduces the work of breathing, PCSICU stay, and may reduce the likelihood of re-intubation. PMID:28163425

  11. Association between obstructive sleep apnea (OSA and depression and the effect of continuous positive airway pressure (CPAP treatment

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    El-Sherbini AM

    2011-12-01

    Full Text Available Amr Makram El-Sherbini1, Adel Salah Bediwy2, Ashraf El-Mitwalli31Department of Psychiatry, Elminia University Hospital, Faculty of Medicine, Elminia, 2Chest Department, Faculty of Medicine, Tanta University, 3Department of Neurology, Mansoura School of Medicine, University of Mansoura, Mansoura, EgyptBackground: Obstructive sleep apnea (OSA is a relatively common disorder which has a negative impact on the psychological well-being of affected individuals.Objective: To assess the association between OSA and depression as well as the effect of treatment with continuous positive airway pressure (CPAP.Methods: A total of 37 newly diagnosed individuals with OSA underwent an overnight polysomnography and were assessed using the Epworth Sleepiness Scale (ESS, the Hamilton Depression Rating Scale (HDRS, and the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Patients were assessed before and after 2 months of CPAP use.Results: Of the 37 patients included in the study, 21 (56.7% had clinically relevant depression as indicated by a score >10 on the HDRS and eleven patients (29.7% met the diagnostic criteria for a major depressive episode using the Structured Clinical Interview. Scores on the HDRS were correlated with the Apnea Hypoxia Index, ESS scores, and oxygen saturation. Patients showed a significant reduction in depressive symptoms and improvement in ESS scores after CPAP treatment.Conclusion: Patients with OSA should be screened carefully for depressive disorders. CPAP should be tried first before starting other treatment modalities for depression.Keywords: obstructive sleep apnea, depression in OSA, CPAP and depression

  12. Boussignac continuous positive airway pressure for the management of acute cardiogenic pulmonary edema: prospective study with a retrospective control group

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    Aarts Leon PHJ

    2007-12-01

    Full Text Available Abstract Background Continuous positive airway pressure (CPAP treatment for acute cardiogenic pulmonary edema can have important benefits in acute cardiac care. However, coronary care units are usually not equipped and their personnel not adequately trained for applying CPAP with mechanical ventilators. Therefore we investigated in the coronary care unit setting the feasibility and outcome of the simple Boussignac mask-CPAP (BCPAP system that does not need a mechanical ventilator. Methods BCPAP was introduced in a coronary care unit where staff had no CPAP experience. All consecutive patients transported to our hospital with acute cardiogenic pulmonary edema, a respiratory rate > 25 breaths/min and a peripheral arterial oxygen saturation of Results During the 2-year prospective BCPAP study period 108 patients were admitted with acute cardiogenic pulmonary edema. Eighty-four of these patients (78% were treated at the coronary care unit of which 66 (61% were treated with BCPAP. During the control period 66 patients were admitted over a 1-year period of whom 31 (47% needed respiratory support in the intensive care unit. BCPAP treatment was associated with a reduced hospital length of stay and fewer transfers to the intensive care unit for intubation and mechanical ventilation. Overall estimated savings of approximately € 3,800 per patient were achieved with the BCPAP strategy compared to conventional treatment. Conclusion At the coronary care unit, BCPAP was feasible, medically effective, and cost-effective in the treatment of acute cardiogenic pulmonary edema. Endpoints included mortality, coronary care unit and hospital length of stay, need of ventilatory support, and cost (savings.

  13. Withdrawal of Continuous Positive Airway Pressure Therapy after Malar Advancement and Le Fort II Distraction in a Case of Apert Syndrome with Obstructive Sleep Apnea

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    Nobuto Onda

    2015-01-01

    Full Text Available Apert syndrome is a congenital syndrome characterized by craniosynostosis and craniofacial dysostosis, among other features, and is reported to cause obstructive sleep apnea (OSA because of upper airway narrowing associated with midfacial dysplasia. We recently encountered a case involving a patient with Apert syndrome complicated by OSA who began to receive continuous positive airway pressure (CPAP therapy at the age of 4. OSA resolved after maxillofacial surgery performed at the age of 11, and CPAP was eventually withdrawn. In pediatric patients with maxillofacial dysplasia complicated by OSA, a long-term treatment plan including CPAP in addition to maxillofacial plastic and reconstructive surgery should be considered in view of the effects of OSA on growth.

  14. Numerical analysis of accidental hydrogen releases from high pressure storage at low temperatures

    DEFF Research Database (Denmark)

    Markert, Frank; Melideo, Daniele; Baraldi, Daniele

    2014-01-01

    . The vessel dynamics are modeled using a simplified engineering and a CFD model to evaluate the performance of various EOS to predict vessel pressures, temperatures mass flow rates and jet flame lengths. It is shown that the chosen EOS and the chosen specific heat capacity correlation are important to model......Evaluations of the performance of simplified engineering and CFD models are important to improve risk assessment tools e.g. to predict accurately releases from various types of hydrogen storages. These tools have to predict releases from a wide range of storage pressures (up to 80 MPa......) and temperatures (down to 20 K), e.g. cryogenic compressed gas storage covers pressures up to 35 MPa and temperatures between 33 K and 338 K. Accurate calculations of high pressure releases require real gas EOS. This paper compares a number of EOS to predict hydrogen properties typical in different storage types...

  15. Numerical simulation of high pressure release and dispersion of hydrogen into air with real gas model

    Science.gov (United States)

    Khaksarfard, R.; Kameshki, M. R.; Paraschivoiu, M.

    2010-06-01

    Hydrogen is a renewable and clean source of energy, and it is a good replacement for the current fossil fuels. Nevertheless, hydrogen should be stored in high-pressure reservoirs to have sufficient energy. An in-house code is developed to numerically simulate the release of hydrogen from a high-pressure tank into ambient air with more accuracy. Real gas models are used to simulate the flow since high-pressure hydrogen deviates from ideal gas law. Beattie-Bridgeman and Abel Noble equations are applied as real gas equation of state. A transport equation is added to the code to calculate the concentration of the hydrogen-air mixture after release. The uniqueness of the code is to simulate hydrogen in air release with the real gas model. Initial tank pressures of up to 70 MPa are simulated.

  16. The importance of administration of early surfactant and nasal continuous positive airway pressure in newborns with respiratory distress syndrome

    Science.gov (United States)

    Ceylan, Abdullah; Gezer, Suat; Demir, Nihat; Tuncer, Oğuz; Peker, Erdal; Kırımi, Ercan

    2014-01-01

    Aim: Mechanical ventilation is an invasive method and causes to important problems in the respiratory tract and lung parenchyma. The objective of our study was to investigate if administration of early surfactant and nasal continuous positive airway pressure (nCPAP) was superior to delayed surfactant administration and mechanical ventilation. Material and Methods: The study was conducted in the Van 100th Year University, Medical Faculty Hospital, Neonatal Intensive Care Unit. One hundred and nine infants with respiratory distrss syndrome (RDS) with a gestational age of 32 weeks and/or below were included in the study. Surfactant was given to 61 infants in the delivery room or intensive care unit and subsequently nCPAP was administered. Surfactant was administered in 48 infants in the control group and mechanical ventilation was inititated subsequently. Informed consent was obtained from the relatives of all patients and ethics committee approval was also obtained (Approval number: 03.02.2011/15). Results: There was no statistically significant difference between the two groups in terms of gestational age, birth weight, gender, height and head circumference measurements (p>0.05). The mean hospitalization time in the patients in the study group was 24.4±17.8 days, whereas the mean time of nCPAP was 28.4 (4–120) hours. In the study group, intracranial hemorrhage was found with a rate of 27.85%, bronchopulmonary dysplasia was found with a rate of 4.91%, pneumothorax was found with a rate of 3.27%, necrotizing enterocolitis was found with a rate of 3.27%, patent ductus arteriosus was found with a rate of 16.39, sepsis was found with a rate of 22.95% and retinopathy of prematurity was found with a rate of 1.63%. No statistically significant difference was found between the study and control groups in terms of the rates of complications. During the follow-up period, 17 (27.86%) patients were lost. The length of stay on mechanical ventilation in the study group was

  17. Erectile Dysfunction and Sexual Hormone Levels in Men With Obstructive Sleep Apnea: Efficacy of Continuous Positive Airway Pressure.

    Science.gov (United States)

    Zhang, Xiao-Bin; Lin, Qi-Chang; Zeng, Hui-Qing; Jiang, Xing-Tang; Chen, Bo; Chen, Xiao

    2016-01-01

    In this study, the prevalence of erectile dysfunction (ED) and serum sexual hormone levels were evaluated in men with obstructive sleep apnea (OSA). In these patients, the efficacy of continuous positive airway pressure (CPAP) was determined. The 207 men (mean age 44.0 ± 11.1 years) enrolled in the study were stratified within four groups based on their apnea-hypopnea index score: simple snoring (n = 32), mild OSA (n = 29), moderate OSA (n = 38), and severe OSA (n = 108). The International Index of Erectile Dysfunction-5 (IIEF-5) score was obtained from each patient, and blood samples for the analysis of sexual hormones (prolactin, luteotropin, follicle-stimulating hormone, estradiol, progestin, and testosterone) were drawn in the morning after polysomnography. The IIEF-5 test and serum sexual hormone measurements were repeated after 3 months of CPAP treatment in 53 men with severe OSA. The prevalence of ED was 60.6 % in OSA patients overall and 72.2 % in those with severe OSA. Compared with the simple snoring group, patients with severe OSA had significantly lower testosterone levels (14.06 ± 5.62 vs. 17.02 ± 4.68, p = .018) and lower IIEF-5 scores (16.33 ± 6.50 vs. 24.09 ± 1.94, p = .001). The differences in the other sexual hormones between groups were not significant. After 3 months of CPAP treatment, there were no significant changes in sexual hormone levels, but the IIEF-5 score had improved significantly (18.21 ± 4.05 vs. 19.21 ± 3.86, p = .001). Severe OSA patients have low testosterone concentration and high ED prevalence. IIEF-5 scores increased significantly after CPAP treatment, but there was no effect on serum testosterone levels.

  18. Effect of continuous positive airway pressure ventilation on nocturnal ST-segment changes in patients with sleep-disordered breathing

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Objective To determine whether sleep-disordered breathing (SDB) may lead to nocturnal myocardial ischemia and whether the severity of this ischemia may be relieved by nasal continuous positive airway pressure (CPAP). Methods Overnight polysomnogram examination and simultaneous 3-channel Holter monitoring were performed on 76 patients with moderate to severe SDB and no history of coronary heart disease. All the cases were treated with CPAP for one night. ST depression was defined as a ST segment decrease of more than 1 mm from baseline and lasting 1 min or more. The total duration (minutes) of ST depression was indexed to the total sleep time (minutes per hour of sleep). Results Twenty-eight patients (37%) showed ST segment depression during their sleep. Before CPAP treatment, the respiratory disturbance index (RDI) and arousal index were significantly higher during periods of ST depression than when ST segments were isoelectric, whereas no significant difference was found in blood oxygen saturation (SaO2). After the CPAP treatment of patients with ST depression, the duration of ST depression was significantly reduced from 36.8±18.9 to 11.4±13.2 min/h (P<0.05). ST depression-related indexes, including RDI, arousal index and the percentage of sleep time spent at SaO2 below 90% (TS90/ TST), were all significantly decreased, with RDI from 63.4±23.8 to 8.1±6.6 /h, arousal index from 51.2±18.9 to 9.6±5.4 /h, and TS90/ TST from 50.6±21.4 to 12.9±14.7% (P<0.05). Conclusion ST-segment depression is rather common in patients with moderate to severe SDB, and CPAP treatment can significantly reduce the duration of ST depression. ST depression in these patients may reflect the myocardial ischemia that really exists and the non-ischemic changes associated with recurrent SDB.

  19. Continuous Positive Airway Pressure for Motion Management in Stereotactic Body Radiation Therapy to the Lung: A Controlled Pilot Study

    Energy Technology Data Exchange (ETDEWEB)

    Goldstein, Jeffrey D. [Department of Radiation Oncology, Chaim Sheba Medical Center, Tel Hashomer, Tel Aviv (Israel); Lawrence, Yaacov R. [Department of Radiation Oncology, Chaim Sheba Medical Center, Tel Hashomer, Tel Aviv (Israel); Sackler School of Medicine, Tel Aviv University, Tel Aviv (Israel); Appel, Sarit; Landau, Efrat; Ben-David, Merav A.; Rabin, Tatiana; Benayun, Maoz; Dubinski, Sergey; Weizman, Noam; Alezra, Dror; Gnessin, Hila; Goldstein, Adam M.; Baidun, Khader [Department of Radiation Oncology, Chaim Sheba Medical Center, Tel Hashomer, Tel Aviv (Israel); Segel, Michael J.; Peled, Nir [Department of Pulmonary Medicine, Chaim Sheba Medical Center, Tel Hashomer, Tel Aviv (Israel); Sackler School of Medicine, Tel Aviv University, Tel Aviv (Israel); Symon, Zvi, E-mail: symonz@sheba.health.gov.il [Department of Radiation Oncology, Chaim Sheba Medical Center, Tel Hashomer, Tel Aviv (Israel); Sackler School of Medicine, Tel Aviv University, Tel Aviv (Israel)

    2015-10-01

    Objective: To determine the effect of continuous positive airway pressure (CPAP) on tumor motion, lung volume, and dose to critical organs in patients receiving stereotactic body radiation therapy (SBRT) for lung tumors. Methods and Materials: After institutional review board approval in December 2013, patients with primary or secondary lung tumors referred for SBRT underwent 4-dimensional computed tomographic simulation twice: with free breathing and with CPAP. Tumor excursion was calculated by subtracting the vector of the greatest dimension of the gross tumor volume (GTV) from the internal target volume (ITV). Volumetric and dosimetric determinations were compared with the Wilcoxon signed-rank test. CPAP was used during treatment if judged beneficial. Results: CPAP was tolerated well in 10 of the 11 patients enrolled. Ten patients with 18 lesions were evaluated. The use of CPAP decreased tumor excursion by 0.5 ± 0.8 cm, 0.4 ± 0.7 cm, and 0.6 ± 0.8 cm in the superior–inferior, right–left, and anterior–posterior planes, respectively (P≤.02). Relative to free breathing, the mean ITV reduction was 27% (95% confidence interval [CI] 16%-39%, P<.001). CPAP significantly augmented lung volume, with a mean absolute increase of 915 ± 432 cm{sup 3} and a relative increase of 32% (95% CI 21%-42%, P=.003), contributing to a 22% relative reduction (95% CI 13%-32%, P=.001) in mean lung dose. The use of CPAP was also associated with a relative reduction in mean heart dose by 29% (95% CI 23%-36%, P=.001). Conclusion: In this pilot study, CPAP significantly reduced lung tumor motion compared with free breathing. The smaller ITV, the planning target volume (PTV), and the increase in total lung volume associated with CPAP contributed to a reduction in lung and heart dose. CPAP was well tolerated, reproducible, and simple to implement in the treatment room and should be evaluated further as a novel strategy for motion management in radiation therapy.

  20. Auto-titrating versus fixed continuous positive airway pressure for the treatment of obstructive sleep apnea: a systematic review with meta-analyses

    Directory of Open Access Journals (Sweden)

    Ip Stanley

    2012-03-01

    Full Text Available Abstract Background Obstructive sleep apnea is a relatively common disorder that can lead to lost productivity and cardiovascular disease. The form of positive airway treatment that should be offered is unclear. Methods MEDLINE and the Cochrane Central Trials registry were searched for English language randomized controlled trials comparing auto-titrating positive airway pressure (APAP with continuous positive airway pressure (CPAP in adults with obstructive sleep apnea (inception through 9/2010. Six researchers extracted information on study design, potential bias, patient characteristics, interventions and outcomes. Data for each study were extracted by one reviewer and confirmed by another. Random effects model meta-analyses were performed for selected outcomes. Results Twenty-four randomized controlled trials met the inclusion criteria. In individual studies, APAP and fixed CPAP resulted in similar changes from baseline in the apnea-hypopnea index, most other sleep study measures and quality of life. By meta-analysis, APAP improved compliance by 11 minutes per night (95% CI, 3 to 19 minutes and reduced sleepiness as measured by the Epworth Sleepiness Scale by 0.5 points (95% CI, 0.8 to 0.2 point reduction compared with fixed CPAP. Fixed CPAP improved minimum oxygen saturation by 1.3% more than APAP (95% CI, 0.4 to 2.2%. Studies had relatively short follow-up and generally excluded patients with significant comorbidities. No study reported on objective clinical outcomes. Conclusions Statistically significant differences were found but clinical importance is unclear. Because the treatment effects are similar between APAP and CPAP, the therapy of choice may depend on other factors such as patient preference, specific reasons for non-compliance and cost.

  1. Adding a custom made pressure release valve during air enema for intussusception: A new technique

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    Hosni Morsi Ahmed

    2015-01-01

    Full Text Available Background: Non-surgical reduction remains the first line treatment of choice for intussusception. The major complication of air enema reduction is bowel perforation. The authors developed a custom made pressure release valve to be added to portable insufflation devices, delivering air at pressures accepted as safe for effective reduction of intussusception in children under fluoroscopic guidance. The aim of this study was to develop a custom made pressure release valve that is suitable for the insufflation devices used for air enema reduction of intussusception and to put this valve into regular clinical practice. Materials and Methods: An adjustable, custom made pressure release valve was assembled by the authors using readily available components. The valve was coupled to a simple air enema insufflation device. The device was used for the trial of reduction of intussusception in a prospective study that included 132 patients. Results: The success rate for air enema reduction with the new device was 88.2%. The mean pressure required to achieve complete reduction was 100 mmHg. The insufflation pressure never exceeded the preset value (120 mmHg. Of the successful cases, 58.3% were reduced from the first attempt while 36.1% required a second insufflation. Only 5.55% required a third insufflation to complete the reduction. In cases with unsuccessful pneumatic reduction attempt (18.1%, surgical treatment was required. Surgery ranged from simple reduction to resection with a primary end to end anastomosis. No complications from air enema were recorded. Conclusions: The authors recommend adding pressure release valves to ensure safety by avoiding pressure overshoot during the procedure.

  2. Cerebral hemodynamics in patients with obstructive sleep apnea syndrome monitored with near-infrared spectroscopy (NIRS) during positive airways pressure (CPAP) therapy: a pilot study

    Science.gov (United States)

    Zhang, Zhongxing; Schneider, Maja; Laures, Marco; Fritschi, Ursula; Lehner, Isabella; Qi, Ming; Khatami, Ramin

    2014-03-01

    In obstructive sleep apnea syndrome (OSA) the periodic reduction or cessation of breathing due to narrowing or occlusion of the upper airway during sleep leads to daytime symptoms and increased cardiovascular risk, including stroke. The higher risk of stroke is related to the impairment in cerebral vascular autoregulation. Continuous positive airways pressure (CPAP) therapy at night is the most effective treatment for OSA. However, there is no suitable bedside monitoring method evaluating the treatment efficacy of CPAP therapy, especially to monitor the recovery of cerebral hemodynamics. NIRS is ideally suited for non-invasive monitoring the cerebral hemodynamics during sleep. In this study, we will for first time assess dynamic changes of cerebral hemodynamics during nocturnal CPAP therapy in 3 patients with OSA using NIRS. We found periodic oscillations in HbO2, HHb, tissue oxygenation index (TOI) and blood volume associated with periodic apnea events without CPAP in all OSA patients. These oscillations were gradually attenuated and finally eliminated with the stepwise increments of CPAP pressures. The oscillations were totally eliminated in blood volume earlier than in other hemodynamic parameters. These results suggested that 1) the cerebral hemodynamic oscillations induced by OSA events can effectively be attenuated by CPAP therapy, and 2) blood flow and blood volume recovered first during CPAP therapy, followed by the recovery of oxygen consumption. Our study suggested that NIRS is a useful tool to evaluate the efficacy of CPAP therapy in patients with OSA bedside and in real time.

  3. Effects of nasal continuous positive airway pressure treatment on insulin resistance and ghrelin levels in non-diabetic apnoeic patients with coronary heart disease

    Institute of Scientific and Technical Information of China (English)

    YANG Dan; LIU Zhi-hong; ZHAO Qing; LUO Qin

    2013-01-01

    Background Obesity is a common risk factor for several diseases.Obesity related hormone and increased insulin resistance (IR) may contribute to the effects of obstructive sleep apnoea on cardiovascular consequences.We investigated ghrelin and IR in non-diabetic apnoeic patients with stable coronary heart disease and assessed the effects of continuous positive airway pressure (CPAP).Methods Plasma ghrelin,glucose and insulin were measured in 22 patients with CPAP and 22 matched controls without CPAP at baseline and three months.Indexes including homeostasis model assessment IR (HOMA IR),HOMA S and HOMA β were calculated for the assessment of IR,insulin sensitivity and pancreatic β cell function.Results At three months follow-up,plasma ghrelin levels and HOMA IR in CPAP group were significantly decreased (,P=0.002 and 0.046,respectively) while those in control group increased significantly (P=0.012 and 0.009,respectively).Significant moderate correlations were found between ghrelin vs.HOMA IR and ghrelin vs.HOMA S after CPAP,however,for those without CPAP,no significant associations were observed.Conclusions Short-term effective continuous positive airway pressure had a significant effect on lowering plasma ghrelin levels and IR,but not body fat.Further large scale and longer term studies are warranted to corroborate these findings.

  4. Atrial distension, arterial pulsation, and vasopressin release during negative pressure breathing in humans

    DEFF Research Database (Denmark)

    Pump, B; Damgaard, M; Gabrielsen, A;

    2001-01-01

    During an antiorthostatic posture change, left atrial (LA) diameter and arterial pulse pressure (PP) increase, and plasma arginine vasopressin (AVP) is suppressed. By comparing the effects of a 15-min posture change from seated to supine with those of 15-min seated negative pressure breathing...... in eight healthy males, we tested the hypothesis that with similar increases in LA diameter, suppression of AVP release is dependent on the degree of increase in PP. LA diameter increased similarly during the posture change and negative pressure breathing (-9 to -24 mmHg) from between 30 and 31 +/- 1 to 34...... +/- 1 mm (P breathing from 36 +/- 3 to 42 +/- 3 mmHg (P

  5. Sustained inflation and incremental mean airway pressure trial during conventional and high-frequency oscillatory ventilation in a large porcine model of acute respiratory distress syndrome

    Directory of Open Access Journals (Sweden)

    Wunder Christian

    2006-06-01

    Full Text Available Abstract Background To compare the effect of a sustained inflation followed by an incremental mean airway pressure trial during conventional and high-frequency oscillatory ventilation on oxygenation and hemodynamics in a large porcine model of early acute respiratory distress syndrome. Methods Severe lung injury (Ali was induced in 18 healthy pigs (55.3 ± 3.9 kg, mean ± SD by repeated saline lung lavage until PaO2 decreased to less than 60 mmHg. After a stabilisation period of 60 minutes, the animals were randomly assigned to two groups: Group 1 (Pressure controlled ventilation; PCV: FIO2 = 1.0, PEEP = 5 cmH2O, VT = 6 ml/kg, respiratory rate = 30/min, I:E = 1:1; group 2 (High-frequency oscillatory ventilation; HFOV: FIO2 = 1.0, Bias flow = 30 l/min, Amplitude = 60 cmH2O, Frequency = 6 Hz, I:E = 1:1. A sustained inflation (SI; 50 cmH2O for 60s followed by an incremental mean airway pressure (mPaw trial (steps of 3 cmH2O every 15 minutes were performed in both groups until PaO2 no longer increased. This was regarded as full lung inflation. The mPaw was decreased by 3 cmH2O and the animals reached the end of the study protocol. Gas exchange and hemodynamic data were collected at each step. Results The SI led to a significant improvement of the PaO2/FiO2-Index (HFOV: 200 ± 100 vs. PCV: 58 ± 15 and TAli: 57 ± 12; p 2-reduction (HFOV: 42 ± 5 vs. PCV: 62 ± 13 and TAli: 55 ± 9; p Ali: 6.1 ± 1 vs. T75: 3.4 ± 0.4; PCV: TAli: 6.7 ± 2.4 vs. T75: 4 ± 0.5; p Conclusion A sustained inflation followed by an incremental mean airway pressure trial in HFOV improved oxygenation at a lower mPaw than during conventional lung protective ventilation. HFOV but not PCV resulted in normocapnia, suggesting that during HFOV there are alternatives to tidal ventilation to achieve CO2-elimination in an "open lung" approach.

  6. Comparison of electrohydraulic lithotripters with rigid and pressure-release ellipsoidal reflectors. II. Cavitation fields.

    Science.gov (United States)

    Bailey, M R; Blackstock, D T; Cleveland, R O; Crum, L A

    1999-08-01

    Dramatically different cavitation was produced by two separate acoustic pulses that had different shapes but similar duration, frequency content, and peak positive and negative pressure. Both pulses were produced by a Dornier HM-3 style lithotripter: one pulse when the ellipsoidal reflector was rigid, the other when the reflector was pressure release. The cavitation, or bubble action, generated by the conventional rigid-reflector pulse was nearly 50 times longer lived and 3-13 times stronger than that produced by the pressure-release-reflector pulse. Cavitation durations measured by passive acoustic detection and high-speed video agreed with calculations based on the Gilmore equation. Cavitation intensity, or destructive potential, was judged (1) experimentally by the size of pits in aluminum foil detectors and (2) numerically by the calculated amplitude of the shock wave emitted by a collapsing bubble. The results indicate that the trailing positive spike in the pressure-release-reflector waveform stifles bubble growth and mitigates the collapse, whereas the trough after the positive spike in the rigid-reflector waveform triggers inertially driven growth and collapse. The two reflectors therefore provide a tool to compare effects in weakly and strongly cavitating fields and thereby help assess cavitation's role in lithotripsy.

  7. Estimation of influence of myofascial release techniques on esophageal pressure in patients after total laryngectomy.

    Science.gov (United States)

    Marszałek, Sławomir; Zebryk-Stopa, Anna; Kraśny, Jacek; Obrebowski, Andrzej; Golusiński, Wojciech

    2009-08-01

    In patients after total laryngectomy, increased tension in myofascial neck and arm areas might be observed. Via fascial continuity it has an adverse impact on the superior esophageal constrictor forming the "mouth of the oesophagus", which hinders learning of esophageal speech. The aim is to assess the effect of manual myofascial release techniques on esophageal pressure in patients after total laryngectomy. Forty patients (12 F, 28 M), aged 43-75 (mean 56.8 years), 9 months to 13 years (average 3 years) after total laryngectomy, 35 patients (87.5%) after neck lymph node resection, 38 patients (95%) after radiotherapy. Esophageal pressure was assessed using modified Seeman's method. Manual myofascial release techniques were applied within head, neck, arms, upper trunk and upper limb areas. Wilcoxon and Shapiro-Wilk's test was used for the purpose of statistical analysis. Statistically significant decrease of the mean esophageal pressure was observed after the physiotherapy treatment. The average pressure among the examined patients decreased from 37.9 to 26.6 mmHg. The application of myofascial manual techniques decreases esophageal pressure, thus allowing patients to learn esophagus speech at a faster pace.

  8. Monitoring Progress and Adherence with Positive Airway Pressure Therapy for Obstructive Sleep Apnea: The Roles of Telemedicine and Mobile Health Applications.

    Science.gov (United States)

    Hwang, Dennis

    2016-06-01

    Technology is changing the way health care is delivered and how patients are approaching their own health. Given the challenge within sleep medicine of optimizing adherence to continuous positive airway pressure (CPAP) therapy in patients with obstructive sleep apnea (OSA), implementation of telemedicine-based mechanisms is a critical component toward developing a comprehensive and cost-effective solution for OSA management. Key elements include the use of electronic messaging, remote monitoring, automated care mechanisms, and patient self-management platforms. Current practical sleep-related telemedicine platforms include Web-based educational programs, automated CPAP follow-up platforms that promote self-management, and peer-based patient-driven Internet support forums.

  9. Effect of Positive Airway Pressure Therapy on Body Mass Index in Obese Patients With Obstructive Sleep Apnea Syndrome: A Prospective Study.

    Science.gov (United States)

    Rishi, Muhammad Adeel; Copur, Ahmet Sinan; Nadeem, Rashid; Fulambarker, Ashok

    2016-01-01

    Because obesity is a common cause of obstructive sleep apnea syndrome (OSAS), weight loss can be an effective treatment. OSAS also may cause weight gain in some patients. Effective treatment of sleep apnea may facilitate weight loss in obese patients. We hypothesize that positive airway pressure (PAP) therapy is associated with weight loss in obese patients with OSAS. This was a single-center observational prospective cohort study. Forty-five patients were diagnosed with OSAS after polysomnographic analysis in sleep laboratory and underwent continuous positive airway pressure titration. Patients were followed for 3 months in terms of change in body mass index (BMI) and compliance with PAP therapy. Of the 45 patients recruited, 3 patients were eliminated because of miss recruitment. Nine patients had incomplete data, and the rest (n = 33) were included for analysis. The mean age was 54.9 ± 16.9 years (mean ± SD), 93.9% were male, and 90.9% were whites. Mean apnea-hypopnea index was 36.3 ± 28.17 events per hour. Mean BMI before treatment was 34.7 ± 3.9 kg/m. Fifteen patients (45.5%) were compliant with therapy of OSAS with PAP. There was no difference in age, gender, neck circumference, BMI, and apnea-hypopnea index of patients compliant to therapy when compared with those who were not. There was a significant decrease in BMI in patients compliant with PAP therapy compared with noncompliant patients (-1.2 ± 0.7 vs. 0.3 ± 0.9 kg/m, P ≤ 0.001). PAP therapy may cause significant loss of weight within 3 months in obese patients with OSAS. Further study is needed to elucidate the physiological basis of this change.

  10. "The blood pressure and dermal sensitivity effects of Nylon hollow fiber releasing Glycerin Trinitrate in vivo "

    Directory of Open Access Journals (Sweden)

    "Ostad SN

    2002-09-01

    Full Text Available In order to improve patient's compliance in taking glycerine trinitrate (GTN nylon hollow fiber which has been successfully used for release of chlorhexidine diacetate and levonorgestrel was employed to make nylon hollow fiber releasing GTN. Hollow nylon fibres of external diameter 0.63 mm, 75 mm long with an internal capacity of 16 μl, were filled with GTN (190 mg/ml in 70% ethanol (v/v or vehicle alone and the ends were heat-sealed. The fibers were then immersed in 10 ml of 0.9% (w/v saline in a separating funnel. The GTN release pattern from fiber, the effect of the product on blood pressure and its potential dermal toxicity were assessed. The release of GTN from the fibres was approximately 2.7 μg/min when the fibres contained 16 mg of drug. The results showed that the amount of GTN within the single fibre was enough to reduce blood pressure significantly, while it did not show significant dermal toxicity. It is concluded that GTN fiber, if used as monofilament, is not an alternative method for GTN delivery.

  11. Evidence for pressure-release melting beneath magmatic arcs from basalt at Galunggung, Indonesia

    Science.gov (United States)

    Sisson, T.W.; Bronto, S.

    1998-01-01

    The melting of peridotite in the mantle wedge above subduction zones is generally believed to involve hydrous fluids derived from the subducting slab. But if mantle peridotite is upwelling within the wedge, melting due to pressure release could also contribute to magma production. Here we present measurements of the volatile content of primitive magmas from Galunggung volcano in the Indonesian are which indicate that these magmas were derived from the pressure-release melting of hot mantle peridotite. The samples that we have analysed consist of mafic glass inclusions in high-magnesium basalts. The inclusions contain uniformly low H2O concentrations (0.21-0.38 wt%), yet relatively high levels of CO2 (up to 750 p.p.m.) indicating that the low H2O concentrations are primary and not due to degassing of the magma. Results from previous anhydrous melting experiments on a chemically similar Aleutian basalts indicate that the Galunggung high-magnesium basalts were last in equilibrium with peridotite at ~1,320 ??C and 1.2 GPa. These high temperatures at shallow sub-crustal levels (about 300-600 ??C hotter than predicted by geodynamic models), combined with the production of nearly H2O- free basaltic melts, provide strong evidence that pressure-release melting due to upwelling in the sub-are mantle has taken place. Regional low- potassium and low-H2O (ref. 5) basalts found in the Cascade are indicate that such upwelling-induced melting can be widespread.

  12. Alternaria-Induced Release of IL-18 from Damaged Airway Epithelial Cells: n NF-kB Dependent Mechanism of Th2 Differentiation?

    OpenAIRE

    2012-01-01

    BACKGROUND: A series of epidemiologic studies have identified the fungus Alternaria as a major risk factor for asthma. The airway epithelium plays a critical role in the pathogenesis of allergic asthma. These reports suggest that activated airway epithelial cells can produce cytokines such as IL-25, TSLP and IL-33 that induce Th2 phenotype. However the epithelium-derived products that mediate the pro-asthma effects of Alternaria are not well characterized. We hypothesized that exposure of the...

  13. Effect of pressure on the release of endogenous dopamine from rat striatum and the role of sodium-calcium exchange.

    Science.gov (United States)

    Paul, M L; Philp, R B

    1992-01-01

    Exposure to environmental pressures in excess of 20 atm abs can precipitate a hyperexcitability state known as high pressure neurologic syndrome (HPNS). Little is known about the underlying neurochemical basis of this syndrome. An in vitro model of the synthesis and release of endogenous dopamine (DA) from rat striatal slices has been used to examine the mechanism underlying the effects of high pressures of He. He at 100 atm abs produced changes in DA release which were strikingly similar to those of the cardiac glycoside, ouabain. Neither pressure nor ouabain (1-10 microM) had any significant effects on the spontaneous (nonevoked) release of DA or its metabolite 3,4-dihydroxyphenylacetic acid, but both pressure and ouabain significantly enhanced the stimulated release of DA which was evoked by a 6-min exposure to 35 mM KCl (P less than 0.05 and P less than 0.001). In both cases, this effect was dependent on the presence of extracellular Ca2+. Augmentation of evoked DA release by both ouabain and He pressure was reversed (P less than 0.05) by 3,4-dichlorobenzamil, a selective antagonist of the membrane Na+/Ca2+ exchange mechanism. The results suggest that pressure exerts its effects on DA release by increasing intracellular-free Ca2+ exchange after pressure-inhibition of the activity of the membrane Na,K-ATPase.

  14. High pressurized CO2 release CFD calculations from onshore pipeline leakages

    Science.gov (United States)

    Herzog, Nicoleta; Gorenz, Paul; Egbers, Christoph

    2013-04-01

    Emissions from high pressurized pipelines can be determined on the basis of hydrodynamical and thermophysical calculations of the escaped fluid. If a rupture occurs when CO2 is onshore transported in liquid form there will be initially a large pressure drop in the pipeline, the pressure will fall until the liquid becomes a mixture of saturated vapor/liquid. In the vicinity of the rupture, liquid CO2 will escape and immediately vaporize and expand, some of the liquid will desublimate into dry ice, which will precipitate onto the ground [1, 2]. The period of time taken for a large amount of carbon dioxide to be discharged would be short. Initially CO2 will escape by pushing the overlying soil upwards at an explosion-like speed. After the pressure in the pipe fell the flow profile of the escaping gas will almost be as described for gaseous material transport. The expansion of carbon dioxide will occur at sonic speed and will continue to do so until the pressure ratio between the CO2 and the ambient air is lower than about 1.9 [3]. As a result of the expansion also the temperature of the escaping gas will fall drastically and a cloud of cold gas will form which is then dispersed and slowly mixed with ambient air. The rate of emptying the pipeline is controlled by the pipe cross-section area and the speed of the escaping gas, or by the pressure difference between the pipeline and the atmosphere. Therefore the mass flow will be largest immediately after the accident with an exponential decay in time. In this study a two-phase model is applied to a high pressurized pipeline through which liquid carbon dioxide flows. A leakage is considered to be at different positions along the pipeline and the release pressure is calculated over several parameter ranges. It is also intended to characterize from hydrodynamical point of view the dispersion of released CO2 in the ambient medium by means of CFD simulations which includes multiphase flow treatment. For that a turbulent two

  15. Curative effect of continuous positive airway pressure on treatment of patients with obstructive sleep apnea hypopnea syndrome and hypertension: A Meta-analysis

    Directory of Open Access Journals (Sweden)

    Bi-fang MIAO

    2016-12-01

    Full Text Available Objective  To systematically evaluate the curative effect of continuous positive airway pressure (CPAP on treatment of patients with obstructive sleep apnea hypopnea syndrome (OSAHS and hypertension. Methods  The data were retrieved of randomized controlled trials (RCTs about the curative effect of CPAP on treatment of patients with OSAHS and hypertension from PubMed, Cochrane Library, CNKI, VIP, CBM and WanFang database from inception to Oct. 2015. Literature screening, data extraction and risk bias assessment were performed by two independent reviewers, and meta-analysis was then carried out by using RevMan 5.3 software. Results  A total of 16 RCTs involving 2101 patients were included. Meta-analysis revealed that, compared with the antihypertensive drug therapy alone, CPAP plus antihypertensive drug therapy significantly reduced the daytime systolic pressure [MD=–12.60, 95%CI(–17.68 to –7.52, P<0.00001], nighttime systolic pressure [MD=–21.90, 95%CI(–25.94 to –17.86, P<0.00001] and nighttime diastolic pressure [MD=–11.90, 95%CI(–15.44 to –8.36, P<0.00001], while created no significant difference in daytime diastolic pressure, 24-h mean systolic pressure and 24-h mean diastolic pressure in a following-up less than 12 weeks. Whereas in the following-up no less than 12 weeks, compared with the antihypertensive drug therapy alone, CPAP plus antihypertensive drug therapy significantly reduced the 24-h mean systolic pressure [MD=–7.88, 95%CI(–12.09 to –3.66, P=0.00002], 24-h mean diastolic pressure [MD=–5.14, 95%CI(–6.00 to –4.28, P<0.00001], daytime systolic pressure [MD=–5.89, 95%CI(–8.79 to –2.98, P<0.0001], daytime diastolic pressure [MD=–4.34, 95%CI(–6.32 to –2.36, P<0.0001]; nighttime systolic pressure [MD=–7.06, 95%CI(–11.12 to –2.99, P=0.0007] and nighttime diastolic pressure [MD=–4.49, 95%CI (–7.39 to –1.58, P=0.006]. Conclusions  The current evidences suggest that on the basis

  16. Continuous positive airway pressure breathing increases the spread of sensory blockade after low-thoracic epidural injection of lidocaine.

    NARCIS (Netherlands)

    Visser, W.A.; Gielen, M.J.M.; Giele, J.L.P.

    2006-01-01

    Factors affecting the distribution of sensory blockade after epidural injection of local anesthetics remain incompletely clarified. To evaluate if increasing intrathoracic pressure affects the spread of thoracic epidural anesthesia, we randomized 20 patients who received an epidural catheter at the

  17. Connexin 30 deficiency impairs renal tubular ATP release and pressure natriuresis.

    Science.gov (United States)

    Sipos, Arnold; Vargas, Sarah L; Toma, Ildikó; Hanner, Fiona; Willecke, Klaus; Peti-Peterdi, János

    2009-08-01

    In the renal tubule, ATP is an important regulator of salt and water reabsorption, but the mechanism of ATP release is unknown. Several connexin (Cx) isoforms form mechanosensitive, ATP-permeable hemichannels. We localized Cx30 to the nonjunctional apical membrane of cells in the distal nephron and tested whether Cx30 participates in physiologically important release of ATP. We dissected, partially split open, and microperfused cortical collecting ducts from wild-type and Cx30-deficient mice in vitro. We used PC12 cells as ATP biosensors by loading them with Fluo-4/Fura Red to measure cytosolic calcium and positioning them in direct contact with the apical surface of either intercalated or principal cells. ATP biosensor responses, triggered by increased tubular flow or by bath hypotonicity, were approximately three-fold greater when positioned next to intercalated cells than next to principal cells. In addition, these responses did not occur in preparations from Cx30-deficient mice or with purinergic receptor blockade. After inducing step increases in mean arterial pressure by ligating the distal aorta followed by the mesenteric and celiac arteries, urine output increased 4.2-fold in wild-type mice compared with 2.6-fold in Cx30-deficient mice, and urinary Na(+) excretion increased 5.2-fold in wild-type mice compared with 2.8-fold in Cx30-deficient mice. Furthermore, Cx30-deficient mice developed endothelial sodium channel-dependent, salt-sensitive elevations in mean arterial pressure. Taken together, we suggest that mechanosensitive Cx30 hemichannels have an integral role in pressure natriuresis by releasing ATP into the tubular fluid, which inhibits salt and water reabsorption.

  18. Sensitivity Analysis of Dousing Spray Trip on Radioactive Release in Pressure Tube Rupture Accident with Both End Fitting Failures

    Energy Technology Data Exchange (ETDEWEB)

    Jang, M. S.; Kang, H. S; Kim, S. R. [NESS, Daejeon (Korea, Republic of)

    2015-10-15

    We analyzed the sensitivity analysis of dousing spray trip conditions on radioactive release. In terms of conservativeness, the set 1 trip would be more appropriate in RR analysis than set 2 trip, which is the general condition of RR analysis. Radioactive releases from the containment building is related to containment air pressure, which increases by the coolant discharge from loss of coolant accident and the actuation conditions of dousing spray and so on. In LOCA analysis, the dousing spray trip conditions are set for the analysis objectives; for peak pressure (PP), for pressure signal (PS), for radioactive release (RR) and etc. In RR analysis, we would determine the dousing spray trip condition to increase radioactive release to the public for conservatism. Therefore, we carried out the sensitivity analysis of dousing spray trip condition on radioactive release from containment building using GOTHIC and SMART program for CANDU.

  19. 14C release from a Soviet-designed pressurized water reactor nuclear power plant.

    Science.gov (United States)

    Uchrin, G; Csaba, E; Hertelendi, E; Ormai, P; Barnabas, I

    1992-12-01

    The Paks Nuclear Power Plant in Hungary runs with four pressurized water reactors, each of 440-MWe capacity. Sampling systems have been developed and used to determine the 14C of various chemical forms (14CO2, 14CO, 14CnHm) in the airborne releases. The average normalized yearly discharge rates for the time period 1988-1991 are equal to 0.77 TBq GWe-1 y-1 for hydrocarbons and 0.05 TBq GWe-1 y-1 for CO2. The contribution of 14CO was less than 0.5% of the total emission. The 14C discharge rate is estimated to be four times higher than the corresponding mean data of Western European pressurized water reactors. The calculated effective dose equivalent to individuals living in the vicinity of the power plant, due to 14C release, was 0.64 microSv in 1991 while the effective dose equivalent due to the natural 14C level was 15 microSv y-1. The long-term global impact of the 14C release in the operational period of the plant (1982-1991) was 1,270 man-Sv. The 14C excess in the environmental air has been measured since 1989 by taking biweekly samples at a distance of 1.7 km from the nuclear power plant. The long-term average of radiocarbon excess coming from the power plant was 2 mBq m-3. The local 14C deposition was followed by tree ring analysis, too. No 14C increase higher than the uncertainty of the measurement (four per thousand = 0.17 mBq m-3) was observed.

  20. The effect of short-term withdrawal from continuous positive airway pressure therapy on sympathetic activity and markers of vascular inflammation in subjects with obstructive sleep apnoea.

    Science.gov (United States)

    Phillips, Craig L; Yang, Qiao; Williams, Andrew; Roth, Michael; Yee, Brendon J; Hedner, Jan A; Berend, Norbert; Grunstein, Ronald R

    2007-06-01

    Obstructive sleep apnoea (OSA) is commonly associated with cardiovascular disease and sympathetic activation. However, it is unclear whether this association is independent of obesity and to what extent treatment with nasal continuous positive airway pressure (CPAP) alleviates the vascular inflammation that underpins cardiovascular disease. We therefore evaluated whether short-term withdrawal from CPAP therapy in subjects with moderate-severe OSA would result in increased levels of sympathetic activity and circulating inflammatory cytokines independent of weight. Vascular inflammatory markers (hsCRP, hsIL-6 and hsTNF-alpha) were assessed in 20 subjects after one and seven nights of withdrawal from CPAP together with the hypoxia-responsive angiogenic marker VEGF and urinary catecholamines. Compared with baseline on CPAP, withdrawal from therapy resulted in an immediate return of OSA with an increase in RDI to 26.7 +/- 5.2 and 39.0 +/- 5.9 events per hour after one and seven nights without CPAP, respectively (both P 0.1). In conclusion, 1 week of CPAP withdrawal was associated with a return of OSA and a marked increase in sympathetic activity without a concomitant elevation of vascular inflammatory markers.

  1. Impact of obstructive sleep apnea treatment by continuous positive airway pressure on cardiometabolic biomarkers: a systematic review from sham CPAP randomized controlled trials.

    Science.gov (United States)

    Jullian-Desayes, Ingrid; Joyeux-Faure, Marie; Tamisier, Renaud; Launois, Sandrine; Borel, Anne-Laure; Levy, Patrick; Pepin, Jean-Louis

    2015-06-01

    Reducing cardiometabolic risk may represent an important target for effective obstructive sleep apnea (OSA) treatment. The impact of continuous positive airway pressure (CPAP), the first line therapy of OSA, on metabolic or inflammatory markers is still debated. A systematic literature search using several databases was performed. We provide a systematic analysis of randomized studies comparing therapeutic versus sham CPAP intervention and also include studies using a CPAP withdrawal design. We addressed the impact of CPAP on the following cardiometabolic biomarkers: 1) plasma and urine catecholamines and their metabolites that reflect sympathetic activity; 2) insulin resistance and lipid metabolism biomarkers; 3) oxidative stress, systemic and vascular inflammation biomarkers; 4) liver enzymes highlighting the association between OSA and nonalcoholic fatty liver disease (NAFLD); 5) coagulation biomarkers. The impact of CPAP on sympathetic activity is robust across studies and occurs rapidly. In contrast to sympathetic activity, the well-designed studies included in this review failed to demonstrate that CPAP alters metabolic or inflammatory markers in OSA. CPAP did not change glucose, lipids, insulin resistance levels or the ratio of patients with metabolic syndrome. In unselected OSA patients, it is not realistic to expect a clinically relevant decrease in cardiometabolic biomarkers with CPAP therapy.

  2. Effects of Continuous Positive Airway Pressure on Cognitive Deficits in Middle-aged Patients with Obstructive Sleep Apnea Syndrome: A Meta-analysis of Randomized Controlled Trials

    Institute of Scientific and Technical Information of China (English)

    Yue-Ying Pan; Yan Deng; Xiu Xu; Ya-Ping Liu; Hui-Guo Liu

    2015-01-01

    Background:Current views on continuous positive airway pressure (CPAP) treatment to improve the cognitive deficits of patients with obstructive sleep apnea syndrome (OSAS) are controversial,so we performed a meta-analysis.Methods:A comprehensive literature search was tmdertaken in PubMed,CINAHL,Medline,PsycInfo,EMBASE,Cochrane Library,CNKI,WanFang,VIP,and CBMdisc for studies published from June 1971 to July 2014.The outcome measures included neuropsychological tests of the 7 cognitive domains detailed below.Results:After screening the titles and abstracts and thoroughly reading the full text,we obtained 13 studies with little risk of bias that incorporated 1744 middle-aged obese participants with mild to severe OSAS.The studies were published from 1994 to 2012.Treatment durations varied from 1 to 24 weeks.The effect sizes of attention,vigilance,processing speed,working memory,memory,verbal fluency,and visuoconstructive skills domains were-0.10 (P =0.24),-0.12 (P =0.04),-0.08 (P =0.16),0.00 (P =0.95),-0.04 (P =0.30),-0.06 (P =0.34),and-0.01 (P =0.92),respectively.Conclusions:Cognition partially improved in patients with OSAS after CPAP treatment.The only domain with significant improvement was vigilance.Rigorous randomized controlled trials need to be performed to obtain clear results.

  3. Effect of continuous positive airway pressure on arterial stiffness in patients with obstructive sleep apnea and hypertension: a meta-analysis.

    Science.gov (United States)

    Lin, Xin; Chen, Gongping; Qi, Jiachao; Chen, Xiaofang; Zhao, Jiangming; Lin, Qichang

    2016-12-01

    Arterial stiffness has been recognized as a predictor of cardiovascular and all-cause mortality in hypertensive patients. However, the impact of continuous positive airway pressure (CPAP) on arterial stiffness in patients with OSA and hypertension remains inconclusive. We performed a meta-analysis to determine whether effective CPAP therapy could decrease arterial stiffness. Two reviewers independently searched PubMed, Embase, Web of Science and Cochrane Library prior to March 5, 2015. Information on characteristics of subjects, study design and pre- and post-CPAP treatment of arterial stiffness was extracted for analysis. Standardized mean difference (SMD) was used to analyze the summary estimates for CPAP therapy. Three articles with 186 patients were included in this meta-analysis, including two observational studies and one randomized controlled study. The meta-analysis showed that CPAP was associated with a statistically significant decrease in arterial stiffness in patients with OSA and hypertension (SMD = -0.65, 95 % confidence interval (CI) = -1.14 to -0.16, z = 2.60, p = 0.009). Our meta-analysis suggested that CPAP among OSA and hypertensive patients was significantly associated with a decrease in arterial stiffness. Further prospective large-scale multicenter RCTs are needed to explore the precise impact of CPAP therapy on arterial stiffness in patients with OSA and hypertension.

  4. Adolescents with obstructive sleep apnea adhere poorly to positive airway pressure (PAP, but PAP users show improved attention and school performance.

    Directory of Open Access Journals (Sweden)

    Dean W Beebe

    Full Text Available BACKGROUND: Obstructive Sleep Apnea (OSA is associated with medical and neurobehavioral morbidity across the lifespan. Positive airway pressure (PAP treatment has demonstrated efficacy in treating OSA and has been shown to improve daytime functioning in adults, but treatment adherence can be problematic. There are nearly no published studies examining functional outcomes such as academic functioning in adolescents treated with PAP. This study was conducted as an initial step towards determining whether PAP treatment improves daytime functioning among adolescents with OSA. METHODS: Self-reported academic grades, self- and parent-reported academic quality of life, and objectively-measured attention were assessed before and after PAP was clinically initiated in a sample of 13 obese adolescents with OSA, as well as 15 untreated obese Controls without OSA. Based on adherence data, the treated group was divided into PAP Users (n = 6 and Non-Adherent participants (n = 7. RESULTS: Though demographically similar, the three groups significantly differed in how their academic performance and attention scores changed from baseline to follow-up. Non-Adherent participants showed worsening functioning over time, while PAP Users showed stable or improved functioning, similar to controls. CONCLUSION: Although many adolescents prescribed PAP for OSA are non-adherent to the treatment, those who adhere to treatment can display improved attention and academic functioning.

  5. Flavor release measurement by atmospheric pressure chemical ionization ion trap mass spectrometry, construction of interface and mathematical modeling of release profiles

    DEFF Research Database (Denmark)

    Haahr, Anne-Mette; Madsen, Henrik; Smedsgaard, Jørn

    2003-01-01

    An instrumental on-line retronasal flavor analysis was developed to obtain information about the release of flavor compounds in expired air from humans during eating. The volatile flavor compounds were measured by ion trap mass spectrometry with an atmospheric pressure chemical ionization source...

  6. Effect of advanced blood pressure control with nifedipine delayed-release tablets on the blood pressure in patients underwent nasal endoscope surgery

    Institute of Scientific and Technical Information of China (English)

    Qing-Hua Xiao; Li Yang; Rong-Ping Chen; Wei-Dong Qiu

    2016-01-01

    Objective:To explore the effect of advanced blood pressure control with nifedipine delayed-release tablets on the blood pressure in patients underwent nasal endoscope surgery and its feasibility.Methods:A total of 80 patients who were admitted in ENT department from June, 2012 to June, 2015 for nasal endoscope surgery were included in the study and randomized into the observation group and the control group with 40 cases in each group. The patients in the observation group were given nifedipine delayed-release tablets for advanced blood pressure control before operation, and were given routine blood pressure control during operation; while the patients in the control group were only given blood pressure control during operation. The changes of blood pressure, mean central arterial pressure, and heart rate before anesthesia (T0), after intubation (T1), during operation (T2), extubation when waking (T3), 30 min after extubation (T4), and 3 h after back to wards (T5) in the two groups were compared. The intraoperative situation and the surgical field quality in the two groups were compared.Results: SBP, DBP, and MAP levels at T1-5 in the two groups were significantly lower than those at T0. SBP, DBP, and MAP levels at T2 were significantly lower than those at other timing points, and were gradually recovered after operation, but were significantly lower than those at T0. The effect taking time of blood pressure reducing, intraoperative nitroglycerin dosage, and postoperative wound surface exudation amount in the observation group were significantly less than those in the control group. The surgical field quality scores in the observation group were significantly superior to those in the control group.Conclusions:Advanced blood pressure control with nifedipine delayed-release tablets can stabilize the blood pressure during the perioperative period in patients underwent nasal endoscope surgery, and enhance the surgical field qualities.

  7. Correlation between balloon release pressure and no-reflow in patients with acute myocardial infarction undergoing direct percutaneous coronary intervention

    Institute of Scientific and Technical Information of China (English)

    Wang Yanfei; Yao Min; Liu Haibo; Yang Yuejin; Xie Junmin; Jia Xinwei; Pan Huanjun

    2014-01-01

    Background Balloon release pressure may increase the incidence of no reflow after direct percutaneous coronary intervention (PCI).This randomized controlled study was designed to analyze the correlation between balloon release pressure and no-reflow in patients with acute myocardial infarction (AMI) undergoing direct PCI.Methods There were 156 AMI patients who underwent PCI from January 1,2010 to December 31,2012,and were divided into two groups according to the stent inflation pressure:a conventional pressure group and a high pressure group.After PCI,angiography was conducted to assess the thrombolysis in myocardial infarction (TIMI) grade with related artery.Examinations were undertaken on all patients before and after the operation including cardiac enzymes,total cholesterol,low-density lipoprotein,blood glucose,homocysteine,β-thromboglobulin (β-TG),Hamilton depression scale (HAMD) and self-rating anxiety scale (SAS).After interventional therapy,the afore-mentioned parameters in both the conventional pressure group and high pressure group were again analyzed.Results The results showed that CK-MB,HAMD,SAS were significantly different (P <0.05) in all patients after PCI,especially the CK-MB in the high pressure group ((25.7±7.6) U/L vs.(76.7±11.8) U/L).CK-MB,HAMD,SAS,and β-TG were comparative before PCI but they were significantly changed (P <0.05) after intervention.No-reflow phenomenon occurred in 13 patients in the high pressure group,which was significantly higher than in the conventional pressure group (17.11% vs.6.25%,P<0.05).Conclusion In stent implantation,using a pressure less than 1823.4 kPa balloon to release pressure may be the better choice to reduce the occurrence of no-reflow following direct PCI.

  8. Evaluation of Tritium Content and Release from Pressurized Water Reactor Fuel Cladding

    Energy Technology Data Exchange (ETDEWEB)

    Robinson, Sharon M. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Chattin, Marc Rhea [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Giaquinto, Joseph [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Jubin, Robert Thomas [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States)

    2015-09-01

    will behave during processing, scoping tests are being performed to determine the tritium content in the cladding pre- and post-tritium pretreatment. Samples of Surry-2 and H.B. Robinson pressurized water reactor cladding were heated to 1100–1200°C to oxidize the zirconium and release all of the tritium in the cladding sample. Cladding samples were also heated within the temperature range of 480–600ºC expected for standard air tritium pretreatment systems, and to a slightly higher temperature (700ºC) to determine the impact of tritium pretreatment on tritium release from the cladding. The tritium content of the Surry-2 and H.B. Robinson cladding was measured to be ~234 and ~500 µCi/g, respectively. Heating the Surry-2 cladding at 500°C for 24 h removed ~0.2% of the tritium from the cladding, and heating at 700°C for 24 h removed ~9%. Heating the H.B. Robinson cladding at 700°C for 24 h removed ~11% of the tritium. When samples of the Surry-2 and H.B. Robinson claddings were heated at 700°C for 96 h, essentially all of the tritium in the cladding was removed. However, only ~3% of the tritium was removed when a sample of Surry-2 cladding was heated at 600°C for 96 h. These data indicate that the amount of tritium released from tritium pretreatment systems will be dependent on both the operating temperature and length of time in the system. Under certain conditions, a significant fraction of the tritium could remain bound in the cladding and would need to be considered in operations involving cladding recycle.

  9. Estimation of airway obstruction using oximeter plethysmograph waveform data

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    Desmond Renee' A

    2005-06-01

    Full Text Available Abstract Background Validated measures to assess the severity of airway obstruction in patients with obstructive airway disease are limited. Changes in the pulse oximeter plethysmograph waveform represent fluctuations in arterial flow. Analysis of these fluctuations might be useful clinically if they represent physiologic perturbations resulting from airway obstruction. We tested the hypothesis that the severity of airway obstruction could be estimated using plethysmograph waveform data. Methods Using a closed airway circuit with adjustable inspiratory and expiratory pressure relief valves, airway obstruction was induced in a prospective convenience sample of 31 healthy adult subjects. Maximal change in airway pressure at the mouthpiece was used as a surrogate measure of the degree of obstruction applied. Plethysmograph waveform data and mouthpiece airway pressure were acquired for 60 seconds at increasing levels of inspiratory and expiratory obstruction. At each level of applied obstruction, mean values for maximal change in waveform area under the curve and height as well as maximal change in mouth pressure were calculated for sequential 7.5 second intervals. Correlations of these waveform variables with mouth pressure values were then performed to determine if the magnitude of changes in these variables indicates the severity of airway obstruction. Results There were significant relationships between maximal change in area under the curve (P Conclusion The findings suggest that mathematic interpretation of plethysmograph waveform data may estimate the severity of airway obstruction and be of clinical utility in objective assessment of patients with obstructive airway diseases.

  10. Efficiency of Continuous Positive Airway Pressure or High-Frequency Jet Ventilation by Means a Nasooral Mask in the Treatment of Pulmonary Edema

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    J. Salantay

    2008-01-01

    Full Text Available Objective: to compare the efficiency of continuous positive airway pressure (CPAP and high-frequency jet ventilation by means of a mask (HFJV-M in the treatment of cardiogenic edema of the lung. Design: a retrospective study. Setting: Department of Anesthesiology and Intensive Medicine, Hospital NsP, Vranov, Slovakia. Subjects and methods. A hundred and ninety-six patients with varying cardiogenic edema of the lung were divided into 3 groups according to the severity of pulmonary edema (PE. By taking into account comparable pharmacotherapy, mean airway pressure, and FiO2, the authors compared the efficiency of CPAP (n=64 and HFJV-M (n=101 from the rate of changes in respiration rate, blood oxygenation, acid-base balance, and the duration of ventilation support and the length of stay in the intensive care unit (ICU. The results were assessed by the unpaired Student’s test. The procedure of artificial ventilation via HFJV-M was approved by the Professional and Ethics Committee, Ministry of Health in the Republic of Slovakia, in 1989 for clinical application. Results. Comparison of CPAP or HFJV-M used in mild PE that was called Phase 1 of PE revealed no statistically significant differences in the parameters being assessed. In severer forms of PE characterized as Phases 2 and 3, the use of HFJV-M in the first 3 hours of ventilation maintenance caused a rapider reduction in spontaneous respiration rate from 25—33 per min to 18—22 per min (p>0.01. The application of HFJV-M also showed a statistically significant difference in the correction rate of PaO2, pH, and oxygenation index (PaO2/FIO2 (p>0.01 predominantly within the first 2 hours of therapy. Comparison of the mean duration of necessary ventilation maintenance (CPAP versus HFJV-M: 10.9 versus 6.8 hours and the mean length of stay in the ICU (CPAP versus HFJV-N: 2.7 versus 2 days revealed a statistically significant difference (p>0.01 and p>0.05, respectively. Only 6.6% of the HFJV-M group

  11. Effects of different levels of positive airway pressure on breathing pattern and heart rate variability after coronary artery bypass grafting surgery

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    C.B.F. Pantoni

    2011-01-01

    Full Text Available The application of continuous positive airway pressure (CPAP produces important hemodynamic alterations, which can influence breathing pattern (BP and heart rate variability (HRV. The aim of this study was to evaluate the effects of different levels of CPAP on postoperative BP and HRV after coronary artery bypass grafting (CABG surgery and the impact of CABG surgery on these variables. Eighteen patients undergoing CABG were evaluated postoperatively during spontaneous breathing (SB and application of four levels of CPAP applied in random order: sham (3 cmH2O, 5 cmH2O, 8 cmH2O, and 12 cmH2O. HRV was analyzed in time and frequency domains and by nonlinear methods and BP was analyzed in different variables (breathing frequency, inspiratory tidal volume, inspiratory and expiratory time, total breath time, fractional inspiratory time, percent rib cage inspiratory contribution to tidal volume, phase relation during inspiration, phase relation during expiration. There was significant postoperative impairment in HRV and BP after CABG surgery compared to the preoperative period and improvement of DFAα1, DFAα2 and SD2 indexes, and ventilatory variables during postoperative CPAP application, with a greater effect when 8 and 12 cmH2O were applied. A positive correlation (P < 0.05 and r = 0.64; Spearman was found between DFAα1 and inspiratory time to the delta of 12 cmH2O and SB of HRV and respiratory values. Acute application of CPAP was able to alter cardiac autonomic nervous system control and BP of patients undergoing CABG surgery and 8 and 12 cmH2O of CPAP provided the best performance of pulmonary and cardiac autonomic functions.

  12. Effects of heated humidification and topical steroids on compliance, nasal symptoms, and quality of life in patients with obstructive sleep apnea syndrome using nasal continuous positive airway pressure.

    LENUS (Irish Health Repository)

    Ryan, Silke

    2012-02-01

    BACKGROUND: Nasal side effects are common in patients with obstructive sleep apnea syndrome (OSAS) starting on nasal continuous positive airway pressure (CPAP) therapy. We tested the hypothesis that heated humidification or nasal topical steroids improve compliance, nasal side effects and quality of life in this patient group. METHODS: 125 patients with the established diagnosis of OSAS (apnea\\/hypopnea index > or = 10\\/h), who tolerated CPAP via a nasal mask, and who had a successful CPAP titration were randomized to 4 weeks of dry CPAP, humidified CPAP or CPAP with additional topical nasal steroid application (fluticasone, GlaxoWellcome). Groups were similar in all demographic variables and in frequency of nasal symptoms at baseline. Outcome measures were objective compliance, quality of life (short form 36), subjective sleepiness (Epworth Sleepiness Scale score) and nasal symptoms such as runny, dry or blocked nose, sneezing and headaches; all variables assessed using a validated questionnaire and by direct interview. RESULTS: There was no difference in compliance between groups after 4 weeks (dry: 5.21 +\\/- 1.66 h\\/night, fluticasone: 5.66 +\\/- 1.68, humidifier: 5.21 +\\/- 1.84; p = 0.444). Quality of life and subjective sleepiness improved in all groups, but there were no differences in the extent of improvement. Nasal Symptoms were less frequently reported in the humidifier group (28%) than in the remaining groups (dry: 70%, fluticasone: 53%, p = 0.002). However, the addition of fluticasone resulted in increased frequency of sneezing. CONCLUSION: The addition of a humidifier, but not nasal steroids decreases the frequency of nasal symptoms in unselected OSAS patients initiating CPAP therapy; however compliance and quality of life remain unaltered.

  13. Nurse-led intensive interventions improve adherence to continuous positive airway pressure therapy and quality of life in obstructive sleep apnea patients

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    Chen XF

    2015-11-01

    Full Text Available Xiaofen Chen,1 Weiting Chen,1 Weijie Hu,2 Kui Huang,3 Jing Huang,4 Yu Zhou5 1Hospital of Stomatology, Wenzhou Medical University, Wenzhou, 2People Hospital of Tiantai, Taizhou, 3Department of Orthodontics, Hospital of Stomatology, Wenzhou Medical University, Wenzhou, 4The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, 5Department of Orthodontics, Hospital of Stomatology, Wenzhou Medical University, Wenzhou, People’s Republic of China Background: Continuous positive airway pressure (CPAP is widely recommended for the treatment of sleep apnea/hypopnea syndrome (SAHS, but its usage by patients is very low. The aim of this study was to assess intensive educational programs and nursing support for the improvement of CPAP use and outcomes in SAHS patients.Methods: Eighty new SAHS patients were randomized to receive nurse-led intensive interventions or usual support at hospital and home. The main outcome measure was CPAP use; changes in sleeping, symptoms, mood, and quality of life were also assessed after 12 months of treatment.Results: All outcome measures were improved after treatment in both groups. However, patients receiving intensive support with significantly higher CPAP use (higher daily CPAP usage by 2.2 hours/day had greater improvements in SAHS symptoms and mood (P<0.05. The intervention group further showed an improvement in the Short Form-36 domains of mental and physical health (P<0.05.Conclusion: The CPAP usage and quality of life can be significantly improved by nurse-led intensive program in obstructive sleep apnea patients. Keywords: CPAP, quality of life, SAHS, compliance

  14. The Effects of Massage with Coconut and Sunflower Oils on Oxygen Saturation of Premature Infants with Respiratory Distress Syndrome Treated With Nasal Continuous Positive Airway Pressure

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    Sousan Valizadeh

    2012-11-01

    Full Text Available Introduction: Nowadays particular emphasis is placed on the developmental aspects of premature infants care. Massage therapy is one of the best-known methods of caring. Due to the minimal touch policy in neonatal intensive care units (NICUs, massaging is not usually performed on premature infants. However, there is not sufficient evidence to support the claim that newborn infants with complex medical conditions should not be massaged. This study aimed to determine the effects of massage with coconut and sunflower oils on oxygen saturation of infants with respiratory distress syndrome (RDS treated with nasal continuous positive airway pressure (NCPAP. Methods: This was a randomized controlled trial on 90 newborns who were admitted to Alzahra Hospital (Tabriz, Iran. The infants were divided into control and massage therapy groups (massage with coconut and sunflower oils. Data was collected using a hospital documentation form. A 15-minute daily massage was performed for 3 days. Respiratory rate (RR, fraction of inspired oxygen (FiO2 and oxygen saturation were measured 5 minutes before the massage, 3 times during the massage, and 5 minutes after the massage. The collected data was analyzed using a mixed model. Results: In comparison to coconut oil and control groups, mean oxygen saturation of sunflower oil group was improved. In addition, the coconut massage group showed lower oxygen saturation than the control group but was all values were within the normal range. Although massage decreased oxygen saturation, there was no need to increase FiO2. Conclusion: Massage therapy can provide developmental care for infants treated with NCPAP.

  15. Postoperative pharyngolaryngeal adverse events with laryngeal mask airway (LMA Supreme) in laparoscopic surgical procedures with cuff pressure limiting 25 cmH₂O: prospective, blind, and randomised study.

    Science.gov (United States)

    Kang, Joo-Eun; Oh, Chung-Sik; Choi, Jae Won; Son, Il Soon; Kim, Seong-Hyop

    2014-01-01

    To reduce the incidence of postoperative pharyngolaryngeal adverse events, laryngeal mask airway (LMA) manufacturers recommend maximum cuff pressures not exceeding 60 cmH₂O. We performed a prospective randomised study, comparing efficacy and adverse events among patients undergoing laparoscopic surgical procedures who were allocated randomly into low (limiting 25 cmH₂O, L group) and high (at 60 cmH₂O, H group) LMA cuff pressure groups with LMA Supreme. Postoperative pharyngolaryngeal adverse events were evaluated at discharge from postanaesthetic care unit (PACU) (postoperative day 1, POD 1) and 24 hours after discharge from PACU (postoperative day 2, POD 2). All patients were well tolerated with LMA without ventilation failure. Before pneumoperitoneum, cuff volume and pressure and oropharyngeal leak pressure (OLP) showed significant differences. Postoperative sore throat at POD 2 (3 versus 12 patients) and postoperative dysphagia at POD 1 and POD 2 (0 versus 4 patients at POD 1; 0 versus 4 patients at POD 2) were significantly lower in L group, compared with H group. In conclusion, LMA with cuff pressure limiting 25 cmH₂O allowed both efficacy of airway management and lower incidence of postoperative adverse events in laparoscopic surgical procedures. This clinical trial is registered with KCT0000334.

  16. Upper airway collapsibility in anesthetized children.

    Science.gov (United States)

    Litman, Ronald S; McDonough, Joseph M; Marcus, Carole L; Schwartz, Alan R; Ward, Denham S

    2006-03-01

    We sought to establish the feasibility of measuring upper airway narrowing in spontaneously breathing, anesthetized children using dynamic application of negative airway pressure. A secondary aim was to compare differences in upper airway collapsibility after the administration of sevoflurane or halothane. Subjects were randomized to either drug for inhaled anesthetic induction. Each was adjusted to their 1 MAC value (0.9% for halothane and 2.5% for sevoflurane) and a blinded anesthesia provider held the facemask without performing manual airway opening maneuvers but with inclusion of an oral airway device. Inspiratory flows were measured during partial upper airway obstruction created by an adjustable negative pressure-generating vacuum motor inserted into the anesthesia circuit. Critical closing pressure of the pharynx (Pcrit) was obtained by plotting the peak inspiratory flow of the obstructed breaths against the corresponding negative pressure in the facemask and extrapolating to zero airflow using linear correlation. Fourteen children were enrolled, seven in each anesthetic group. Two children in the halothane group did not develop flow-limited airway obstruction despite negative pressures as low as -9 cm H2O. Pcrit for sevoflurane ranged from -6.7 to -11.6 (mean +/- sd, -9.8 +/- 1.9) cm H2O. Pcrit for halothane ranged from -8.1 to -33 (mean +/- sd, -19.4 +/- 9.3) cm H2O (sevoflurane versus halothane, P = 0.048). We conclude that when using dynamic application of negative airway pressure, halothane appears to cause less upper airway obstruction than sevoflurane at equipotent concentrations.

  17. Wire-guided (Seldinger technique) intubation through a face mask in urgent, difficult and grossly distorted airways.

    Science.gov (United States)

    Heier, Jake M; Schroeder, Kristopher M; Galgon, Richard E; Arndt, George A

    2012-07-01

    We report two cases of successful urgent intubation using a Seldinger technique for airway management through an anesthesia facemask, while maintaining ventilation in patients with difficult airways and grossly distorted airway anatomy. In both cases, conventional airway management techniques were predicted to be difficult or impossible, and a high likelihood for a surgical airway was present. This technique was chosen as it allows tracheal tube placement through the nares during spontaneous ventilation with the airway stented open and oxygen delivery with either continuous positive airway pressure and/or pressure support ventilation. This unhurried technique may allow intubation when other techniques are unsuitable, while maintaining control of the airway.

  18. Wire-guided (Seldinger technique intubation through a face mask in urgent, difficult and grossly distorted airways

    Directory of Open Access Journals (Sweden)

    Jake M Heier

    2012-01-01

    Full Text Available We report two cases of successful urgent intubation using a Seldinger technique for airway management through an anesthesia facemask, while maintaining ventilation in patients with difficult airways and grossly distorted airway anatomy. In both cases, conventional airway management techniques were predicted to be difficult or impossible, and a high likelihood for a surgical airway was present. This technique was chosen as it allows tracheal tube placement through the nares during spontaneous ventilation with the airway stented open and oxygen delivery with either continuous positive airway pressure and/or pressure support ventilation. This unhurried technique may allow intubation when other techniques are unsuitable, while maintaining control of the airway.

  19. Is Delayed Pressure Urticaria Associated with Increased Systemic Release of sCD40L?

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    T. Jasinska

    2013-01-01

    Full Text Available Background. Elevated levels of soluble CD40 Ligand (sCD40L were found in serum but not in plasma of patients with chronic spontaneous urticaria (CU. What is important is that sCD40L has proinflammatory properties, and its elevated plasma level may indicate increased risk of cardiovascular events. These observations should stimulate further evaluation of sCD40L in different forms of urticaria. Aim. In the present study, sCD40L plasma level was investigated in delayed pressure urticaria (DPU. Methods. As platelets are predominant and variable sources of sCD40L, we investigated sCD40L concentration in platelet-poor plasma (PPP, which seems the best way to minimize the potential contribution of these cells to the ligand level. Results. Plasma sCD40L concentration was significantly increased in the DPU group compared to the healthy controls. Conclusions. It seems that DPU is associated with increased systemic release of sCD40L, which is believed to derive predominantly from activated platelets. The present study as well as the earlier contributions suggest that distinct cells activity, including platelets, may be identified in different types of urticaria.

  20. Airway management in trauma

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    Rashid M Khan

    2011-01-01

    Full Text Available Trauma has assumed epidemic proportion. 10% of global road accident deaths occur in India. Hypoxia and airway mismanagement are known to contribute up to 34% of pre-hospital deaths in these patients. A high degree of suspicion for actual or impending airway obstruction should be assumed in all trauma patients. Objective signs of airway compromise include agitation, obtundation, cyanosis, abnormal breath sound and deviated trachea. If time permits, one should carry out a brief airway assessment prior to undertaking definitive airway management in these patients. Simple techniques for establishing and maintaining airway patency include jaw thrust maneuver and/or use of oro- and nas-opharyngeal airways. All attempts must be made to perform definitive airway management whenever airway is compromised that is not amenable to simple strategies. The selection of airway device and route- oral or -nasal, for tracheal intubation should be based on nature of patient injury, experience and skill level.

  1. Influence of Head and Neck Position on Oropharyngeal Leak Pressure and Cuff Position with the ProSeal Laryngeal Mask Airway and the I-Gel: A Randomized Clinical Trial

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    Sandeep Kumar Mishra

    2015-01-01

    Full Text Available Background. This study was designed to assess and compare the effect of head and neck position on the oropharyngeal leak pressures and cuff position (employing fibreoptic view of the glottis and ventilation scores between ProSeal LMA and the I-gel. Material and Methods. After induction of anesthesia, the supraglottic device was inserted and ventilation confirmed. The position of the head was randomly changed from neutral to flexion, extension, and lateral rotation (left. The oropharyngeal leak pressures, fibreoptic view of glottis, ventilation scores, and delivered tidal volumes and end tidal CO2 were noted in all positions. Results. In both groups compared with neutral position, oropharyngeal leak pressures were significantly higher with flexion and lower with extension but similar with rotation of head and neck. However the oropharyngeal leak pressure was significantly higher for ProSeal LMA compared with the I-gel in all positions. Peak airway pressures were significantly higher with flexion in both groups (however this did not affect ventilation, lower with extension in ProSeal group, and comparable in I-gel group but did not change significantly with rotation of head and neck in both groups. Conclusion. Effective ventilation can be done with both ProSeal LMA and I-gel with head in all the above positions. ProSeal LMA has a better margin of safety than I-gel due to better sealing pressures except in flexion where the increase in airway pressure is more with the former. Extreme precaution should be taken in flexion position in ProSeal LMA.

  2. Continuous Positive Airway Pressure (CPAP)

    Science.gov (United States)

    ... heart disease, diabetes, and stroke. What Are the Disadvantages Of CPAP? The CPAP device needs to be ... able to advise you on the treatment options. Copyright © 2015 American Academy of Otolaryngology–Head and Neck ...

  3. Initial Treatment of Respiratory Distress Syndrome with Nasal Intermittent Mandatory Ventilation versus Nasal Continuous Positive Airway Pressure: A Randomized Controlled Trial

    Science.gov (United States)

    Armanian, Amir-Mohammad; Badiee, Zohreh; Heidari, Ghobad; Feizi, Awat; Salehimehr, Nima

    2014-01-01

    Background: Neonatal respiratory distress syndrome (RDS) in premature infants who survived and its complications are a common problem. Due to high morbidity and mechanical ventilation (MV) nowadays researchers in interested minimizing MV. To determine, in very low birth weight (BW) preterm neonates with RDS, if initial treatment with nasal intermittent mandatory ventilation (early NIMV) compared with early nasal continuous positive airway pressure (early NCPAP) obtains more favorable outcomes in terms of the duration of treatment, and the need for endotracheal tube ventilation. Methods: In this single-center randomized control trial study, infants (BW ≤ 1500 g and/or gestational age ≤ 34 weeks) with respiratory distress were considered eligible. Forty-four infants were randomly assigned to receive early-NIMV and 54 comparable infants to early-NCPAP. Surfactants were given, when FIO2 requirement was of >30%. Primary outcomes were failure of noninvasive respiratory support, that is, the need for MV in the first 48 h of life and for the duration of noninvasive respiratory support in each group. Results: 98 infants were enrolled (44 in the NIMV and 54 in the NCPAP group). The Preventive power of MV of NIMV usage (95.5%) was not lower than the NCPAP (98.1%) strength (hazard ratio: 0.21 (95% confidence interval: 0.02-2.66); P: 0.23). The duration of noninvasive respiratory support in the NIMV group was significantly shorter than NCPAP (the median (range) was 24 (18.00-48.00) h versus 48.00 (22.00-120.00) h in NIMV versus NCPAP groups; P < 0.001). Similarly, the duration of dependency on oxygen was less, for NIMV (the median (range) was 96.00 (41.00-504.00) h versus144.00 (70.00-1130.00) h in NIMV versus NCPAP groups; P: 0.009). Interestingly, time to full enteral feeds and length of hospital stay were more favorable in the NIMV versus the NCPAP group. Conclusions: Initial treatment of RDS with NIMV was safe, and well tolerated. Furthermore, NIMV had excellent

  4. Initial treatment of respiratory distress syndrome with nasal intermittent mandatory ventilation versus nasal continuous positive airway pressure: A randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Amir-Mohammad Armanian

    2014-01-01

    Full Text Available Background: Neonatal respiratory distress syndrome (RDS in premature infants who survived and its complications are a common problem. Due to high morbidity and mechanical ventilation (MV nowadays researchers in interested minimizing MV. To determine, in very low birth weight (BW preterm neonates with RDS, if initial treatment with nasal intermittent mandatory ventilation (early NIMV compared with early nasal continuous positive airway pressure (early NCPAP obtains more favorable outcomes in terms of the duration of treatment, and the need for endotracheal tube ventilation. Methods: In this single-center randomized control trial study, infants (BW ≤ 1500 g and/or gestational age ≤ 34 weeks with respiratory distress were considered eligible. Forty-four infants were randomly assigned to receive early-NIMV and 54 comparable infants to early-NCPAP. Surfactants were given, when FIO 2 requirement was of >30%. Primary outcomes were failure of noninvasive respiratory support, that is, the need for MV in the first 48 h of life and for the duration of noninvasive respiratory support in each group. Results: 98 infants were enrolled (44 in the NIMV and 54 in the NCPAP group. The Preventive power of MV of NIMV usage (95.5% was not lower than the NCPAP (98.1% strength (hazard ratio: 0.21 (95% confidence interval: 0.02-2.66; P: 0.23. The duration of noninvasive respiratory support in the NIMV group was significantly shorter than NCPAP (the median (range was 24 (18.00-48.00 h versus 48.00 (22.00-120.00 h in NIMV versus NCPAP groups; P < 0.001. Similarly, the duration of dependency on oxygen was less, for NIMV (the median (range was 96.00 (41.00-504.00 h versus144.00 (70.00-1130.00 h in NIMV versus NCPAP groups; P: 0.009. Interestingly, time to full enteral feeds and length of hospital stay were more favorable in the NIMV versus the NCPAP group. Conclusions: Initial treatment of RDS with NIMV was safe, and well tolerated. Furthermore, NIMV had excellent

  5. Effect of continuous positive airway pressure treatment on vascular endothelial function in patients with obstructive sleep apnea hypopnea syndrome and coronary artery disease

    Institute of Scientific and Technical Information of China (English)

    张希龙; 殷凯生; 毛辉; 王虹; 杨玉

    2004-01-01

    Background Continuous positive airway pressure (CPAP) treatment has been proven to be effective in improving the symptoms of coexisting coronary heart disease (CHD) in patients with obstructive sleep apnea hypopnea syndrome (OSAHS). However, it is still unclear whether such improvements are linked to changes in vascular endothelial function. This research was carried out to investigate the effects of CPAP treatment on vascular endothelial function in patients with OSAHS and CHD.Methods Thirty-six patients with moderate or severe OSAHS and CHD undergoing three months of CPAP treatment were recruited for this study. The changes in their morning plasma nitric oxide (NO) and endothelin (ET) levels, NO/ET ratio, total ischemic burden (TIB) of the myocardium, apnea hypopnea index (AHI), and minimal and mean pulse oxygen saturation (SpO2) were compared and analyzed before and during CPAP treatment. Results Compared with the plasma levels of ET [(51.39±11.69) ng/L] and NO [(36.67±11.86) μmol/L], NO/ET (0.71±0.14), AHI (32.4±7.9), minimal SpO2 [(68.9±11.4)%], and myocardial TIB [(66.29±16.37) mm*min] before treatment, there were significant decreases in ET [(33.41±10.03) ng/L] (P<0.05), increases in NO [(59.89±10.26) μmol/L] and NO/ET (1.79±0.38) (P<0.01), decreases in AHI (1.9±0.5), and increases in minimal SpO2 [(90.6±1.8) %] (all P<0.01) and myocardial TIB [(36.42±10.87) mm*min] (P<0.05) after three months of CPAP treatment.Conclusion CPAP treatment may play an important role in the improvement and protection of vascular endothelial dysfunction and myocardial ischemia in OSAHS patients with CHD.

  6. Effect of Continuous Positive Airway Pressure Therapy on Glycemic Excursions and Insulin Sensitivity in Patients with Obstructive Sleep Apnea-hypopnea Syndrome and Type 2 Diabetes

    Institute of Scientific and Technical Information of China (English)

    Li-Xin Guo; Xin Zhao; Qi Pan; Xue Sun; Hui Li; Xiao-Xia Wang; Li-Na Zhang

    2015-01-01

    Background:For patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) and type 2 diabetes mellitus (T2DM),the night sleep interruption and intermittent hypoxia due to apnea or hypopnea may induce glycemic excursions and reduce insulin sensitivity.This study aimed to investigate the effect of continuous positive airway pressure (CPAP) therapy in patients with OSAHS and T2DM.Methods:Continuous glucose monitoring system (CGMS) was used in 40 patients with T2DM and newly diagnosed OSAHS.The measurements were repeated after 30 days of CPAP treatment.Subsequently,insulin sensitivity and glycohemoglobin (HbA1c) were measured and compared to the pretreatment data.Results:After CPAP therapy,the CGMS indicators showed that the 24-h mean blood glucose (MBG) and the night time MBG were significantly reduced (P < 0.05 and P =0.03,respectively).The mean ambulatory glucose excursions (MAGEs) and the mean of daily differences were also significantly reduced (P < 0.05 and P =0.002,respectively) compared to pretreatment levels.During the night,MAGE also significantly decreased (P =0.049).The differences between the highest and lowest levels of blood glucose over 24 h and during the night were significantly lower than prior to CPAP treatment (P < 0.05 and P =0.024,respectively).The 24 h and night time durations of high blood glucose (>7.8 mmol/L and > 11.1 mmol/L) decreased (P < 0.05 and P < 0.05,respectively) after the treatment.Inaddition,HbA1c levels were also lower than those before treatment (P < 0.05),and the homeostasis model assessment index of insulin resistance was also significantly lower than before CPAP treatment (P =0.034).Conclusions:CPAP therapy may have a beneficial effect on improving not only blood glucose but also upon insulin sensitivity in T2DM patients with OSAHS.This suggests that CPAP may be an effective treatment for T2DM in addition to intensive diabetes management.

  7. Improved wound healing in pressure-induced decubitus ulcer with controlled release of basic fibroblast growth factor

    Energy Technology Data Exchange (ETDEWEB)

    Jiang Wei [Department of Respiratory Diseases, Tangdu Hospital, Fourth Military Medical University, Xi' an 710038 (China); Wang Hailun [Department of Dermatology, Tangdu Hospital, Fourth Military Medical University, Xi' an 710038 (China); Jin Faguang [Department of Respiratory Diseases, Tangdu Hospital, Fourth Military Medical University, Xi' an 710038 (China)], E-mail: nidewenzhang@163.com; Yu Chunyan [Department of Dermatology, Tangdu Hospital, Fourth Military Medical University, Xi' an 710038 (China); Chu Dongling [Department of Respiratory Diseases, Tangdu Hospital, Fourth Military Medical University, Xi' an 710038 (China); Wang Lin [Department of Internal Medicine, 316 Hospital of PLA, Beijing 100093 (China); Lu Xian [93942 Unit Hospital of PLA, Xianyang 710012 (China)

    2008-07-14

    The purpose was to evaluate the efficacy of the wound dressing containing basic fibroblast growth factor (bFGF)-loaded microspheres on promoting healing in pressure-induced decubitus ulcer. In this study, the pressure-induced ulcer in swine was used as a model to demonstrate the hypothesis that controlled release of bFGF has the potential to provide optimal healing milieu for chronic wounds in the repair process. Average size of the microspheres was 14.36 {+-} 3.56 {mu}m and the network gelatin sponges were characterized with an average pore size of 80-160 {mu}m. Both the in vitro release efficiency and the protein bioactivity revealed that bFGF was released from the microspheres in a controlled manner and it was biologically active as assessed by its ability to induce the proliferation of fibroblasts. Pressure-induced ulcer was created at 500 g/cm{sup 2} pressure loaded on swine dorsal skin 12 h daily for 2 consecutive days. After removal of the pressure load, the gelatin sponge containing bFGF gelatin microspheres or bFGF in solution was implanted into the wound. Swine were sacrificed at 7, 14, and 21 days after implantation, and a full-thickness biopsy was taken and stained for histological analysis. It was observed that controlled release of bFGF provided an accelerated recovery in the wound areas. Histological investigations showed that the dressings were biocompatible and had capability of proliferating fibroblasts and inducing neovascularisation. The present study implied the clinical potential of gelatin sponge with bFGF microspheres to promote the healing in pressure-induced decubitus ulcer.

  8. The release of dipicolinic acid--the rate-limiting step of Bacillus endospore inactivation during the high pressure thermal sterilization process.

    Science.gov (United States)

    Reineke, Kai; Schlumbach, Karl; Baier, Daniel; Mathys, Alexander; Knorr, Dietrich

    2013-03-01

    High pressure combined with elevated temperatures can produce low acid, commercially sterile and shelf-stable foods. Depending on the temperature and pressure levels applied, bacterial endospores pass through different pathways, which can lead to a pressure-induced germination or inactivation. Regardless of the pathway, Bacillus endospores first release pyridine-2,6-dicarboxylic acid (DPA), which contributes to the low amount of free water in the spore core and is consequently responsible for the spore's high resistance against wet and dry heat. This is therefore the rate-limiting step in the high pressure sterilization process. To evaluate the impact of a broad pressure, temperature and time domain on the DPA release, Bacillus subtilis spores were pressure treated between 0.1 and 900 MPa at between 30 and 80 °C under isothermal isobaric conditions during dwell time. DPA quantification was assessed using HPLC, and samples were taken both immediately and 2 h after the pressure treatment. To obtain a release kinetic for some pressure-temperature conditions, samples were collected between 1s and 60 min after decompression. A multiresponse kinetic model was then used to derive a model covering all kinetic data. The isorate lines modeled for the DPA release in the chosen pressure-temperature landscape enabled the determination of three distinct zones. (I) For pressures 50 °C, a 90% DPA release was achievable in less than 5 min and no difference in the amount of DPA was found immediately 2 h after pressurization. This may indicate irreversible damage to the inner spore membrane or membrane proteins. (II) Above 600 MPa the synergism between pressure and temperature diminished, and the treatment temperature alone dominated DPA release. (III) Pressures pressure-induced physiological like germination with cortex degradation, which continues after pressure release. Furthermore, at 600 MPa and 40 °C, a linear relationship was found for the DPA release rate constants ln

  9. Hydrostatic pressure and shear stress affect endothelin-1 and nitric oxide release by endothelial cells in bioreactors.

    Science.gov (United States)

    Vozzi, Federico; Bianchi, Francesca; Ahluwalia, Arti; Domenici, Claudio

    2014-01-01

    Abundant experimental evidence demonstrates that endothelial cells are sensitive to flow; however, the effect of fluid pressure or pressure gradients that are used to drive viscous flow is not well understood. There are two principal physical forces exerted on the blood vessel wall by the passage of intra-luminal blood: pressure and shear. To analyze the effects of pressure and shear independently, these two stresses were applied to cultured cells in two different types of bioreactors: a pressure-controlled bioreactor and a laminar flow bioreactor, in which controlled levels of pressure or shear stress, respectively, can be generated. Using these bioreactor systems, endothelin-1 (ET-1) and nitric oxide (NO) release from human umbilical vein endothelial cells were measured under various shear stress and pressure conditions. Compared to the controls, a decrease of ET-1 production by the cells cultured in both bioreactors was observed, whereas NO synthesis was up-regulated in cells under shear stress, but was not modulated by hydrostatic pressure. These results show that the two hemodynamic forces acting on blood vessels affect endothelial cell function in different ways, and that both should be considered when planning in vitro experiments in the presence of flow. Understanding the individual and synergic effects of the two forces could provide important insights into physiological and pathological processes involved in vascular remodeling and adaptation.

  10. Airway distensibility in Chronic Obstructive Airway Disease

    DEFF Research Database (Denmark)

    Winkler Wille, Mathilde Marie; Pedersen, Jesper Holst; Dirksen, Asger

    2013-01-01

    -20% (mild), 20%-30% (moderate) or >30% (severe). Spirometry was performed annually and participants were divided into severity groups according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD). Data were analysed in a mixed effects regression model with log(airway lumen diameter......Rationale – Chronic Obstructive Pulmonary Disease (COPD) is a combination of chronic bronchitis and emphysema, which both may lead to airway obstruction. Under normal circumstances, airway dimensions vary as a function of inspiration level. We aim to study the influence of COPD and emphysema...... in causing airway narrowing, the latter most likely due to loss of elastic recoil of surrounding tissue....

  11. The Effects of a Chactoid Scorpion Venom and Its Purified Toxins on Rat Blood Pressure and Mast Cells Histamine Release

    Directory of Open Access Journals (Sweden)

    Philip Lazarovici

    2013-07-01

    Full Text Available The effect of the venom of the Chactoid family of scorpions on blood pressure was scantly investigated and was addressed in the present study using the venom of the Israeli scorpion, Scorpio maurus palmatus. Blood pressure in rats was monitored via cannulated femoral artery, while venom and toxins were introduced into femoral vein. Venom injection elicited a biphasic effect, expressed first by a fast and transient hypotensive response, which lasted up to 10 min, followed by a hypertensive response, which lasted up to one hour. It was found that these effects resulted from different venom components. Phospholipase A2 produced the hypotensive effect, while a non-enzymatic neurotoxic polypeptide fraction produced the hypertensive effect. Surprisingly, the main neurotoxic polypeptide to mice had no effect on blood pressure. In vitro experiments indicated that the hypertensive factors caused histamine release from the peritoneal mast cells, but this effect is assumed to be not relevant to their in vivo effect. In spite of the cytotoxic activity of phospholipase A2, it did not release histamine. These findings suggest that the effects of venom and isolated fractions on blood pressure parameters are mediated by different mechanisms, which deserve further pharmacological investigation.

  12. The effects of a chactoid scorpion venom and its purified toxins on rat blood pressure and mast cells histamine release.

    Science.gov (United States)

    Ettinger, Keren; Cohen, Gadi; Momic, Tatjana; Lazarovici, Philip

    2013-07-29

    The effect of the venom of the Chactoid family of scorpions on blood pressure was scantly investigated and was addressed in the present study using the venom of the Israeli scorpion, Scorpio maurus palmatus. Blood pressure in rats was monitored via cannulated femoral artery, while venom and toxins were introduced into femoral vein. Venom injection elicited a biphasic effect, expressed first by a fast and transient hypotensive response, which lasted up to 10 min, followed by a hypertensive response, which lasted up to one hour. It was found that these effects resulted from different venom components. Phospholipase A₂ produced the hypotensive effect, while a non-enzymatic neurotoxic polypeptide fraction produced the hypertensive effect. Surprisingly, the main neurotoxic polypeptide to mice had no effect on blood pressure. In vitro experiments indicated that the hypertensive factors caused histamine release from the peritoneal mast cells, but this effect is assumed to be not relevant to their in vivo effect. In spite of the cytotoxic activity of phospholipase A₂, it did not release histamine. These findings suggest that the effects of venom and isolated fractions on blood pressure parameters are mediated by different mechanisms, which deserve further pharmacological investigation.

  13. In vitro surfactant and perfluorocarbon aerosol deposition in a neonatal physical model of the upper conducting airways.

    Directory of Open Access Journals (Sweden)

    Estibalitz Goikoetxea

    Full Text Available OBJECTIVE: Aerosol delivery holds potential to release surfactant or perfluorocarbon (PFC to the lungs of neonates with respiratory distress syndrome with minimal airway manipulation. Nevertheless, lung deposition in neonates tends to be very low due to extremely low lung volumes, narrow airways and high respiratory rates. In the present study, the feasibility of enhancing lung deposition by intracorporeal delivery of aerosols was investigated using a physical model of neonatal conducting airways. METHODS: The main characteristics of the surfactant and PFC aerosols produced by a nebulization system, including the distal air pressure and air flow rate, liquid flow rate and mass median aerodynamic diameter (MMAD, were measured at different driving pressures (4-7 bar. Then, a three-dimensional model of the upper conducting airways of a neonate was manufactured by rapid prototyping and a deposition study was conducted. RESULTS: The nebulization system produced relatively large amounts of aerosol ranging between 0.3±0.0 ml/min for surfactant at a driving pressure of 4 bar, and 2.0±0.1 ml/min for distilled water (H2Od at 6 bar, with MMADs between 2.61±0.1 µm for PFD at 7 bar and 10.18±0.4 µm for FC-75 at 6 bar. The deposition study showed that for surfactant and H2Od aerosols, the highest percentage of the aerosolized mass (∼65% was collected beyond the third generation of branching in the airway model. The use of this delivery system in combination with continuous positive airway pressure set at 5 cmH2O only increased total airway pressure by 1.59 cmH2O at the highest driving pressure (7 bar. CONCLUSION: This aerosol generating system has the potential to deliver relatively large amounts of surfactant and PFC beyond the third generation of branching in a neonatal airway model with minimal alteration of pre-set respiratory support.

  14. The laryngeal mask airway at altitude.

    Science.gov (United States)

    Wilson, Grant D; Sittig, Steven E; Schears, Gregory J

    2008-02-01

    The Laryngeal Mask Airway (LMA) is an accepted adjunct for airway management in emergency patients. There are a number of case reports describing its use in transport medicine for infant to adult patients, including during flight. Although studies of the effect altitude has on air-filled tracheal tubes exists, we were unable to find documentation of the effect of altitude on laryngeal mask airways. Our objective was to assess the effect of altitude on the LMA in both fixed wing and rotary wing models. We performed an in vitro study of the effect of altitude on the LMA cuff. Infant and adult airway trainer mannequins with properly sized and inserted LMA-Classic laryngeal mask airways were monitored for cuff pressure changes while flown at altitudes commonly encountered during air medical transport. Both models demonstrated that LMA cuff pressures may exceed manufacturer recommended levels for safe use even at the relatively low altitudes experienced during rotor wing flight. Properly inserted and inflated laryngeal mask airways at ground level may result in overinflated LMA cuffs when flown to altitudes commonly used for rotor and fixed wing medical transport unless monitored and corrected.

  15. Particle image velocimetry for quantification of high pressure CO 2 release

    NARCIS (Netherlands)

    Jong, A. de; Spruijt, M.

    2013-01-01

    In the current work evaluation of CO2 release velocity profiles is determined using Particle Image Velocimetry (PIV). The formation of solid CO2 particles using the rapid expansion of nozzle flow is used as a seeder particle, making the method truly nonintrusive and negates the use of special seeder

  16. Development of a regional-scale pollen release and transport modeling framework for investigating the impact of climate change on allergic airway disease

    Science.gov (United States)

    Duhl, T. R.; Zhang, R.; Guenther, A. B.; Chung, S. H.; Avise, J. C.; Lamb, B. K.; VanReken, T. M.; Flagan, R. C.; House, J. M.

    2011-12-01

    To investigate how pollen occurrence may be influenced by climate change and interact with anthropogenic pollutants to affect human health in a changing world, a new model of pollen emissions from terrestrial, temperate vegetation has been developed and incorporated into the WRF/CMAQ regional air-quality modeling framework. The pollen emission model, a module of the Model of Emissions of Gases and Aerosols from Nature is driven by meteorological variables and is designed to be sensitive to potential climate shifts and is flexible with respect to the vegetation species and plant functional types (PFTs) represented. The initial evaluation of the model focuses on pollens from important allergenic tree, grass, and weed species present in a model domain centered over southern California during Mar-Jun 2010. Vegetation cover and species composition data were drawn from numerous datasets and a database of allergenic vegetation species, their pollen potential, and relative allergenicities has been developed. PFT-specific pollen release modules with mechanisms that vary according to the Köppen climate classification of the simulation area are described. In general, for the moderate Mediterranean and oceanic climate zones encompassing the most populous fraction of the southern California domain, temperature is the main driver controlling the timing of pollen release while precipitation controls the total amount of pollen produced by the species selected for simulation. For the initial evaluation period, 30-arc second monthly-mean precipitation data for 1971-2000 and Oct 2008 to Dec 2009 from the Parameter-elevation Regressions on Independent Slopes Model (PRISM) are used to estimate the total amount of pollen available for each species. 4-km x 4-km temperature results from the WRF (Weather Forecasting and Research) model for Oct 2009 to Jun 2010 are used to model the onset of pollen season. Once emitted into the atmosphere, the CMAQ (Community Multiscale Air Quality

  17. Pavlovian conditioning of corticotropin-releasing factor-induced increase of blood pressure and corticosterone secretion in the rat.

    Science.gov (United States)

    Kreutz, M; Hellhammer, D; Murison, R; Vetter, H; Krause, U; Lehnert, H

    1992-05-01

    Corticotropin-releasing factor (CRF) is clearly involved in the central regulation of the pituitary-adrenal axis and, moreover, of autonomic nervous system functions. Enhanced sympathetic activity with subsequent increases in blood pressure and heart rate and attenuation of the baroreceptor reflex results from the intracerebroventricular (i.c.v.) administration of CRF. Additionally, the peptide has a variety of potent effects on behavioural responses in animals similar to those observed after an experimentally evoked stress. It was therefore of obvious interest to examine whether CRF is a possible mediator of the learning processes associated with physiological stress reaction patterns. This report clearly demonstrates a classical conditioning of the endocrine (i.e. corticosterone secretion) and haemodynamic (i.e. blood pressure) sequelae following central CRF application and thus indicates that this mechanism is of physiological significance for learned stress responses.

  18. Evaluation of short-term use of nocturnal nasal continuous positive airway pressure for a clinical profile and exercise capacity in adult patients with obstructive sleep apnea-hypopnea syndrome

    Directory of Open Access Journals (Sweden)

    Amrit K Goel

    2015-01-01

    Full Text Available Background and Aim: The obstructive sleep apnea-hypopnea syndrome (OSAHS is a common chronic respiratory disease, characterized by repetitive complete or partial collapse of the upper airway during sleep. The clinical spectrum extends between stoppage of breathing, snoring, daytime somnolence, and fatigue, to serious cardiovascular disease, stroke, metabolic syndrome, increased morbidity, and mortality. We aim to evaluate the short-term use of nasal continuous positive airway pressure (nCPAP therapy for the clinical profile and exercise capacity of patients with OSAHS. Patient Selection: Twenty patients diagnosed with moderate-to-severe OSAHS were enrolled in the study (study group - 15; clinically and PSG-matched control group - 5. Materials and Methods: Each patient was clinically evaluated for sleep-related symptoms, and also assessed with spirometry, the six-minute walk test (6MWT, and a symptom-limited incremental cardiopulmonary exercise test (CPET. The study group patients were administered nCPAP therapy for eight hours each night for four weeks, while the control group patients were just observed. They were re-assessed after four weeks and the data were statistically analyzed between the two groups. Results: The study group patients showed a significant (P- < 0.05 improvement in the OSAHS symptoms-the Epworth sleepiness score, six-minute walk distance; duration of exercise, power output, peak oxygen uptake, anaerobic threshold, diastolic blood pressure, dyspnea, and fatigue-in comparison with the control group patients. The improvement in exercise capacity following nCPAP therapy was attributed to the relief of disabling the OSAHS symptoms and improved cardiovascular, ventilator, and musculoskeletal functions. Conclusion: All OSAHS patients must be treated with nCPAP.

  19. An experimental model of episodic gas release through fracture of fluid confined within a pressurized elastic reservoir

    Science.gov (United States)

    Rocco, Stefano; Woods, Andrew W.; Harrington, Jon; Norris, Simon

    2017-01-01

    We present new experiments that identify a mechanism for episodic release of gas from a pressurized, deformable reservoir confined by a clay seal, as a result of the transition from bulk deformation to channel growth through the clay. Air is injected into the center of a thin cylindrical cell initially filled with a mixture of bentonite clay and water. For sufficiently dry mixtures, the pressure initially increases with little volume change. On reaching the yield stress of the clay-water mixture, the lid of the cell then deforms elastically and an air-filled void forms in the center of the cell as the clay is driven radially outward. With continued supply of air, the pressure continues to increase until reaching the fracture strength of the clay. A fracture-like channel then forms and migrates to the outer edge of the cell, enabling the air to escape. The pressure then falls, and the clay flows back toward the center of the cell and seals the channel so the cycle can repeat. The phenomena may be relevant at mud volcanoes.

  20. Engineering Airway Epithelium

    Directory of Open Access Journals (Sweden)

    John P. Soleas

    2012-01-01

    Full Text Available Airway epithelium is constantly presented with injurious signals, yet under healthy circumstances, the epithelium maintains its innate immune barrier and mucociliary elevator function. This suggests that airway epithelium has regenerative potential (I. R. Telford and C. F. Bridgman, 1990. In practice, however, airway regeneration is problematic because of slow turnover and dedifferentiation of epithelium thereby hindering regeneration and increasing time necessary for full maturation and function. Based on the anatomy and biology of the airway epithelium, a variety of tissue engineering tools available could be utilized to overcome the barriers currently seen in airway epithelial generation. This paper describes the structure, function, and repair mechanisms in native epithelium and highlights specific and manipulatable tissue engineering signals that could be of great use in the creation of artificial airway epithelium.

  1. Effects of β2 Agonists, Corticosteroids, and Novel Therapies on Rhinovirus-Induced Cytokine Release and Rhinovirus Replication in Primary Airway Fibroblasts

    Directory of Open Access Journals (Sweden)

    David Van Ly

    2011-01-01

    Full Text Available Rhinovirus-(RV- induced asthma exacerbations account for high asthma-related health costs and morbidity in Australia. The cellular mechanism underlying this pathology is likely the result of RV-induced nuclear-factor-kappa-B-(NF-κB- dependent inflammation. NF-κB may also be important in RV replication as inhibition of NF-κB inhibits replication of other viruses such as human immunodeficiency virus and cytomegalovirus. To establish the role of NF-κB inhibitors in RV-induced IL- 6 and IL-8 and RV replication, we used pharmacological inhibitors of NF-κB, and steroids and/or β2 agonists were used for comparison. Primary human lung fibroblasts were infected with RV-16 in the presence of NF-κB inhibitors: BAY-117085 and dimethyl fumarate; β2 agonist: salmeterol; and/or corticosteroids: dexamethasone; fluticasone. RV-induced IL-6 and IL-8 and RV replication were assessed using ELISAs and virus titration assays. RV replicated and increased IL-6 and IL-8 release. Salmeterol increased, while dexamethasone and fluticasone decreased RV-induced IL-6 and IL-8 (P<0.05. The NF-κB inhibitor BAY-117085 inhibited only RV-induced IL-6 (P<0.05 and dimethyl fumarate did not alter RV-induced IL-6 and IL-8. Dimethylfumarate increased RV replication whilst other drugs did not alter RV replication. These data suggest that inhibition of NF-κB alone is unlikely to be an effective treatment compared to current asthma therapeutics.

  2. Impact of airway morphological changes on pulmonary flows in scoliosis

    Science.gov (United States)

    Farrell, James; Garrido, Enrique; Valluri, Prashant

    2016-11-01

    The relationship between thoracic deformity in scoliosis and lung function is poorly understood. In a pilot study, we reviewed computed tomography (CT) routine scans of patients undergoing scoliosis surgery. The CT scans were processed to segment the anatomy of the airways, lung and spine. A three-dimensional model was created to study the anatomical relationship. Preliminary analysis showed significant airway morphological differences depending on the anterior position of the spine. A computational fluid dynamics (CFD) study was also conducted on the airway geometry using the inspiratory scans. The CFD model assuming non-compliant airway walls was capable of showing pressure drops in areas of high airway resistance, but was unable to predict regional ventilation differences. Our results indicate a dependence between the dynamic deformation of the airway during breathing and lung function. Dynamic structural deformation must therefore be incorporated within any modelling approaches to guide clinicians on the decision to perform surgical correction of the scoliosis.

  3. Airway management in trauma

    Directory of Open Access Journals (Sweden)

    Rao B

    2004-01-01

    Full Text Available Airway Management for the victims of major trauma is the first priority in the care of the trauma victim and is a core skill in emergency medicine and critical care. Endotracheal intubation remains the gold standard for trauma airway management. Airway management in trauma patients is not just the capability to insert an oral/nasal airway or endotracheal tube beyond the vocal cords. The five components integral to modern, sophisticated airway management in trauma patients include equipment, pharmacologic adjuncts, manual techniques, physical circumstances, and patient profile. A trauma patient may require airway management in a variety of physical circumstances. Whereas, the commonly used airway management algorithms may not suffice in all these situations, the construction of a truly complete decision tree is also virtually impossible. There is consensus that it is not the intervention per se but rather the conditions, skills, and performance that might be the possible variables that affect outcome. Paramedics have only limited experience and on-the-job skills for invasive airway management. Difficult airway management is best left for the experienced physicians to handle.

  4. Randomized crossover comparison of the laryngeal mask airway classic with i-gel laryngeal mask airway in the management of difficult airway in post burn neck contracture patients

    Directory of Open Access Journals (Sweden)

    Jeevan Singh

    2012-01-01

    Full Text Available Purpose: The objective of the study was to compare the performance of i-gel supraglottic airway with cLMA in difficult airway management in post burn neck contracture patients and assess the feasibility of i-gel use for emergency airway management in difficult airway situation with reduced neck movement and limited mouth opening. Methods: Prospective, crossover, randomized controlled trial was performed amongst forty eight post burn neck contracture patients with limited mouth opening and neck movement. i-gel and cLMA were placed in random order in each patient. Primary outcome was overall success rate. Other measurements were time to successful ventilation, airway leak pressure, fiberoptic glottic view, visualization of square wave pattern. Results: Success rate for the i-gel was 91.7% versus 79.2% for the cLMA. i-gel required shorter insertion time (19.3 seconds vs. 23.5 seconds, P=0.000. Airway leak pressure difference was statistically significant (i-gel 21.2 cm H20; cLMA 16.9 cm H 2 0; P=0.00. Fiberoptic view through the i-gel showed there were less epiglottic downfolding and better fiberoptic view of the glottis than cLMA. Overall agreement in insertion outcome for i-gel was 22/24 (91.7% successes and 2/24(8.3% failure and for cLMA, 19/24 (79.16% successes and 5/24 (16.7% failure in the first attempt. Conclusion: The i-gel is cheap, effective airway device which is easier to insert and has better clinical performance in the difficult airway management of the airway in the post burn contracture of the neck. Our study shows that i-gel is feasible for emergency airway management in difficult airway situation with reduced neck movement and limited mouth opening in post burn neck.

  5. Elective use of the Ventrain for upper airway obstruction during high-frequency jet ventilation.

    Science.gov (United States)

    Fearnley, Robert A; Badiger, Sheela; Oakley, Richard J; Ahmad, Imran

    2016-09-01

    The safety of high pressure source ventilation (jet ventilation) is dependent upon upper airway patency to facilitate adequate passive expiration and prevent increasing intrathoracic pressure and its associated deleterious sequelae. Distortions in airway anatomy may make passive expiration inadequate or impossible in some patients. We report the elective use of the Ventrain device to provide ventilation in a clinical setting of upper airway obstruction in a patient with post radiation fibrosis that had previously prevented passive expiration during attempted high pressure source ventilation.

  6. A Review of Energy Release Processes from the Failure of Pneumatic Pressure Vessels

    Science.gov (United States)

    1988-08-01

    RT) is not a good approximation. There are several equations cf state that can be used for real gases (e.g., Van der Waal’s, Beattie - Bridgeman ...The gas pressure can be written in terms of an appropriate equation of state for either an ideal or real gas. Initial fragment velocity is...assumption3 reduce Equation (1) to: -w - AE - AU (2) The ideal gas law states that foz the expailsion of a gas: W - -C, AT (3) where: C, - constant

  7. Airway management in patients with burn contractures of the neck.

    Science.gov (United States)

    Prakash, Smita; Mullick, Parul

    2015-12-01

    Airway management of patients with burn contracture of the neck (PBC neck) is a challenge to the anesthesiologist. Patient evaluation includes history, physical and airway examination. A safe approach in the airway management of a patient with moderate to severe PBC neck is to secure the airway with the patient awake. The anesthesiologist should have a pre-planned strategy for intubation of the difficult airway. The choices advocated for airway management of such patients include awake fiberoptic-guided intubation, use of intubating laryngeal mask airway, intubation without neuromuscular blocking agents, intubation with neuromuscular blocking agents after testing the ability to ventilate by mask, pre-induction neck scar release under local anesthesia and ketamine or sedation followed by direct laryngoscopy and intubation and video-laryngoscope guided intubation, amongst others. Preparation of the patient includes an explanation of the proposed procedure, sedation, administration of antisialogogues and regional anesthesia of the airway. The various options for intubation of patients with PBC neck, intraoperative concerns and safe extubation are described. Back-up plans, airway rescue strategies and a review of literature on this subject are presented.

  8. Pediatric airway nightmares.

    Science.gov (United States)

    D'Agostino, James

    2010-02-01

    Pediatric disorders that involve actual or potential airway compromise are among the most challenging cases that emergency department providers face. This article discusses the diagnosis and management of common and uncommon conditions in infants and children who may present with airway obstruction.

  9. On the phase between pressure and heat release fluctuations for propane/hydrogen flames and its role in mode transitions

    KAUST Repository

    Hong, Seunghyuck

    2013-12-01

    This paper presents an experimental investigation into mode-transitions observed in a 50-kW, atmospheric pressure, backward-facing step combustor burning lean premixed C3H8/H2 fuel mixtures over a range of equivalence ratios, fuel compositions and preheat temperatures. The combustor exhibits distinct acoustic response and dynamic flame shape (collectively referred to as "dynamic modes") depending on the operating conditions. We simultaneously measure the dynamic pressure and flame chemiluminescence to examine the phase between pressure (p\\') and heat release fluctuations (q\\') in the observed dynamic modes. Results show that the heat release is in phase with the pressure oscillations (θqp≈0) at the onset of a dynamic mode, while as the operating conditions change within the mode, the phase grows until it reaches a critical value θqp=θc, at which the combustor switches to another dynamic mode. According to the classical Rayleigh criterion, this critical phase (θc) should be π/2, whereas our data show that the transition occurs well below this value. A linear acoustic energy balance shows that this critical phase marks the point where acoustic losses across the system boundaries equal the energy addition from the combustion process to the acoustic field. Based on the extended Rayleigh criterion in which the acoustic energy fluxes through the system boundaries as well as the typical Rayleigh source term (p\\'q\\') are included, we derive an extended Rayleigh index defined as Re=θqp/θc, which varies between 0 and 1. This index, plotted against a density-weighted strained consumption speed, indicates that the impact of the operating parameters on the dynamic mode selection of the combustor collapses onto a family of curves, which quantify the state of the combustor within a dynamic mode. At Re=0, the combustor enters a mode, and switches to another as Re approaches 1. The results provide a metric for quantifying the instability margins of fuel

  10. Upper airway resistance syndrome.

    Science.gov (United States)

    Montserrat, J M; Badia, J R

    1999-03-01

    This article reviews the clinical picture, diagnosis and management of the upper airway resistance syndrome (UARS). Presently, there is not enough data on key points like the frequency of UARS and the morbidity associated with this condition. Furthermore, the existence of LIARS as an independent sleep disorder and its relation with snoring and obstructive events is in debate. The diagnosis of UARS is still a controversial issue. The technical limitations of the classic approach to monitor airflow with thermistors and inductance plethysmography, as well as the lack of a precise definition of hypopnea, may have led to a misinterpretation of UARS as an independent diagnosis from the sleep apnea/hypopnea syndrome. The diagnosis of this syndrome can be missed using a conventional polysomnographic setting unless appropriate techniques are applied. The use of an esophageal balloon to monitor inspiratory effort is currently the gold standard. However, other sensitive methods such as the use of a pneumotachograph and, more recently, nasal cannula/pressure transducer systems or on-line monitoring of respiratory impedance with the forced oscillation technique may provide other interesting possibilities. Recognition and characterization of this subgroup of patients within sleep breathing disorders is important because they are symptomatic and may benefit from treatment. Management options to treat UARS comprise all those currently available for sleep apnea/hypopnea syndrome (SAHS). However, the subset of patients classically identified as LIARS that exhibit skeletal craneo-facial abnormalities might possibly obtain further benefit from maxillofacial surgery.

  11. Hydrostatic pressure activates ATP-sensitive K+ channels in lung epithelium by ATP release through pannexin and connexin hemichannels.

    Science.gov (United States)

    Richter, Katrin; Kiefer, Kevin P; Grzesik, Benno A; Clauss, Wolfgang G; Fronius, Martin

    2014-01-01

    Lungs of air-breathing vertebrates are constantly exposed to mechanical forces and therefore are suitable for investigation of mechanotransduction processes in nonexcitable cells and tissues. Freshly dissected Xenopus laevis lungs were used for transepithelial short-circuit current (ISC) recordings and were exposed to increased hydrostatic pressure (HP; 5 cm fluid column, modified Ussing chamber). I(SC) values obtained under HP (I(5cm)) were normalized to values before HP (I(0cm)) application (I(5cm)/I(0cm)). Under control conditions, HP decreased I(SC) (I(5cm)/I(0cm)=0.84; n=68; Plung. These data show an activation of KATP in pulmonary epithelial cells in response to HP that is induced by ATP release through mechanosensitive pannexin and connexin hemichannels. These findings represent a novel mechanism of mechanotransduction in nonexcitable cells.

  12. Novel atmospheric pressure plasma device releasing atomic hydrogen: reduction of microbial-contaminants and OH radicals in the air

    Science.gov (United States)

    Nojima, Hideo; Park, Rae-Eun; Kwon, Jun-Hyoun; Suh, Inseon; Jeon, Junsang; Ha, Eunju; On, Hyeon-Ki; Kim, Hye-Ryung; Choi, Kyoung Hui; Lee, Kwang-Hee; Seong, Baik-Lin; Jung, Hoon; Kang, Shin Jung; Namba, Shinichi; Takiyama, Ken

    2007-01-01

    A novel atmospheric pressure plasma device releasing atomic hydrogen has been developed. This device has specific properties such as (1) deactivation of airborne microbial-contaminants, (2) neutralization of indoor OH radicals and (3) being harmless to the human body. It consists of a ceramic plate as a positive ion generation electrode and a needle-shaped electrode as an electron emission electrode. Release of atomic hydrogen from the device has been investigated by the spectroscopic method. Optical emission of atomic hydrogen probably due to recombination of positive ions, H+(H2O)n, generated from the ceramic plate electrode and electrons emitted from the needle-shaped electrode have been clearly observed in the He gas (including water vapour) environment. The efficacy of the device to reduce airborne concentrations of influenza virus, bacteria, mould fungi and allergens has been evaluated. 99.6% of airborne influenza virus has been deactivated with the operation of the device compared with the control test in a 1 m3 chamber after 60 min. The neutralization of the OH radical has been investigated by spectroscopic and biological methods. A remarkable reduction of the OH radical in the air by operation of the device has been observed by laser-induced fluorescence spectroscopy. The cell protection effects of the device against OH radicals in the air have been observed. Furthermore, the side effects have been checked by animal experiments. The harmlessness of the device has been confirmed.

  13. Inflammatory mechanisms and treatment of obstructive airway diseases with neutrophilic bronchitis.

    Science.gov (United States)

    Simpson, Jodie L; Phipps, Simon; Gibson, Peter G

    2009-10-01

    Obstructive airway diseases such as asthma and chronic obstructive pulmonary disease (COPD) are major global health issues. Although considered as distinct diseases, airway inflammation is a key underlying pathophysiological process in asthma, COPD and bronchiectasis. Persistent neutrophilic airway inflammation (neutrophilic bronchitis) occurs with innate immune activation and is a feature of each of these airway diseases. Little is known about the mechanisms leading to neutrophilic bronchitis and few treatments are effective in reducing neutrophil accumulation in the airways. There is a similar pattern of inflammatory mediator release and toll like receptor 2 expression in asthma, COPD and bronchiectasis. We propose the existence of an active amplification mechanism, an effector arm of the innate immune system, involving toll like receptor 2, operating in persistent neutrophilic bronchitis. Neutrophil persistence in the airways can occur through a number of mechanisms such as impaired apoptosis, efferocytosis and mucus hypersecretion, all of which are impaired in airways disease. Impairment of neutrophil clearance results in a reduced ability to respond to bacterial infection. Persistent activation of airway neutrophils may result in the persistent activation of the innate immune system resulting in further airway insult. Current therapies are limited for the treatment of neutrophilic bronchitis; possible treatments being investigated include theophylline, statins, antagonists of pro-inflammatory cytokines and macrolide antibiotics. Macrolides have shown great promise in their ability to reduce airway inflammation, and can reduce airway neutrophils, levels of CXCL8 and neutrophil proteases in the airways. Studies also show improvements in quality of life and exacerbation rates in airways diseases.

  14. Compliance Measurements of the Upper Airway in Pediatric Down Syndrome Sleep Apnea Patients.

    Science.gov (United States)

    Subramaniam, Dhananjay Radhakrishnan; Mylavarapu, Goutham; McConnell, Keith; Fleck, Robert J; Shott, Sally R; Amin, Raouf S; Gutmark, Ephraim J

    2016-04-01

    Compliance of soft tissue and muscle supporting the upper airway are two of several factors contributing to pharyngeal airway collapse. We present a novel, minimally invasive method of estimating regional variations in pharyngeal elasticity. Magnetic resonance images for pediatric sleep apnea patients with Down syndrome [9.5 ± 4.3 years (mean age ± standard deviation)] were analyzed to segment airways corresponding to baseline (no mask pressure) and two positive pressures. A three dimensional map was created to evaluate axial and circumferential variation in radial displacements of the airway, dilated by the positive pressures. The displacements were then normalized with respect to the appropriate transmural pressure and radius of an equivalent circle to obtain a measure of airway compliance. The resulting elasticity maps indicated the least and most compliant regions of the pharynx. Airway stiffness of the most compliant region [403 ± 204 (mean ± standard deviation) Pa] decreased with severity of obstructive sleep apnea. The non-linear response of the airway wall to continuous positive airway pressure was patient specific and varied between anatomical locations. We identified two distinct elasticity phenotypes. Patient phenotyping based on airway elasticity can potentially assist clinical practitioners in decision making on the treatments needed to improve airway patency.

  15. Airway epithelial cell responses to ozone injury

    Energy Technology Data Exchange (ETDEWEB)

    Leikauf, G.D.; Simpson, L.G.; Zhao, Qiyu [Univ. of Cincinnati Medical Center, OH (United States)] [and others

    1995-03-01

    The airway epithelial cell is an important target in ozone injury. Once activated, the airway epithelium responds in three phases. The initial, or immediate phase, involves activation of constitutive cells, often through direct covalent interactions including the formation of secondary ozonolysis products-hydroxyhydroperoxides, aldehydes, and hydrogen peroxide. Recently, we found hydroxyhydroperoxides to be potent agonists; of bioactive eicosanoid formation by human airway epithelial cells in culture. Other probable immediate events include activation and inactivation of enzymes present on the epithelial surface (e.g., neutral endopeptidase). During the next 2 to 24 hr, or early phase, epithelial cells respond by synthesis and release of chemotactic factors, including chemokines-macrophage inflammatory protein-2, RANTES, and interleukin-8. Infiltrating leukocytes during this period also release elastase, an important agonist of epithelial cell mucus secretion and additional chemokine formation. The third (late) phase of ozone injury is characterized by eosinophil or monocyte infiltration. Cytokine expression leads to alteration of structural protein synthesis, with increases in fibronectin evident by in situ hybridization. Synthesis of epithelial antiproteases, e.g., secretary leukocyte protease inhibitor, may also increase locally 24 to 48 hr after elastase concentrations become excessive. Thus, the epithelium is not merely a passive barrier to ozone injury but has a dynamic role in directing the migration, activating, and then counteracting inflammatory cells. Through these complex interactions, epithelial cells can be viewed as the initiators (alpha) and the receptors (omega) of ozone-induced airway disease. 51 refs., 2 figs., 3 tabs.

  16. Upper Airway Elasticity Estimation in Pediatric Down Syndrome Sleep Apnea Patients Using Collapsible Tube Theory.

    Science.gov (United States)

    Subramaniam, Dhananjay Radhakrishnan; Mylavarapu, Goutham; McConnell, Keith; Fleck, Robert J; Shott, Sally R; Amin, Raouf S; Gutmark, Ephraim J

    2016-05-01

    Elasticity of the soft tissues surrounding the upper airway lumen is one of the important factors contributing to upper airway disorders such as snoring and obstructive sleep apnea. The objective of this study is to calculate patient specific elasticity of the pharynx from magnetic resonance (MR) images using a 'tube law', i.e., the relationship between airway cross-sectional area and transmural pressure difference. MR imaging was performed under anesthesia in children with Down syndrome (DS) and obstructive sleep apnea (OSA). An airway segmentation algorithm was employed to evaluate changes in airway cross-sectional area dilated by continuous positive airway pressure (CPAP). A pressure-area relation was used to make localized estimates of airway wall stiffness for each patient. Optimized values of patient specific Young's modulus for tissue in the velopharynx and oropharynx, were estimated from finite element simulations of airway collapse. Patient specific deformation of the airway wall under CPAP was found to exhibit either a non-linear 'hardening' or 'softening' behavior. The localized airway and tissue elasticity were found to increase with increasing severity of OSA. Elasticity based patient phenotyping can potentially assist clinicians in decision making on CPAP and airway or tissue elasticity can supplement well-known clinical measures of OSA severity.

  17. Emergency airway puncture - slideshow

    Science.gov (United States)

    ... presentations/100113.htm Emergency airway puncture - series—Normal anatomy To ... larynx is a tubular structure in the neck, through which air passes to the lungs. The thryoid and cricoid cartilage form the narrowest ...

  18. Emergency airway puncture

    Science.gov (United States)

    ... inserted into the throat, just below the Adam's apple (cricoid cartilage), into the airway. In a hospital, ... Choking Browse the Encyclopedia A.D.A.M., Inc. is accredited by URAC, also known as the ...

  19. SUSCEPTIBILITY TO POLLUTANT-INDUCED AIRWAY INFLAMMATION IS NEUROGENICALLY MEDIATED.

    Science.gov (United States)

    Neurogenic inflammation in the airways involves the activation of sensory irritant receptors (capsaicin, VR1) by noxious stimuli and the subsequent release of neuropeptides (e.g., SP, CGRP, NKA) from these fibers. Once released, these peptides initiate and sustain symptoms of ...

  20. Airway management in trauma.

    Science.gov (United States)

    Langeron, O; Birenbaum, A; Amour, J

    2009-05-01

    Maintenance of a patent and prevention of aspiration are essential for the management of the trauma patient, that requires experienced physicians in airway control techniques. Difficulties of the airway control in the trauma setting are increased by the vital failures, the risk of aspiration, the potential cervical spine injury, the combative patient, and the obvious risk of difficult tracheal intubation related to specific injury related to the trauma. Endotracheal intubation remains the gold standard in trauma patient airway management and should be performed via the oral route with a rapid sequence induction and a manual in-line stabilization maneuver, to decrease the risks previously mentioned. Different techniques to control the airway in trauma patients are presented: improvement of the laryngoscopic vision, lighted stylet tracheal intubation, retrograde technique for orotracheal intubation, the laryngeal mask and the intubating laryngeal mask airways, the combitube and cricothyroidotomy. Management of the airway in trauma patients requires regular training in these techniques and the knowledge of complementary techniques allowing tracheal intubation or oxygenation to overcome difficult intubation and to prevent major complications as hypoxemia and aspiration.

  1. 持续正压通气在重症毛细支气管炎中的应用%The clinical application of continuous positive airway pressure in severe bronchiolitis

    Institute of Scientific and Technical Information of China (English)

    史瑞鹤; 刘恩梅

    2015-01-01

    毛细支气管炎是小婴儿最常见的下呼吸道感染性疾病,目前尚无特异性治疗,主要以对症支持治疗为主,近年来其治疗方法的探索一直是临床热点。持续正压通气(CPAP)作为一种安全、有效、无创的治疗方法,能有效缓解毛细支气管炎患儿的症状,改善预后,其临床应用越来越受到重视。文章对持续正压通气在重症毛细支气管炎患儿中的临床应用进行综述。%Bronchiolitis is the most common lower respiratory tract disease in infants. There is no speciifc treatment for it and the treatment is mainly supportive. The management of bronchiolitis is the clinical hotspot recently. Continuous positive airway pressure (CPAP) has gained more attention in clinical application as it is a safe, effective, and noninvasive method and can effectively relieve symptoms of bronchiolitis and improve prognosis. This paper reviews the clinical application of CPAP in infants with severe bronchiolitis.

  2. Disruption of Pseudomonas putida by high pressure homogenization: a comparison of the predictive capacity of three process models for the efficient release of arginine deiminase.

    Science.gov (United States)

    Patil, Mahesh D; Patel, Gopal; Surywanshi, Balaji; Shaikh, Naeem; Garg, Prabha; Chisti, Yusuf; Banerjee, Uttam Chand

    2016-12-01

    Disruption of Pseudomonas putida KT2440 by high-pressure homogenization in a French press is discussed for the release of arginine deiminase (ADI). The enzyme release response of the disruption process was modelled for the experimental factors of biomass concentration in the broth being disrupted, the homogenization pressure and the number of passes of the cell slurry through the homogenizer. For the same data, the response surface method (RSM), the artificial neural network (ANN) and the support vector machine (SVM) models were compared for their ability to predict the performance parameters of the cell disruption. The ANN model proved to be best for predicting the ADI release. The fractional disruption of the cells was best modelled by the RSM. The fraction of the cells disrupted depended mainly on the operating pressure of the homogenizer. The concentration of the biomass in the slurry was the most influential factor in determining the total protein release. Nearly 27 U/mL of ADI was released within a single pass from slurry with a biomass concentration of 260 g/L at an operating pressure of 510 bar. Using a biomass concentration of 100 g/L, the ADI release by French press was 2.7-fold greater than in a conventional high-speed bead mill. In the French press, the total protein release was 5.8-fold more than in the bead mill. The statistical analysis of the completely unseen data exhibited ANN and SVM modelling as proficient alternatives to RSM for the prediction and generalization of the cell disruption process in French press.

  3. Radionuclides release from re-irradiated fuel under high temperature and pressure conditions. Gamma-ray measurements of VEGA-5 test

    Energy Technology Data Exchange (ETDEWEB)

    Hidaka, Akihide; Kudo, Tamotsu; Nakamura, Takehiko; Kanazawa, Toru; Kiuchi, Toshio; Uetsuka, Hiroshi [Japan Atomic Energy Research Inst., Tokai, Ibaraki (Japan). Tokai Research Establishment

    2003-03-01

    The VEGA (Verification Experiments of radionuclides Gas/Aerosol release) program is being performed at JAERI to clarify mechanisms of radionuclides release from irradiated fuel during severe accidents and to improve source term predictability. The fifth VEGA-5 test was conducted in January 2002 to confirm the reproducibility of decrease in cesium release under elevated pressure that was observed in the VEGA-2 test and to investigate the release behavior of short-life radionuclides. The PWR fuel of 47 GWd/tU after about 8.2 years of cooling was re-irradiated at Nuclear Safety Research Reactor (NSRR) for 8 hours before the heat-up test. After that, the two pellets of 10.9 g without cladding were heated up to about 2,900 K at 1.0 MPa under the inert He condition. The experiment reconfirmed the decrease in cesium release rate under the elevated pressure. The release data on short-life radionuclides such as Ru-103, Ba-140 and Xe-133 that have never been observed in the previous VEGA tests without re-irradiation was obtained using the {gamma} ray measurement. (author)

  4. Modeling the dynamics of airway constriction: effects of agonist transport and binding.

    Science.gov (United States)

    Amin, Samir D; Majumdar, Arnab; Frey, Urs; Suki, Béla

    2010-08-01

    Recent advances have revealed that during exogenous airway challenge, airway diameters cannot be adequately predicted by their initial diameters. Furthermore, airway diameters can also vary greatly in time on scales shorter than a breath. To better understand these phenomena, we developed a multiscale model that allowed us to simulate aerosol challenge in the airways during ventilation. The model incorporates agonist-receptor binding kinetics to govern the temporal response of airway smooth muscle contraction on individual airway segments, which, together with airway wall mechanics, determines local airway caliber. Global agonist transport and deposition are coupled with pressure-driven flow, linking local airway constrictions with global flow dynamics. During the course of challenge, airway constriction alters the flow pattern, redistributing the agonist to less constricted regions. This results in a negative feedback that may be a protective property of the normal lung. As a consequence, repetitive challenge can cause spatial constriction patterns to evolve in time, resulting in a loss of predictability of airway diameters. Additionally, the model offers new insights into several phenomena including the intra- and interbreath dynamics of airway constriction throughout the tree structure.

  5. Chitin-Induced Airway Epithelial Cell Innate Immune Responses Are Inhibited by Carvacrol/Thymol

    OpenAIRE

    Ali Reza Khosravi; David J Erle

    2016-01-01

    Chitin is produced in large amounts by fungi, insects, and other organisms and has been implicated in the pathogenesis of asthma. Airway epithelial cells are in direct contact with environmental particles and serve as the first line of defense against inhaled allergens and pathogens. The potential contributions of airway epithelial cells to chitin-induced asthma remain poorly understood. We hypothesized that chitin directly stimulates airway epithelial cells to release cytokines that promote ...

  6. Airway Management in Fixed Flexion Deformity using an Alternative Method of ILMA Insertion

    Directory of Open Access Journals (Sweden)

    Sudhir K Singh

    2008-01-01

    Full Text Available Fixed flexion deformity is a sequel of burns and their release under anaesthesia pose difficulty during intubation. Various modalities are used for airway management in such cases. Here we present the successful airway manage-ment in a patient with post burn contracture who was managed with use of intubating laryngeal mask airway (ILMA introduced in reverse direction with 180 0 rotation for insertion.

  7. Integrated care pathways for airway diseases (AIRWAYS-ICPs)

    NARCIS (Netherlands)

    Bousquet, J.; Addis, A.; Adcock, I.; Agache, I.; Agusti, A.; Alonso, A.; Annesi-Maesano, I.; Anto, J. M.; Bachert, C.; Baena-Cagnani, C. E.; Bai, C.; Baigenzhin, A.; Barbara, C.; Barnes, P. J.; Bateman, E. D.; Beck, L.; Bedbrook, A.; Bel, E. H.; Benezet, O.; Bennoor, K. S.; Benson, M.; Bernabeu-Wittel, M.; Bewick, M.; Bindslev-Jensen, C.; Blain, H.; Blasi, F.; Bonini, M.; Bonini, S.; Boulet, L. P.; Bourdin, A.; Bourret, R.; Bousquet, P. J.; Brightling, C. E.; Briggs, A.; Brozek, J.; Buh, R.; Bush, A.; Caimmi, D.; Calderon, M.; Calverley, P.; Camargos, P. A.; Camuzat, T.; Canonica, G. W.; Carlsen, K. H.; Casale, T. B.; Cazzola, M.; Sarabia, A. M. Cepeda; Cesario, A.; Chen, Y. Z.; Chkhartishvili, E.; Chavannes, N. H.; Chiron, R.; Chuchalin, A.; Chung, K. F.; Cox, L.; Crooks, G.; Crooks, M. G.; Cruz, A. A.; Custovic, A.; Dahl, R.; Dahlen, S. E.; De Blay, F.; Dedeu, T.; Deleanu, D.; Demoly, P.; Devillier, P.; Didier, A.; Dinh-Xuan, A. T.; Djukanovic, R.; Dokic, D.; Douagui, H.; Dubakiene, R.; Eglin, S.; Elliot, F.; Emuzyte, R.; Fabbri, L.; Wagner, A. Fink; Fletcher, M.; Fokkens, W. J.; Fonseca, J.; Franco, A.; Frith, P.; Furber, A.; Gaga, M.; Garces, J.; Garcia-Aymerich, J.; Gamkrelidze, A.; Gonzales-Diaz, S.; Gouzi, F.; Guzman, M. A.; Haahtela, T.; Harrison, D.; Hayot, M.; Heaney, L. G.; Heinrich, J.; Hellings, P. W.; Hooper, J.; Humbert, M.; Hyland, M.; Iaccarino, G.; Jakovenko, D.; Jardim, J. R.; Jeandel, C.; Jenkins, C.; Johnston, S. L.; Jonquet, O.; Joos, G.; Jung, K. S.; Kalayci, O.; Karunanithi, S.; Keil, T.; Khaltaev, N.; Kolek, V.; Kowalski, M. L.; Kull, I.; Kuna, P.; Kvedariene, V.; Le, L. T.; Carlsen, K. C. Lodrup; Louis, R.; MacNee, W.; Mair, A.; Majer, I.; Manning, P.; Keenoy, E. de Manuel; Masjedi, M. R.; Meten, E.; Melo-Gomes, E.; Menzies-Gow, A.; Mercier, G.; Mercier, J.; Michel, J. P.; Miculinic, N.; Mihaltan, F.; Milenkovic, B.; Molimard, M.; Mamas, I.; Montilla-Santana, A.; Morais-Almeida, M.; Morgan, M.; N'Diaye, M.; Nafti, S.; Nekam, K.; Neou, A.; Nicod, L.; O'Hehir, R.; Ohta, K.; Paggiaro, P.; Palkonen, S.; Palmer, S.; Papadopoulos, N. G.; Papi, A.; Passalacqua, G.; Pavord, I.; Pigearias, B.; Plavec, D.; Postma, D. S.; Price, D.; Rabe, K. F.; Pontal, F. Radier; Redon, J.; Rennard, S.; Roberts, J.; Robine, J. M.; Roca, J.; Roche, N.; Rodenas, F.; Roggeri, A.; Rolland, C.; Rosado-Pinto, J.; Ryan, D.; Samolinski, B.; Sanchez-Borges, M.; Schunemann, H. J.; Sheikh, A.; Shields, M.; Siafakas, N.; Sibille, Y.; Similowski, T.; Small, I.; Sola-Morales, O.; Sooronbaev, T.; Stelmach, R.; Sterk, P. J.; Stiris, T.; Sud, P.; Tellier, V.; To, T.; Todo-Bom, A.; Triggiani, M.; Valenta, R.; Valero, A. L.; Valiulis, A.; Valovirta, E.; Van Ganse, E.; Vandenplas, O.; Vasankari, T.; Vestbo, J.; Vezzani, G.; Viegi, G.; Visier, L.; Vogelmeier, C.; Vontetsianos, T.; Wagstaff, R.; Wahn, U.; Wallaert, B.; Whalley, B.; Wickman, M.; Williams, D. M.; Wilson, N.; Yawn, B. P.; Yiallouros, P. K.; Yorgancioglu, A.; Yusuf, O. M.; Zar, H. J.; Zhong, N.; Zidarn, M.; Zuberbier, T.

    2014-01-01

    The objective of Integrated Care Pathways for Airway Diseases (AIRWAYS-ICPs) is to launch a collaboration to develop multi-sectoral care pathways for chronic respiratory diseases in European countries and regions. AIRWAYS-ICPs has strategic relevance to the European Union Health Strategy and will ad

  8. Comparison of Supreme Laryngeal Mask Airway and ProSeal Laryngeal Mask Airway during Cholecystectomy

    OpenAIRE

    2012-01-01

    Objective: This study compared the safety and efficacy of the Supreme Laryngeal Mask Airway (S-LMA) with that of the ProSeal-LMA (P-LMA) in laparoscopic cholecystectomy. Material and Methods: Sixty adults were randomly allocated. Following anaesthesia induction, experienced LMA users inserted the airway devices. Results: Oropharyngeal leak pressure was similar in groups (S-LMA, 27.8±2.9 cmH20; P-LMA, 27.0±4.7 cmH20; p=0.42) and did not change...

  9. Comparison of Supreme Laryngeal Mask Airway and ProSeal Laryngeal Mask Airway during Cholecystectomy

    OpenAIRE

    2012-01-01

    Objective: This study compared the safety and efficacy of the Supreme Laryngeal Mask Airway (S-LMA) with that of the ProSeal-LMA (P-LMA) in laparoscopic cholecystectomy.Material and Methods: Sixty adults were randomly allocated. Following anaesthesia induction, experienced LMA users inserted the airway devices. Results: Oropharyngeal leak pressure was similar in groups (S-LMA, 27.8±2.9 cmH20; P-LMA, 27.0±4.7 cmH20; p=0.42) and did not change during the induction of and throughout pneumoperit...

  10. Airway reconstruction in children

    Directory of Open Access Journals (Sweden)

    Rao Sanjay

    2009-01-01

    Full Text Available Aim/Background : Airway anomalies are infrequent but potentially life threatening in children. A program to care for these difficult children was set up at our institution, and this paper summarizes our experience. Methods: A total of 34 children were enrolled in the program over a period of three years. These children were evaluated as per the standard protocols. Treatment was individualized. Results: Of these 34 children, 28 had their airways restored and are doing well. Four children continue to remain on tracheostomy and two will require long term tracheostomy. There were two deaths. All children are under surveillance as there is a risk of recurrence. Conclusions: Airway anomalies are complex problems with significant morbidity and mortality. Current therapeutic modalities allow for good results. Most children were successfully decannulated and did well.

  11. Paediatric airway management: basic aspects

    DEFF Research Database (Denmark)

    Holm-Knudsen, R J; Rasmussen, L S

    2009-01-01

    . Airway obstruction can be avoided by paying close attention to the positioning of the head of the child and by keeping the mouth of the child open during mask ventilation. The use of oral and nasopharyngeal airways, laryngeal mask airways, and cuffed endotracheal tubes is discussed with special reference...... to the circumstances in infants. A slightly different technique during laryngoscopy is suggested. The treatment of airway oedema and laryngospasm is described....

  12. Flow characteristics in the airways of a COPD patient with a saber-sheath trachea

    Science.gov (United States)

    Jin, Dohyun; Choi, Haecheon; Lee, Changhyun; Choi, Jiwoong; Kim, Kwanggi

    2016-11-01

    The chronic obstructive pulmonary disease (COPD) is a lung disease characterized by the irreversible airflow limitation caused by the damaged small airways and air sacs. Although COPD is not a disease of the trachea, many patients with COPD have saber-sheath tracheas. The effects of this morphological change in the trachea geometry on airflow are investigated in the present study. An unstructured finite volume method is used for the simulations during tidal breathing in normal and COPD airways, respectively. During inspiration, local large pressure drop is observed in the saber-sheath region of the COPD patient. During expiration, vortical structures are observed at the right main bronchus of the COPD airway, while the flow in the normal airway remains nearly laminar. High wall shear stress exists at convex regions of both airways during inspiration and expiration. However, due to the morphological changes in the COPD airway, relatively higher wall shear stress is observed in the patient airways.

  13. Pharmacokinetics and Paw Withdrawal Pressure in Female Guinea Pigs (Cavia porcellus) Treated with Sustained-Release Buprenorphine and Buprenorphine Hydrochloride.

    Science.gov (United States)

    Smith, Brian J; Wegenast, Daniel J; Hansen, Ryan J; Hess, Ann M; Kendall, Lon V

    2016-11-01

    Providing appropriate analgesia is essential in minimizing pain and maintaining optimal animal care and welfare in laboratory animals. Guinea pigs are common animal models in biomedical research, often requiring analgesic support. Here we evaluated the pharmacokinetics and efficacy of a sustained-release formulation of buprenorphine (Bup-SR) in this species. Guinea pigs (n = 7 each group) received either Bup-HCl (0.05 mg/kg BID for 3 d) or Bup-SR (0.3 mg/kg once). Plasma collection and measurement of paw-withdrawal pressure (PWP) was conducted at 0, 1, 3, 6, 12, 26, 48, and 72 h after treatment. Plasma levels of Bup-HCl peaked at 2331 pg/mL at 1 h after administration and declined to 165 pg/mL by 12 h. Plasma concentrations of Bup-SR peaked at 1344 pg/mL at 26 h after administration and declined to 429 pg/mL by 48 h. The PWP of the Bup-HCltreated guinea pigs peaked at 674 g at 1 h and declined to 402 g at 6 h, whereas that of Bup-SRtreated guinea pigs at 1 h was 361 g, 555 g at 6 h (significantly higher than that after Bup-HCl), and peaked at 680 g at 12 h. The PWP of both treatments was similar from 24 to 72 h and ranged from 348 to 450 g. The plasma concentration and PWP showed good correlation. These results suggest that Bup-SR provides consistent analgesia equivalent to that of Bup-HCl for a prolonged period of time and that Bup-SR is an alternative method of analgesia in guinea pigs.

  14. Humidified High Flow Nasal Cannula versus Nasal Continuous Positive Airway Pressure as an Initial Respiratory Support in Preterm Infants with Respiratory Distress: a Randomized, Controlled Non-Inferiority Trial.

    Science.gov (United States)

    Shin, Jeonghee; Park, Kyuhee; Lee, Eun Hee; Choi, Byung Min

    2017-04-01

    Heated, humidified, high-flow nasal cannula (HHFNC) is frequently used as a noninvasive respiratory support for preterm infants with respiratory distress. But there are limited studies that compares HHFNC with nasal continuous positive airway pressure (nCPAP) only as the initial treatment of respiratory distress in preterm infants immediately after birth. The aim of this study is to assess the effectiveness and safety of HHFNC compared to nCPAP for the initial treatment of preterm infants with respiratory distress. Preterm infants at between 30 and 35 weeks of gestational age were randomized to HHFNC or nCPAP when they showed respiratory distress in less than 24 hours of age postnatally. Preterm infants who needed invasive respiratory supports were excluded. Primary outcome was the incidence of treatment failure (defined as need for the intubation or mechanical ventilation). Eighty-five infants were analyzed. Sixteen of 42 infants randomized to HHFNC showed treatment failure compared to 9 of 43 infants using nCPAP (Risk difference 17.17 [-1.90-36.23]; P = 0.099). In terms of the reason for treatment failure, the frequency of hypoxia was significantly higher in the HHFNC group than in the nCPAP group (P = 0.020). There was no difference between the 2 groups in terms of respiratory and clinical outcomes and complications. Although HHFNC is safe compared to nCPAP, it is not certain that HHFNC is effective compared to nCPAP non-inferiorly as an initial respiratory support in preterm infants with respiratory distress.

  15. Oral appliance therapy versus nasal continuous positive airway pressure in obstructive sleep apnea syndrome: a randomized, placebo-controlled trial on self-reported symptoms of common sleep disorders and sleep-related problems.

    Science.gov (United States)

    Nikolopoulou, Maria; Byraki, Anna; Ahlberg, Jari; Heymans, Martijn W; Hamburger, H L; De Lange, Jan; Lobbezoo, Frank; Aarab, Ghizlane

    2017-03-10

    Obstructive sleep apnea syndrome (OSAS) is associated with several sleep disorders and sleep-related problems. Therefore, the aim of this study was to compare the effects of a mandibular advancement device (MAD) with those of nasal continuous positive airway pressure (nCPAP) on self-reported symptoms of common sleep disorders and sleep-related problems in mild and moderate OSAS patients. In this randomized placebo-controlled trial sixty-four OSAS patients (52.0± 9.6 years) were randomly assigned to an MAD, nCPAP or an intra-oral placebo appliance in a parallel design. All participants filled out the validated Dutch Sleep Disorders Questionnaire (SDQ) twice: one before treatment and one after six months of treatment. With 88 questions, thirteen scales were constructed, representing common sleep disorders and sleep-related problems. Linear mixed model analyses were performed to study differences between the groups for the different SDQ scales over time. The MAD group showed significant improvements over time in symptoms corresponding with "insomnia", "excessive daytime sleepiness", "psychiatric sleep disorder", "periodic limb movements", "sleep apnea", "sleep paralysis", "daytime dysfunction", "hypnagogic hallucinations/dreaming", "restless sleep", "negative conditioning", and "automatic behaviour" (range of P values: 0.000-0.014). These improvements in symptoms were, however, not significantly different from the improvements in symptoms observed in the nCPAP and placebo groups (range of P values: 0.090-0.897). It can be concluded that there is no significant difference between MAD and nCPAP in their positive effects on self-reported symptoms of common sleep disorders and sleep-related problems in mild and moderate OSAS patients. These beneficial effects may be a result of placebo effects. This article is protected by copyright. All rights reserved.

  16. Airway Clearance Devices for Cystic Fibrosis

    Science.gov (United States)

    2009-01-01

    Executive Summary Objective The purpose of this evidence-based analysis is to examine the safety and efficacy of airway clearance devices (ACDs) for cystic fibrosis and attempt to differentiate between devices, where possible, on grounds of clinical efficacy, quality of life, safety and/or patient preference. Background Cystic fibrosis (CF) is a common, inherited, life-limiting disease that affects multiple systems of the human body. Respiratory dysfunction is the primary complication and leading cause of death due to CF. CF causes abnormal mucus secretion in the airways, leading to airway obstruction and mucus plugging, which in turn can lead to bacterial infection and further mucous production. Over time, this almost cyclical process contributes to severe airway damage and loss of respiratory function. Removal of airway secretions, termed airway clearance, is thus an integral component of the management of CF. A variety of methods are available for airway clearance, some requiring mechanical devices, others physical manipulation of the body (e.g. physiotherapy). Conventional chest physiotherapy (CCPT), through the assistance of a caregiver, is the current standard of care for achieving airway clearance, particularly in young patients up to the ages of six or seven. CF patients are, however, living much longer now than in decades past. The median age of survival in Canada has risen to 37.0 years for the period of 1998-2002 (5-year window), up from 22.8 years for the 5-year window ending in 1977. The prevalence has also risen accordingly, last recorded as 3,453 in Canada in 2002, up from 1,630 in 1977. With individuals living longer, there is a greater need for independent methods of airway clearance. Airway Clearance Devices There are at least three classes of airway clearance devices: positive expiratory pressure devices (PEP), airway oscillating devices (AOD; either handheld or stationary) and high frequency chest compression (HFCC)/mechanical percussion (MP

  17. Obesity and obstructive sleep apnoea: mechanisms for increased collapsibility of the passive pharyngeal airway.

    Science.gov (United States)

    Isono, Shiroh

    2012-01-01

    Epidemiological evidence suggests there are significant links between obesity and obstructive sleep apnoea (OSA), with a particular emphasis on the importance of fat distribution in the development of OSA. In patients with OSA, the structure of the pharyngeal airway collapses. A collapsible tube within a rigid box collapses either due to decreased intraluminal pressure or increased external tissue pressure (i.e. reduction in transmural pressure), or due to reduction in the longitudinal tension of the tube. Accordingly, obesity should structurally increase the collapsibility of the pharyngeal airway due to excessive fat deposition at two distinct locations. In the pharyngeal airway region, excessive soft tissue for a given maxillomandibular enclosure size (upper airway anatomical imbalance) can increase tissue pressure surrounding the pharyngeal airway, thereby narrowing the airway. Even mild obesity may cause anatomical imbalance in individuals with a small maxilla and mandible. Lung volume reduction due to excessive central fat deposition may decrease longitudinal tracheal traction forces and pharyngeal wall tension, changing the 'tube law' in the pharyngeal airway (lung volume dependence of the upper airway). The lung volume dependence of pharyngeal airway patency appears to contribute more significantly to the development of OSA in morbidly obese, apnoeic patients. Neurostructural interactions required for stable breathing may be influenced by obesity-related hormones and cytokines. Accumulating evidence strongly supports these speculations, but further intensive research is needed.

  18. Eosinophil cationic protein stimulates and major basic protein inhibits airway mucus secretion

    DEFF Research Database (Denmark)

    Lundgren, J D; Davey, R T; Lundgren, B

    1991-01-01

    Possible roles of eosinophil (EO) products in modulating the release of mucus from airway explants were investigated. Cell- and membrane-free lysates from purified human EOs (1 to 20 x 10(5)) caused a dose-dependent release of respiratory glycoconjugates (RGC) from cultured feline tracheal explants...... chromatography. ECP (0.025 to 25 micrograms/ml) caused a dose-dependent increase in RGC release from both feline and human airway explants and also stimulated the release of the serous cell-marker, lactoferrin, from human bronchial explants. EO-derived neurotoxin (0.025 to 50 micrograms/ml) failed to affect RGC...... release, whereas MBP (50 micrograms/ml) significantly inhibited RGC release from feline explants. Thus, ECP stimulates RGC and lactoferrin release from airway explants, whereas MBP inhibits RGC release....

  19. Distinct PKA and Epac compartmentalization in airway function and plasticity

    NARCIS (Netherlands)

    Dekkers, Bart G. J.; Racke, Kurt; Schmidt, Martina

    2013-01-01

    Asthma and chronic obstructive pulmonary disease (COPD) are obstructive lung diseases characterized by airway obstruction, airway inflammation and airway remodelling. Next to inflammatory cells and airway epithelial cells, airway mesenchymal cells, including airway smooth muscle cells and (myo)fibro

  20. Severe upper airway obstruction during sleep.

    Science.gov (United States)

    Bonekat, H William; Hardin, Kimberly A

    2003-10-01

    Few disorders may manifest with predominantly sleep-related obstructive breathing. Obstructive sleep apnea (OSA) is a common disorder, varies in severity and is associated with significant cardiovascular and neurocognitive morbidity. It is estimated that between 8 and 18 million people in the United States have at least mild OSA. Although the exact mechanism of OSA is not well-delineated, multiple factors contribute to the development of upper airway obstruction and include anatomic, mechanical, neurologic, and inflammatory changes in the pharynx. OSA may occur concomitantly with asthma. Approximately 74% of asthmatics experience nocturnal symptoms of airflow obstruction secondary to reactive airways disease. Similar cytokine, chemokine, and histologic changes are seen in both disorders. Sleep deprivation, chronic upper airway edema, and inflammation associated with OSA may further exacerbate nocturnal asthma symptoms. Allergic rhinitis may contribute to both OSA and asthma. Continuous positive airway pressure (CPAP) is the gold standard treatment for OSA. Treatment with CPAP therapy has also been shown to improve both daytime and nighttime peak expiratory flow rates in patients with concomitant OSA and asthma. It is important for allergists to be aware of how OSA may complicate diagnosis and treatment of asthma and allergic rhinitis. A thorough sleep history and high clinical suspicion for OSA is indicated, particularly in asthma patients who are refractory to standard medication treatments.

  1. Advances in prehospital airway management.

    Science.gov (United States)

    Jacobs, Pe; Grabinsky, A

    2014-01-01

    Prehospital airway management is a key component of emergency responders and remains an important task of Emergency Medical Service (EMS) systems worldwide. The most advanced airway management techniques involving placement of oropharyngeal airways such as the Laryngeal Mask Airway or endotracheal tube. Endotracheal tube placement success is a common measure of out-of-hospital airway management quality. Regional variation in regard to training, education, and procedural exposure may be the major contributor to the findings in success and patient outcome. In studies demonstrating poor outcomes related to prehospital-attempted endotracheal intubation (ETI), both training and skill level of the provider are usually often low. Research supports a relationship between the number of intubation experiences and ETI success. National standards for certification of emergency medicine provider are in general too low to guarantee good success rate in emergency airway management by paramedics and physicians. Some paramedic training programs require more intense airway training above the national standard and some EMS systems in Europe staff their system with anesthesia providers instead. ETI remains the cornerstone of definitive prehospital airway management, However, ETI is not without risk and outcomes data remains controversial. Many systems may benefit from more input and guidance by the anesthesia department, which have higher volumes of airway management procedures and extensive training and experience not just with training of airway management but also with different airway management techniques and adjuncts.

  2. Parapharyngeal abscess following use of a laryngeal mask airway during open revision septorhinoplasty

    Directory of Open Access Journals (Sweden)

    Benjamin van der Woerd

    2015-01-01

    Conclusion: Laryngeal mask airways have a high rate of success and low rate of complications. In this reported case, pressure necrosis from over-inflation of the LMA is thought to have perforated the right pyriform fossa. The perforation created a communication into the parapharyngeal space causing infection. We report this case to highlight the importance of identifying possible complications associated with a routine method of airway management during shared airway surgeries.

  3. A PAF receptor antagonist inhibits acute airway inflammation and late-phase responses but not chronic airway inflammation and hyperresponsiveness in a primate model of asthma

    Directory of Open Access Journals (Sweden)

    R. H. Gundel

    1992-01-01

    Full Text Available We have examined the effects of a PAF receptor antagonist, WEB 2170, on several indices of acute and chronic airway inflammation and associated changes in lung function in a primate model of allergic asthma. A single oral administration WEB 2170 provided dose related inhibition of the release of leukotriene C4 (LTC4 and prostaglandin D2 (PGD2 recovered and quantified in bronchoalveolar lavage (BAL fluid obtained during the acute phase response to inhaled antigen. In addition, oral WEB 2170 treatment in dual responder primates blocked the acute influx of neutrophils into the airways as well as the associated late-phase airway obstruction occurring 6 h after antigen inhalation. In contrast, a multiple dosing regime with WEB 2170 (once a day for 7 consecutive days failed to reduce the chronic airway inflammation (eosinophilic and associated airway hyperresponsiveness to inhaled methacholine that is characteristic of dual responder monkeys. Thus, we conclude that the generation of PAF following antigen inhalation contributes to the development of lipid mediators, acute airway inflammation and associated late-phase airway obstruction in dual responder primates; however, PAF does not play a significant role in the maintenance of chronic airway inflammation and associated airway hyperresponsiveness in this primate model.

  4. Upper airway imaging and its role in preoperative airway evaluation

    Directory of Open Access Journals (Sweden)

    Jagadish G Sutagatti

    2016-01-01

    Full Text Available Ultrasonography (USG is well-known as a fast, safe, and noninvasive technique. Its application for imaging of the airway is now gaining momentum. The upper airway has a complex anatomy, and its assessment forms a vital part of every preanesthetic evaluation. Ultrasound (US imaging can help in upper airway assessment in the preoperative period. There are various approaches to upper airway USG. The technique has its own advantages, disadvantages, and limitations. This simple yet challenging imaging technique is all set to become an important part of routine preoperative airway evaluation. This article reviews the various approaches to upper airway US imaging, interpretation of the images, limitations, and disadvantages of the technique and its varied clinical applications in the preoperative period. The scientific material presented here was hand searched from textbooks and journals, electronically from PubMed, and Google scholar using text words.

  5. Relationship between airway pathophysiology and airway inflammation in older asthmatics

    DEFF Research Database (Denmark)

    Porsbjerg, Celeste M; Gibson, Peter G; Pretto, Jeffrey J;

    2013-01-01

    BACKGROUND AND OBJECTIVE: Asthma-related morbidity is greater in older compared with younger asthmatics. Airway closure is also greater in older asthmatics, an observation that may be explained by differences in airway inflammation. We hypothesized that in older adult patients with asthma......: Mean patient age was 67 years (confidence interval: 63-71) with a mean FEV1 of 78 % predicted (confidence interval: 70-85%). AHR correlated with sputum eosinophils (r = 0.68, P = 0.005) and eNO (r = 0.71, P ... or eNO. CONCLUSIONS: In older patients with asthma, airway inflammatory cells are linked to abnormal airway physiology. Eosinophilic airway inflammation is associated with AHR while neutrophilic inflammation may be an important determinant of airflow limitation at rest and airway closure during...

  6. Dependence of macrophage superoxide release on the pulse amplitude of an applied pressure regime: a potential factor at the soft tissue-implant interface.

    Science.gov (United States)

    Shin, Hainsworth Y; Frechette, Danielle M; Rohner, Nathan; Zhang, Xiaoyan; Puleo, David A; Bjursten, Lars M

    2016-03-01

    Failure of soft tissue implants has been largely attributed to the influence of biomaterial surface properties on the foreign body response, but some implant complications, e.g. macrophage accumulation and necrosis, are still not effectively addressed with surface treatments to minimize deleterious biomaterial effects. We explored an alternative explanation for implant failure, linking biocompatibility with implant micromotion-induced pressure fluctuations at the tissue-biomaterial interface. For this purpose, we used a custom in vitro system to characterize the effects of pressure fluctuations on the activity of macrophages, the predominant cells at a healing implant site. Initially, we quantified superoxide production by HL60-derived macrophage-like cells under several different pressure regimes with means of 5-40 mmHg, amplitudes of 0-15 mmHg and frequencies of 0-1.5 Hz. All pressure regimes tested elicited significantly (p superoxide production by macrophage-like cells relative to parallel controls. Notably, pressure-sensitive reductions in superoxide release correlated (r(2)  = 0.74; p superoxide production and cell viability, we also explored the influence of cyclic pressure on macrophage numbers and death. Compared to controls, adherent macrophage-like cells exposed to 7.5/2.5 mmHg cyclic pressures for 6 h exhibited significantly (p superoxide dismutase. Collectively, our results suggest that pressure pulses are a putative regulator of macrophage adhesion via a superoxide-related effect. Pressure fluctuations, e.g. due to implant micromotion, may, therefore, potentially modulate macrophage-dependent wound healing.

  7. Integrated care pathways for airway diseases (AIRWAYS-ICPs)

    DEFF Research Database (Denmark)

    Bousquet, J; Addis, A; Adcock, I

    2014-01-01

    The objective of Integrated Care Pathways for Airway Diseases (AIRWAYS-ICPs) is to launch a collaboration to develop multi-sectoral care pathways for chronic respiratory diseases in European countries and regions. AIRWAYS-ICPs has strategic relevance to the European Union Health Strategy....... AIRWAYSICPs was initiated by Area 5 of the Action Plan B3 of the European Innovation Partnership on Active and Healthy Ageing. All stakeholders are involved (health and social care, patients, and policy makers)....

  8. Biomarkers in Airway Diseases

    Directory of Open Access Journals (Sweden)

    Janice M Leung

    2013-01-01

    Full Text Available The inherent limitations of spirometry and clinical history have prompted clinicians and scientists to search for surrogate markers of airway diseases. Although few biomarkers have been widely accepted into the clinical armamentarium, the authors explore three sources of biomarkers that have shown promise as indicators of disease severity and treatment response. In asthma, exhaled nitric oxide measurements can predict steroid responsiveness and sputum eosinophil counts have been used to titrate anti-inflammatory therapies. In chronic obstructive pulmonary disease, inflammatory plasma biomarkers, such as fibrinogen, club cell secretory protein-16 and surfactant protein D, can denote greater severity and predict the risk of exacerbations. While the multitude of disease phenotypes in respiratory medicine make biomarker development especially challenging, these three may soon play key roles in the diagnosis and management of airway diseases.

  9. 不同病因致急性呼吸衰竭患者行无创双水平气道正压通气治疗的临床价值探析%Clinical Value of Noninvasive Bi-level Positive Airway Pressure Ventilation in Patients With Acute Respiratory Failure Caused by Different Causes

    Institute of Scientific and Technical Information of China (English)

    李晓理

    2016-01-01

    目的:对不同病因致急性呼吸衰竭患者行无创双水平气道正压通气治疗的临床价值进行评价分析。方法对68例急性呼吸衰竭患者依据病因的不同分成心源性肺水肿组和重症肺炎组,接受无创双水平气道正压通气治疗,对比分析治疗效果。结果心源性肺水肿组患者治疗后动脉血气指标、症状缓解时间、治疗时间、住院时间与对照组比较差异有统计学意义(P <0.05)。结论无创双水平气道正压通气对不同病因引起的急性呼吸衰竭具有良好的治疗效果。%Objective The different causes in patients with acute respiratory failure and clinical value of noninvasive bi-level positive airway pressure ventilation in the treatment of evaluation and analysis. Methods 68 patients with acute respiratory failure were divided according to different causes of cardiogenic pulmonary edema and severe pneumonia group, accepted non-invasive bi-level positive airway pressure therapy, comparative analysis of the treatment effect. Results Cardiogenic pulmonary edema patients arterial blood gas treatment, remission time, treatment time, duration of hospitalization with the control group was significantly different (P<0.05). Conclusion Noninvasive bi-level positive airway pressure ventilation in acute respiratory failure caused by different causes have a good therapeutic effect.

  10. 节律性压力波对家犬气道黏蛋白分泌平衡的影响及其机制%Effect of rhythmic pressure waves on balancing airway basic mucus secretion in dogs

    Institute of Scientific and Technical Information of China (English)

    刘诗兰; 尤列·皮尔曼; 维克多·科罗索夫; 周向东

    2013-01-01

    目的:观察不同压力对家犬气道黏液层黏蛋白(MUC)分泌的影响,并初步探讨其参与机制。方法:24只健康家犬行双腔支气管导管插管,并随机分为4组(n=6)。A组家犬正常呼吸的频率及压力双侧通气(A1,A2);B组一侧不通气(B1),另一侧予以过量通气(B2);C组预先张力敏感性阳离子通道4(TRPV4)阻断剂钉红(RR)后按A组通气模式通气(C1,C2);D组预先TRPV4阻断剂RR处理后按B组通气模式通气(D1,D2)。通气12 h后,ELISA检测3组支气管灌洗液(BALF)中MUC(2,5AC和5B)蛋白含量;RT-PCR检测支气管肺组织匀浆中MUC(2,5AC和5B) mRNA转录水平。结果:与正常通气的A2组比较,过量通气的B2组家犬BALF中3种MUC蛋白含量显著升高,且以MUC5AC为主(P<0.05);与A1组比较,未通气的B1组则明显下降(P<0.05)。与A1,A2组比较,给予RR处理后的C1,C2组蛋白含量均明显降低(P<0.05)。与过量通气的B2组比较,给予TRPV4特异性阻断剂处理后再过量通气的D2组3种MUC蛋白含量亦明显下降(P<0.05)。与A2组比较过量通气的B2组肺组织MUC(2,5AC和5B) mRNA表达均明显上调(P<0.05);与A1,A2比较,给予RR处理后C1,C2组肺组织3种MUC mRNA转录水平显著下降(P<0.05);给予RR预处理后与B2组相比,D2组内MUC mRNA转录水平显著下调(P<0.05)。结论:节律性压力波参与维持家犬气道上皮黏液层黏蛋白分泌平衡调控,其机制主要通过TRPV4通道实现。%Objective:To investigate the effect of different pressure on mucin (MUC) secretion in dog airway mucus layer and explore the participation mechanisms. Methods:Totally 24 healthy dogs were randomly divided into 4 groups (n=6) after double-lumen endobronchial tube intubation. In group A the dogs were ventilated bilaterally with normal breathing frequency and pressure;In group B:one side of the dog lung did not ventilate, while the other side was excessively ventilated. In

  11. Infant flow biphasic nasal continuous positive airway pressure (BP- NCPAP vs. infant flow NCPAP for the facilitation of extubation in infants' ≤ 1,250 grams: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    O'Brien Karel

    2012-04-01

    Full Text Available Abstract Background The use of mechanical ventilation is associated with lung injury in preterm infants and therefore the goal is to avoid or minimize its use. To date there is very little consensus on what is considered the "best non-invasive ventilation mode" to be used post-extubation. The objective of this study was to compare the effectiveness of biphasic nasal continuous positive airway pressure (BP-NCPAP vs. NCPAP in facilitating sustained extubation in infants ≤ 1,250 grams. Methods We performed a randomized controlled trial of BP-NCPAP vs. NCPAP in infants ≤ 1,250 grams extubated for the first time following mechanical ventilation since birth. Infants were extubated using preset criteria or at the discretion of the attending neonatologist. The primary outcome was the incidence of sustained extubation for 7 days. Secondary outcomes included incidence of adverse events and short-term neonatal outcomes. Results Sixty-seven infants received BP-NCPAP and 69 NCPAP. Baseline characteristics were similar between groups. The trial was stopped early due to increased use of non-invasive ventilation from birth, falling short of our calculated sample size of 141 infants per group. The incidence of sustained extubation was not statistically different between the BP-NCPAP vs. NCPAP group (67% vs. 58%, P = 0.27. The incidence of adverse events and short-term neonatal outcomes were similar between the two groups (P > 0.05 except for retinopathy of prematurity which was noted to be higher (P = 0.02 in the BP-NCPAP group. Conclusions Biphasic NCPAP may be used to assist in weaning from mechanical ventilation. The effectiveness and safety of BP-NCPAP compared to NCPAP needs to be confirmed in a large multi-center trial as our study conclusions are limited by inadequate sample size. Clinical Trials Registration # NCT00308789 Source of support Grant # 06-06, Physicians Services Incorporated Foundation, Toronto, Canada. Summit technologies Inc. provided

  12. 早期联合应用NCPAP和PS治疗新生儿呼吸窘迫综合征%Early Nasal Continuous Positive Airway Pressure And Pulmonary Surfactant Therapy For Neonatal Respiratory Distress Syndrome

    Institute of Scientific and Technical Information of China (English)

    周媛; 杨静; 王岩岩; 王李敏

    2012-01-01

    目的 讨论经鼻持续气道正压通气(NCPAP)联合肺表面活性物质(PS)治疗新生儿呼吸窘迫综合征(NRDS)的治疗效果.方法 应用NCPAP联合PS治疗25例呼吸窘迫综合征的新生儿,并对其临床特点、动脉血气分析进行分析.结果 23例发绀和呼吸困难症状均有所减轻或消失.X线表现肺透亮度明显改善,或病变未进展,血气分析参数明显改善.2例因病情加重放弃治疗.结论 NCPAP联合PS能迅速有效地治疗新生儿呼吸窘迫综合征.用这种方法通过阻止呼吸窘迫综合征的进展,降低了以后应用呼吸机的需要.细致观察和正确的护理也是治疗成功的关键.%Objective To investigate the effects of nasal continuous positive airway pressure ( NCPAP ) early combined with pul-monary surfactant ( PS ) on newborn with respiratory distress syndrome ( RDS ). Methods 25 cases of newborn with respiratory distress syndrome were treated by Curosurf ( 100 ~ 200 mg/kg, every times ) and then they were given breath support by NCPAP. The clinical characteristics and results of blood gas analysis were evaluated. Results The symptoms of cyanosis and breathing difficulties disappeared or were reduced in 23 cases. The lung permeability showed by X-ray was obviously improved. Because the condition became more serious, two cases gave up. Conclusions Early NCPAP combined with PS have a good effect for newborn with respiratory distress syndrome, and improving the survival rate. It can decrease the requirement for respiratory machine by preventing respiratory distress syndrome. The cor-rect nursing is the key of successful treatment.

  13. Use of the i-gel™ supraglottic airway device in a patient with subglottic stenosis -a case report-.

    Science.gov (United States)

    Lee, Ki Hwa; Kang, Eun Su; Jung, Jae Wook; Park, Jae Hong; Choi, Young Gyun

    2013-09-01

    The airway management of patients with subglottic stenosis poses many challenges for the anesthesiologists. Many anesthesiologists use a narrow endotracheal tube for airway control. This, however, can lead to complications such as tracheal mucosal trauma, tracheal perforation or bleeding. The ASA difficult airway algorithm recommends the use of supraglottic airway devices in a failed intubation/ventilation scenario. In this report, we present a case of failed intubation in a patient with subglottic stenosis successfully managed during an i-gel™ supraglottic airway device. The device provided a good seal, and allowed for controlled mechanical ventilation with acceptable peak pressures while the patient was in the beach-chair position.

  14. Preparation of porous poly(trimethylene carbonate) structures for controlled release applications using high pressure CO2

    NARCIS (Netherlands)

    Nalawade, S.P.; Westerman, D.; Leeke, G.; Santos, R.C.D.; Grijpma, D.W.; Feijen, J.

    2008-01-01

    Porous poly(trimethylene carbonate) structures can readily be prepared using high pressure CO2. Differences in CO2 solubility in the polymer matrix at the different processing temperatures and pressures lead to different pore morphologies upon depressurization. Furthermore, crystallization of the in

  15. Zinc supplementation alters airway inflammation and airway hyperresponsiveness to a common allergen

    Directory of Open Access Journals (Sweden)

    Morgan Carrie I

    2011-12-01

    Full Text Available Abstract Background Zinc supplementation can modulate immunity through inhibition of NF-κB, a transcription factor that controls many immune response genes. Thus, we sought to examine the mechanism by which zinc supplementation tempers the response to a common allergen and determine its effect on allergic airway inflammation. Methods Mice were injected with zinc gluconate prior to German cockroach (GC feces (frass exposure and airway inflammation was assessed. Primary bone marrow-derived neutrophils and DMSO-differentiated HL-60 cells were used to assess the role of zinc gluconate on tumor necrosis factor (TNFα expression. NF-κB:DNA binding and IKK activity were assessed by EMSA and in vitro kinase assay. Protein levels of A20, RIP1 and TRAF6 were assessed by Western blot analysis. Establishment of allergic airway inflammation with GC frass was followed by administration of zinc gluconate. Airway hyperresponsiveness, serum IgE levels, eosinophilia and Th2 cytokine production were assessed. Results Administration of zinc gluconate prior to allergen exposure resulted in significantly decreased neutrophil infiltration and TNFα cytokine release into the airways. This correlated with decreased NF-κB activity in the whole lung. Treatment with zinc gluconate significantly decreased GC frass-mediated TNFα production from bone-marrow derived neutrophils and HL-60 cells. We confirmed zinc-mediated decreases in NF-κB:DNA binding and IKK activity in HL-60 cells. A20, a natural inhibitor of NF-κB and a zinc-fingered protein, is a potential target of zinc. Zinc treatment did not alter A20 levels in the short term, but resulted in the degradation of RIP1, an important upstream activator of IKK. TRAF6 protein levels were unaffected. To determine the application for zinc as a therapeutic for asthma, we administered zinc following the establishment of allergic airway inflammation in a murine model. Zinc supplementation decreased airway hyperresponsiveness

  16. Ultrasound of the airway

    Directory of Open Access Journals (Sweden)

    Pankaj Kundra

    2011-01-01

    Full Text Available Currently, the role of ultrasound (US in anaesthesia-related airway assessment and procedural interventions is encouraging, though it is still ill defined. US can visualise anatomical structures in the supraglottic, glottic and subglottic regions. The floor of the mouth can be visualised by both transcutaneous view of the neck and also by transoral or sublinguial views. However, imaging the epiglottis can be challenging as it is suspended in air. US may detect signs suggestive of difficult intubation, but the data are limited. Other possible applications in airway management include confirmation of correct endotracheal tube placement, prediction of post-extubation stridor, evaluation of soft tissue masses in the neck prior to intubation, assessment of subglottic diameter for determination of paediatric endotracheal tube size and percutaneous dilatational tracheostomy. With development of better probes, high-resolution imaging, real-time picture and clinical experience, US has become the potential first-line noninvasive airway assessment tool in anaesthesia and intensive care practice.

  17. Ion transport in epithelial spheroids derived from human airway cells

    DEFF Research Database (Denmark)

    Pedersen, P S; Frederiksen, O; Holstein-Rathlou, N H

    1999-01-01

    In the present study, we describe a novel three-dimensional airway epithelial explant preparation and demonstrate its use for ion transport studies by electrophysiological technique. Suspension cultures of sheets of epithelial cells released by protease treatment from cystic fibrosis (CF) and non...

  18. 持续气道正压通气治疗重度阻塞型睡眠呼吸暂停综合征的探讨%Prediction of the Level of Continuous Positive Airway Pressure in the Managemert of Severe Obstrutive Sleep Apnea Syndrome

    Institute of Scientific and Technical Information of China (English)

    周建群; 郭兮恒; 胥振扬; 刘莉

    2002-01-01

    Objective To evaluate the effect of continuous positive airway pressure (CPAP) on the management ofsevere of obstructive sleep hypoxemia. Methods 25 patients with severe OSAS were enrolled in the study, the respiratorydisturbance index (RDI),the percentage of time spent at SaO2 below 90% (TS90),deoxygenation index (DOI) of both beforeand after the CPAP treatment. The actual level of CPAP (Pm) were calculated. Results RDI, TS90, DOI were improvedsignificantly after CPAP treatment, there was a close positive linear correlation between DOI and Pm. Conclusions It wassuggested that CPAP has a good effect on severe OSAS, DOI maybe valuable in predicting Pm in the management of severeOSAS.

  19. Anticholinergic treatment in airways diseases.

    LENUS (Irish Health Repository)

    Flynn, Robert A

    2009-10-01

    The prevalence of chronic airways diseases such as chronic obstructive pulmonary disease and asthma is increasing. They lead to symptoms such as a cough and shortness of breath, partially through bronchoconstriction. Inhaled anticholinergics are one of a number of treatments designed to treat bronchoconstriction in airways disease. Both short-acting and long-acting agents are now available and this review highlights their efficacy and adverse event profile in chronic airways diseases.

  20. Analysis of Releasing Curve for High Pressure Chamber%高压容腔卸压曲线的研究

    Institute of Scientific and Technical Information of China (English)

    任晓剑; 武晓凤; 姚平喜; 张晓俊

    2013-01-01

    提出了使油液以无冲击、振动和气蚀的最大动量变化量排出高压容腔的卸压思想。通过理论分析与公式推导,得到了卸压过程中高压容腔压力、卸压阀开口面积、卸压时间三者之间的关系。基于负载敏感原理,对卸压阀阀芯结构进行了初步设计,分析表明:此阀口可满足快速、无冲击卸压的要求。%A pressure relief method was proposed with which the high pressure fluid was discharged with maximum momentum variable quantity in less impact,less vibration and non-cavitation. By theoretical analysis and formula derivation,the relationships a-mong the pressure of chamber,the throttle area of pressure relief valve,the pressure relief time were obtained. Based on the load-sens-ing theory,the structure of pressure relief valve core was preliminarily designed. The result shows that the valve port can meet the pres-sure relief requirement of rapid,non-impact.

  1. The autocrine role of tryptase in pressure overload-induced mast cell activation, chymase release and cardiac fibrosis

    Directory of Open Access Journals (Sweden)

    Jianping Li

    2016-03-01

    Results and conclusion: The results indicate the presence of PAR-2 on MCs and that tryptase inhibition and nedocromil prevented TAC-induced fibrosis and increases in MC density, activation, and chymase release. Tryptase also significantly increased chymase concentration in ventricular slice culture media, which was prevented by the tryptase inhibitor. Hydroxyproline concentration in culture media was significantly increased with tryptase incubation as compared to the control group and the tryptase group incubated with nafamostat mesilate or chymostatin. We conclude that tryptase contributes to TAC-induced cardiac fibrosis primarily via activation of MCs and the amplified release of chymase.

  2. Pharmacology of airway smooth muscle proliferation

    NARCIS (Netherlands)

    Gosens, Reinoud; Roscioni, Sara S.; Dekkers, Bart G. J.; Pera, Tonio; Schmidt, Martina; Schaafsma, Dedmer; Zaagsma, Johan; Meurs, Herman

    2008-01-01

    Airway smooth muscle thickening is a pathological feature that contributes significantly to airflow limitation and airway hyperresponsiveness in asthma. Ongoing research efforts aimed at identifying the mechanisms responsible for the increased airway smooth muscle mass have indicated that hyperplasi

  3. Cholinergic regulation of airway inflammation and remodelling

    NARCIS (Netherlands)

    Kolahian, Saeed; Gosens, Reinoud

    2012-01-01

    Acetylcholine is the predominant parasympathetic neurotransmitter in the airways that regulates bronchoconstriction and mucus secretion. Recent findings suggest that acetylcholine regulates additional functions in the airways, including inflammation and remodelling during inflammatory airway disease

  4. The Effects of a Chactoid Scorpion Venom and Its Purified Toxins on Rat Blood Pressure and Mast Cells Histamine Release

    OpenAIRE

    2013-01-01

    The effect of the venom of the Chactoid family of scorpions on blood pressure was scantly investigated and was addressed in the present study using the venom of the Israeli scorpion, Scorpio maurus palmatus. Blood pressure in rats was monitored via cannulated femoral artery, while venom and toxins were introduced into femoral vein. Venom injection elicited a biphasic effect, expressed first by a fast and transient hypotensive response, which lasted up to 10 min, followed by a hypertensive res...

  5. 双水平呼吸道正压通气治疗重叠综合征的临床效果观察%Clinical observation of Bi-level positive airway pressure ventilation therapy treating overlap syndrome

    Institute of Scientific and Technical Information of China (English)

    刘晓丽; 刘芳勋; 张华; 刘芳; 牛志红; 黄秀清; 蒋延文

    2016-01-01

    Objective To discuss the therapeutic effect of Bi-Level positive airway pressure (Bi-PAP) ventilation therapy treating overlap syndrome.Methods Fifty patients with chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea hypopnea syndrome(OSAHS) from August 2013 to December 2014 in Beijing Shijitan Hospital,Capital Medical University were collected;according to the random number table method,all patients were divided into observation group and control group(25 cases in each group).The observation group was treated by Bi-PAP for 72 h and the control group was treated by continuous positive airway pressure (CPAP) for 72 h.pH value,arterial partial pressure of oxygen (PaO2),arterial partial pressure of carbon dioxide (PaCO2),arterial oxygen saturation (SaO2),serum C reactive protein (CRP) and tumor necrosis factor-α (TNF-α) levels before and after treatment in two groups were compared.After treatment,the apnea hypopnea index (AHI),the longest apnea duration,forced expiratory volume in one second (FEV1) and forced vital capacity(FVC) in two groups were compared.Results The pH value,PaO2,PaCO2,SaO2 had no statistical difference in two groups before treatment(P >0.05).After treatment,the pH value,PaO2 and SaO2 were significantly higher in observation group than those in control group;PaCO2 was significantly lower[(7.41 ±0.05) vs (7.31 ±0.04),(90 ±5)mmHg vs (76 ± 7) mmHg,(98.3 ± 1.2) % vs (95.7 ± 1.6) %,(45 ± 6) mmHg vs (57 ± 8) mmHg,P < 0.05].Serum CRP and TNF-α levels did not show significant difference before treatment in 2 groups(P >0.05);after treatment,those in the observation group were significantly lower than those of the control group[(4.9 ± 1.2) mg/L vs (7.6 ±1.1) mg/L,(44 ± 8) ng/L vs (53 ± 6) ng/L,P < 0.05].Mter treatment,the AHI and the longest apnea duration in observation group were significantly lower than those of the control group[(7.2 ±2.9) vs (15.6 ±3.2),(10 ±4)s vs (16 ±5)s,P <0.05].After treatment

  6. A mechanical design principle for tissue structure and function in the airway tree.

    Science.gov (United States)

    LaPrad, Adam S; Lutchen, Kenneth R; Suki, Béla

    2013-01-01

    With every breath, the dynamically changing mechanical pressures must work in unison with the cells and soft tissue structures of the lung to permit air to efficiently traverse the airway tree and undergo gas exchange in the alveoli. The influence of mechanics on cell and tissue function is becoming apparent, raising the question: how does the airway tree co-exist within its mechanical environment to maintain normal cell function throughout its branching structure of diminishing dimensions? We introduce a new mechanical design principle for the conducting airway tree in which mechanotransduction at the level of cells is driven to orchestrate airway wall structural changes that can best maintain a preferred mechanical microenvironment. To support this principle, we report in vitro radius-transmural pressure relations for a range of airway radii obtained from healthy bovine lungs and model the data using a strain energy function together with a thick-walled cylinder description. From this framework, we estimate circumferential stresses and incremental Young's moduli throughout the airway tree. Our results indicate that the conducting airways consistently operate within a preferred mechanical homeostatic state, termed mechanical homeostasis, that is characterized by a narrow range of circumferential stresses and Young's moduli. This mechanical homeostatic state is maintained for all airways throughout the tree via airway wall dimensional and mechanical relationships. As a consequence, cells within the airway walls throughout the airway tree experience similar oscillatory strains during breathing that are much smaller than previously thought. Finally, we discuss the potential implications of how the maintenance of mechanical homeostasis, while facilitating healthy tissue-level alterations necessary for maturation, may lead to airway wall structural changes capable of chronic asthma.

  7. Transient receptor potential ankyrin 1 channel localized to non-neuronal airway cells promotes non-neurogenic inflammation.

    Directory of Open Access Journals (Sweden)

    Romina Nassini

    Full Text Available BACKGROUND: The transient receptor potential ankyrin 1 (TRPA1 channel, localized to airway sensory nerves, has been proposed to mediate airway inflammation evoked by allergen and cigarette smoke (CS in rodents, via a neurogenic mechanism. However the limited clinical evidence for the role of neurogenic inflammation in asthma or chronic obstructive pulmonary disease raises an alternative possibility that airway inflammation is promoted by non-neuronal TRPA1. METHODOLOGY/PRINCIPAL FINDINGS: By using Real-Time PCR and calcium imaging, we found that cultured human airway cells, including fibroblasts, epithelial and smooth muscle cells express functional TRPA1 channels. By using immunohistochemistry, TRPA1 staining was observed in airway epithelial and smooth muscle cells in sections taken from human airways and lung, and from airways and lung of wild-type, but not TRPA1-deficient mice. In cultured human airway epithelial and smooth muscle cells and fibroblasts, acrolein and CS extract evoked IL-8 release, a response selectively reduced by TRPA1 antagonists. Capsaicin, agonist of the transient receptor potential vanilloid 1 (TRPV1, a channel co-expressed with TRPA1 by airway sensory nerves, and acrolein or CS (TRPA1 agonists, or the neuropeptide substance P (SP, which is released from sensory nerve terminals by capsaicin, acrolein or CS, produced neurogenic inflammation in mouse airways. However, only acrolein and CS, but not capsaicin or SP, released the keratinocyte chemoattractant (CXCL-1/KC, IL-8 analogue in bronchoalveolar lavage (BAL fluid of wild-type mice. This effect of TRPA1 agonists was attenuated by TRPA1 antagonism or in TRPA1-deficient mice, but not by pharmacological ablation of sensory nerves. CONCLUSIONS: Our results demonstrate that, although either TRPV1 or TRPA1 activation causes airway neurogenic inflammation, solely TRPA1 activation orchestrates an additional inflammatory response which is not neurogenic. This finding suggests

  8. 改良Proseal喉罩与改良普通喉罩在无痛纤维支气管镜检查中的气道管理%Comparison of modified Proseal laryngeal mask and three-way laryngeal mask airway for painless fiberoptic bronchoscopy in airway management in effect

    Institute of Scientific and Technical Information of China (English)

    王绍林; 张进; 张鹏; 殷骏; 俞蕾; 何磊; 程庆余; 刘小彬

    2012-01-01

    Objective To compare the effects of airway management with modified Proseal laryngeal mask airway and modified laryngeal mask airway in painless fiberoptic bronchoscopy. Methods Forty patients who scheduled for painless fiheroptic bronechscopy were randomly divided into two groups (n = 20): Modified Proseal laryngeal mask airway group (group P) and modified laryngeal mask airway group (group L). After induction of general anesthesia were inserted with hands. BP, HR and SpO2 were measured respectively before anesthesia laryngeal mask airway (To), immediately after inserting laryngeal mask airway (T1 ) and 3 min (T2). The laryngeal mask airway insertion time, complications, the ventilated assessment, fiberoptic bronchoscopy assessed and airway sealing pressure were also simultaneously recorded. Results There was no significant difference in laryngeal mask airway insertion time, BP. HR and SpO2 at each point Airway sealing pressure in group P was significantly higher than that in group L (P<0. 01). The excellent rates of ventilated assessment and fiberoptic bronchoscopy scores were both 100% in group P, and were much higher than those in group L (85%, 80% respectively F<0. 01). Blood staining in group P was less than that in group L (1 vs. 7 cases, respectively P<0. 05). Conclusion The modified Proseal laryngeal mask is better than modified laryngeal mask airway at the aspects of gas-tightness, assessment of ventilation and fiberoptic bronchoscopy. but no effects on hemodynamics in two groups.Objective To compare the effects of airway management with modified Proseal laryngeal mask airway and modified laryngeal mask airway in painless fiberoptic bronchoscopy. Methods Forty patients who scheduled for painless fiheroptic bronechscopy were randomly divided into two groups (n = 20): Modified Proseal laryngeal mask airway group (group P) and modified laryngeal mask airway group (group L). After induction of general anesthesia were inserted with hands. BP, HR and SpO2 were

  9. Clinical value of upper airway pressure measurement and Friedman staging system in preoperative evaluation for obstructive sleep apnea hypopnea syndrome%上气道测压与Friedman分型在上气道阻塞平面判断中的相关性研究

    Institute of Scientific and Technical Information of China (English)

    田旭; 李五一; 霍红; 余蓉; 王剑

    2011-01-01

    Objective To evaluate the clinical value of localization of upper airway obstructive site with pressure measurements and Friedman staging system in preoperative upper airway reconstructive surgery for obstructive sleep apnea-hypopnea syndrome (OSAHS), and to evaluate the value of Friedman staging system in predicting the upper airway obstructive site. Methods One hundred and three patients with snoring, daytime sleepiness diagnosed as OSAHS by polysomnography were first classified using Friedman staging system, and then examined using whole night recording, including airway continuous pressure measurements (Apnea Graph, AG). AG transducer catheter containing two pressure and two temperature sensors used for obstruction site determination and detection of apnea events during sleep. Obstructive sites were divided into upper (retropalatal region) or lower level (retroglossal region). Using constituent ratio to reflect the obstructive proportion of different levels so as to find the correlation between Friedman staging system and localization of upper airway obstructive site with pressure measurements performed during sleep,and to evaluate the clinical value of Friedman staging system in predicting the severity of OSAHS. Results There was statistically significant difference in the constituent ratio of retroglossal obstruction determined by AG, according to Friedman staging system, Friedman tongue position (FTP) and tonsil size grading ( F =13. 876, 7. 655,10. 207 respectively, P <0. 05 ). The constituent ratio of retroglossal obstruction between stage Ⅳ and Ⅰ , Ⅱ, Ⅲ(P<0.01) was significantly different. With the increasing of Friedman staging,the constituent ratio of retroglossal obstruction had the tendency of increasing. The constituent ratio of retroglossal obstruction between FTP grade 2 and grade 3, grade 4 ( P < 0. 05 ) was significantly different.With the increasing of FTP grading, the constituent ratio of retroglossal obstruction had the tendency

  10. Role of laryngeal mask airway in laparoscopic cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    José; M; Bele?a; Ernesto; Josué; Ochoa; Mónica; Nú?ez; Carlos; Gilsanz; Alfonso; Vidal

    2015-01-01

    Laparoscopic cholecystectomy is one of the most commonly performed surgical procedures and the laryngeal mask airway(LMA) is the most common supraglottic airway device used by the anesthesiologists to manage airway during general anesthesia. Use of LMA has some advantages when compared to endotracheal intubation, such as quick and ease of placement, a lesser requirement for neuromuscular blockade and a lower incidence of postoperative morbididy. However, the use of the LMA in laparoscopy is controversial, based on a concern about increased risk of regurgitation and pulmonary aspiration. The ability of these devices to provide optimal ventilation during laparoscopic procedures has been also questioned. The most important parameter to secure an adequate ventilation and oxygenation for the LMA under pneumoperitoneum condition is its seal pressure of airway. A good sealing pressure, not only state correct patient ventilation, but it reduces the potential risk of aspiration due to the better seal of airway. In addition, the LMAs incorporating a gastric access, permitting a safe anesthesia based on these commented points. We did a literature search to clarify if the use of LMA in preference to intubation provides inadequate ventilation or increase the risk of aspiration in patients undergoing laparoscopic cholecystectomy. We found evidence stating that LMA with drain channel achieves adequate ventilation for these procedures. Limited evidence was found to consider these devices completely safe against aspiration. However, we observed that the incidence of regurgitation and aspiration associated with the use of the LMA in laparoscopic surgery is very low.

  11. Airway obstruction and gas leak during mask ventilation of preterm infants in the delivery room.

    LENUS (Irish Health Repository)

    2011-07-01

    Preterm infants with inadequate breathing receive positive pressure ventilation (PPV) by mask with variable success. The authors examined recordings of PPV given to preterm infants in the delivery room for prevalence of mask leak and airway obstruction.

  12. A sensory neuronal ion channel essential for airway inflammation and hyperreactivity in asthma.

    Science.gov (United States)

    Caceres, Ana I; Brackmann, Marian; Elia, Maxwell D; Bessac, Bret F; del Camino, Donato; D'Amours, Marc; Witek, JoAnn S; Fanger, Chistopher M; Chong, Jayhong A; Hayward, Neil J; Homer, Robert J; Cohn, Lauren; Huang, Xiaozhu; Moran, Magdalene M; Jordt, Sven-Eric

    2009-06-02

    Asthma is an inflammatory disorder caused by airway exposures to allergens and chemical irritants. Studies focusing on immune, smooth muscle, and airway epithelial function revealed many aspects of the disease mechanism of asthma. However, the limited efficacies of immune-directed therapies suggest the involvement of additional mechanisms in asthmatic airway inflammation. TRPA1 is an irritant-sensing ion channel expressed in airway chemosensory nerves. TRPA1-activating stimuli such as cigarette smoke, chlorine, aldehydes, and scents are among the most prevalent triggers of asthma. Endogenous TRPA1 agonists, including reactive oxygen species and lipid peroxidation products, are potent drivers of allergen-induced airway inflammation in asthma. Here, we examined the role of TRPA1 in allergic asthma in the murine ovalbumin model. Strikingly, genetic ablation of TRPA1 inhibited allergen-induced leukocyte infiltration in the airways, reduced cytokine and mucus production, and almost completely abolished airway hyperreactivity to contractile stimuli. This phenotype is recapitulated by treatment of wild-type mice with HC-030031, a TRPA1 antagonist. HC-030031, when administered during airway allergen challenge, inhibited eosinophil infiltration and prevented the development of airway hyperreactivity. Trpa1(-/-) mice displayed deficiencies in chemically and allergen-induced neuropeptide release in the airways, providing a potential explanation for the impaired inflammatory response. Our data suggest that TRPA1 is a key integrator of interactions between the immune and nervous systems in the airways, driving asthmatic airway inflammation following inhaled allergen challenge. TRPA1 may represent a promising pharmacological target for the treatment of asthma and other allergic inflammatory conditions.

  13. Effects of metoclopramide and metoclopramide/dopamine on blood pressure and insulin release in normotensive, hypertensive, and type 2 diabetic subjects.

    Science.gov (United States)

    Contreras, Freddy; Fouillioux, Christian; Lares, Mary; Bolívar, Hector; Hernández, Rafael Hernández; Velasco, Manuel; Cano, Raquel; Chacin, Maricarmen; Bermúdez, Valmore

    2010-01-01

    The objective is to determine cardiovascular and insulin release effects under metoclopramide (MTC) and dopamine (DA) infusion by using an acute comparative design with the intravenous infusion of both drugs. We evaluated 15 normal (normotensive and normoglycemic) subjects, 13 hypertensive, and 15 type 2 diabetic subjects. Subjects were submitted to an experimental design in which we first gave them a 0.9% saline solution for 30 minutes, and then administered MTC at 7.5 microg kg min through an intravenous infusion during a period of 30 minutes. Although subjects were receiving MTC, we added an intravenous infusion of DA at 1-3 microg kg min during 30 minutes. Blood pressure, heart rate, serum lipid profile, and insulin levels were measured. Sympathetic reactivity by the cold pressor test was also measured. In normotensive subjects, there was a systolic blood pressure and heart rate increase during MTC plus DA infusion. In subjects with diabetes mellitus there was a heart rate increase without changes in blood pressure during the MTC plus DA infusion period. In hypertensive subjects, MTC induced a significant decrease of systolic and diastolic blood pressure. During MTC plus DA period there was an increase of heart rate but no significant changes in blood pressure. During cold pressor test in both diabetic and hypertensive subjects, there were significant increases of both blood pressure and heart rate. Insulin serum levels increased in normotensive and hypertensive subjects but were attenuated in subjects with diabetes mellitus. We conclude that there is a pharmacologic interaction between MTC and DA, that the pressor effects of DA are due to activation to beta and alpha adrenergic receptors, and that the cardiovascular effects of DA in type 2 diabetic subjects are attenuated by a probable defect in sympathetic system and to endothelial dysfunction.

  14. 经鼻持续气道正压给氧多中心临床试验研究%A multi-center clinical trial of oxygen administration with nasal continuous positive airway pressure

    Institute of Scientific and Technical Information of China (English)

    持续气道正压给氧临床试验协作组

    2008-01-01

    目的 评价经鼻持续气道正压(CPAP)给氧的效果.方法 2003年1月至2007年12月首都儿科研究所(牵头)和北京市9家郊区县医院对107例因肺部疾患导致低氧血症新生儿和婴幼儿进行多中心临床试验,通过脉搏血氧仪并结合临床观察对国产的CPAP氧疗仪和普通给氧方法 (面罩、头罩)在改善血氧饱和度的效果方面进行评价.结果 CPAP治疗组46例,普通给氧组61例.应用CPAP后新生儿组在给氧后0.5 h及2 h血氧饱和度为(88.6±7.9)%及(94.4±5.0)%,普通给氧组为(82.4±5.7)%及(90.3±4.5)%,两组间差异有显著性(P<0.05).婴幼儿组在CPAP给氧后1 h血氧饱和度为(95.7±2.6)%,普通给氧组为(87.3±15.8)%,两组间差异有显著性(P<0.05).给氧后紫绀和呼吸困难程度的改善,CPAP组优于普通给氧组.结论 经鼻CPAP氧疗仪是适用于基层、安全、有效、效果优于普通给氧方法 的给氧工具.%Objective To evaluate the effect of nasal continuous positive airway pressure (CPAP).Methods A randomized controlled multi-center clinical trial was conducted during January 2003 to December 2007 in 107 newborns and infants with hypoxemia due to pulmonary diseases.These patients were hospitalized in Capital Institute of Pediatrics and 9 local hospitals.The changes of arterial oxygen saturation and clinical signs were studied after CPAP treatment and conventional oxygen therapy.Results CPAP group recruited 46 cases,conventional oxygen therapy group included 61 cases.After CPAP treatment,oxygen saturation values in newborns at 0.5 and 2 hour were (88.6±7.9)% and (94.4±5.0)%,and there was significant difference as compared with those in conventional oxygen therapy group [(82.4±5.7)% and (90.3±4.5)%].Oxygen saturation value of infants with CPAP at 1 hour was (95.7±2.6)%,and there was significant difference as compared with that in conventional oxygen therapy group[(87.3±15.8)%].Oxygen therapy alleviated the severity of cyanosis and dyspnea

  15. Hemodynamic responses and upper airway morbidity following tracheal intubation in patients with hypertension: conventional laryngoscopy versus an intubating laryngeal mask airway

    Directory of Open Access Journals (Sweden)

    Elif Bengi Sener

    2012-01-01

    Full Text Available OBJECTIVES: We compared hemodynamic responses and upper airway morbidity following tracheal intubation via conventional laryngoscopy or intubating laryngeal mask airway in hypertensive patients. METHODS: Forty-two hypertensive patients received a conventional laryngoscopy or were intubated with a intubating laryngeal mask airway. Anesthesia was induced with propofol, fentanyl, and cis-atracurium. Measurements of systolic and diastolic blood pressures, heart rate, rate pressure product, and ST segment changes were made at baseline, preintubation, and every minute for the first 5 min following intubation. The number of intubation attempts, the duration of intubation, and airway complications were recorded. RESULTS: The intubation time was shorter in the conventional laryngoscopy group than in the intubating laryngeal mask airway group (16.33 ± 10.8 vs. 43.04±19.8 s, respectively (p<0.001. The systolic and diastolic blood pressures in the intubating laryngeal mask airway group were higher than those in the conventional laryngoscopy group at 1 and 2 min following intubation (p<0.05. The rate pressure product values (heart rate x systolic blood pressure at 1 and 2 min following intubation in the intubating laryngeal mask airway group (15970.90 ± 3750 and 13936.76 ± 2729, respectively were higher than those in the conventional laryngoscopy group (13237.61 ± 3413 and 11937.52 ± 3160, respectively (p<0.05. There were no differences in ST depression or elevation between the groups. The maximum ST changes compared with baseline values were not significant between the groups (conventional laryngoscopy group: 0.328 mm versus intubating laryngeal mask airway group: 0.357 mm; p = 0.754. The number and type of airway complications were similar between the groups. CONCLUSION: The intense and repeated oropharyngeal and tracheal stimulation resulting from intubating laryngeal mask airway induces greater pressor responses than does stimulation resulting from

  16. Neuropeptides control the dynamic behavior of airway mucosal dendritic cells.

    Science.gov (United States)

    Voedisch, Sabrina; Rochlitzer, Sabine; Veres, Tibor Z; Spies, Emma; Braun, Armin

    2012-01-01

    The airway mucosal epithelium is permanently exposed to airborne particles. A network of immune cells patrols at this interface to the environment. The interplay of immune cells is orchestrated by different mediators. In the current study we investigated the impact of neuronal signals on key functions of dendritic cells (DC). Using two-photon microscopic time-lapse analysis of living lung sections from CD11c-EYFP transgenic mice we studied the influence of neuropeptides on airway DC motility. Additionally, using a confocal microscopic approach, the phagocytotic capacity of CD11c(+) cells after neuropeptide stimulation was determined. Electrical field stimulation (EFS) leads to an unspecific release of neuropeptides from nerves. After EFS and treatment with the neuropeptides vasoactive intestinal peptide (VIP) or calcitonin gene-related peptide (CGRP), airway DC in living lung slices showed an altered motility. Furthermore, the EFS-mediated effect could partially be blocked by pre-treatment with the receptor antagonist CGRP(8-37). Additionally, the phagocytotic capacity of bone marrow-derived and whole lung CD11c(+) cells could be inhibited by neuropeptides CGRP, VIP, and Substance P. We then cross-linked these data with the in vivo situation by analyzing DC motility in two different OVA asthma models. Both in the acute and prolonged OVA asthma model altered neuropeptide amounts and DC motility in the airways could be measured. In summary, our data suggest that neuropeptides modulate key features motility and phagocytosis of mouse airway DC. Therefore altered neuropeptide levels in airways during allergic inflammation have impact on regulation of airway immune mechanisms and therefore might contribute to the pathophysiology of asthma.

  17. Influence of Nasal Continues Positive Airway Pressure on Retention of Carbon Dioxide in Newborn%新生儿经鼻持续气管正压通气对二氧化碳潴留的影响

    Institute of Scientific and Technical Information of China (English)

    吴玫; 陈大鹏; 熊英; 陈超

    2012-01-01

    Objective To investigate the influence of nasal continues positive airway pressure (nCPAP) on retention of carbon dioxide(CO2) in newborns.Methods From June to December 2009,a total of 46 newborns who had nCPAP treatment for 72 hours in West China Second University Hospital,Sichuan University were included in nCPAP group.Meanwhile,another 20 cases of neonates with jaundice were selected as control group.The artery blood gas was detected by STEPHAN CPCP-B just before nCPAP treatment and at 30 min,6 h,12 h,24 h,36 h after nCPAP treatment in nCPAP group.The same method determined the artery blood gas in control group.The blood gas analysis results between nCPAP group before nCPAP treatment and control group,and between nCPAP group at different time slots and control group were analyzed by statistical methods.The procedure of this study was consistent with ethical standard which was established by the committee of investigation in human beings of West China Second University Hospital,Sichuan University.And it was approved by this committee.Guardians were informed of grouping and their written informed consent was obtained before clinical studies.There had no significance differences between two groups among gestational age at delivery,day age,and gender (P>0.05).Results There had significant difference between nCPAP group before nCPAP treatment and control group in pH value and partial pressure of oxygen in artery (Pao2) (P<0.01),but partial pressure of CO2 in artery (PaCO2 ),levels of ( HCO3ˉ ),standard bicarbonate (SB) and base excess (BE) had no significant difference (P>0.05).The blood gas results of nCPAP group at different treatment time slots and control group showed that even using nCPAP in newborns with normal Paco2 for 72 h,there were no signs of retention of CO2 (P>0.05).Conclusions Using nCPAP in newborn with normal PaCO2 for 72 h may not cause serous retention of CO2.%目的 探讨新生儿使用经鼻持续气管正压通气(nCPAP)前

  18. Using optical coherence tomography (OCT) imaging in the evaluation of airway dynamics (Conference Presentation)

    Science.gov (United States)

    Szabari, Margit V.; Kelly, Vanessa J.; Applegate, Matthew B.; Chee, Chunmin; Tan, Khay M.; Hariri, Lida P.; Harris, R. Scott; Winkler, Tilo; Suter, Melissa J.

    2016-03-01

    Asthma is a chronic disease resulting in periodic attacks of coughing and wheezing due to temporarily constricted and clogged airways. The pathophysiology of asthma and the process of airway narrowing are not completely understood. Appropriate in vivo imaging modality with sufficient spatial and temporal resolution to dynamically assess the behavior of airways is missing. Optical coherence tomography (OCT) enables real-time evaluation of the airways during dynamic and static breathing maneuvers. Our aim was to visualize the structure and function of airways in healthy and Methacholine (MCh) challenged lung. Sheep (n=3) were anesthetized, mechanically ventilated and imaged with OCT in 4 dependent and 4 independent airways both pre- and post-MCh administration. The OCT system employed a 2.4 Fr (0.8 mm diameter) catheter and acquired circumferential cross-sectional images in excess of 100 frames per second during dynamic tidal breathing, 20 second static breath-holds at end-inspiration and expiration pressure, and in a response to a single deep inhalation. Markedly different airway behavior was found in dependent versus non-dependent airway segments before and after MCh injection. OCT is a non-ionizing light-based imaging modality, which may provide valuable insight into the complex dynamic behavior of airway structure and function in the normal and asthmatic lung.

  19. Potential role of the airway wall in the asthma of obesity.

    Science.gov (United States)

    Bates, Jason H T; Dixon, Anne E

    2015-01-01

    The pathogenesis of late-onset TH2-low asthma in obesity is thought to be related to weight-related decreases in lung volume, but why only a subset of individuals with obesity develop this condition is unknown. We tested the hypothesis that natural variations in both airway wall stiffness and airway wall thickness could lead to a subpopulation of hyperresponsive individuals exhibiting the symptoms of asthma in the setting of obesity. Increases in airway resistance (Raw) after airway smooth muscle stimulation were simulated using a computational model of an elastic airway embedded in elastic parenchyma. Using a range of randomly chosen values for both airway wall stiffness and thickness, we determined the resulting probability distributions of Raw responsiveness for a variety of different levels of transpulmonary pressure (Ptp). As Ptp decreased from 5 to 1 cmH2O, the resulting distributions of Raw moved toward progressively higher levels of responsiveness. With appropriate choices for the mean and standard deviation of the parameter that controls either airway wall stiffness or thickness, the model predicts a relationship between airway hyperresponsiveness and body mass index that is similar to that which has been reported in populations with obesity. We conclude that natural variations in airway wall mechanics and geometry between different individuals can potentially explain why an increasing percentage of the population exhibits the symptoms of asthma as the obesity of the population increases.

  20. Influence of the adenosine A1 receptor on blood pressure regulation and renin release

    DEFF Research Database (Denmark)

    Brown, Russell D.; Thorén, Peter; Steege, Andreas

    2006-01-01

    The present study was performed to investigate the role of adenosine A1 receptors in regulating blood pressure in conscious mice. Adenosine A1-receptor knockout (A1R-/-) mice and their wild-type (A1R+/+) littermates were placed on standardized normal-salt (NS), high-salt (HS), or salt-deficient (SD......) diets for a minimum of 10 days before telemetric blood pressure and urinary excretion measurements in metabolic cages. On the NS diet, daytime and nighttime mean arterial blood pressure (MAP) was 7-10 mmHg higher in A1R-/- than in A1R+/+ mice. HS diet did not affect the MAP in A1R-/- mice......, but the daytime and nighttime MAP of the A1R+/+ mice increased by approximately 10 mmHg, to the same level as that in the A1R-/-. On the SD diet, day- and nighttime MAP decreased by approximately 6 mmHg in both A1R-/- and A1R+/+ mice, although the MAP remained higher in A1R-/- than in A1R+/+ mice. Although plasma...

  1. Prognostic Effects of Obstructive Sleep Apnea Treated with Continuous Positive Airway Pressure or Upper Airway Surgery on Coronary Heart Disease: A Systematic Review%持续气道正压通气或上呼吸道手术治疗对合并阻塞性睡眠呼吸暂停冠心病患者预后影响的系统评价

    Institute of Scientific and Technical Information of China (English)

    王少丽; 史大卓; 王承龙

    2012-01-01

    Objective To evaluate prognostic impact of treatment with Continuous Positive Airway Pressure (CPAP) or upper airway surgery on the patients with obstructive sleep apnea (OSA) and coronary heart disease (CHD). Methods Database search in The Cochrane Library, PubMed, OVID and CBM (from establishment dates to October 2009) were conducted. Cohort studies and randomized controlled trials of OSA with CPAP or upper airway surgery in CHD patients were identified. We assessed the quality of the included trials and extracted the relevant data. Statistical analysis was performed using RevMan 4.3.2 software. Results A total of 4 cohort studies involving 945 participants were included. The results of meta-analysis were as follows: a) there were no significant differences in the rate of late lumen loss and 10-year mortality between CHD patients with OSA treated by CPAP and those without OSA (RR=1.84, 95%CI 0.73 to 4.68, P=0.20; RR=0.80, 95%CI 0.24 to 2.64, P=0.71). b) CPAP or uvulopalatopharyngoplasty used in the treatment of OSA on CHD patients after PCI had a significant decrease in the rate of 5-year cardiac death when compared with those untreated OSA patients (RR=0.34, 95%CI 0.14 to 0.82, P=0.02). But there were no differences in the rate of 5-year all-cause mortality, major adverse cardiac events (MACE) between the two groups respectively (RR=0.66,95%CI 0.39 to 1.10, P=0.11; RR=0.97, 95%CI 0.81 to 1.15, P=0.69). c) CPAP or upper airway surgery in treating OSA significantly reduced the risk of MACE occurrence during the 86.5±39 months follow-up period (RR=0.22, 95%CI 0.07 to 0.72, P=0.01). Conclusion Current evidence indicates that treating OSA with CPAP or upper airway surgery in CHD patients might be associ-ated with a decrease in the risk of cardiac death. But more studies are necessary to evaluate prognostic impact of treatment with CPAP or upper airway surgery on the patients with OSA and CHD. However, due to the limited quantity and quality of the included studies

  2. 无创双水平气道正压通气治疗不同病因致急性呼吸衰竭的临床观察%The Clinical Observation of Noninvasive Bilevel Positive Airway Pressure Ventilation on Acute Respiratory Failure Caused by Different Etiology

    Institute of Scientific and Technical Information of China (English)

    温振杰; 陈军; 刘建凌

    2014-01-01

    目的:探讨无创双水平气道正压通气治疗不同病因致急性呼吸衰竭临床效果。方法选择急性呼吸衰竭患者共48例,根据不同病因分为观察组(心源性肺水肿)和对照组(重症肺炎)。两组均实施无创双水平气道正压通气治疗。观察两组治疗效果。结果观察组治疗后的动脉血气指标分别和对照组治疗6 h后的动脉血气指标比较,差异有统计学意义(P<0.05)。观察组患者症状缓解时间、无创双水平正压通气治疗时间、住院时间、气管插管发生分别和对照组比较,差异有统计学意义(P<0.05)。结论无创双水平气道正压通气对心源性肺水肿和重症肺炎所致急性呼吸衰竭均有显著治疗效果,但对心源性肺水肿所致急性呼吸衰竭效果更佳。%Objective To explore the effect of noninvasive bilevel positive airway pressure ventilation on acute respiratory failure caused by different etiology. Methods 48 cases with acute respiratory failure were divided into observation group (cardiogenic pulmonary edema) and control group (severe pneumonia) according to different causes. The two groups underwent noninvasive bilevel positive airway pressure ventilation. The therapeutic effect of two groups was observed . Results The arterial blood gas indexes in the observation group compared with those in control group after six hours treatment respectively,the difference was statistically significant (P<0.05).The symptoms time, noninvasive bilevel positive pressure ventilation time, hospitalization time, tracheal intubation occurred in the observation group compared with those in control group after treatment respectively, the difference was statistically significant (P<0.05).Conclusion The noninvasive bilevel positive airway pressure ventilation on acute respiratory failure caused by acute cardiogenic pulmonary edema or severe pneumonia has significant effect, but its efficacy in patients with

  3. Fuel reactivity and release of pollutants and alkali vapours in pressurized combustion for combined cycle power generation

    Energy Technology Data Exchange (ETDEWEB)

    Aho, M.; Haemaelaeinen, J.; Paakkinen, K.; Rantanen, J. [VTT Energy, Jyvaeskylae (Finland); Hernberg, R.; Haeyrinen, V.; Joutsenoja, T. [Tampere Univ. of Technology (Finland). Lab. of Plasma Technology

    1996-12-01

    This project forms a part of the overall Pressurized Power Coal Combustion Project Area (PPFC) which aims at an assessment of the viability and technical merits of pressurized pulverized coal combustion, in an atmosphere of recycled flue gas and oxygen in a coordinated and harmonized programme. The objective of the research at Technical Research Centre of Finland (VTT) and Tampere University of Technology (TUT) is aimed at determining the consequences of solid fuel burning in a mixture of oxygen and recycled flue gases. Combustion conditions of a pressurized entrained flow of pulverized coal and char particles in PEFR are determined with high precision. The effects of experimental parameters on the formation of nitrogen oxides (N{sub 2}O, NO and NO{sub 2}) and gaseous alkali compounds (indicated as NaX(g) and KX(g)) are studied. An effective on-line analysis method for vaporised Na and K compounds was developed. The dependency between particle temperatures and the vaporisation of Na and K was measured with three coals. The results show that alkali removal before gas turbines is always necessary with these coals if combusted in combined cycles. Pressure decreases the formation of NO and has usually no clear effect on the formation of N{sub 2}O. The order of NO/N{sub 2}O ratios correspond to fuel-O/fuel-N ratios. Increase of PO{sub 2} (oxygen concentration) of combustion gas increases the formation of NO{sub 2}. Remarkable concentrations of NO{sub 2} were often measured at high PO{sub 2} at 800-850 deg C. Therefore, NO{sub 2} should be measured from pressurized fluidized bed reactors. Some trends of the formation of NO{sub 2} with coal differ clearly from those with its parent char: N{sub 2}O formation is not strongly temperature dependent with char, and the concentrations of N{sub 2}O formed from char are much lower than those of coal. PO{sub 2} does not effect on the formation of NO from char in the studied range

  4. [Acute pulmonary edema secondary to acute upper airway obstruction].

    Science.gov (United States)

    Sánchez-Ortega, J L; Carpintero-Moreno, F; Olivares-López, A; Borrás-Rubio, E; Alvarez-López, M J; García-Izquierdo, A

    1992-01-01

    We report a 72 years old woman with mild arterial hypertension and no other pathological history who presented an acute pulmonary edema due to acute obstruction of the upper airway secondary to vocal chord paralysis developing during the immediate postoperative phase of thyroidectomy. The acute pulmonary edema resolved after application of tracheal reintubation, mechanical ventilation controlled with end expiratory positive pressure, diuretics, morphine, and liquid restriction. We discuss the possible etiopathogenic possibilities of this infrequent clinical picture and we suggest that all patients who suffered and acute obstruction of the upper airways require a careful clinical surveillance in order to prevent the development of the pulmonary syndrome.

  5. Upper airway obstruction during midazolam sedation: modification by nasal CPAP.

    Science.gov (United States)

    Nozaki-Taguchi, N; Isono, S; Nishino, T; Numai, T; Taguchi, N

    1995-08-01

    We examined the depressant effect of midazolam on respiration in 21 healthy women undergoing lower abdominal surgery with spinal anaesthesia. Airway gas flow, airway pressure, and the sound of snoring were recorded together with arterial oxygen saturation (SpO2). After spinal anaesthesia was established, subjects were deeply sedated with pentazocine 15 mg followed by incremental doses of midazolam 1 mg i.v. up to 0.1 mg.kg-1. When SpO2 decreased to midazolam sedation for spinal anaesthesia.

  6. Negative-Pressure Pulmonary Edema.

    Science.gov (United States)

    Bhattacharya, Mallar; Kallet, Richard H; Ware, Lorraine B; Matthay, Michael A

    2016-10-01

    Negative-pressure pulmonary edema (NPPE) or postobstructive pulmonary edema is a well-described cause of acute respiratory failure that occurs after intense inspiratory effort against an obstructed airway, usually from upper airway infection, tumor, or laryngospasm. Patients with NPPE generate very negative airway pressures, which augment transvascular fluid filtration and precipitate interstitial and alveolar edema. Pulmonary edema fluid collected from most patients with NPPE has a low protein concentration, suggesting hydrostatic forces as the primary mechanism for the pathogenesis of NPPE. Supportive care should be directed at relieving the upper airway obstruction by endotracheal intubation or cricothyroidotomy, institution of lung-protective positive-pressure ventilation, and diuresis unless the patient is in shock. Resolution of the pulmonary edema is usually rapid, in part because alveolar fluid clearance mechanisms are intact. In this review, we discuss the clinical presentation, pathophysiology, and management of negative-pressure or postobstructive pulmonary edema.

  7. Vessel-guided Airway Tree Segmentation

    DEFF Research Database (Denmark)

    Lo, P.; Sporring, J.; Ashraf, H.;

    2010-01-01

    This paper presents a method for airway tree segmentation that uses a combination of a trained airway appearance model, vessel and airway orientation information, and region growing. We propose a voxel classification approach for the appearance model, which uses a classifier that is trained...... to differentiate between airway and non-airway voxels. This is in contrast to previous works that use either intensity alone or hand crafted models of airway appearance. We show that the appearance model can be trained with a set of easily acquired, incomplete, airway tree segmentations. A vessel orientation...

  8. Airway complications after lung transplantation.

    Science.gov (United States)

    Machuzak, Michael; Santacruz, Jose F; Gildea, Thomas; Murthy, Sudish C

    2015-01-01

    Airway complications after lung transplantation present a formidable challenge to the lung transplant team, ranging from mere unusual images to fatal events. The exact incidence of complications is wide-ranging depending on the type of event, and there is still evolution of a universal characterization of the airway findings. Management is also wide-ranging. Simple observation or simple balloon bronchoplasty is sufficient in many cases, but vigilance following more severe necrosis is required for late development of both anastomotic and nonanastomotic airway strictures. Furthermore, the impact of coexisting infection, rejection, and medical disease associated with high-level immunosuppression further complicates care.

  9. Airway vascular reactivity and vascularisation in human chronic airway disease

    NARCIS (Netherlands)

    Bailey, Simon R; Boustany, Sarah; Burgess, Janette K; Hirst, Stuart J; Sharma, Hari S; Simcock, David E; Suravaram, Padmini R; Weckmann, Markus

    2009-01-01

    Altered bronchial vascular reactivity and remodelling including angiogenesis are documented features of asthma and other chronic inflammatory airway diseases. Expansion of the bronchial vasculature under these conditions involves both functional (vasodilation, hyperperfusion, increased microvascular

  10. Aging increases upper airway collapsibility in Fischer 344 rats.

    Science.gov (United States)

    Ray, Andrew D; Ogasa, Toshiyuki; Magalang, Ulysses J; Krasney, John A; Farkas, Gaspar A

    2008-11-01

    The upper airway muscles play an important role in maintaining upper airway collapsibility, and the incidence of sleep-disordered breathing increases with age. We hypothesize that the increase in airway collapsibility with increasing age can be linked to changes in upper airway muscle mechanics and structure. Eight young (Y: 6 mo) and eight old (O: 30 mo) Fischer 344 rats were anesthetized and mechanically ventilated, and the pharyngeal pressure associated with flow limitation (Pcrit) was measured 1) with the hypoglossal (cnXII) nerve intact, 2) following bilateral cnXII denervation, and 3) during cnXII stimulation. With the cnXII intact, the upper airways of older rats were more collapsible compared with their younger counterparts [Pcrit = -7.1 +/- 0.6 (SE) vs. -9.5 +/- 0.7 cmH2O, respectively; P = 0.033]. CnXII denervation resulted in an increase in Pcrit such that Pcrit became similar in both groups (O: -4.2 +/- 0.5 cmH2O; Y: -5.4 +/- 0.5 cmH2O). In all rats, cnXII stimulation decreased Pcrit (less collapsible) in both groups (O: -11.3 +/- 1.0 cmH2O; Y: -10.2 +/- 1.0 cmH2O). The myosin heavy chain composition of the genioglossus muscle demonstrated a decrease in the percentage of the IIb isoform (38.3 +/- 2.5 vs. 21.7 +/- 1.7%; P collapsible with age and that the increase in upper airway collapsibility with age is likely related to altered neural control rather than to primary alterations in upper airway muscle structure and function.

  11. Airway Epithelium Stimulates Smooth Muscle Proliferation

    OpenAIRE

    Malavia, Nikita K.; Raub, Christopher B.; Mahon, Sari B.; Brenner, Matthew; Reynold A Panettieri; George, Steven C.

    2009-01-01

    Communication between the airway epithelium and stroma is evident during embryogenesis, and both epithelial shedding and increased smooth muscle proliferation are features of airway remodeling. Hence, we hypothesized that after injury the airway epithelium could modulate airway smooth muscle proliferation. Fully differentiated primary normal human bronchial epithelial (NHBE) cells at an air–liquid interface were co-cultured with serum-deprived normal primary human airway smooth muscle cells (...

  12. Bi level positive airway pressure ( Bipap ) treatment of overlap syndrome patients quality of life%双水平气道正压( Bipap)呼吸机治疗对重叠综合征患者生存质量的影响

    Institute of Scientific and Technical Information of China (English)

    田迎春; 代云红; 何建林

    2012-01-01

    Objective To investigate the effect of bi-level positive airway pressure ( Bipap ) treatment of overlap syndrome patients quality of life. Methods A random number method 103 patients with overlap syndrome were divided into the experimental group 55 cases and control group 48 cases. Two groups of patients were implemented in routine treatment, experimental group on the basis of with bi-level positive airway pressure ( Bipap) ventilator therapy. 24 weeks later, using the health status questionnaire ( Medical Oatcome Stady Short-forn36, Mos Sf-36 ) to evaluate the patient's quality of life. Results After treatment, the health status questionnaire ( Mos Sf-36 ) in physiological function, life skills, emotional role function, mental health score increased ( P < 0. 05). Conclusion Bi-level positive airway pressure ( Bipap ) ventilator treatment can improve the patients quality of life.%目的 探讨双水平气道正压(Bipap)呼吸机治疗对重叠综合征患者生存质量的影响.方法 采用随机数字法将103例重叠综合征患者分为试验组55例和对照组48例.两组患者均实施常规治疗,试验组在此基础上配合双水平气道正压(Bipap)呼吸机治疗.24周后,采用健康状况调查问卷(Medical Oatcome Stady Short-forn36,Mos Sf-36)评定患者的生存质量.结果 试验组经过治疗后,健康状况问卷( Mos Sf-36)中生理功能、生活能力、情绪角色功能、精神健康评分增加(P<0.05).结论 双水平气道正压(Bipap)呼吸机治疗可提高患者的生活质量

  13. 双水平气道正压通气在重症支气管哮喘治疗中的临床价值%The Clinical Value of Bi-level Positive Airway Pressure Ventilation in the Treatment of Severe Bronchial Asthma

    Institute of Scientific and Technical Information of China (English)

    林鸿浮

    2015-01-01

    Objective To study the clinical value of bi-level positive airway pressure ventilation in the treatment of severe bronchial asthma. Methods 62 patients admitted between January 2010 and December 2014 were divided into two groups, the observation group and the control group, with 32 cases in each by the treatment method. The observation group were treated by bi-level positive airway pressure ventilation, while the control group were treated by the conventional drugs. And the values of blood gas indexes before and after treatment and length of stay were compared between the two groups. Results After treatment, the value of PaO2, SaO2, PaCO2, length of stay was (95.6±5.6)mmHg, (92.8±4.6)%, (42.8±3.2)mmHg and (7.3±2.1)d, respectively in the observation group, and compared with the values of the above indexes in the control group, the differences were statistically significant (P<0.05). Conclusion Bi-level positive airway pressure ventilation has signifi-cant clinical effect in the treatment of severe bronchial asthma.%目的:研究双水平气道正压通气在重症支气管哮喘治疗中的临床价值。方法整群选取2010年1月-2014年12月收治的62例患者为研究对象,按治疗方法分为两组(各32例),观察组双水平气道正压通气,对照组常规药物,比较治疗前后血气指标变化状况和治疗后住院时间。结果观察组患者治疗后PaO2、SaO2、PaCO2和住院时间分别为(95.6±5.6)mmHg、(92.8±4.6)%、(42.8±3.2)mmHg、(7.3±2.1)d同对照组患者相比(P<0.05)。结论在治疗重症支气管哮喘临床上双水平气道正压通气获得显著效果。

  14. Airway management and morbid obesity

    DEFF Research Database (Denmark)

    Kristensen, Michael S

    2010-01-01

    Morbidly obese patients present with excess fatty tissue externally on the breast, neck, thoracic wall and abdomen and internally in the mouth, pharynx and abdomen. This excess tissue tends to make access (intubation, tracheostomy) to and patency (during sedation or mask ventilation) of the upper...... in morbidly obese patients and should be followed by actions to counteract atelectasis formation. The decision as to weather to use a rapid sequence induction, an awake intubation or a standard induction with hypnotics should depend on the thorough airway examination and comorbidity and should not be based...... solely on whether morbid obesity is present or not. It is important to ensure sufficient depth of anaesthesia before initiating manipulation of the airway because inadequate anaesthesia depth predisposes to aspiration if airway management becomes difficult. The intubating laryngeal mask airway is more...

  15. Airway epithelial repair, regeneration, and remodeling after injury in chronic obstructive pulmonary disease.

    Science.gov (United States)

    Puchelle, Edith; Zahm, Jean-Marie; Tournier, Jean-Marie; Coraux, Christelle

    2006-11-01

    In chronic obstructive pulmonary disease (COPD), exacerbations are generally associated with several causes, including pollutants, viruses, bacteria that are responsible for an excess of inflammatory mediators, and proinflammatory cytokines released by activated epithelial and inflammatory cells. The normal response of the airway surface epithelium to injury includes a succession of cellular events, varying from the loss of the surface epithelium integrity to partial shedding of the epithelium or even complete denudation of the basement membrane. The epithelium then has to repair and regenerate to restore its functions, through several mechanisms, including basal cell spreading and migration, followed by proliferation and differentiation of epithelial cells. In COPD, the remodeling of the airway epithelium, such as squamous metaplasia and mucous hyperplasia that occur during injury, may considerably disturb the innate immune functions of the airway epithelium. In vitro and in vivo models of airway epithelial wound repair and regeneration allow the study of the spatiotemporal modulation of cellular and molecular interaction factors-namely, the proinflammatory cytokines, the matrix metalloproteinases and their inhibitors, and the intercellular adhesion molecules. These factors may be markedly altered during exacerbation periods of COPD and their dysregulation may induce remodeling of the airway mucosa and a leakiness of the airway surface epithelium. More knowledge of the mechanisms involved in airway epithelium regeneration may pave the way to cytoprotective and regenerative therapeutics, allowing the reconstitution of a functional, well-differentiated airway epithelium in COPD.

  16. Mechanisms determining cholinergic neural responses in airways of young and mature rabbits.

    Science.gov (United States)

    Larsen, Gary L; Loader, Joan; Nguyen, Dee Dee; Fratelli, Cori; Dakhama, Azzeddine; Colasurdo, Giuseppe N

    2004-08-01

    Neural pathways help control airway caliber and responsiveness. Yet little is known of how neural control changes as a function of development. In rabbits, we found electrical field stimulation (EFS) of airway nerves led to more marked contractile responses in 2- vs. 13-week-old animals. This enhanced response to EFS may be due to prejunctional, junctional, and/or postjunctional neural mechanisms. We assessed these mechanisms in airways of 2- and 13-week-old rabbits. The contractile responses to methacholine did not differ in the groups, suggesting postjunctional neural events are not primarily responsible for differing responses to EFS. To address junctional events, acetylcholinesterase (AChE) was measured (spectrophotometry). AChE was elevated in 2-week-olds. However, this should lead to less and not greater responses. Prejunctionally, EFS-induced acetylcholine (ACh) release was assessed by HPLC. Airways of 2-week-old rabbits released significantly more ACh than airways from mature rabbits. Choline acetyltransferase, a marker of cholinergic nerves, was not different between groups, suggesting that more ACh release in young rabbits was not due to increased nerve density. ACh release in the presence of polyarginine increased significantly in both groups, supporting the presence of functional muscarinic autoreceptors (M2) at both ages. Because substance P (SP) increases release of ACh, SP was measured by ELISA. This neuropeptide was significantly elevated in airways of younger rabbits. Nerve growth factor (NGF) increased SP and was also significantly increased in airways from younger rabbits. This work suggests that increases in EFS-induced responsiveness in young rabbits are likely due to prejunctional events with enhanced release of ACh. Increases in NGF and SP early in life may contribute to this increased responsiveness.

  17. A new removable airway stent

    Directory of Open Access Journals (Sweden)

    Tore Amundsen

    2016-09-01

    Full Text Available Background: Malignant airway obstruction is a feared complication and will most probably occur more frequently in the future because of increasing cancer incidence and increased life expectancy in cancer patients. Minimal invasive treatment using airway stents represents a meaningful and life-saving palliation. We present a new removable airway stent for improved individualised treatment. Methods: To our knowledge, the new airway stent is the world's first knitted and uncovered self-expanding metal stent, which can unravel and be completely removed. In an in vivo model using two anaesthetised and spontaneously breathing pigs, we deployed and subsequently removed the stents by unravelling the device. The procedures were executed by flexible bronchoscopy in an acute and a chronic setting – a ‘proof-of-principle’ study. Results: The new stent was easily and accurately deployed in the central airways, and it remained fixed in its original position. It was easy to unravel and completely remove from the airways without clinically significant complications. During the presence of the stent in the chronic study, granulation tissue was induced. This tissue disappeared spontaneously with the removal. Conclusions: The new removable stent functioned according to its purpose and unravelled easily, and it was completely removed without significant technical or medical complications. Induced granulation tissue disappeared spontaneously. Further studies on animals and humans are needed to define its optimal indications and future use.

  18. Vessel-guided airway tree segmentation

    DEFF Research Database (Denmark)

    Lo, Pechin Chien Pau; Sporring, Jon; Ashraf, Haseem

    2010-01-01

    This paper presents a method for airway tree segmentation that uses a combination of a trained airway appearance model, vessel and airway orientation information, and region growing. We propose a voxel classification approach for the appearance model, which uses a classifier that is trained...... to differentiate between airway and non-airway voxels. This is in contrast to previous works that use either intensity alone or hand crafted models of airway appearance. We show that the appearance model can be trained with a set of easily acquired, incomplete, airway tree segmentations. A vessel orientation...... similarity measure is introduced, which indicates how similar the orientation of an airway candidate is to the orientation of the neighboring vessel. We use this vessel orientation similarity measure to overcome regions in the airway tree that have a low response from the appearance model. The proposed...

  19. Analysis of airways in computed tomography

    DEFF Research Database (Denmark)

    Petersen, Jens

    Chronic Obstructive Pulmonary Disease (COPD) is major cause of death and disability world-wide. It affects lung function through destruction of lung tissue known as emphysema and inflammation of airways, leading to thickened airway walls and narrowed airway lumen. Computed Tomography (CT) imaging...... have become the standard with which to assess emphysema extent but airway abnormalities have so far been more challenging to quantify. Automated methods for analysis are indispensable as the visible airway tree in a CT scan can include several hundreds of individual branches. However, automation...... of scan on airway dimensions in subjects with and without COPD. The results show measured airway dimensions to be affected by differences in the level of inspiration and this dependency is again influenced by COPD. Inspiration level should therefore be accounted for when measuring airways, and airway...

  20. [Upper airway obstruction caused by a floppy epiglottis--report of two cases of amyotrophic lateral sclerosis (ALS)].

    Science.gov (United States)

    Ito, Keiko; Chitose, Hiroko; Kobayashi, Asako

    2009-09-01

    The motor system is extensively affected in amyotrophic lateral sclerosis (ALS). Rapid disease progression almost certainly ensures that about half of thsese cases will experience respiratory muscle paralysis to breathe within about five years. We report two cases of ALS involving upper airway obstruction. Fiberoptic laryngoscopy showed floppy epiglottis, tilted posteriorly and horizontally and impacting against the posterior pharyngeal wall during inspiration. Several months later, airway obstruction grew exceedingly worse, and the tilted epiglottis did not return to its vertical resting position. Tracheostomy was conducted during this period. We found that laryngoscopy may be useful in the evaluation of upper airway obstruction, and it may be safer to avoid continuous positive airway pressure.

  1. On locating the obstruction in the human upper airway

    Science.gov (United States)

    Wang, Yong; Elghobashi, S.

    2013-11-01

    The fluid dynamical properties of the air flow in the human upper airway (UA) are not fully understood at present due to the three-dimensional, patient-specific complex geometry of the airway, flow transition from laminar to turbulent and flow-structure interaction during the breathing cycle. One of the major challenges to surgeons is determining the location of the UA obstruction before performing corrective surgeries. It is quite difficult at present to experimentally measure the instantaneous velocity and pressure at specific points in the human airway. On the other hand, direct numerical simulation (DNS) can predict all the flow properties and resolve all its relevant length- and time-scales. We developed a DNS solver with lattice Boltzmann method (LBM), and used it to investigate the flow in two patient-specific UAs reconstructed from CT scan data. Inspiration and expiration flows through these two airways are studied and compared. Pressure gradient-time signals at different locations in the UAs are used to determine the location of the obstruction. This work was supported by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health (NIH).

  2. Oxygenation, Ventilation, and Airway Management in Out-of-Hospital Cardiac Arrest: A Review

    Directory of Open Access Journals (Sweden)

    Tomas Henlin

    2014-01-01

    Full Text Available Recently published evidence has challenged some protocols related to oxygenation, ventilation, and airway management for out-of-hospital cardiac arrest. Interrupting chest compressions to attempt airway intervention in the early stages of OHCA in adults may worsen patient outcomes. The change of BLS algorithms from ABC to CAB was recommended by the AHA in 2010. Passive insufflation of oxygen into a patent airway may provide oxygenation in the early stages of cardiac arrest. Various alternatives to tracheal intubation or bag-mask ventilation have been trialled for prehospital airway management. Simple methods of airway management are associated with similar outcomes as tracheal intubation in patients with OHCA. The insertion of a laryngeal mask airway is probably associated with worse neurologically intact survival rates in comparison with other methods of airway management. Hyperoxemia following OHCA may have a deleterious effect on the neurological recovery of patients. Extracorporeal oxygenation techniques have been utilized by specialized centers, though their use in OHCA remains controversial. Chest hyperinflation and positive airway pressure may have a negative impact on hemodynamics during resuscitation and should be avoided. Dyscarbia in the postresuscitation period is relatively common, mainly in association with therapeutic hypothermia, and may worsen neurological outcome.

  3. Oxygenation, ventilation, and airway management in out-of-hospital cardiac arrest: a review.

    Science.gov (United States)

    Henlin, Tomas; Michalek, Pavel; Tyll, Tomas; Hinds, John D; Dobias, Milos

    2014-01-01

    Recently published evidence has challenged some protocols related to oxygenation, ventilation, and airway management for out-of-hospital cardiac arrest. Interrupting chest compressions to attempt airway intervention in the early stages of OHCA in adults may worsen patient outcomes. The change of BLS algorithms from ABC to CAB was recommended by the AHA in 2010. Passive insufflation of oxygen into a patent airway may provide oxygenation in the early stages of cardiac arrest. Various alternatives to tracheal intubation or bag-mask ventilation have been trialled for prehospital airway management. Simple methods of airway management are associated with similar outcomes as tracheal intubation in patients with OHCA. The insertion of a laryngeal mask airway is probably associated with worse neurologically intact survival rates in comparison with other methods of airway management. Hyperoxemia following OHCA may have a deleterious effect on the neurological recovery of patients. Extracorporeal oxygenation techniques have been utilized by specialized centers, though their use in OHCA remains controversial. Chest hyperinflation and positive airway pressure may have a negative impact on hemodynamics during resuscitation and should be avoided. Dyscarbia in the postresuscitation period is relatively common, mainly in association with therapeutic hypothermia, and may worsen neurological outcome.

  4. Airflow behavior changes in upper airway caused by different head and neck positions: Comparison by computational fluid dynamics.

    Science.gov (United States)

    Wei, Wei; Huang, Shi-Wei; Chen, Lian-Hua; Qi, Yang; Qiu, Yi-Min; Li, Shi-Tong

    2017-02-08

    The feasibility of computational fluid dynamics (CFD) to evaluate airflow characteristics in different head and neck positions has not been established. This study compared the changes in volume and airflow behavior of the upper airway by CFD simulation to predict the influence of anatomical and physiological airway changes due to different head-neck positions on mechanical ventilation. One awake volunteer with no risk of difficult airway underwent computed tomography in neutral position, extension position (both head and neck extended), and sniffing position (head extended and neck flexed). Three-dimensional airway models of the upper airway were reconstructed. The total volume (V) and narrowest area (Amin) of the airway models were measured. CFD simulation with an Spalart-Allmaras model was performed to characterize airflow behavior in neutral, extension, and sniffing positions of closed-mouth and open-mouth ventilation. The comparison result for V was neutral pressure drop and velocity increasing were more obvious in neutral than sniffing or extension position at the same airflow rate. In sniffing position, pressure differences decreased and velocity remained almost constant. Recirculation airflow was generated near the subglottic region in neutral and extension positions. Sniffing position improves airway patency by increasing airway volume and decreasing airway resistance, suggesting that sniffing position may be the optimal choice for mask ventilation.

  5. Airway management using a supraglottic airway device without endotracheal intubation for positive ventilation of anaesthetized rats.

    Science.gov (United States)

    Cheong, S H; Lee, J H; Kim, M H; Cho, K R; Lim, S H; Lee, K M; Park, M Y; Yang, Y I; Kim, D K; Choi, C S

    2013-04-01

    Endotracheal intubation is often necessary for positive pressure ventilation of rats during open thoracic surgery. Since endotracheal intubation in rats is technically difficult and is associated with numerous complications, many techniques using various devices have been described in the scientific literature. In this study, we compared the effectiveness of airway management of a home-made supraglottic airway device (SAD), which is cheap to fabricate and easy to place with that of an endotracheal intubation tube in enflurane-anaesthetized rats. Twenty male Sprague-Dawley rats (200-300 g) were randomly assigned to two equal groups for positive pressure mechanical ventilation using either the SAD or an endotracheal intubation tube. The carotid artery of each rat was cannulated for continuous blood pressure measurements and obtaining blood samples for determination of oxygen tension, carbon dioxide tension, and blood acidity before, during and after SAD placement or endotracheal intubation. Proper placement of the SAD was confirmed by observing chest wall movements that coincided with the operation of the mechanical ventilator. No complications and adverse events were encountered in the rats in which the SAD was placed, during SAD placement and immediate removal, during their mechanical ventilation through the SAD, and one week after SAD removal. From the results of blood gas analyses, we conclude that anaesthetized rats can be successfully ventilated using an SAD for open thoracic surgery.

  6. Angiogenesis is induced by airway smooth muscle strain.

    Science.gov (United States)

    Hasaneen, Nadia A; Zucker, Stanley; Lin, Richard Z; Vaday, Gayle G; Panettieri, Reynold A; Foda, Hussein D

    2007-10-01

    Angiogenesis is an important feature of airway remodeling in both chronic asthma and chronic obstructive pulmonary disease (COPD). Airways in those conditions are exposed to excessive mechanical strain during periods of acute exacerbations. We recently reported that mechanical strain of human airway smooth muscle (HASM) led to an increase in their proliferation and migration. Sustained growth in airway smooth muscle in vivo requires an increase in the nutritional supply to these muscles, hence angiogenesis. In this study, we examined the hypothesis that cyclic mechanical strain of HASM produces factors promoting angiogenic events in the surrounding vascular endothelial cells. Our results show: 1) a significant increase in human lung microvascular endothelial cell (HMVEC-L) proliferation, migration, and tube formation following incubation in conditioned media (CM) from HASM cells exposed to mechanical strain; 2) mechanical strain of HASM cells induced VEGF expression and release; 3) VEGF neutralizing antibodies inhibited the proliferation, migration, and tube formations of HMVEC-L induced by the strained airway smooth muscle CM; 4) mechanical strain of HASM induced a significant increase in hypoxia-inducible factor-1alpha (HIF-1alpha) mRNA and protein, a transcription factor required for VEGF gene transcription; and 5) mechanical strain of HASM induced HIF-1alpha/VEGF through dual phosphatidylinositol 3-kinase (PI3K)/Akt/mammalian target of rapamycin (mTOR) and ERK pathways. In conclusion, exposing HASM cells to mechanical strain induces signal transduction pathway through PI3K/Akt/mTOR and ERK pathways that lead to an increase in HIF-1alpha, a transcription factor required for VEGF expression. VEGF release by mechanical strain of HASM may contribute to the angiogenesis seen with repeated exacerbation of asthma and COPD.

  7. Comparative Study of laryngeal mask airway Supreme and laryngeal mask airway Classic in paralyzed patients

    OpenAIRE

    2016-01-01

    Aim and Objectives: The present study was undertaken to compare the LMA Classic with LMA Supreme in assessing the ease of insertion, number of attempts, time for insertion, any unwanted responses, stability of device, peak airway pressure, leak volume and leak fraction and postoperative complications.Methods: A total of 274 patients of ASA grade 1 and 2 were included in the study and divided into two groups with 137 patients in each group: the LMA Classic group (group C) and LMA Supreme group...

  8. Simulation of turbulent airflow using a CT based upper airway model of a racehorse.

    Science.gov (United States)

    Rakesh, Vineet; Datta, Ashim K; Ducharme, Normand G; Pease, Anthony P

    2008-06-01

    Computational model for airflow through the upper airway of a horse was developed. Previous flow models for human airway do not hold true for horses due to significant differences in anatomy and the high Reynolds number of flow in the equine airway. Moreover, models that simulate the entire respiratory cycle and emphasize on pressures inside the airway in relation to various anatomical diseases are lacking. The geometry of the airway was created by reconstructing images obtained from computed tomography scans of a thoroughbred racehorse. Different geometries for inhalation and exhalation were used for the model based on the difference in the nasopharynx size during the two phases of respiration. The Reynolds averaged Navier-Stokes equations were solved for the isothermal flow with the standard k-epsilon model for turbulence. Transient pressure boundary conditions for the entire breathing cycle were obtained from past experimental studies on live horses. The flow equations were solved in a commercial finite volume solver. The flow rates, computed based on the applied pressure conditions, were compared to experimentally measured flow rates for model validation. Detailed analysis of velocity, pressure, and turbulence characteristics of the flow was done. Velocity magnitudes at various slices during inhalation were found to be higher than corresponding velocity magnitudes during exhalation. The front and middle parts of the nasopharynx were found to have minimum intraluminal pressure in the airway during inhalation. During exhalation, the pressures in the soft palate were higher compared to those in the larynx, epiglottis, and nasopharynx. Turbulent kinetic energy was found to be maximum at the entry to the airway and gradually decreased as the flow moved inside the airway. However, turbulent kinetic energy increased in regions of the airway with abrupt change in area. Based on the analysis of pressure distribution at different sections of the airway, it was concluded

  9. Influence by lidocaine by intravenous injection on airway pressure during intubation anesthesia by double-lumen tube%利多卡因静脉注射对双腔气管导管插管麻醉期间气道压力的影响

    Institute of Scientific and Technical Information of China (English)

    胡秀才; 齐英凯; 韩倩; 王雷; 单士强

    2016-01-01

    Objective To investigate influence by lidocaine by intravenous injection on airway pressure during intubation anesthesia by double-lumen tube. Methods A total of 80 peripheral lung cancer patients, who received thoracoscopic lobectomy, were randomly divided into group Ⅰ and group Ⅱ, with 40 cases in each group. Group Ⅰ received lidocaine by intravenous injection before anesthesia, and continuous intravenous pumping of lidocaine after anesthesia intubation. Group Ⅱ received normal saline by intravenous injection at corresponding time point before anesthesia, and continuous intravenous pumping of normal saline after anesthesia intubation. Observation was made on plateau pressure and peak airway pressure at the time of lateral two-lung ventilation (T1), one-lung ventilation (T2), intraoperative broken bronchus (T3), and intraoperative two-lung ventilation (T4). Results Group Ⅰ had all lower plateau pressure as (15±3), (24±3), (23±3) and (21±4) cm H2O (1 cm H2O=0.098 kPa) and peak airway pressure as (18±4), (25±5), (25±3) and (23±3) cm H2O at T1, T2, T3 and T4 than group Ⅱ (P<0.05). Conclusion Preventive implement of lidocaine by intravenous injection before anesthesia induction can effectively reduce ventilation pressure and barotraumas during one-lung ventilation in thoracoscopic lobectomy patients, as well as improve one-lung ventilation effect.%目的:探讨利多卡因静脉注射对双腔气管导管插管麻醉期间气道压力的影响。方法80例周围型肺癌行胸腔镜肺叶切除术患者,随机分为组Ⅰ和组Ⅱ,各40例。组Ⅰ患者在麻醉前静脉注射利多卡因,麻醉插管后持续静脉泵注利多卡因。组Ⅱ患者在麻醉前相应时间点静脉注射生理盐水,麻醉插管后持续静脉泵注生理盐水。观察侧卧位双肺通气(T1)、单肺通气(T2)、术中离断支气管(T3)、术后双肺通气(T4)时的平台压和气道峰压。结果组Ⅰ患者 T1、T2、T3、T4时平台压(15±3)、(24±3)

  10. Numerical simulation of soft palate movement and airflow in human upper airway by fluid-structure interaction method

    Science.gov (United States)

    Sun, Xiuzhen; Yu, Chi; Wang, Yuefang; Liu, Yingxi

    2007-08-01

    In this paper, the authors present airflow field characteristics of human upper airway and soft palate movement attitude during breathing. On the basis of the data taken from the spiral computerized tomography images of a healthy person and a patient with Obstructive Sleep Apnea-Hypopnea Syndrome (OSAHS), three-dimensional models of upper airway cavity and soft palate are reconstructed by the method of surface rendering. Numerical simulation is performed for airflow in the upper airway and displacement of soft palate by fluid-structure interaction analysis. The reconstructed three-dimensional models precisely preserve the original configuration of upper airways and soft palate. The results of the pressure and velocity distributions in the airflow field are quantitatively determined, and the displacement of soft palate is presented. Pressure gradients of airway are lower for the healthy person and the airflow distribution is quite uniform in the case of free breathing. However, the OSAHS patient remarkably escalates both the pressure and velocity in the upper airway, and causes higher displacement of the soft palate. The present study is useful in revealing pathogenesis and quantitative mutual relationship between configuration and function of the upper airway as well as in diagnosing diseases related to anatomical structure and function of the upper airway.

  11. Numerical simulation of soft palate movement and airflow in human upper airway by fluid-structure interaction method

    Institute of Scientific and Technical Information of China (English)

    Xiuzhen Sun; Chi Yu; Yuefang Wang; Yingxi Liu

    2007-01-01

    In this paper, the authors present airflow field characteristics of human upper airway and soft palate move-ment attitude during breathing. On the basis of the data taken from the spiral computerized tomography images of a healthy person and a patient with Obstructive Sleep Apnea-Hypopnea Syndrome (OSAHS), three-dimensional models of upper air-way cavity and soft palate are reconstructed by the method of surface rendering. Numerical simulation is performed for airflow in the upper airway and displacement of soft palate by fluid-structure interaction analysis. The reconstructed three-dimensional models precisely preserve the original config-uration of upper airways and soft palate. The results of the pressure and velocity distributions in the airflow field are quantitatively determined, and the displacement of soft palate is presented. Pressure gradients of airway are lower for the healthy person and the airflow distribution is quite uniform in the case of free breathing. However, the OSAHS patient remarkably escalates both the pressure and velocity in the upper airway, and causes higher displacement of the soft palate. The present study is useful in revealing pathogenesis and quantitative mutual relationship between configuration and function of the upper airway as well as in diagnosing diseases related to anatomical structure and function of the upper airway.

  12. A RANDOMIZED CROSSOVER COMPARISON OF THE LARYNGEAL MASK AIRWAY PROSEAL AND LARYNGEAL MASK AIRWAY SUPREME IN ANESTHETIZED ADULT PATIENTS

    Directory of Open Access Journals (Sweden)

    Vinayaka

    2015-10-01

    Full Text Available BACKGROUND : Newer supraglottic airway devices have been recently introduced, motivated by the need for a single use equivalent to the reusable LMA Proseal. LMA Supreme is a new single use laryngeal mask airway with gastric access providing an easy, reliable airway and good airway seal. The objectives of the present study were to compare LMA Proseal and LMA Supreme for ease of insertion, oropharyn geal leak pressure and fibre - optic position in anesthetized adult patients. MATERIAL AND METHODS : We conducted a prospective randomized study in 60 ASA grade I and II adult patients posted for elective surgeries under general anesthesia. Both devices were inserted into each patient in random order. Two attempts were allowed. Digital insertion was used for the first attempt and guided insertion for the second attempt. The ease of insertion, oropharyngeal leak pressure and fibre - optic position were determined . RESULTS : First attempt and overall success of insertion were similar (LMA Proseal 93.33% and 100%; LMA Supreme 96.66% and 100%. Guided insertion was always successful following failed digital insertion. There was no difference in the mean duration of insertion for both the devices (23.92±1.44 vs 23.44±1.72seconds. The mean oropharyngeal leak pressure was significantly higher for the LMA Proseal than the LMA Supreme (23.24 vs 19.37cm of H 2 O (p<0.05. The fibre - optic view of the glottis was similar for both the devices. CONCLUSION : In this study, the ease of insertion and fibre - optic position were similar for the LMA Proseal and LMA Supreme, but oropharyngeal leak pressure is higher for the LMA Proseal. The LMA Proseal provides a more effective seal tha n LMA Supreme for positive pressure ventilation.

  13. Treating asthma means treating airway smooth muscle cells

    NARCIS (Netherlands)

    Zuyderduyn, S; Sukkar, M B; Fust, A; Dhaliwal, S; Burgess, J K

    2008-01-01

    Asthma is characterised by airway hyperresponsiveness, airway inflammation and airway remodelling. Airway smooth muscle cells are known to be the main effector cells of airway narrowing. In the present paper, studies will be discussed that have led to a novel view of the role of airway smooth muscle

  14. RAGE: a new frontier in chronic airways disease.

    Science.gov (United States)

    Sukkar, Maria B; Ullah, Md Ashik; Gan, Wan Jun; Wark, Peter A B; Chung, Kian Fan; Hughes, J Margaret; Armour, Carol L; Phipps, Simon

    2012-11-01

    Asthma and chronic obstructive pulmonary disease (COPD) are heterogeneous inflammatory disorders of the respiratory tract characterized by airflow obstruction. It is now clear that the environmental factors that drive airway pathology in asthma and COPD, including allergens, viruses, ozone and cigarette smoke, activate innate immune receptors known as pattern-recognition receptors, either directly or indirectly by causing the release of endogenous ligands. Thus, there is now intense research activity focused around understanding the mechanisms by which pattern-recognition receptors sustain the airway inflammatory response, and how these mechanisms might be targeted therapeutically. One pattern-recognition receptor that has recently come to attention in chronic airways disease is the receptor for advanced glycation end products (RAGE). RAGE is a member of the immunoglobulin superfamily of cell surface receptors that recognizes pathogen- and host-derived endogenous ligands to initiate the immune response to tissue injury, infection and inflammation. Although the role of RAGE in lung physiology and pathophysiology is not well understood, recent genome-wide association studies have linked RAGE gene polymorphisms with airflow obstruction. In addition, accumulating data from animal and clinical investigations reveal increased expression of RAGE and its ligands, together with reduced expression of soluble RAGE, an endogenous inhibitor of RAGE signalling, in chronic airways disease. In this review, we discuss recent studies of the ligand-RAGE axis in asthma and COPD, highlight important areas for future research and discuss how this axis might potentially be harnessed for therapeutic benefit in these conditions.

  15. Airway surface liquid volume expansion induces rapid changes in amiloride-sensitive Na+ transport across upper airway epithelium-Implications concerning the resolution of pulmonary edema

    Science.gov (United States)

    Azizi, Fouad; Arredouani, Abdelilah; Mohammad, Ramzi M

    2015-01-01

    During airway inflammation, airway surface liquid volume (ASLV) expansion may result from the movement of plasma proteins and excess liquid into the airway lumen due to extravasation and elevation of subepithelial hydrostatic pressure. We previously demonstrated that elevation of submucosal hydrostatic pressure increases airway epithelium permeability resulting in ASLV expansion by 500 μL cm−2 h−1. Liquid reabsorption by healthy airway epithelium is regulated by active Na+ transport at a rate of 5 μL cm−2 h−1. Thus, during inflammation the airway epithelium may be submerged by a large volume of luminal liquid. Here, we have investigated the mechanism by which ASLV expansion alters active epithelial Na+ transport, and we have characterized the time course of the change. We used primary cultures of tracheal airway epithelium maintained under air interface (basal ASLV, depth is 7 ± 0.5 μm). To mimic airway flooding, ASLV was expanded to a depth of 5 mm. On switching from basal to expanded ASLV conditions, short-circuit current (Isc, a measure of total transepithelial active ion transport) declined by 90% with a half-time (t1/2) of 1 h. 24 h after the switch, there was no significant change in ATP concentration nor in the number of functional sodium pumps as revealed by [3H]-ouabain binding. However, amiloride-sensitive uptake of 22Na+ was reduced by 70% upon ASLV expansion. This process is reversible since after returning cells back to air interface, Isc recovered with a t1/2 of 5–10 h. These results may have important clinical implications concerning the development of Na+ channels activators and resolution of pulmonary edema. PMID:26333829

  16. Multiscale Vessel-guided Airway Tree Segmentation

    DEFF Research Database (Denmark)

    Lo, Pechin Chien Pau; Sporring, Jon; de Bruijne, Marleen

    2009-01-01

    that is trained to differentiate between airway and non-airway voxels. Vessel and airway orientation information are used in the form of a vessel orientation similarity measure, which indicates how similar the orientation of the an airway candidate is to the orientation of the neighboring vessel. The method...... is evaluated within EXACT’09 on a diverse set of CT scans. Results show a favorable combination of a relatively large portion of the tree detected correctly with very few false positives....

  17. Mouth-opening increases upper-airway collapsibility without changing resistance during midazolam sedation.

    Science.gov (United States)

    Ayuse, T; Inazawa, T; Kurata, S; Okayasu, I; Sakamoto, E; Oi, K; Schneider, H; Schwartz, A R

    2004-09-01

    Sedative doses of anesthetic agents affect upper-airway function. Oral-maxillofacial surgery is frequently performed on sedated patients whose mouths must be as open as possible if the procedures are to be accomplished successfully. We examined upper-airway pressure-flow relationships in closed mouths, mouths opened moderately, and mouths opened maximally to test the hypothesis that mouth-opening compromises upper-airway patency during midazolam sedation. From these relationships, upper-airway critical pressure (Pcrit) and upstream resistance (Rua) were derived. Maximal mouth-opening increased Pcrit to -3.6 +/- 2.9 cm H2O compared with -8.7 +/- 2.8 (p = 0.002) for closed mouths and -7.2 +/- 4.1 (p = 0.038) for mouths opened moderately. In contrast, Rua was similar in all three conditions (18.4 +/- 6.6 vs. 17.7 +/- 7.6 vs. 21.5 +/- 11.6 cm H2O/L/sec). Moreover, maximum mouth-opening produced an inspiratory airflow limitation at atmosphere that was eliminated when nasal pressure was adjusted to 4.3 +/- 2.7 cm H2O. We conclude that maximal mouth-opening increases upper-airway collapsibility, which contributes to upper-airway obstruction at atmosphere during midazolam sedation.

  18. Pharmacogenetics, pharmacogenomics and airway disease

    Directory of Open Access Journals (Sweden)

    Hall Ian P

    2001-11-01

    Full Text Available Abstract The availability of a draft sequence for the human genome will revolutionise research into airway disease. This review deals with two of the most important areas impinging on the treatment of patients: pharmacogenetics and pharmacogenomics. Considerable inter-individual variation exists at the DNA level in targets for medication, and variability in response to treatment may, in part, be determined by this genetic variation. Increased knowledge about the human genome might also permit the identification of novel therapeutic targets by expression profiling at the RNA (genomics or protein (proteomics level. This review describes recent advances in pharmacogenetics and pharmacogenomics with regard to airway disease.

  19. Functional phenotype of airway myocytes from asthmatic airways

    NARCIS (Netherlands)

    Wright, David B.; Trian, Thomas; Siddiqui, Sana; Pascoe, Chris D.; Ojo, Oluwaseun O.; Johnson, Jill R.; Dekkers, Bart G. J.; Dakshinamurti, Shyamala; Bagchi, Rushita; Burgess, Janette K.; Kanabar, Varsha

    2013-01-01

    In asthma, the airway smooth muscle (ASM) cell plays a central role in disease pathogenesis through cellular changes which may impact on its microenvironment and alter ASM response and function. The answer to the long debated question of what makes a 'healthy' ASM cell become 'asthmatic' still remai

  20. Pentraxin 3 (PTX3 expression in allergic asthmatic airways: role in airway smooth muscle migration and chemokine production.

    Directory of Open Access Journals (Sweden)

    Jingbo Zhang

    Full Text Available BACKGROUND: Pentraxin 3 (PTX3 is a soluble pattern recognition receptor with non-redundant functions in inflammation and innate immunity. PTX3 is produced by immune and structural cells. However, very little is known about the expression of PTX3 and its role in allergic asthma. OBJECTIVES AND METHODS: We sought to determine the PTX3 expression in asthmatic airways and its function in human airway smooth muscle cells (HASMC. In vivo PTX3 expression in bronchial biopsies of mild, moderate and severe asthmatics was analyzed by immunohistochemistry. PTX3 mRNA and protein were measured by real-time RT-PCR and ELISA, respectively. Proliferation and migration were examined using (3H-thymidine incorporation, cell count and Boyden chamber assays. RESULTS: PTX3 immunoreactivity was increased in bronchial tissues of allergic asthmatics compared to healthy controls, and mainly localized in the smooth muscle bundle. PTX3 protein was expressed constitutively by HASMC and was significantly up-regulated by TNF, and IL-1β but not by Th2 (IL-4, IL-9, IL-13, Th1 (IFN-γ, or Th-17 (IL-17 cytokines. In vitro, HASMC released significantly higher levels of PTX3 at the baseline and upon TNF stimulation compared to airway epithelial cells (EC. Moreover, PTX3 induced CCL11/eotaxin-1 release whilst inhibited the fibroblast growth factor-2 (FGF-2-driven HASMC chemotactic activity. CONCLUSIONS: Our data provide the first evidence that PTX3 expression is increased in asthmatic airways. HASMC can both produce and respond to PTX3. PTX3 is a potent inhibitor of HASMC migration induced by FGF-2 and can upregulate CCL11/eotaxin-1 release. These results raise the possibility that PTX3 may play a dual role in allergic asthma.

  1. Prolonged ozone exposure in an allergic airway disease model: Adaptation of airway responsiveness and airway remodeling

    Directory of Open Access Journals (Sweden)

    Park Chang-Soo

    2006-02-01

    Full Text Available Abstract Background Short-term exposure to high concentrations of ozone has been shown to increase airway hyper-responsiveness (AHR. Because the changes in AHR and airway inflammation and structure after chronic ozone exposure need to be determined, the goal of this study was to investigate these effects in a murine model of allergic airway disease. Methods We exposed BALB/c mice to 2 ppm ozone for 4, 8, and 12 weeks. We measured the enhanced pause (Penh to methacholine and performed cell differentials in bronchoalveolar lavage fluid. We quantified the levels of IL-4 and IFN-γ in the supernatants of the bronchoalveolar lavage fluids using enzyme immunoassays, and examined the airway architecture under light and electron microscopy. Results The groups exposed to ozone for 4, 8, and 12 weeks demonstrated decreased Penh at methacholine concentrations of 12.5, 25, and 50 mg/ml, with a dose-response curve to the right of that for the filtered-air group. Neutrophils and eosinophils increased in the group exposed to ozone for 4 weeks compared to those in the filtered-air group. The ratio of IL-4 to INF-γ increased significantly after exposure to ozone for 8 and 12 weeks compared to the ratio for the filtered-air group. The numbers of goblet cells, myofibroblasts, and smooth muscle cells showed time-dependent increases in lung tissue sections from the groups exposed to ozone for 4, 8, and 12 weeks. Conclusion These findings demonstrate that the increase in AHR associated with the allergic airway does not persist during chronic ozone exposure, indicating that airway remodeling and adaptation following repeated exposure to air pollutants can provide protection against AHR.

  2. The human airway epithelial basal cell transcriptome.

    Directory of Open Access Journals (Sweden)

    Neil R Hackett

    Full Text Available BACKGROUND: The human airway epithelium consists of 4 major cell types: ciliated, secretory, columnar and basal cells. During natural turnover and in response to injury, the airway basal cells function as stem/progenitor cells for the other airway cell types. The objective of this study is to better understand human airway epithelial basal cell biology by defining the gene expression signature of this cell population. METHODOLOGY/PRINCIPAL FINDINGS: Bronchial brushing was used to obtain airway epithelium from healthy nonsmokers. Microarrays were used to assess the transcriptome of basal cells purified from the airway epithelium in comparison to the transcriptome of the differentiated airway epithelium. This analysis identified the "human airway basal cell signature" as 1,161 unique genes with >5-fold higher expression level in basal cells compared to differentiated epithelium. The basal cell signature was suppressed when the basal cells differentiated into a ciliated airway epithelium in vitro. The basal cell signature displayed overlap with genes expressed in basal-like cells from other human tissues and with that of murine airway basal cells. Consistent with self-modulation as well as signaling to other airway cell types, the human airway basal cell signature was characterized by genes encoding extracellular matrix components, growth factors and growth factor receptors, including genes related to the EGF and VEGF pathways. Interestingly, while the basal cell signature overlaps that of basal-like cells of other organs, the human airway basal cell signature has features not previously associated with this cell type, including a unique pattern of genes encoding extracellular matrix components, G protein-coupled receptors, neuroactive ligands and receptors, and ion channels. CONCLUSION/SIGNIFICANCE: The human airway epithelial basal cell signature identified in the present study provides novel insights into the molecular phenotype and biology of

  3. Add-on-Statin Extended Release Nicotinic Acid/Laropiprant but Not the Switch to High-Dose Rosuvastatin Lowers Blood Pressure: An Open-Label Randomized Study

    Directory of Open Access Journals (Sweden)

    Anastazia Kei

    2011-01-01

    Full Text Available Introduction. Nicotinic acid (NA and statins have been associated with reductions in blood pressure (BP. Patients and Methods. We recruited 68 normotensive and hypertensive dyslipidemic patients who were treated with a conventional statin dose and had not achieved lipid targets. Patients were randomized to switch to high-dose rosuvastatin (40 mg/day or to add-on current statin treatment with extended release (ER NA/laropiprant (1000/20 mg/day for the first 4 weeks followed by 2000/40 mg/day for the next 8 weeks for 3 months. Results. Switching to rosuvastatin 40 mg/day was not associated with significant BP alterations. In contrast, the addition of ER-NA/laropiprant to current statin treatment resulted in a 7% reduction of systolic BP (from 134±12 to 125±10 mmHg, <.001 versus baseline and =.01 versus rosuvastatin group and a 5% reduction of diastolic BP (from 81±9 to 77±6 mmHg, =.009 versus baseline and =.01 versus rosuvastatin group. These reductions were significant only in the subgroup of hypertensives and were independent of the hypolipidemic effects of ER-NA/laropiprant. Conclusions. Contrary to the switch to high-dose rosuvastatin, the addition of ER-NA/laropiprant to statin treatment was associated with significant reductions in both systolic and diastolic BP.

  4. Positive expiratory pressure and oscillatory positive expiratory pressure therapies.

    Science.gov (United States)

    Myers, Timothy R

    2007-10-01

    Airway clearance techniques, historically referred to as chest physical therapy, have traditionally consisted of a variety of breathing maneuvers or exercises and manual percussion and postural drainage. The methods and types of airway clearance techniques and devices have rapidly increased in an effort to find a more efficacious strategy that allows for self-therapy, better patient adherence and compliance, and more efficient durations of care. Mechanically applied pressure devices have migrated from European countries over the last several decades to clinical practice in the United States. I conducted a comprehensive MEDLINE search of two such devices: positive expiratory pressure (PEP) and oscillatory positive expiratory pressure (OPEP) and their role in airway clearance strategies. This was followed by a comprehensive search for cross-references in an attempt to identify additional studies. The results of that search are contained and reported in this review. From a methods standpoint, most of the studies of PEP and OPEP for airway clearance are limited by crossover designs and small sample sizes. While PEP and OPEP do not definitively prove superiority to other methods of airway clearance strategies, there is no clear evidence that they are inferior. Ultimately, the correct choice may be an airway clearance strategy that is clinically and cost effective, and is preferred by the patient so that adherence and compliance can be at the very least supported.

  5. Incidence of unanticipated difficult airway using an objective airway score versus a standard clinical airway assessment

    DEFF Research Database (Denmark)

    Nørskov, Anders Kehlet; Rosenstock, Charlotte Valentin; Wetterslev, Jørn

    2013-01-01

    the examination and registration of predictors for difficult mask ventilation with a non-specified clinical airway assessment on prediction of difficult mask ventilation.Method/Design: We cluster-randomized 28 Danish departments of anaesthesia to airway assessment either by the SARI or by usual non...... reduction equalling a number needed to treat of 180. Sample size estimation is adjusted for the study design and based on standards for randomization on cluster-level. With an average cluster size of 2,500 patients, 70,000 patients will be enrolled over a 1-year trial period. The database is programmed so...

  6. Vessel-guided Airway Tree Segmentation

    DEFF Research Database (Denmark)

    Lo, P.; Sporring, J.; Ashraf, H.;

    2010-01-01

    This paper presents a method for airway tree segmentation that uses a combination of a trained airway appearance model, vessel and airway orientation information, and region growing. We propose a voxel classification approach for the appearance model, which uses a classifier that is trained...... method is evaluated on 250 low dose computed tomography images from a lung cancer screening trial. Our experiments showed that applying the region growing algorithm on the airway appearance model produces more complete airway segmentations, leading to on average 20% longer trees, and 50% less leakage...

  7. Inflammatory bowel disease and airway diseases

    Science.gov (United States)

    Vutcovici, Maria; Brassard, Paul; Bitton, Alain

    2016-01-01

    Airway diseases are the most commonly described lung manifestations of inflammatory bowel disease (IBD). However, the similarities in disease pathogenesis and the sharing of important environmental risk factors and genetic susceptibility suggest that there is a complex interplay between IBD and airway diseases. Recent evidence of IBD occurrence among patients with airway diseases and the higher than estimated prevalence of subclinical airway injuries among IBD patients support the hypothesis of a two-way association. Future research efforts should be directed toward further exploration of this association, as airway diseases are highly prevalent conditions with a substantial public health impact. PMID:27678355

  8. The Lung Microbiome and Airway Disease.

    Science.gov (United States)

    Lynch, Susan V

    2016-12-01

    A growing body of literature has demonstrated relationships between the composition of the airway microbiota (mixed-species communities of microbes that exist in the respiratory tract) and critical features of immune response and pulmonary function. These studies provide evidence that airway inflammatory status and capacity for repair are coassociated with specific taxonomic features of the airway microbiome. Although directionality has yet to be established, the fact that microbes are known drivers of inflammation and tissue damage suggests that in the context of chronic inflammatory airway disease, the composition and, more importantly, the function, of the pulmonary microbiome represent critical factors in defining airway disease outcomes.

  9. Mucus hypersecretion in the airway

    Institute of Scientific and Technical Information of China (English)

    WANG Ke; WEN Fu-qiang; XU Dan

    2008-01-01

    @@ Mucus hypersecretion is a distinguishing feature of Chronic intlammation diseases,such as asthma,1chronic bronchitis.2 bronchiectasis3 and cystic fibrosis.4Mucus hypersecretion leads to impairment of mucociliary clearance,abnormal bacterial plantation,mucus plug in the airway,and dysfunction of gas exchange.5

  10. Airway nerves: in vitro electrophysiology.

    Science.gov (United States)

    Fox, Alyson

    2002-06-01

    Recording the activity of single airway sensory fibres or neuronal cell bodies in vitro has allowed detailed characterisation of fibre types and membrane properties. Fibre types can be identified by their conduction velocities and further studied by the application of drugs to their receptive field. C-fibres are sensitive to mechanical stimuli and a range of irritant chemicals (bradykinin, capsaicin, low pH, platelet-activating factor), whereas Adelta-fibres are relatively insensitive to chemical stimuli and appear to correlate to the rapidly adapting receptors identified in airways in vivo. Their site of origin also differs: upper airway C-fibres arise predominantly from the jugular ganglion and Adelta-fibres from the jugular and nodose ganglia. Intracellular recording from cell bodies in the ganglia has revealed a calcium-dependent potassium current common to many putative C-fibre cell bodies. This slow after hyperpolarisation current may be inhibited by stimuli that excite and sensitise C-fibres - this could be an important mechanism underlying the sensitisation of C-fibres in airway irritability.

  11. Comparação dos níveis de pressão positiva contínua nas vias aéreas através de dois sistemas A comparison of the continuous positive airway pressures produced by two systems

    Directory of Open Access Journals (Sweden)

    Marcela Raquel de Oliveira Lima

    2004-01-01

    = 0,000. CONCLUSÃO: Através dos nossos registros, foi possível observar que o sistema pressão positiva contínua nas vias aéreas no Inter 3® comportou-se de forma mais estável e linear do que a pressão positiva contínua nas vias aéreas no selo d'água, uma vez que esta apresentou grandes variações pressóricas.OBJECTIVE: To compare the generation of continuous positive airway pressure using a hand-made device (underwater seal or a ventilator (Inter 3®. METHODOLOGY: Two positive airway pressure generation systems were compared through laboratory simulations. Measurements were not considered if the mechanical ventilator required calibration or in the presence of gas flow variation (flowmeter sphere oscillation. Recordings were assessed in terms of the capacity to produce the desired pressure (3, 5 and 6 cmH2O when submitted to three different flow values (8, 10 and 12 l/min. For that end, Student's t test for paired samples and the nonparametric Man-Whitney test for independent samples were employed. RESULTS: We verified that the systems behave in different manners under the same conditions of flow and positive end expiratory pressure. For the mechanical ventilator, the mean pressure behavior under continuous positive airway pressure at 3 cmH2O with flows of 8, 10 and 12 l/min were 2.26±0.41, 2.22±0.37, 2.04±0.41, respectively; under positive end-expiratory pressure at 5 cmH2O we found 3.96±0.41, 3.87±0.43 and 3.75±0.52; and under positive end-expiratory pressure at 6 cmH2O the values recorded were 4.94±0.40, 4.85±0.41 and 4.72±0.37. For the underwater seal, the mean pressure behavior under continuous positive airway pressure at 3 cmH2O with flows of 8, 10 and 12 l/min were 4.24±0.24, 4.46±0.26, 4.72±0.37, respectively; at 5 cmH2O the values were 5.97±0.17, 6.28±0.18, 6.47±0.31; and at 6 cmH2O we recorded 6.85±0.20, 7.17±0.29 and 7.53±0.31. All the comparisons were statistically significant (p = 0.000. CONCLUSION: Through our recordings it

  12. Possible role of differential growth in airway wall remodeling in asthma

    KAUST Repository

    Moulton, D. E.

    2011-01-20

    Possible role of differential growth in airway wall remodeling in asthma. J Appl Physiol 110: 1003-1012, 2011. First published January 20, 2011; doi:10.1152/japplphysiol.00991.2010.- Airway remodeling in patients with chronic asthma is characterized by a thickening of the airway walls. It has been demonstrated in previous theoretical models that this change in thickness can have an important mechanical effect on the properties of the wall, in particular on the phenomenon of mucosal folding induced by smooth muscle contraction. In this paper, we present a model for mucosal folding of the airway in the context of growth. The airway is modeled as a bilayered cylindrical tube, with both geometric and material nonlinearities accounted for via the theory of finite elasticity. Growth is incorporated into the model through the theory of morphoelasticity. We explore a range of growth possibilities, allowing for anisotropic growth as well as different growth rates in each layer. Such nonuniform growth, referred to as differential growth, can change the properties of the material beyond geometrical changes through the generation of residual stresses. We demonstrate that differential growth can have a dramatic impact on mucosal folding, in particular on the critical pressure needed to induce folding, the buckling pattern, as well as airway narrowing. We conclude that growth may be an important component in airway remodeling. Copyright © 2011 the American Physiological Society.

  13. Sarcoidosis of the upper and lower airways.

    Science.gov (United States)

    Morgenthau, Adam S; Teirstein, Alvin S

    2011-12-01

    Sarcoidosis is a systemic granulomatous disease of undetermined etiology characterized by a variable clinical presentation and disease course. Although clinical granulomatous inflammation may occur within any organ system, more than 90% of sarcoidosis patients have lung disease. Sarcoidosis is considered an interstitial lung disease that is frequently characterized by restrictive physiologic dysfunction on pulmonary function tests. However, sarcoidosis also involves the airways (large and small), causing obstructive airways disease. It is one of a few interstitial lung diseases that affects the entire length of the respiratory tract - from the nose to the terminal bronchioles - and causes a broad spectrum of airways dysfunction. This article examines airway dysfunction in sarcoidosis. The anatomical structure of the airways is the organizational framework for our discussion. We discuss sarcoidosis involving the nose, sinuses, nasal passages, larynx, trachea, bronchi and small airways. Common complications of airways disease, such as, atelectasis, fibrosis, bullous leions, bronchiectasis, cavitary lesions and mycetomas, are also reviewed.

  14. Membrane Currents in Airway Smooth Muscle: Mechanisms and Therapeutic Implications

    Directory of Open Access Journals (Sweden)

    Luke J Janssen

    1997-01-01

    Full Text Available Electrophysiological and pharmacological techniques were used to characterize the membrane conductance changes underlying spasmogen-evoked depolarization in airway smooth muscle (ASM. Changes included a transient activation of chloride ion channels and prolonged suppression of potassium ion channels; both changes are triggered by release of internally sequestered calcium ion and in turn cause opening of voltage-dependent calcium channels. The resultant influx of calcium ions contributes to contraction as well as to refilling of the internal calcium ion pool. Bronchodilators, on the other hand, act in part through activation of potassium channels, with consequent closure of calcium channels. The tools used to study ion channels in ASM are described, and the investigations of the roles of ion channels in ASM physiology (autacoid-evoked depolarization and hyperpolarization and pathophysiology (airway hyperresponsiveness are summarized. Finally, how the relationship between ion channels and ASM function/dysfunction may relate to the treatment of asthma and related breathing disorders is discussed.

  15. Renin release

    DEFF Research Database (Denmark)

    Schweda, Frank; Friis, Ulla; Wagner, Charlotte;

    2007-01-01

    The aspartyl-protease renin is the key regulator of the renin-angiotensin-aldosterone system, which is critically involved in salt, volume, and blood pressure homeostasis of the body. Renin is mainly produced and released into circulation by the so-called juxtaglomerular epithelioid cells, located......, salt, and volume overload. In contrast, the events controlling the function of renin-secreting cells at the organ and cellular level are markedly less clear and remain mysterious in certain aspects. The unravelling of these mysteries has led to new and interesting insights into the process of renin...

  16. Airway remodeling in asthma: what really matters.

    Science.gov (United States)

    Fehrenbach, Heinz; Wagner, Christina; Wegmann, Michael

    2017-03-01

    Airway remodeling is generally quite broadly defined as any change in composition, distribution, thickness, mass or volume and/or number of structural components observed in the airway wall of patients relative to healthy individuals. However, two types of airway remodeling should be distinguished more clearly: (1) physiological airway remodeling, which encompasses structural changes that occur regularly during normal lung development and growth leading to a normal mature airway wall or as an acute and transient response to injury and/or inflammation, which ultimately results in restoration of a normal airway structures; and (2) pathological airway remodeling, which comprises those structural alterations that occur as a result of either disturbed lung development or as a response to chronic injury and/or inflammation leading to persistently altered airway wall structures and function. This review will address a few major aspects: (1) what are reliable quantitative approaches to assess airway remodeling? (2) Are there any indications supporting the notion that airway remodeling can occur as a primary event, i.e., before any inflammatory process was initiated? (3) What is known about airway remodeling being a secondary event to inflammation? And (4), what can we learn from the different animal models ranging from invertebrate to primate models in the study of airway remodeling? Future studies are required addressing particularly pheno-/endotype-specific aspects of airway remodeling using both endotype-specific animal models and "endotyped" human asthmatics. Hopefully, novel in vivo imaging techniques will be further advanced to allow monitoring development, growth and inflammation of the airways already at a very early stage in life.

  17. Effect of continuous positive airway pressure during one lung ventilation on pulmonary function in patients undergoing video-assisted thoracoscopic repair of atrial septal defect%单肺通气期间连续气道正压通气对胸腔镜房间隔缺损修补术患者肺功能的影响

    Institute of Scientific and Technical Information of China (English)

    王磊; 陈宇; 钱燕宁; 丁正年; 孙杰

    2010-01-01

    目的 探讨单肺通气期间连续气道正压通气(CPAP)对胸腔镜房间隔缺损修补术患者肺功能的影响.方法 拟行房间隔缺损修补术的患者20例,年龄16~30岁,体重41~64 kg,性别不限,ASA分级Ⅱ级,随机分为2组(n=10):对照组和CPAP组.两组单肺通气时VT 8 ml/kg,呼吸频率12~16次/min,吸呼比1:2,维持PET CO2 35~40 mm Hg.CPAP组单肺通气期间,非通气侧肺采用CPAP,压力为6 cm H2O.术中监测氧合指数、肺顺应性和气道压,记录拔管时间、单肺通气期间心血管事件和低氧血症的发生情况.结果 与对照组比较,CPAP组氧合指数和肺顺应性升高,拔管时间缩短,低氧血症发生率低(P<0.01),两组患者气道压力在正常范围且未发生心血管事件.结论 单肺通气期间行CPAP(6 cm H2O)可改善胸腔镜房间隔缺损修补术患者的肺功能.%Objective To investigate the effect of continuous positive airway pressure(CPAP)during one lung ventilation on pulmonary function in patients undergoing video-assisted thoracoscopic repair of atrial septal defect.Methods Twenty ASA Ⅱ patients of both sexes,aged 16-30 yr,weighing 41-64 kg,scheduled for video-assisted thoracoscopic repair of atrial septal defect,were randomly divided into 2 groups(n = 10 each): control group and CPAP group.One lung ventilation(VT 8 ml/kg,RR 12-16 bpm,I:E 1:2,PETCO2 35-40 mm Hg)was perform in both groups.CPAP(6 cm H2O)was perform during one lung ventilation in group CPAP.The oxygenation index,pulmonary compliance and airway pressure were recorded during operation.The cardiovascular events,hyoxemia and extubation time were recorded.Results The oxygenation index and pulmonary compliance were significantly higher,extubation time was shorter,and the incidence of hyoxemia was lower in CPAP group than in control group(P < 0.01).The airway pressure was in the normal range in both groups.No cardiovascular events was found in both groups.Conclusion CPAP(6cm H2O)during one lung

  18. Simvastatin attenuates lipopolysaccharide-induced airway mucus hypersecretion in rats

    Institute of Scientific and Technical Information of China (English)

    OU Xue-mei; WANG Bai-ding; WEN Fu-qiang; FENG Yu-lin; HUANG Xiang-yang; XIAO Jun

    2008-01-01

    Background Mucus hypersecretion in the respiratory tract and goblet cell metaplasia in the airway epithelium contribute to the morbidity and mortality associated with airway inflammatory diseases.This study aimed to examine the effect and mechanisms of simvastatin on airway mucus hypersecretion in rats treated with lipopolysaccharide (LPS).Methods Mucus hypersecretion in rat airways was induced by intra-tracheal instillation of LPS.Rats treated with or without LPS were administered intra-peritoneally simvastatin (5 and 20 mg/kg) for 4 days.Expression of Muc5ac,RhoA and mitogen-activated protein kinases (MAPK) p38 in lung were detected by real-time polymerase chain reaction (PCR),immunohistochemistry or Western blotting.Tumor necrosis factor (TNF)-a and IL-8 in bronchoalveolar lavage fluid (BALF)were assayed by an enzyme-linked lectin assay and enzyme linked immunosorbent assay (ELISA).Results Simvastatin attenuated LPS-induced goblet cell hyperplasia in bronchial epithelium and Muc5ac hypersecretion at both the gene and protein levels in lung (P<0.05).Moreover,simvastatin inhibited neutrophil accumulation and the increased concentration of TNF-α and IL-8 in BALF follows LPS stimulation (P<0.05).The higher dose of simvastatin was associated with a more significant reduction in Muc5ac mRNA expression,neutrophil accumulation and inflammatory cytokine release.Simultaneously,the increased expression of RhoA and p38 MAPK were observed in LPS-treated lung (P<0.05).Simvastatin inhibited the expression of RhoA and p38 phosphorylation in lung following LPS stimulation (P<0.05).However,the increased expression of p38 protein in LPS-traated lung was not affected by simvastatin administration.Conclusions Simvastatin attenuates airway mucus hypersecretion and pulmonary inflammatory damage induced by LPS.The inhibitory effect of simvastatin on airway mucus hypersecretion may be through,at least in part,the suppression of neutrophil accumulation and inflammatory cytokine

  19. Clinical assessment of awake endotracheal intubation using the lightwand technique alone in patients with difficult airways

    Institute of Scientific and Technical Information of China (English)

    XUE Fu-shan; HE Nong; LIAO Xu; XU Xiu-Zheng; XU Yachao; YANG Quan-yong; LUO Mao-ping; ZHANG Yan-ming

    2009-01-01

    Background There is few study to determine whether the use of the lightwand technique alone could achieve effective, safe and successful awake endotracheal intubation (ETI), therefore we designed a prospective clinical study to systematically evaluate the feasibility, safety and efficacy of awake ETI using the lightwand alone in patients with difficult airways.Methods Seventy adult patients with difficult airways were enrolled in this study. After the desired sedation with fentanyl and midazolam, airway topical anesthesia was performed with 9 ml of 2% lidocaine, which were in order sprayed in three aliquots at 5 minutes intervals into the supraglottic (two doses) and laryngotracheal areas (one dose) using a combined unit of the lightwand and MADgic atomizer. After airway topical anesthesia, awake ETI was performed using a Lightwand. Subjective assessments by patients and operators using the visual analogue scores (VAS), and objective assessments by an independent investigator using patients' tolerance and reaction scores, coughing severity, intubating conditions and cardiovascular variables were taken as the observed parameters.Results Of 210 airway sprays, 197 (93.8%) were successfully completed on the first attempt. The total time for airway spray was (14.6±1.5) minutes. During airway topical anesthesia, the average patients' tolerance scores were 1.7-2.3. After airway topical anesthesia, the mean VAS for discomfort levels that the patients reported was 6.5. Also airway topical anesthesia procedure was rated as acceptable and no discomfort by 94.3% of patients. The lightwand-guided awake ETI was successfully completed on first attempt within 29 seconds in all patients. During awake ETI, patients' reaction and coughing scores were 1.9 and 1.6, respectively. All patients exhibited excellent or acceptable intubating conditions. Cardiovascular monitoring revealed that changes of systolic blood pressure and heart rate at each stage of airway manipulations were less

  20. Role of cholinergic neural transmission on airway resistance in the dog.

    Science.gov (United States)

    Kondo, T; Kobayashi, I; Hayama, N; Tazaki, G; Ohta, Y

    2000-04-12

    The unique contractile profiles of bronchial smooth muscle (Kondo et al., 1995) and its neural control were investigated by comparing responses of the bronchus and trachea to acute hypercapnia, stimulation of vagus efferent fibers before and after intravenous atropine, and intravenous acetylcholine in decerebrated and paralyzed dogs. During acute hypercapnia, airway resistance represented by peak airway pressure (Pedley et al., 1970) significantly increased as well as tracheal tension (Ttr). During electric stimulation of the vagal efferent fibers, Ttr increased and was sustained throughout the simulation period while the peak airway pressure was not maintained at the peak level. The peak Ttr and the airway resistance (Raw) calculated from ventilatory flow and airway pressure increased with increases in intensity of electric stimulation. Ttr reached its maximal level at an intensity 16 times of the threshold (T), while Raw became maximal at 4T. Although both the Ttr-stimulus intensity and Raw-intensity curves were shifted to the right by administration of intravenous atropine, the Raw curve shifted more to the right than the Ttr curve with the same dose of atropine. When muscular muscarinic receptors were directly stimulated by intravenous acetylcholine, Ttr once increased and then decreased promptly while peak airway pressure remained at a high level for a few minutes. These findings suggested that the bronchus is more sensitive to vagal efferent stimulation and susceptible to competitive antagonist of actylcholine than the trachea. In conclusion, the contractile profiles of the fifth-order bronchus we have reported (Kondo et al., 1995) were reflected in airway resistance, and the neuromuscular junction may be the site of adaptation of bronchoconstrictor response to motor nerve adaptation.

  1. Effect of continuous positive airway pressure treatment on serum angiotensin converting enzyme levels in patients with obesity-associated obstructive sleep apnea syndrome%持续气道正压通气对阻塞性睡眠呼吸暂停综合征患者血清血管紧张素转换酶水平的影响

    Institute of Scientific and Technical Information of China (English)

    沈文富; 李红苗; 王强; 王骏; 蒋冬兰; 严锡祥

    2012-01-01

    目的:探讨持续气道正压通气(continuous positive air-way pressure,CPAP)对阻塞性睡眠呼吸暂停综合征(obstructive sleep apnea syndrome,OSAS)患者血清中血管紧张素转换酶(angiotensin converting enzyme,ACE)水平的影响.方法:根据睡眠期多导睡眠监测中的呼吸暂停低通气指数(apnea hypopnea index,AHI) 检查结果,选择43例符合OSAS诊断标准的患者作为研究对象(OSAS组),测定OSAS组实施CPAP治疗1个月前后ACE水平,与AHI正常者(正常组)比较,并分析OSAS组中ACE与睡眠呼吸紊乱指数的相关性.结果:OSAS组治疗前ACE浓度(23.35±15.62) U/L显著低于正常组(38.95±21.83) U/L (P0.05),相关性分析显示OSAS组中ACE浓度与AHI无明显相关性(r=-0.018,P>0.05).结论:OSAS患者血清中ACE水平与睡眠呼吸紊乱指数无明显相关性,与正常人相比,OSAS患者血清ACE显著降低,CPAP治疗不能影响ACE水平变化.%Objective: To investigate the influence of continuous positive airway pressure( CPAP )treatment on the serum angiotensin converting enzyme levels in patients with obstructive sleep apnea syndrome ( OSAS ). Methods: Based on apnea hypopnea index( AHI ) measured by polysomnography, 43 patients were diagnosed as OSAS( OSAS group ) and enrolled in this study. The serum ACE levels of OSAS group were measured and compared with the subjects without OSAS( normal groups ). In patients with OSAS, the relationship between levels of ACE and AHI were analyzed. Results: Compared with normal group[ ( 38. 95 ±21.83 ) U/L], serum ACE levels in OSAS group[ ( 23.35 ±15.62 ) U/L,P 0. 05 ). No relationship was observed in OSAS group between the ACE levels and AHI levels. Conclusion: The serum ACE levels in OSAS group was significantly higher than in normal group. The CPAP treatment cannot change the ACE level in OSAS patients. The serum ACE levels were not correlated with the AHI levels in OSAS patients.

  2. Blood pressure control with a single-pill combination of indapamide sustained-release and amlodipine in patients with hypertension: the EFFICIENT study.

    Directory of Open Access Journals (Sweden)

    Uday Jadhav

    Full Text Available OBJECTIVE: Despite antihypertensive treatment, most hypertensive patients still have high blood pressure (BP, notably high systolic blood pressure (SBP. The EFFICIENT study examines the efficacy and acceptability of a single-pill combination of sustained-release (SR indapamide, a thiazide-like diuretic, and amlodipine, a calcium channel blocker (CCB, in the management of hypertension. METHODS: Patients who were previously uncontrolled on CCB monotherapy (BP≥140/90 mm Hg or were previously untreated with grade 2 or 3 essential hypertension (BP≥160/100 mm Hg received a single-pill combination tablet containing indapamide SR 1.5 mg and amlodipine 5 mg daily for 45 days, in this multicenter prospective phase 4 study. The primary outcome was mean change in BP from baseline; percentage of patients achieving BP control (BP<140/90 mm Hg was a secondary endpoint. SBP reduction (ΔSBP versus diastolic BP reduction (ΔDBP was evaluated (ΔSBP/ΔDBP from baseline to day 45. Safety and tolerability were also assessed. RESULTS: Mean baseline BP of 196 patients (mean age 52.3 years was 160.2/97.9 mm Hg. After 45 days, mean SBP decreased by 28.5 mm Hg (95% CI, 26.4 to 30.6, while diastolic BP decreased by 15.6 mm Hg (95% CI, 14.5 to 16.7. BP control (<140/90 mm Hg was achieved in 85% patients. ΔSBP/ΔDBP was 1.82 in the overall population. Few patients (n = 3 [2%] reported side effects, and most (n = 194 [99%] adhered to treatment. CONCLUSION: In patients who were previously uncontrolled on CCB monotherapy or untreated with grade 2 or 3 hypertension, single-pill combination indapamide SR/amlodipine reduced BP effectively--especially SBP--over 45 days, and was safe and well tolerated. TRIAL REGISTRATION: Clinical Trial Registry-India CTRI/2010/091/000114.

  3. Comparison of laryngeal mask airway use with endotracheal intubation during anesthesia of western lowland gorillas (Gorilla gorilla gorilla).

    Science.gov (United States)

    Cerveny, Shannon N; D'Agostino, Jennifer J; Davis, Michelle R; Payton, Mark E

    2012-12-01

    The laryngeal mask airway is an alternative to endotracheal intubation that achieves control of the airway by creating a seal around the larynx with an inflatable cuff. This study compared use of the laryngeal mask airway with endotracheal intubation in anesthetized western lowland gorillas (Gorilla gorilla gorilla). Eight adult gorillas were immobilized for routine and diagnostic purposes for a total of nine anesthetic events. During each anesthetic event, gorillas were either intubated (n = 4; group A) or fitted with a laryngeal mask airway (n= 5; group B). Time required to place each airway device, physiologic parameters, and arterial blood gas were measured and compared between the two groups. There were no significant differences between the two groups for time required to place airway device, heart rate, hemoglobin oxygen saturation, end-tidal carbon dioxide, arterial partial pressure of carbon dioxide, or arterial pH between the two groups. Mean arterial partial pressure of oxygen was significantly greater in group B, 15 (group A: 94 +/- 44 mm Hg; group B: 408 +/- 36 mm Hg; P= 0.0025) and 45 (group A: 104 +/- 21 mm Hg; group B: 407 +/- 77 mm Hg; P = 0.0026) min after airway device placement. Mean respiratory rate was significantly greater in group A at multiple time points. Mean arterial pressure (group A: 129 +/- 16 mm Hg; group B: 60 +/- 8 mm Hg) and diastolic blood pressure (group A: 115 +/- 21 mm Hg; group B: 36 +/- 10 mm Hg) were significantly greater in group A at the time of airway device placement. The laryngeal mask airway maintained oxygenation and ventilation effectively in all gorillas and is a useful alternative to endotracheal intubation in western lowland gorillas.

  4. Transient receptor potential ankyrin 1 channel localized to non-neuronal airway cells promotes non-neurogenic inflammation

    DEFF Research Database (Denmark)

    Nassini, Romina; Pedretti, Pamela; Moretto, Nadia

    2012-01-01

    and fibroblasts, acrolein and CS extract evoked IL-8 release, a response selectively reduced by TRPA1 antagonists. Capsaicin, agonist of the transient receptor potential vanilloid 1 (TRPV1), a channel co-expressed with TRPA1 by airway sensory nerves, and acrolein or CS (TRPA1 agonists), or the neuropeptide...... substance P (SP), which is released from sensory nerve terminals by capsaicin, acrolein or CS), produced neurogenic inflammation in mouse airways. However, only acrolein and CS, but not capsaicin or SP, released the keratinocyte chemoattractant (CXCL-1/KC, IL-8 analogue) in bronchoalveolar lavage (BAL...

  5. Transient receptor potential ankyrin 1 channel localized to non-neuronal airway cells promotes non-neurogenic inflammation

    DEFF Research Database (Denmark)

    Nassini, Romina; Pedretti, Pamela; Moretto, Nadia;

    2012-01-01

    The transient receptor potential ankyrin 1 (TRPA1) channel, localized to airway sensory nerves, has been proposed to mediate airway inflammation evoked by allergen and cigarette smoke (CS) in rodents, via a neurogenic mechanism. However the limited clinical evidence for the role of neurogenic...... and fibroblasts, acrolein and CS extract evoked IL-8 release, a response selectively reduced by TRPA1 antagonists. Capsaicin, agonist of the transient receptor potential vanilloid 1 (TRPV1), a channel co-expressed with TRPA1 by airway sensory nerves, and acrolein or CS (TRPA1 agonists), or the neuropeptide...

  6. Retinoic acid prevents virus-induced airway hyperreactivity and M2 receptor dysfunction via anti-inflammatory and antiviral effects

    OpenAIRE

    Moreno-Vinasco, Liliana; Verbout, Norah G.; Fryer, Allison D.; Jacoby, David B.

    2009-01-01

    Inhibitory M2 muscarinic receptors on airway parasympathetic nerves normally limit acetylcholine release. Viral infections decrease M2 receptor function, increasing vagally mediated bronchoconstriction. Since retinoic acid deficiency causes M2 receptor dysfunction, we tested whether retinoic acid would prevent virus-induced airway hyperreactivity and prevent M2 receptor dysfunction. Guinea pigs infected with parainfluenza virus were hyperreactive to electrical stimulation of the vagus nerves,...

  7. Plethysmographic measurements of specific airway resistance in young children

    DEFF Research Database (Denmark)

    Bisgaard, Hans; Nielsen, Kim G

    2005-01-01

    children. This article reviews the method, and proposes a protocol and criteria for quality assurance for assessment of sRaw in preschool children from 2 years of age. sRaw measurements offers a method for clinical monitoring and research during this critical period of growth and development early in life.......Validated methods for lung function measurements in young children are lacking. Plethysmographic measurement of specific airway resistance (sRaw) provides such a method applicable from 2 years of age. sRaw gauges airway resistance from the measurements of the pressure changes driving the airflow...... also been documented by this technique, and sRaw has recently been used in longitudinal studies of young children with chronic pulmonary diseases. Future developments should provide improved algorithms for thermal correction of the respired volumes and adapt the equipment to the special needs of young...

  8. Ventilación con liberación de presión en la vía aérea, en neonatos con insuficiencia respiratoria aguda Airway pressure release ventilation in newborns

    OpenAIRE

    Emmanuel Jiménez-Castro; Olman Coronado-García; Leonardo Orozco-Saborio; Alicia Boza-Mora

    2013-01-01

    La ventilación con liberación de presión en la vía aérea (APRV)es una modalidad ventilatoria que utiliza presión positiva controlada en la vía aérea, con el fin de maximizar el reclutamiento alveolar, con tiempos inspiratorios prolongados, permitiendo la respiración espontánea durante ambas fases del ciclo respiratorio. Los autores describen su experiencia en una serie de 12 casos con pacientes neonatales con insuficiencia respiratoria aguda, que fueron tratados con la APRV ventilación con li...

  9. Physiological impact of abnormal lipoxin A₄ production on cystic fibrosis airway epithelium and therapeutic potential.

    Science.gov (United States)

    Higgins, Gerard; Ringholz, Fiona; Buchanan, Paul; McNally, Paul; Urbach, Valérie

    2015-01-01

    Lipoxin A4 has been described as a major signal for the resolution of inflammation and is abnormally produced in the lungs of patients with cystic fibrosis (CF). In CF, the loss of chloride transport caused by the mutation in the cystic fibrosis transmembrane conductance regulator (CFTR) Cl(-) channel gene results in dehydration, mucus plugging, and reduction of the airway surface liquid layer (ASL) height which favour chronic lung infection and neutrophil based inflammation leading to progressive lung destruction and early death of people with CF. This review highlights the unique ability of LXA4 to restore airway surface hydration, to stimulate airway epithelial repair, and to antagonise the proinflammatory program of the CF airway, circumventing some of the most difficult aspects of CF pathophysiology. The report points out novel aspects of the cellular mechanism involved in the physiological response to LXA4, including release of ATP from airway epithelial cell via pannexin channel and subsequent activation of and P2Y11 purinoreceptor. Therefore, inadequate endogenous LXA4 biosynthesis reported in CF exacerbates the ion transport abnormality and defective mucociliary clearance, in addition to impairing the resolution of inflammation, thus amplifying the vicious circle of airway dehydration, chronic infection, and inflammation.

  10. Regulation of ion transport via apical purinergic receptors in intact rabbit airway epithelium

    DEFF Research Database (Denmark)

    Poulsen, Asser Nyander; Klausen, Thomas Levin; Pedersen, Peter Steen;

    2005-01-01

    and unidirectional Cl- fluxes decreased significantly. The results suggest that nucleotides released to the airway surface liquid exert an autocrine regulation of epithelial NaCl absorption mainly by inhibiting the amiloride-sensitive epithelial Na+ channel (ENaC) and paracellular anion conductance via a P2Y...

  11. Mast cell numbers in airway smooth muscle and PC(20)AMP in asthma and COPD

    NARCIS (Netherlands)

    Liesker, J. J. W.; ten Hacken, N. H. T.; Rutgers, S. R.; Zeinstra-Smith, M.; Postma, D. S.; Timens, W.

    2007-01-01

    Introduction: Most patients with asthma and many patients with COPD show bronchial hyperresponsiveness to adenosine (BHRAMP). BHRAMP may be caused by release of mast cell histamine, which induces smooth muscle contraction. Aim of the study: To evaluate whether mast cell numbers in airway smooth musc

  12. Ambroxol suppresses influenza-virus proliferation in the mouse airway by increasing antiviral factor levels.

    Science.gov (United States)

    Yang, B; Yao, D F; Ohuchi, M; Ide, M; Yano, M; Okumura, Y; Kido, H

    2002-05-01

    The protective effect of ambroxol, a mucolytic agent which has antioxidant properties and stimulates the release of pulmonary surfactant, against influenza-virus proliferation in the airway was investigated in mice. Ambroxol or the vehicle was administered intraperitoneally twice a day for 5-7 days to mice shortly after intranasal infection with a lethal dose of influenza A/Aichi/68 (H3N2) virus, and the survival rate, virus titre and levels of factors regulating virus proliferation in the airway fluid were analysed. Ambroxol significantly suppressed virus multiplication and improved the survival rate of mice. The effect of ambroxol reached a peak at 10 mg x kg(-1) x day(-1), higher doses being less effective. Ambroxol stimulated the release of suppressors of influenza-virus multiplication, such as pulmonary surfactant, mucus protease inhibitor, immunoglobulin (Ig)-A and IgG, although it stimulated the release of a trypsin-type protease that potentiates virus proliferation. In addition, ambroxol transiently suppressed release of the cytokines, tumour necrosis factor-alpha, interferon-gamma and interleukin-12, into airway fluid. Although ambroxol had several negative effects on the host defence system, overall it strikingly increased the concentrations of suppressors of influenza-virus multiplication in the airway.

  13. Airway Management of Post-burn Neck Contracture with Microstomia: Age Old Technique Revisited

    Directory of Open Access Journals (Sweden)

    Chetna Jadeja;

    2012-12-01

    Full Text Available This case report describes airway management of a patient of post burn neck contracture with fixed flexion deformity and restricted mouth opening. Attempt to intubate the patient with fiberoptic bronchoscope failed so the neck contracture was released under tumescent anaesthesia. The patient was then intubated with the help of stylet.

  14. Basal Secretion of Lysozyme from Human Airways in Vitro

    Directory of Open Access Journals (Sweden)

    Patricia Roger

    1999-01-01

    Full Text Available The aim of this study was to examine the basal release of lysozyme from isolated human lung tissues. Measurements of lysozyme in the fluids derived from lung preparations were performed using a rate-of-lysis assay subsequent to acidification of the biological samples. Lysozyme released from bronchial preparations into fluids was greater than that observed for parenchymal tissues. The lysozyme quantities detected in bronchial fluids were not modified by removal of the surface epithelium. Furthermore, the quantities of lysozyme in bronchial fluids was correlated with the size of the bronchial preparations. These results suggest that the lysozyme was principally secreted by the human bronchi (submucosal layer rather than by parenchyma tissues and that a greater release was observed in the proximal airways.

  15. Airway injury during emergency transcutaneous airway access: a comparison at cricothyroid and tracheal sites.

    LENUS (Irish Health Repository)

    Salah, Nazar

    2009-12-01

    Oxygenation via the cricothyroid membrane (CTM) may be required in emergencies, but inadvertent tracheal cannulation may occur. In this study, we compared airway injury between the tracheal and CTM sites using different techniques for airway access.

  16. Computational modeling of unsteady surfactant-laden liquid plug propagation in neonatal airways

    Science.gov (United States)

    Olgac, Ufuk; Muradoglu, Metin

    2013-07-01

    Surfactant-free and surfactant-laden liquid plug propagation in neonatal airways in various generations representing the upper and lower airways are investigated computationally using a finite-difference/front-tracking method. Emphasis is placed on the unsteady surfactant-laden plug propagation as a model for Surfactant Replacement Therapy (SRT) and airway reopening. The numerical method is designed to solve the evolution equations of the interfacial and bulk surfactant concentrations coupled with the incompressible Navier-Stokes equations. Available experimental data for surfactant Survanta are used to relate surface tension coefficient to surfactant concentration at the interface. It is found that, for the surfactant-free case, the trailing film thickness is in good agreement with Taylor's law for plugs with plug length greater than the airway width. Mechanical stresses that could be injurious to epithelial cells such as pressure and shear stress and their gradients are maximized on the front and rear menisci with increasing magnitudes in the lower generations. These mechanical stresses, especially pressure and pressure gradient, are diminished with the introduction of surfactants. Surfactant is absorbed onto the trailing film and thickens it, eventually leading to either plug rupture or, if totally consumed prior to rupture, to steadily propagating plug. In the upper airways, initially small plugs rupture rapidly and plugs with comparable initial plug length with the airway width persist and propagate steadily. For a more effective SRT treatment, we recommend utilization of plugs with initial plug length greater than the airway width. Increasing surfactant strength or increasing the initially instilled surfactant concentration is found to be ineffective.

  17. A randomised trial to compare i-gel and ProSeal™ laryngeal mask airway for airway management in paediatric patients

    Science.gov (United States)

    Nirupa, R; Gombar, Satinder; Ahuja, Vanita; Sharma, Preeti

    2016-01-01

    Background and Aims: i-gel™ is a newer supraglottic airway device with a unique non-inflatable cuff. We aimed to compare i-gel™ with ProSeal™ laryngeal mask airway (PLMA™) in children scheduled for surgery under general anaesthesia (GA) with controlled ventilation. Methods: This prospective, randomised controlled study was conducted in 100 surgical patients, aged 2–6 years of American Society of Anesthesiologists Physical Status I–II scheduled under GA. Patients were randomly allocated to receive either size 2 i-gel™ or PLMA™ as an airway device. The primary aim was oropharyngeal leak pressure assessed at 5 min following correct placement of the device. Secondary outcomes measured included number of attempts, ease of insertion, time of insertion, quality of initial airway, fibre-optic grading and effects on pulmonary mechanics. Statistical analysis was done using paired t-test and Chi-square test. Results: The demographic data were similar in both the groups. The oropharyngeal leak pressure in the i-gel™ group was 29.5 ± 2.5 cmH2 O as compared to 26.1 ± 3.8 cmH2 O in PLMA™ group (P = 0.002). The time taken for successful insertion in PLMA™ was longer as compared to i-gel (12.4 ± 2.7 vs. 10.2 ± 1.9 s, P = 0.007). The quality of initial airway was superior with i-gel™. The number of attempts, ease of insertion of supraglottic device, insertion of orogastric tube and pulmonary mechanics were similar in both the groups. Conclusion: Size 2 i-gel™ exhibited superior oropharyngeal leak pressure and quality of airway in paediatric patients with controlled ventilation as compared to PLMA™ although the pulmonary mechanics were similar.

  18. A randomised trial to compare i-gel and ProSeal™ laryngeal mask airway for airway management in paediatric patients

    Directory of Open Access Journals (Sweden)

    R Nirupa

    2016-01-01

    Full Text Available Background and Aims: i-gel™ is a newer supraglottic airway device with a unique non-inflatable cuff. We aimed to compare i-gel™ with ProSeal™ laryngeal mask airway (PLMA™ in children scheduled for surgery under general anaesthesia (GA with controlled ventilation. Methods: This prospective, randomised controlled study was conducted in 100 surgical patients, aged 2-6 years of American Society of Anesthesiologists Physical Status I-II scheduled under GA. Patients were randomly allocated to receive either size 2 i-gel™ or PLMA™ as an airway device. The primary aim was oropharyngeal leak pressure assessed at 5 min following correct placement of the device. Secondary outcomes measured included number of attempts, ease of insertion, time of insertion, quality of initial airway, fibre-optic grading and effects on pulmonary mechanics. Statistical analysis was done using paired t-test and Chi-square test. Results: The demographic data were similar in both the groups. The oropharyngeal leak pressure in the i-gel™ group was 29.5 ± 2.5 cmH 2 O as compared to 26.1 ± 3.8 cmH 2 O in PLMA™ group (P = 0.002. The time taken for successful insertion in PLMA™ was longer as compared to i-gel (12.4 ± 2.7 vs. 10.2 ± 1.9 s, P = 0.007. The quality of initial airway was superior with i-gel™. The number of attempts, ease of insertion of supraglottic device, insertion of orogastric tube and pulmonary mechanics were similar in both the groups. Conclusion: Size 2 i-gel™ exhibited superior oropharyngeal leak pressure and quality of airway in paediatric patients with controlled ventilation as compared to PLMA™ although the pulmonary mechanics were similar.

  19. Comparison of the streamlined pharynx airway liner with the conventional laryngeal mask airway for airway management during general anesthesia%SLIPA~(TM)喉罩与普通喉罩用于全麻气道管理的比较

    Institute of Scientific and Technical Information of China (English)

    徐建设; 陈辉; 傅卫军; 唐靖

    2010-01-01

    Objective To compare the performance of the streamlined pharynx airway liner (SLIPA~(TM)) with the conventional laryngeal mask airway(LMA) for airway management in minor surgery under general anesthesia. Methods Sixty fasted adult patients with ASA status Ⅰ~Ⅱ were randomly designed to establish SLIPA~(TM) airway (SLIPA~(TM) group) or LMA airway(LMA group) for airway management during anesthesia. Article airway handling, pharynx sealing, ventilation maintenance and adverse reactions with SLIPA~(TM) group and LMA group were assessed. Results SLIPA~(TM) had comparable total rate of successful insertion and airway placement difficulty to LMA(P>0.05). Maximum seal pressure was (22±5) cm H_20 and (24±6) cm H_2O in SLIPA~(TM) group and LMA group (P>0.05), respectively. A leak was noticed in 20% and 16.7% of patiemts in LMA group when patients' lungs were ventilated using intermittent positive pressure ventilation mode after airway mask placment and during surgery, and 3.3% and 0 in SLIPA~(TM) group (P0.05).通气道插入后SLIPA~(TM)组1例患者(3.3%)、LMA组6例患者(20%)需进一步调整位置方可行间歇正压通气;术中lJMA组5例患者(16.7%)需重新调整方可维持间歇正压通气,SLIPA~(TM)组均顺利完成手术全程间歇正压通气(P<0.05).2种喉罩通气道喉损伤的发生率差异无统计学意义.结论 SLIPA~(TM)喉罩的临床性能与LMA相似,是一种可替代LMA的通气道.SLIPA~(TM)喉罩操作简便,对咽喉损伤较小,维持间歇正压通气较LMA更为稳定.

  20. IL-17A modulates oxidant stress-induced airway hyperresponsiveness but not emphysema.

    Science.gov (United States)

    Pinart, Mariona; Zhang, Min; Li, Feng; Hussain, Farhana; Zhu, Jie; Wiegman, Coen; Ryffel, Bernard; Chung, Kian Fan

    2013-01-01

    IL-17A induces the release of pro-inflammatory cytokines and of reactive oxygen species which could lead to neutrophilic inflammation. We determined the role of IL-17 receptor (IL-17R) signalling in oxidant-induced lung emphysema and airway hyperresponsiveness. IL-17R(-/-) and wild-type C57/BL6 mice were exposed to ozone (3 ppm; 3 hours) for 12 times over 6 weeks. Bronchial responsiveness to acetylcholine was measured, and lungs were retrieved. Mean linear intercept (Lm) and isometric contractile responses of intrapulmonary airways to acetylcholine were determined. In wild-type mice but not in IL-17R(-/-), chronic ozone exposure caused airway hyperresponsiveness. The increase in Lm after chronic ozone exposure of wild-type mice was also observed in IL-17R(-/-) mice. The increased maximal contractile response to acetylcholine seen in airways of wild-type mice exposed to ozone was abolished in IL-17R(-/-) mice. p38-mitogen-activated protein kinase (MAPK) and dexamethasone-dependent increase in contractile response was reduced in airways from IL-17R(-/-) ozone-exposed mice. Lung inflammation scores were not altered in IL-17R(-/-) mice exposed to ozone compared to wild-type mice. The increased release of IL-17 and IL-1β, and the activation of p38 MAPK in the lungs of ozone-exposed mice was reduced in IL-17R(-/-) mice. IL-17R signalling underlies the increase in airway hyperresponsiveness seen after ozone exposure, mediated by the increased contractility of airway smooth muscle. The emphysema and lung inflammation induced by ozone is not dependent on IL-17.

  1. IL-17A modulates oxidant stress-induced airway hyperresponsiveness but not emphysema.

    Directory of Open Access Journals (Sweden)

    Mariona Pinart

    Full Text Available IL-17A induces the release of pro-inflammatory cytokines and of reactive oxygen species which could lead to neutrophilic inflammation. We determined the role of IL-17 receptor (IL-17R signalling in oxidant-induced lung emphysema and airway hyperresponsiveness. IL-17R(-/- and wild-type C57/BL6 mice were exposed to ozone (3 ppm; 3 hours for 12 times over 6 weeks. Bronchial responsiveness to acetylcholine was measured, and lungs were retrieved. Mean linear intercept (Lm and isometric contractile responses of intrapulmonary airways to acetylcholine were determined. In wild-type mice but not in IL-17R(-/-, chronic ozone exposure caused airway hyperresponsiveness. The increase in Lm after chronic ozone exposure of wild-type mice was also observed in IL-17R(-/- mice. The increased maximal contractile response to acetylcholine seen in airways of wild-type mice exposed to ozone was abolished in IL-17R(-/- mice. p38-mitogen-activated protein kinase (MAPK and dexamethasone-dependent increase in contractile response was reduced in airways from IL-17R(-/- ozone-exposed mice. Lung inflammation scores were not altered in IL-17R(-/- mice exposed to ozone compared to wild-type mice. The increased release of IL-17 and IL-1β, and the activation of p38 MAPK in the lungs of ozone-exposed mice was reduced in IL-17R(-/- mice. IL-17R signalling underlies the increase in airway hyperresponsiveness seen after ozone exposure, mediated by the increased contractility of airway smooth muscle. The emphysema and lung inflammation induced by ozone is not dependent on IL-17.

  2. Method for 3D Airway Topology Extraction

    Directory of Open Access Journals (Sweden)

    Roman Grothausmann

    2015-01-01

    Full Text Available In lungs the number of conducting airway generations as well as bifurcation patterns varies across species and shows specific characteristics relating to illnesses or gene variations. A method to characterize the topology of the mouse airway tree using scanning laser optical tomography (SLOT tomograms is presented in this paper. It is used to test discrimination between two types of mice based on detected differences in their conducting airway pattern. Based on segmentations of the airways in these tomograms, the main spanning tree of the volume skeleton is computed. The resulting graph structure is used to distinguish between wild type and surfactant protein (SP-D deficient knock-out mice.

  3. Airway Tree Extraction with Locally Optimal Paths

    DEFF Research Database (Denmark)

    Lo, Pechin Chien Pau; Sporring, Jon; Pedersen, Jesper Johannes Holst

    2009-01-01

    This paper proposes a method to extract the airway tree from CT images by continually extending the tree with locally optimal paths. This is in contrast to commonly used region growing based approaches that only search the space of the immediate neighbors. The result is a much more robust method...... for tree extraction that can overcome local occlusions. The cost function for obtaining the optimal paths takes into account of an airway probability map as well as measures of airway shape and orientation derived from multi-scale Hessian eigen analysis on the airway probability. Significant improvements...

  4. Anatomic Optical Coherence Tomography of Upper Airways

    Science.gov (United States)

    Chin Loy, Anthony; Jing, Joseph; Zhang, Jun; Wang, Yong; Elghobashi, Said; Chen, Zhongping; Wong, Brian J. F.

    The upper airway is a complex and intricate system responsible for respiration, phonation, and deglutition. Obstruction of the upper airways afflicts an estimated 12-18 million Americans. Pharyngeal size and shape are important factors in the pathogenesis of airway obstructions. In addition, nocturnal loss in pharyngeal muscular tone combined with high pharyngeal resistance can lead to collapse of the airway and periodic partial or complete upper airway obstruction. Anatomical optical coherence tomography (OCT) has the potential to provide high-speed three-dimensional tomographic images of the airway lumen without the use of ionizing radiation. In this chapter we describe the methods behind endoscopic OCT imaging and processing to generate full three dimensional anatomical models of the human airway which can be used in conjunction with numerical simulation methods to assess areas of airway obstruction. Combining this structural information with flow dynamic simulations, we can better estimate the site and causes of airway obstruction and better select and design surgery for patients with obstructive sleep apnea.

  5. AIRWAY VISUALIZATION: EYES SEE WHAT MIND KNOWS.

    Science.gov (United States)

    Sorbello, Massimiliano; Frova, Giulio; Zdravković, Ivana

    2016-03-01

    Airway management is basic for anesthesia practice, and sometimes it can represent a really dramatic scenario for both the patient and the physicians. Laryngoscopy has been the gold standard of airway visualization for more than 60 years, showing its limitations and failure rates with time. New technology has made available an opportunity to move the physician's eye inside patient airways thanks to video laryngoscopy and video assisted airway management technique. Undoubtedly, we have entered a new era of high resolution airway visualization and different approach in airway instrumentation. Nevertheless, each new technology needs time to be tested and considered reliable, and pitfalls and limitations may come out with careful and long lasting analysis, so it is probably not the right time yet to promote video assisted approach as a new gold standard for airway visualization, despite the fact that it certainly offers some new prospects. In any case, whatever the visualization approach, no patient dies because of missed airway visualization or failed intubation, but due to failed ventilation, which remains without doubt the gold standard of any patient safety goal and airway management technique.

  6. Cholinergic Regulation of Airway Inflammation and Remodelling

    Directory of Open Access Journals (Sweden)

    Saeed Kolahian

    2012-01-01

    Full Text Available Acetylcholine is the predominant parasympathetic neurotransmitter in the airways that regulates bronchoconstriction and mucus secretion. Recent findings suggest that acetylcholine regulates additional functions in the airways, including inflammation and remodelling during inflammatory airway diseases. Moreover, it has become apparent that acetylcholine is synthesized by nonneuronal cells and tissues, including inflammatory cells and structural cells. In this paper, we will discuss the regulatory role of acetylcholine in inflammation and remodelling in which we will focus on the role of the airway smooth muscle cell as a target cell for acetylcholine that modulates inflammation and remodelling during respiratory diseases such as asthma and COPD.

  7. Ultrasonography in the management of the airway

    DEFF Research Database (Denmark)

    Kristensen, M S

    2011-01-01

    In this study, it is described how to use ultrasonography (US) for real-time imaging of the airway from the mouth, over pharynx, larynx, and trachea to the peripheral alveoli, and how to use this in airway management. US has several advantages for imaging of the airway - it is safe, quick...... or the esophagus by placing the ultrasound probe transversely on the neck at the level of the suprasternal notch during intubation, thus confirming intubation without the need for ventilation or circulation. US can be applied before anesthesia induction and diagnose several conditions that affect airway management...

  8. Airway smooth muscle dynamics : a common pathway of airway obstruction in asthma

    NARCIS (Netherlands)

    An, S S; Bai, T R; Bates, J H T; Black, J L; Brown, R H; Brusasco, V; Chitano, P; Deng, L; Dowell, M; Eidelman, D H; Fabry, B; Fairbank, N J; Ford, L E; Fredberg, J J; Gerthoffer, W T; Gilbert, S H; Gosens, R; Gunst, S J; Halayko, A J; Ingram, R H; Irvin, C G; James, A L; Janssen, L J; King, G G; Knight, D A; Lauzon, A M; Lakser, O J; Ludwig, M S; Lutchen, K R; Maksym, G N; Martin, J G; Mauad, T; McParland, B E; Mijailovich, S M; Mitchell, H W; Mitchell, R W; Mitzner, W; Murphy, T M; Paré, P D; Pellegrino, R; Sanderson, M J; Schellenberg, R R; Seow, C Y; Silveira, P S P; Smith, P G; Solway, J; Stephens, N L; Sterk, P J; Stewart, A G; Tang, D D; Tepper, R S; Tran, T; Wang, L

    2007-01-01

    Excessive airway obstruction is the cause of symptoms and abnormal lung function in asthma. As airway smooth muscle (ASM) is the effecter controlling airway calibre, it is suspected that dysfunction of ASM contributes to the pathophysiology of asthma. However, the precise role of ASM in the series o

  9. Pim1 kinase protects airway epithelial cells from cigarette smoke-induced damage and airway inflammation

    NARCIS (Netherlands)

    de Vries, M.; Heijink, Hilde; Gras, R.; den Boef, L. E.; Reinders-Luinge, M.; Pouwels, S. D.; Hylkema, Machteld; van der Toorn, Marco; Brouwer, U.; van Oosterhout, A. J. M.; Nawijn, M. C.

    2014-01-01

    Exposure to cigarette smoke (CS) is the main risk factor for developing chronic obstructive pulmonary disease and can induce airway epithelial cell damage, innate immune responses, and airway inflammation. We hypothesized that cell survival factors might decrease the sensitivity of airway epithelial

  10. Lung hyperinflation stimulates the release of inflammatory mediators in spontaneously breathing subjects.

    Science.gov (United States)

    Malbouisson, L M S; Szeles, T F; Barbalho, L; Massoco, C O; Carmona, M J C; Carvalho, C R R; Pelosi, P; Auler, J O C

    2010-02-01

    Lung hyperinflation up to vital capacity is used to re-expand collapsed lung areas and to improve gas exchange during general anesthesia. However, it may induce inflammation in normal lungs. The objective of this study was to evaluate the effects of a lung hyperinflation maneuver (LHM) on plasma cytokine release in 10 healthy subjects (age: 26.1 +/- 1.2 years, BMI: 23.8 +/- 3.6 kg/m(2)). LHM was performed applying continuous positive airway pressure (CPAP) with a face mask, increased by 3-cmH(2)O steps up to 20 cmH(2)O every 5 breaths. At CPAP 20 cmH(2)O, an inspiratory pressure of 20 cmH(2)O above CPAP was applied, reaching an airway pressure of 40 cmH(2)O for 10 breaths. CPAP was then decreased stepwise. Blood samples were collected before and 2 and 12 h after LHM. TNF-alpha, IL-1beta, IL-6, IL-8, IL-10, and IL-12 were measured by flow cytometry. Lung hyperinflation significantly increased (P lung stretching was associated with an early inflammatory response in healthy spontaneously breathing subjects.

  11. Alkali release and sorption during combustion and gasification of coal under pressure; Freisetzung und Einbindung von Alkalien bei der Verbrennung und Vergasung von Kohle unter Druck

    Energy Technology Data Exchange (ETDEWEB)

    Steffin, C.R.; Wanzl, W.; Heek, K.H. van [DMT-Gesellschaft fuer Forschung und Pruefung mbH, Essen (Germany). Geschaeftsbereich FuelTec - Kokerei- und Brennstofftechnik

    1999-09-01

    Investigations and model calculations have shown that water-soluble alkaline substances (in German coal, mostly NaCl) are released by a desorption process rather than a purely physical evaporation process. Sorption takes place in the presence of reactive oxygen species (H{sub 2}O or O{sub 2}), but only the reaction with water vapour is applicable to technical processes. Soorption is preferred to desorption at low temperatures both kinetically and thermodynamically. Metakaolin has a high alkali sorption capacity and potential depending significantly on the chemical properties of the clay mineral. With increasing basicity, the sorption potential decreases drastically, which has a significant effect in terms of fuel selection and mode of operation of the process of coal dust combustion under pressure. A fuel with low alkali emissions would be a coal grade with a small fraction of water-soluble alkalis and a high fraction of acid clay minerals. Intensive scrubbing in a wet chemical treatment stage may serve to reduce the water-soluble alkalis. [Deutsch] Die Untersuchungen und Modellrechnungen haben gezeigt, dass die Freisetzung der wasserloeslichen Alkalien, was in deutschen Steinkohlen hauptsaechlich NaCl ist, ein Desorptionsmechanismus zugrunde liegt und die Vorstellung eines rein physikalischen Verdampfungsprozesses verworfen werden muss. Die Einbindung der Alkalien findet unter Teilnahme reaktiver Sauerstoffspezies (H{sub 2}O oder O{sub 2}) statt, wobei aber nur die Reaktion mit Wasserdampf auch auf technische Prozesse uebertragbar ist. Die Einbindung ist gegenueber der Desorption bei niedrigen Temperaturen kinetisch und thermodynamisch bevorzugt. Metakaolin besitzt eine hohe Kapazitaet und ein hohes Potential zur Einbindung von Alkalien, wobei die Faehigkeit zur Einbindung ganz entscheidend von den chemischen Eigenschaften des Tonminerals abhaengig ist. Mit steigender Basizitaet nimmt das Einbindungspotential der Mineralsubstanz drastisch ab. Das hat auch

  12. 利用卸压槽治理软岩巷道底鼓%Pressure Releasing Groove Applied to Floor Heave Control of Mine Sof t Rock Roadway

    Institute of Scientific and Technical Information of China (English)

    郝建斌; 魏巍; 董长龙

    2014-01-01

    在建矿井奇台一矿主采B3煤层,厚度约22m ,埋深518~540m。中央辅助运输大巷沿煤层底板掘进。底板属极软岩,遇水易膨胀,出现底鼓现象。巷道掘进后,底板即鼓起,且速度较快,平均底鼓速度达10mm/d ,原采用常规浇筑混凝土底板的办法来加以治理,未获成功。后根据具体情况,在巷道底板中间开挖卸压槽,并采用反底拱支护方式来治理底鼓,效果良好,为软岩巷道底鼓治理提供了新的经验。%In a construction mine of Qitai No.1 mine ,a main mining seam was B3 seam ,a thickness of the seam was about 22m and a depth of the seam was 518~540m. A mine central auxiliary transporta‐tion roadway was headed along the seam floor. The seam floor was an ultra soft rock ,could be easily swelled with water and would cause a floor heave phenomenon.After the mine roadway headed ,the floor would be soon heaved ,the heave speed was fast and an average floor heave speed was 10mm/day. A previous conventional method with a site pouring concrete floor was applied to control the floor heave and the method was not success.Late ,according to the certain condition ,a pressure releasing groove was excavated in the middle of the mine roadway ,a reverse floor arch support method was ap‐plied to control the floor heave and excellent effect was obtained. Thus a new experience was provided to the floor heave control of the mine soft rock roadway.

  13. An ovine tracheal explant culture model for allergic airway inflammation

    Directory of Open Access Journals (Sweden)

    Abeynaike Latasha

    2010-08-01

    Full Text Available Abstract Background The airway epithelium is thought to play an important role in the pathogenesis of asthmatic disease. However, much of our understanding of airway epithelial cell function in asthma has been derived from in vitro studies that may not accurately reflect the interactive cellular and molecular pathways active between different tissue constituents in vivo. Methods Using a sheep model of allergic asthma, tracheal explants from normal sheep and allergic sheep exposed to house dust mite (HDM allergen were established to investigate airway mucosal responses ex vivo. Explants were cultured for up to 48 h and tissues were stained to identify apoptotic cells, goblet cells, mast cells and eosinophils. The release of cytokines (IL-1α, IL-6 and TNF-α by cultured tracheal explants, was assessed by ELISA. Results The general morphology and epithelial structure of the tracheal explants was well maintained in culture although evidence of advanced apoptosis within the mucosal layer was noted after culture for 48 h. The number of alcian blue/PAS positive mucus-secreting cells within the epithelial layer was reduced in all cultured explants compared with pre-cultured (0 h explants, but the loss of staining was most evident in allergic tissues. Mast cell and eosinophil numbers were elevated in the allergic tracheal tissues compared to naïve controls, and in the allergic tissues there was a significant decline in mast cells after 24 h culture in the presence or absence of HDM allergen. IL-6 was released by allergic tracheal explants in culture but was undetected in cultured control explants. Conclusions Sheep tracheal explants maintain characteristics of the airway mucosa that may not be replicated when studying isolated cell populations in vitro. There were key differences identified in explants from allergic compared to control airways and in their responses in culture for 24 h. Importantly, this study establishes the potential for the

  14. An atmospheric pressure chemical ionization-ion-trap mass spectrometer for the on-line analysis of volatile compounds in foods: a tool for linking aroma release to aroma perception.

    Science.gov (United States)

    Le Quéré, Jean-Luc; Gierczynski, Isabelle; Sémon, Etienne

    2014-09-01

    An atmospheric pressure chemical ionization ion-trap mass spectrometer was set up for the on-line analysis of aroma compounds. This instrument, which has been successfully employed for some years in several in vitro and in vivo flavour release studies, is described for the first time in detail. The ion source was fashioned from polyether ether ketone and operated at ambient pressure and temperature making use of a discharge corona pin facing coaxially the capillary ion entrance of the ion-trap mass spectrometer. Linear dynamic ranges (LDR), limits of detection (LOD) and other analytical characteristics have been re-evaluated. LDRs and LODs have been found fully compatible with the concentrations of aroma compounds commonly found in foods. Thus, detection limits have been found in the low ppt range for common flavouring aroma compounds (for example 5.3 ppt (0.82 ppbV) for ethyl hexanoate and 4.8 ppt (1.0 ppbV) for 2,5-dimethylpyrazine). This makes the instrument applicable for in vitro and in vivo aroma release investigations. The use of dynamic sensory techniques such as the temporal dominance of sensations (TDS) method conducted simultaneously with in vivo aroma release measurements allowed to get some new insights in the link between flavour release and flavour perception.

  15. 蒸气压对聚合物包膜肥料氮素释放特性的影响%Influence of Vapor Pressure on the Nitrogen Release of Polymer-coated Fertilizers

    Institute of Scientific and Technical Information of China (English)

    陈可可; 张保林; 侯翠红

    2013-01-01

    为了从微观和动力学的角度揭示聚合物包膜肥料氮素释放的机理,研究了不同介质的蒸汽压对国内外生产工艺、养分释放机理不相同的4种聚合物包膜肥料中的氮素释放特性的影响。结果表明:在水、KH2PO4饱和溶液、KCl 饱和溶液3种介质蒸汽压下,4种供试肥料的氮素累积释放率均为:H2O>KH2PO4饱和溶液>KCl饱和溶液,利用一级动力学方程和Arrhenius方程联合得出3种介质蒸汽压下4种供试肥料的氮素释放活化能依次为:H2O<KH2PO4饱和溶液<KCl饱和溶液。缓/控释肥料的氮素累积释放率随包膜层内外的蒸汽压差增大而增大,包膜材料、肥料核心养分类型均影响肥料养分的释放。%In order to reveal the mechanism of nitrogen release of polymer-coated fertilizers, the N release characteristic from 4 polymer-coated fertilizers which have different produce technics and nutrition release mechanism was investigated in this paper. The results showed that: based on the experiments of nitrogen release under different vapor pressure, the cumulate release rate of nitrogen from polymer-coated fertilizers was: H2O > saturated solution of KH2PO4 > saturated solution of KCl; the nitrogen release activation energy from polymer-coated fertilizers was: H2O < saturated solution of KH2PO4 < saturated solution of KCl. The cumulate release rate of nitrogen from polymer-coated fertilizers increased as the difference between vapor pressure in or out integument increasing, and both the coated materials and the types of nutrient affected the release rate of nitrogen release from fertilizers.

  16. Adaptação do Bird Mark 7 para oferta de pressão positiva contínua nas vias aéreas em ventilação não-invasiva: estudo em modelo mecânico Adapting the Bird Mark 7 to deliver noninvasive continuous positive airway pressure: a bench study

    Directory of Open Access Journals (Sweden)

    Beatriz Mayumi Kikuti

    2008-03-01

    Full Text Available OBJETIVO: Testar a eficiência da adaptação do ventilador Bird Mark 7 para oferecer pressão positiva contínua nas vias aéreas, conhecida como continuous positive airway pressure (CPAP em inglês, em ventilação não-invasiva. MÉTODOS: Estudo experimental utilizando um modelo mecânico do sistema respiratório. O Bird Mark 7 foi alimentado com 400 e 500 kPa e foi testado em CPAP de 5, 10 e 15 cmH2O. Para avaliar a eficiência da adaptação foram analisados os seguintes variáveis: diferença entre a CPAP pré-determinada e a CPAP realmente atingida (CPAPreal; área da pressão da via aérea sob o nível de CPAP ajustado (ÁREA CPAP; e volume corrente gerado. RESULTADOS: A adaptação do Bird Mark 7 para oferecer CPAP em ventilação não-invasiva conseguiu atingir o volume corrente esperado em todas as situações de esforço inspiratório (normal ou elevado, pressão de alimentação (400 ou 500 kPa e valor de CPAP (5, 10 ou 15 cmH2O. Para os CPAPs de 5 e 10 cmH2O, o CPAPreal foi muito próximo do pré-determinado, e a ÁREA CPAP teve valor próximo de zero. Para o CPAP de 15 cmH2O, o CPAPreal ficou abaixo do pré-determinado, e a ÁREA CPAP teve valor elevado. CONCLUSÃO: A eficiência da adaptação do Bird Mark 7 para oferecer CPAP em ventilação não-invasiva foi boa para os valores de CPAP de 5 e 10 cmH2O e insuficiente para CPAP de 15 cmH2O. Se adaptado como em nosso estudo, o Bird Mark 7 pode ser uma opção para oferta de CPAP até 10 cmH2O em locais onde equipamentos de ventilação não-invasiva são escassos ou inexistentes.OBJECTIVE: To test the efficiency of the Bird Mark 7 ventilator adapted to deliver continuous positive airway pressure (CPAP in noninvasive positive pressure ventilation. METHODS: This was an experimental study using a mechanical model of the respiratory system. A Bird Mark 7 ventilator was supplied with 400 and 500 kPa and tested at CPAP of 5, 10 and 15 cmH2O. The following variables were analyzed

  17. Airway blood flow response to dry air hyperventilation in sheep

    Energy Technology Data Exchange (ETDEWEB)

    Parsons, G.H.; Baile, E.M.; Pare, P.D.

    1986-03-01

    Airway blood flow (Qaw) may be important in conditioning inspired air. To determine the effect of eucapneic dry air hyperventilation (hv) on Qaw in sheep the authors studied 7 anesthetized open-chest sheep after 25 min. of warm dry air hv. During each period of hv the authors have recorded vascular pressures, cardiac output (CO), and tracheal mucosal and inspired air temperature. Using a modification of the reference flow technique radiolabelled microspheres were injected into the left atrium to make separate measurements after humid air and dry air hv. In 4 animals a snare around the left main pulmonary artery was used following microsphere injection to prevent recirculation (entry into L lung of microspheres from the pulmonary artery). Qaw to the trachea and L lung as measured and Qaw for the R lung was estimated. After the final injection the sheep were killed and bronchi (Br) and lungs removed. Qaw (trachea plus L lung plus R lung) in 4 sheep increased from a mean of 30.8 to 67.0 ml/min. Airway mucosal temp. decreased from 39/sup 0/ to 33/sup 0/C. The authors conclude that dry air hv cools airway mucosa and increases Qaw in sheep.

  18. Airway smooth muscle dynamics: a common pathway of airway obstruction in asthma.

    Science.gov (United States)

    An, S S; Bai, T R; Bates, J H T; Black, J L; Brown, R H; Brusasco, V; Chitano, P; Deng, L; Dowell, M; Eidelman, D H; Fabry, B; Fairbank, N J; Ford, L E; Fredberg, J J; Gerthoffer, W T; Gilbert, S H; Gosens, R; Gunst, S J; Halayko, A J; Ingram, R H; Irvin, C G; James, A L; Janssen, L J; King, G G; Knight, D A; Lauzon, A M; Lakser, O J; Ludwig, M S; Lutchen, K R; Maksym, G N; Martin, J G; Mauad, T; McParland, B E; Mijailovich, S M; Mitchell, H W; Mitchell, R W; Mitzner, W; Murphy, T M; Paré, P D; Pellegrino, R; Sanderson, M J; Schellenberg, R R; Seow, C Y; Silveira, P S P; Smith, P G; Solway, J; Stephens, N L; Sterk, P J; Stewart, A G; Tang, D D; Tepper, R S; Tran, T; Wang, L

    2007-05-01

    Excessive airway obstruction is the cause of symptoms and abnormal lung function in asthma. As airway smooth muscle (ASM) is the effecter controlling airway calibre, it is suspected that dysfunction of ASM contributes to the pathophysiology of asthma. However, the precise role of ASM in the series of events leading to asthmatic symptoms is not clear. It is not certain whether, in asthma, there is a change in the intrinsic properties of ASM, a change in the structure and mechanical properties of the noncontractile components of the airway wall, or a change in the interdependence of the airway wall with the surrounding lung parenchyma. All these potential changes could result from acute or chronic airway inflammation and associated tissue repair and remodelling. Anti-inflammatory therapy, however, does not "cure" asthma, and airway hyperresponsiveness can persist in asthmatics, even in the absence of airway inflammation. This is perhaps because the therapy does not directly address a fundamental abnormality of asthma, that of exaggerated airway narrowing due to excessive shortening of ASM. In the present study, a central role for airway smooth muscle in the pathogenesis of airway hyperresponsiveness in asthma is explored.

  19. Comparison of Cobra perilaryngeal airway (CobraPLA TM with flexible laryngeal mask airway in terms of device stability and ventilation characteristics in pediatric ophthalmic surgery

    Directory of Open Access Journals (Sweden)

    Rani A Sunder

    2012-01-01

    Full Text Available Background: Supraglottic airway devices play an important role in ophthalmic surgery. The flexible laryngeal mask airway (LMA TM is generally the preferred airway device. However, there are no studies comparing it with the Cobra perilaryngeal airway (CobraPLA TM in pediatric ophthalmic procedures. Aims: To analyze the intraoperative device stability and ability to maintain normocarbia of CobraPLA TM and compare it to that with flexible LMA TM . Materials and Methods: Ninety children of American Society for Anesthesiologists physical status 1 and 2, aged 3-15 years scheduled for elective ophthalmic surgeries were randomly assigned to either the CobraPLA TM or the flexible LMA TM group. After placement of each airway device, oropharyngeal leak pressure (OLP was noted. Adequate seal of the devices was confirmed at an inspired pressure of 15 cm H 2 O and pressure-controlled ventilation was initiated. Device displacement was diagnosed if there was a change in capnograph waveform, audible or palpable gas leak, change in expired tidal volume to 6 kPa, or need to increase inspired pressure to >18 cm H 2 O to maintain normocarbia. Results: Demographic data, duration, and type of surgery in both the groups were similar. A higher incidence of intraoperative device displacement was noted with the CobraPLA TM in comparison to flexible LMA TM (P < 0.001. Incidence of displacement was higher in strabismus surgery (7/12. Insertion characteristics and ventilation parameters were comparable. The OLP was significantly higher in CobraPLA TM group (28 ± 6.8 cm H 2 O compared to the flexible LMA TM group (19.9 ± 4.5 cm H 2 O (P < 0.001. Higher surgeon dissatisfaction (65.9% was seen in the CobraPLA TM group. Conclusion: The high incidence of device displacement and surgeon dissatisfaction make CobraPLA TM a less favorable option than flexible LMA TM in ophthalmic surgery.

  20. A randomised crossover trial comparing a single-use polyvinyl chloride laryngeal mask airway with a single-use silicone laryngeal mask airway.

    Science.gov (United States)

    Bell, S F; Morris, N G; Rao, A; Wilkes, A R; Goodwin, N

    2012-12-01

    We compared insertion rates of single-use polyvinyl chloride laryngeal mask airways (LMAs) vs single-use silicone LMAs in 72 anaesthetised patients. Both airways were produced by Flexicare Medical. Laryngeal mask airway insertion was successful on the first attempt in 68/72 (94%) polyvinyl chloride LMAs vs 64/72 (89%) silicone LMAs (p = 0.39). Overall insertion rates were 72/72 (100%) for the polyvinyl chloride LMAs and 71/72 (99%) for the silicone LMAs (p = 1.0). Mean (SD) insertion times were similar for polyvinyl chloride and silicone LMAs: 24.3 (5.1)s vs 24.8 (7.8)s (p = 0.64). Laryngeal mask airway position, as assessed using a fibrescope, was not different (p = 0.077). The median (IQR [range]) leak pressure was 16 (12-20 [6-30]) cmH(2) O for the polyvinyl LMA and 18 (13-22 [6-30]) cmH(2) O or the silicone LMA (p = 0.037). In conclusion, we did not find any important differences between polyvinyl chloride and silicone laryngeal mask airways.

  1. Neutrophil-Derived Exosomes: A New Mechanism Contributing to Airway Smooth Muscle Remodeling.

    Science.gov (United States)

    Vargas, Amandine; Roux-Dalvai, Florence; Droit, Arnaud; Lavoie, Jean-Pierre

    2016-09-01

    Neutrophils infiltrate the airways of patients with asthma of all severities, yet their role in the pathogenesis of asthma and their contribution to airway remodeling is largely unknown. We hypothesized that neutrophils modulate airway smooth muscle (ASM) proliferation in asthma by releasing bioactive exosomes. These newly discovered nano-sized vesicles have the capacity to modulate immune responses, cell migration, cell differentiation, and other aspects of cell-to-cell communication. The aim of the study is to determine whether bioactive exosomes are released by neutrophils, and, if so, characterize their proteomic profile and evaluate their capacity to modulate ASM cell proliferation. Exosomes were isolated from equine neutrophil supernatants by differential centrifugation and filtration methods, followed by size-exclusion chromatography. Nanovesicles were characterized using electron microscopy, particle size determination, and proteomic analyses. Exosomes were cocultured with ASM cells and analyzed for exosome internalization by confocal microscopy. ASM proliferation was measured using an impedance-based system. Neutrophils release exosomes that have characteristic size, morphology, and exosomal markers. We identified 271 proteins in exosomes from both LPS and unstimulated neutrophils, and 16 proteins that were differentially expressed, which carried proteins associated with immune response and positive regulation of cell communication. Furthermore, neutrophil-derived exosomes were rapidly internalized by ASM cells and altered their proliferative properties. Upon stimulation of LPS, neutrophil-derived exosomes can enhance the proliferation of ASM cells and could therefore play an important role in the progression of asthma and promoting airway remodeling in severe and corticosteroid-insensitive patients with asthma.

  2. Extraction of Airways from CT (EXACT’09)

    DEFF Research Database (Denmark)

    Lo, Pechin; Ginneken, Bram van; Reinhardt, Joseph M.;

    2012-01-01

    This paper describes a framework for establishing a reference airway tree segmentation, which was used to quantitatively evaluate 15 different airway tree extraction algorithms in a standardized manner. Because of the sheer difficulty involved in manually constructing a complete reference standar...

  3. Endothelin receptor antagonist and airway dysfunction in pulmonary arterial hypertension

    Directory of Open Access Journals (Sweden)

    Borst Mathias M

    2009-12-01

    Full Text Available Abstract Background In idiopathic pulmonary arterial hypertension (IPAH, peripheral airway obstruction is frequent. This is partially attributed to the mediator dysbalance, particularly an excess of endothelin-1 (ET-1, to increased pulmonary vascular and airway tonus and to local inflammation. Bosentan (ET-1 receptor antagonist improves pulmonary hemodynamics, exercise limitation, and disease severity in IPAH. We hypothesized that bosentan might affect airway obstruction. Methods In 32 IPAH-patients (19 female, WHO functional class II (n = 10, III (n = 22; (data presented as mean ± standard deviation pulmonary vascular resistance (11 ± 5 Wood units, lung function, 6 minute walk test (6-MWT; 364 ± 363.7 (range 179.0-627.0 m, systolic pulmonary artery pressure, sPAP, 79 ± 19 mmHg, and NT-proBNP serum levels (1427 ± 2162.7 (range 59.3-10342.0 ng/L were measured at baseline, after 3 and 12 months of oral bosentan (125 mg twice per day. Results and Discussion At baseline, maximal expiratory flow at 50 and 25% vital capacity were reduced to 65 ± 25 and 45 ± 24% predicted. Total lung capacity was 95.6 ± 12.5% predicted and residual volume was 109 ± 21.4% predicted. During 3 and 12 months of treatment, 6-MWT increased by 32 ± 19 and 53 ± 69 m, respectively; p Conclusion This study gives first evidence in IPAH, that during long-term bosentan, improvement of hemodynamics, functional parameters or serum biomarker occur independently from persisting peripheral airway obstruction.

  4. Cyclic mechanical strain-induced proliferation and migration of human airway smooth muscle cells: role of EMMPRIN and MMPs.

    Science.gov (United States)

    Hasaneen, Nadia A; Zucker, Stanley; Cao, Jian; Chiarelli, Christian; Panettieri, Reynold A; Foda, Hussein D

    2005-09-01

    Airway smooth muscle (ASM) proliferation and migration are major components of airway remodeling in asthma. Asthmatic airways are exposed to mechanical strain, which contributes to their remodeling. Matrix metalloproteinase (MMP) plays an important role in remodeling. In the present study, we examined if the mechanical strain of human ASM (HASM) cells contributes to their proliferation and migration and the role of MMPs in this process. HASM were exposed to mechanical strain using the FlexCell system. HASM cell proliferation, migration and MMP release, activation, and expression were assessed. Our results show that cyclic strain increased the proliferation and migration of HASM; cyclic strain increased release and activation of MMP-1, -2, and -3 and membrane type 1-MMP; MMP release was preceded by an increase in extracellular MMP inducer; Prinomastat [a MMP inhibitor (MMPI)] significantly decreased cyclic strain-induced proliferation and migration of HASM; and the strain-induced increase in the release of MMPs was accompanied by an increase in tenascin-C release. In conclusion, cyclic mechanical strain plays an important role in HASM cell proliferation and migration. This increase in proliferation and migration is through an increase in MMP release and activation. Pharmacological MMPIs should be considered in the pursuit of therapeutic options for airway remodeling in asthma.

  5. Extraction of airways from CT (EXACT’09)

    DEFF Research Database (Denmark)

    Lo, Pechin Chien Pau; Ginneken, Bram van; Reinhardt, Joseph M.

    2012-01-01

    This paper describes a framework for establishing a reference airway tree segmentation, which was used to quantitatively evaluate 15 different airway tree extraction algorithms in a standardized manner. Because of the sheer difficulty involved in manually constructing a complete reference standard...... or not it is a correctly segmented part of the airway tree. Finally, the reference airway trees are constructed by taking the union of all correctly extracted branch segments. Fifteen airway tree extraction algorithms from different research groups are evaluated on a diverse set of 20 chest computed tomography (CT) scans...... from the evaluation showed that no single algorithm could extract more than an average of 74% of the total length of all branches in the reference standard, indicating substantial differences between the algorithms. A fusion scheme that obtained superior results is presented, demonstrating...

  6. Vocal Function and Upper Airway Thermoregulation in Five Different Environmental Conditions

    Science.gov (United States)

    Sandage, Mary J.; Connor, Nadine P.; Pascoe, David D.

    2014-01-01

    Purpose: Phonation threshold pressure and perceived phonatory effort were hypothesized to increase and upper airway temperature to decrease following exposure to cold and/or dry air. Greater changes were expected with mouth versus nose breathing. Method: In a within-participant repeated measures design, 15 consented participants (7 men, 8 women)…

  7. Pressão expiratória positiva na via aérea por máscara facial na hemodinâmica de pós-operatórios cardíacos Expiratory positive airway pressure in postoperative cardiac hemodynamics

    Directory of Open Access Journals (Sweden)

    Ana Claudia Borges dos Santos Sena

    2010-10-01

    Full Text Available FUNDAMENTOS: A pressão expiratória positiva na via aérea por máscara facial (EPAP é utilizada no pós-operatório de cirurgias cardíacas, entretanto, seus efeitos hemodinâmicos não foram claramente estudados. OBJETIVO: Avaliar as alterações hemodinâmicas causadas pela EPAP em pacientes pós-cirurgia cardíaca monitorados por cateter de Swan-Ganz. MÉTODOS: Foram incluídos no estudo, pacientes no primeiro ou segundo pós-operatório de cirurgia cardíaca, estáveis hemodinamicamente e com cateter de Swan-Ganz. Eles foram avaliados em repouso e após o uso de 10 cmH2O de EPAP, de forma randomizada. As variáveis estudadas foram: saturação de oxigênio, frequências cardíaca e respiratória, pressões arteriais médias sistêmica e pulmonar (PAM e PAMP, pressões venosa central (PVC e de oclusão da atéria pulmonar (POAP, débito e índice cardíacos, e resistências vasculares sistêmica e pulmonar. Os pacientes foram divididos em subgrupos (com fração de ejeção 50% e os dados foram comparados por teste t e ANOVA. RESULTADOS: Vinte e oito pacientes foram estudados (22 homens, idade média 68 ± 11 anos. Comparando o período de repouso versus EPAP, as alterações observadas foram: POAP (11,9 ± 3,8 para 17,1 ± 4,9 mmHg, p BACKGROND: Expiratory positive airway pressure (EPAP is used in after cardiac surgeries. However, its hemodynamic effects have not been clearly studied. OBJECTIVE: To evaluate the hemodynamic changes caused by EPAP in patients after cardiac surgery monitored by Swan-Ganz. METHODS: Patients at the first or second cardiac surgery postoperative period hemodynamically stable with a Swan-Ganz catheter were included in the study. They were assessed at rest and after using 10 cmH2O EPAP at random. The variables studied were: oxygen saturation, heart rate and respiratory rate, mean artery pressures and pulmonary artery mean pressures (MAP and PAMP, central venous pressure (CVP and pulmonary capillary wedge pressure

  8. Efficacy of a type of endotracheal tube of extended with terminal swelling and resistance bending pressure for airway management during mechanical ventilation in children in prone position%加长带膨大端抗折压型气管导管用于俯卧位小儿机械通气时气道管理的效果

    Institute of Scientific and Technical Information of China (English)

    赵泽宇; 程庆; 张蓉; 王馨雪; 刘建波; 黄建盛

    2016-01-01

    Objective To evaluate the efficacy of a type of endotracheal tube of extended with terminal swelling and resistance bending pressure for airway management during mechanical ventilation in children in prone position.Methods Sixty pediatric patients with cerebral palsy of both sexes,aged 3-7 yr,weighing 11-23 kg,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective selective functional posterior rhizotomy,were randomly allocated into 2 groups (n =30 each) using a random number table:endotracheal tube of extended with terminal swelling and resistance bending pressure group (group E) and reinforced tracheal tube group (group C).After induction of anesthesia,the type of endotracheal tube of extended with terminal swelling and resistance bending pressure was inserted in group E,and the reinforced endotracheal tube was inserted in group C.The tidal volume,minute ventilation,dynamic lung compliance,arterial oxygen saturation and end-tidal pressure of carbon dioxide in pressurecontrolled ventilation mode were recorded in the two groups.Tube shedding caused by using of the extended tube was recorded during operation.Blood samples were collected from the femoral artery for blood gas analysis.Results Compared with group C,the tidal volume and minute ventilation were significantly increased (P<0.05),and no significant change was found in dynamic lung compliance,arterial oxygen saturation and end-tidal pressure of carbon dioxide in group E (P>0.05).Compared with the value before anesthesia,no significant change was found in pH value,arterial oxygen partial pressure and partial pressure of arterial carbon dioxide at the end of operation in the two groups (P>0.05).In group C,the extended tube wasused in 3 patients,and among the 3 cases,one patient developed tube shedding which was treated immediately.Conclusion The type of endotracheal tube of extended with terminal swelling and resistance bending pressure provides better efficacy than

  9. Hereditary and microbiological factors influencing the airway immunological profile of neonates

    DEFF Research Database (Denmark)

    Følsgaard, Nilofar

    2012-01-01

    Asthma and wheezing together with the other atopic disorders; allergy, eczema and rhinitis are the most common chronic diseases in children with major impact on quality of life for patients and significant socioeconomic costs due to health care utilization. The airway mucosa is constantly exposed...... the penetration and impact of the exposome. The ability to mediate a balanced and appropriate immune response is fundamental for managing healthy airways while inappropriate release of inflammatory mediators may have unfavorable long-term consequences such as asthma. Genetic predisposition to atopic diseases...... is well-recognized, with estimated heritability as high as 60% in asthma. Atopic hereditary disease linkage in the offspring seems stronger for maternal than paternal atopic disease. But it is not known how parental atopic disease may affect early immunity in the target organ, the airways. COPSAC has...

  10. Store-operated Ca2+ channels in airway epithelial cell function and implications for asthma

    Science.gov (United States)

    Samanta, Krishna; Parekh, Anant B.

    2016-01-01

    The epithelial cells of the lung are at the interface of a host and its environment and are therefore directly exposed to the inhaled air-borne particles. Rather than serving as a simple physical barrier, airway epithelia detect allergens and other irritants and then help organize the subsequent immune response through release of a plethora of secreted signals. Many of these signals are generated in response to opening of store-operated Ca2+ channels in the plasma membrane. In this review, we describe the properties of airway store-operated channels and their role in regulating airway epithelial cell function. This article is part of the themed issue ‘Evolution brings Ca2+ and ATP together to control life and death’. PMID:27377718

  11. Fatigue of airway obstruction during long-term exposure to allergen aerosol.

    Science.gov (United States)

    Zimmermann, I; Curschmann, P; Kowalski, J; Ulmer, W T

    1977-12-15

    The response to prolonged antigen exposure and the potentiation of airway resistance increase to ACH challenge, after this exposure, were studied on sixteen boxer dogs. One group of animals presented fatigue to A.E. after 3 hours of exposure. This group developed an increased response to ACH aerosol after fatigue to antigen was present. In a second group of dogs, absence of fatigue during prolonged exposure to allergen was observed. A growing tendency of Edyn (as an index of airway resistance) was observed after 5 hours of exposure. The therapeutical influence of bilateral vagus blockade was tested in these last animals. Blockade of nervus vagus released airway obstruction during prolonged allergen exposure and no bronchoconstriction was observed after ACH challenge during blockade.

  12. Regulation of Tight Junctions in Upper Airway Epithelium

    Directory of Open Access Journals (Sweden)

    Takashi Kojima

    2013-01-01

    Full Text Available The mucosal barrier of the upper respiratory tract including the nasal cavity, which is the first site of exposure to inhaled antigens, plays an important role in host defense in terms of innate immunity and is regulated in large part by tight junctions of epithelial cells. Tight junction molecules are expressed in both M cells and dendritic cells as well as epithelial cells of upper airway. Various antigens are sampled, transported, and released to lymphocytes through the cells in nasal mucosa while they maintain the integrity of the barrier. Expression of tight junction molecules and the barrier function in normal human nasal epithelial cells (HNECs are affected by various stimuli including growth factor, TLR ligand, and cytokine. In addition, epithelial-derived thymic stromal lymphopoietin (TSLP, which is a master switch for allergic inflammatory diseases including allergic rhinitis, enhances the barrier function together with an increase of tight junction molecules in HNECs. Furthermore, respiratory syncytial virus infection in HNECs in vitro induces expression of tight junction molecules and the barrier function together with proinflammatory cytokine release. This paper summarizes the recent progress in our understanding of the regulation of tight junctions in the upper airway epithelium under normal, allergic, and RSV-infected conditions.

  13. Reliability and Validity of Self-rating Adverse Reaction Scale of Continuous Positive Airway Pressure among Patients with Obstructive Sleep Apnea Hypopnea Syndrome%阻塞性睡眠呼吸暂停低通气综合征患者持续正压通气治疗副作用自评量表的信度与效度研究

    Institute of Scientific and Technical Information of China (English)

    贾雯碧; 杨希; 曾继红; 余林

    2013-01-01

    目的:评价阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome, OSAHS)患者持续正压通气(continuous positive airway pressure, CPAP)治疗副作用自评量表的信度与效度。方法根据相关文献和临床工作自制CPAP治疗副作用自评量表,采用内部一致性分析和重测信度法检测量表的信度;采用专家评议,选用副反应量表(Treatment Emergent Symptom Scale, TESS)、汉密尔顿焦虑量表(Hamilton Anxiety Scale, HAMA)、健康调查简表(the MOS 36-item Short-form Health Survey, SF-36)作为效标并结合因子分析法测量量表效度。结果量表内部一致性信度Cronbach’sα系数为0.825,重测信度为0.687;内容效度指数为0.870,量表与TESS、HAMA、SF-36显著相关(P0.4。结论 CPAP治疗副作用自评量表具有较好的信度与效度,可应用于OSAHS患者CPAP治疗副作用以及其对依从性影响的评估。%Objective To evaluate the reliability and validity of self-rating adverse reaction of continuous positive airway pressure (CPAP) scale among patients with obstructive sleep apnea hypopnea syndrome (OSAHS). Methods A self-rating adverse reaction of CPAP scale was developed based on literatures and clinical practice. The reliability of the scale was evaluated by internal consistency and test-retest reliability. Through expert review, taking Treatment Emergent Symptom Scale (TESS), Hamilton Anxiety Scale (HAMA) and the MOS 36-item Short-form Health Survey (SF-36) as criterion, the validity of the scale was evaluated with factor analysis. Results Cronbach’sαcoefficient was 0.825, ICC 0.687 and CVI 0.870. The scale was significantly related with TESS, HAMA and SF-36 (P<0.01) with the accumulative variance contribution rate of 77.271% and the load of every item on corresponding factor was higher than 0.4. Conclusion The self-rating adverse reaction of CPAP scale among OSAHS patients is with good reliability and

  14. Efeitos da pressão positiva expiratória nas vias aéreas sobre a atividade eletromiográfica da musculatura acessória da inspiração em portadores de DPOC Effects of expiratory positive airway pressure on the electromyographic activity of accessory inspiratory muscles in COPD patients

    Directory of Open Access Journals (Sweden)

    Dannuey Machado Cardoso

    2011-02-01

    Full Text Available OBJETIVO: Avaliar a atividade eletromiográfica (AE dos músculos esternocleidomastoideo (ECM e escaleno durante e após a aplicação de expiratory positive airway pressure (EPAP, pressão positiva expiratória nas vias aéreas em portadores de DPOC. MÉTODOS: Ensaio clínico simples cego com 13 indivíduos hígidos como controles e 12 pacientes com DPOC estável. No momento basal, foram determinados a AE em respiração espontânea, parâmetros da função pulmonar e a força muscular respiratória. Posteriormente, foi aplicada EPAP de 15 cmH2O com uma máscara facial durante 25 min, com o registro do sinal eletromiográfico dos músculos ECM e escaleno a cada 5 min. Um último registro foi obtido 10 min após a retirada da máscara. RESULTADOS: Observamos que o comportamento da AE dos músculos ECM e escaleno foi semelhante nos controles e pacientes com DPOC (p = 0,716 e p = 0,789, respectivamente. Porém, ao longo da aplicação de EPAP, ambos os músculos mostraram uma tendência ao aumento da AE. Além disso, houve uma redução significativa da AE do ECM entre o momento final e basal (p = 0,034. CONCLUSÕES: A aplicação de EPAP promoveu uma redução significativa da AE do músculo ECM tanto nos controles quanto nos portadores de DPOC estável. Porém, isso não ocorreu em relação à AE do músculo escaleno.OBJECTIVE: To evaluate the electromyographic activity (EA of sternocleidomastoid (SCM and scalene muscles during and after the use of expiratory positive airway pressure (EPAP in patients with COPD. METHODS: This was a clinical single-blind trial involving 13 healthy subjects as controls and 12 patients with stable COPD. At baseline, we determined EA during spontaneous respiration, lung function parameters, and respiratory muscle strength. Subsequently, EPAP at 15 cmH2O was applied by means of a face mask for 25 min, during which the EA of the SCM and scalene muscles was recorded every 5 min. A final record was obtained 10 min

  15. Effects of non-invasive bi-level positive airway pressure ventilation on chronic obstructive pulmonary disease complicating with type II respiratpry failure%无创双水平气道正压通气治疗慢性阻塞性肺疾病并发Ⅱ型呼吸衰竭疗效观察

    Institute of Scientific and Technical Information of China (English)

    魏庆娟; 李传文

    2011-01-01

    目的:探讨经面罩双水平气道正压通气(bi-leve positive airway pressure,BiPAP)呼吸机治疗慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)并发Ⅱ型呼吸衰竭的疗效.方法:66例COPD并发Ⅱ型呼吸衰竭患者随机分为治疗组及对照组,两组均给予抗感染、解痉平喘、祛痰、支持对症等常规治疗,对照组加低浓度吸氧,治疗组加面罩BiPAP呼吸机治疗.结果:治疗组和对照组相比,治疗后24h动脉血氧饱和度、动脉血氧分压明显上升,心率、呼吸频率、动脉血二氧化碳分压、pH值明显下降,住院时间缩短,差异均有统计学意义(P<0.01).治疗组总有效率84.8%(28/33)与对照组66.7%(22/33)相比差异有统计学意义(P<0.05).结论:COPD并发Ⅱ型呼吸衰竭患者早期使用BiPAP呼吸机治疗,对低氧血症和CO2潴留的改善疗效显著.

  16. 综合护理在持续气道正压通气 CPAP 在新生儿呼吸衰竭中的临床应用比较%Clinical application of comprehensive nursing in continuous positive airway pressure (CPAP) in neonatal respiratory failure

    Institute of Scientific and Technical Information of China (English)

    江玉凤

    2015-01-01

    目的:分析综合护理对实施持续气道正压通气治疗的呼吸衰竭新生儿的作用效果。方法选择本院收治的呼吸衰竭新生儿58例为研究对象,随机分为2组,均实施持续气道正压通气治疗。实验组采取综合护理措施,分析其治疗护理前后血气相关指标 p(O2)、p(CO2)、pH 的变化,比较2组患儿护理满意度、住院时间、住院费用、疾病认知度。结果与治疗前相比较,实验组 p(O2)经 CPAP 治疗后12 h、24 h 明显升高,p(CO2)明显降低,pH 升高,差异有统计学意义(P <0.05);对照组p(O2)、p(CO2)、pH 较治疗前未见明显变化,差异无统计学意义(P >0.05);经过 CPAP 治疗后,与对照组比较,实验组 p(O2)升高,p(CO2)降低,pH 升高,差异有统计学意义 P <0.05);治疗后12 h 与24 h 相比较,实验组 p(O2)、p(CO2)、pH 无明显变化,差异无统计学意义(P >0.05);对护理人员的满意度进行评价,实验组总满意度100%,对照组总满意度仅为71.43%,2组比较差异有统计学意义(P <0.05);实验组患者的住院时间较对照组缩短,住院费用降低,2组间比较差异有统计学意义(P <0.05);与对照组比较,实验组患者对疾病认知度的评分较高,组间比较差异有统计学意义(P <0.05)。结论对出现呼吸衰竭的新生儿采取持续气道正压通气治疗,并采取综合护理措施,能够及时的纠正低氧血症及高碳酸血症,缓解呼吸衰竭,患者的护理满意度明显提高。%ABSTRACT:Objective To analyze effect of comprehensive nursing in continuous positive airway pressure (CPAP)treatment of respiratory failure in neonates.Methods A total of 58 new-borns with respiratory failure were randomly divided into two groups.They were both implement-ed continuous positive airway pressure (CPAP)treatment,the treatment

  17. Application Effect of Non-invasive Bi -level Positive Airway Pressure Ventilation in the Treatment of Patients With Acute Severe Asthma%无创双水平正压通气在急性重症哮喘患者治疗中的应用效果

    Institute of Scientific and Technical Information of China (English)

    郝柯; 陈兵阳; 代义春

    2016-01-01

    目的 观察无创双水平正压通气在急性重症哮喘患者治疗中的应用效果.方法 选取2012年12月—2014年12月成都市第七人民医院呼吸科收治的急性重症哮喘患者122例,随机分为对照组和观察组,各61例.两组患者均给予常规治疗,观察组患者在常规治疗基础上采用瑞思迈VPAPⅢ自动同步无创双水平正压呼吸机进行通气治疗,1周为1个疗程,共治疗2个疗程.比较两组患者治疗前后血气指标〔动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、氧合指数及动脉血氧饱和度(SaO2)〕,采用Hogg方法评定两组患者治疗前后哮喘症状评分,并观察治疗期间不良反应/并发症发生情况.结果 治疗前两组患者PaO2、PaCO2、氧合指数、SaO2比较,差异无统计学意义(P>0.05);治疗后观察组患者PaO2、氧合指数、SaO2高于对照组,PaCO2低于对照组(P0.05);治疗后观察组患者哮喘症状评分低于对照组(P0.05).结论 无创双水平正压通气治疗急性重症哮喘效果确切,能有效改善患者血气指标,减轻哮喘症状,且安全性较高.%Objective To observe the application effect of non - invasive bi - level positive airway pressure ventilation in the treatment of patients with acute severe asthma. Methods From December 2012 to December 2014 in the Department of Respiratory Medicine,the Seventh People's Hospital of Chengdu,a total of 122 patients with acute severe asthma were selected, and they were randomly divided into control group and observation group,each of 61 cases. Patients of both groups received conventional treatment after admission,while patients of observation group received extra non - invasive bi - level positive airway pressure ventilation for 2 courses(1 week as a course). Blood - gas index(including PaO2 ,PaCO2 ,oxygenation index and SaO2 )before and after treatment were compared between the two groups,asthma - symptom score before and after treatment was respectively

  18. ProSeal laryngeal mask airway as an alternative to standard endotracheal tube in securing upper airway in the patients undergoing beating-heart coronary artery bypass grafting

    Directory of Open Access Journals (Sweden)

    Kalpana Shah

    2017-01-01

    Full Text Available Background: ProSeal laryngeal mask airways (PLMAs are routinely used after failed tracheal intubation as airway rescue, facilitating tracheal intubation by acting as a conduit and to secure airway during emergencies. In long duration surgeries, use of endotracheal tube (ETT is associated with various hemodynamic complications, which are minimally affected during PLMA use. However, except for few studies, there are no significant data available that promote the use of laryngeal mask during cardiac surgery. This prospective study was conducted with the objective of demonstrating the advantages of PLMA over ETT in the patients undergoing beating-heart coronary artery bypass graft (CABG. Methodology: This prospective, interventional study was carried out in 200 patients who underwent beating-heart CABG. Patients were randomized in equal numbers to either ETT group or PLMA group, and various hemodynamic and respiratory parameters were observed at different time points. Results: Patients in PLMA group had mean systolic blood pressure 126.10 ± 5.31 mmHg compared to the patients of ETT group 143.75 ± 6.02 mmHg. Pulse rate in the PLMA group was less (74.52 ± 10.79 per min (P < 0.05 compared to ETT group (81.72 ± 9.8. Thus, hemodynamic changes were significantly lower (P < 0.05 in PLMA than in ETT group. Respiratory parameters such as oxygen saturation, pressure CO 2 (pCO 2 , peak airway pressure, and lung compliance were similar to ETT group at all evaluation times. The incidence of adverse events was also lower in PLMA group. Conclusion: In experience hand, PLMA offers advantages over the ETT in airway management in the patients undergoing beating-heart CABG.

  19. Numeric simulation of the upper airway structure and airflow dynamic characteristics after unilateral complete maxillary resection.

    Science.gov (United States)

    Qian, Yumei; Qian, Haixin; Wu, Yadong; Jiao, Ting

    2013-01-01

    This study investigated upper airway aerodynamic characteristics of patients who underwent maxillectomy using three-dimensional reconstruction and computational fluid dynamics. The results revealed the generation of low-velocity vortices throughout the entire maxillary defect during respiration. The nasal structure on the nonsurgical side changed postsurgically, possibly due to the pressure gradient between the defective and healthy side. The bilateral disturbed airflow patterns are believed to be the cause of common symptoms. The numeric simulation technique could be used as a potential method to understand upper airway morphology changes and respiratory functions, thus guiding the fabrication of prostheses.

  20. Matrix stiffness-modulated proliferation and secretory function of the airway smooth muscle cells.

    Science.gov (United States)

    Shkumatov, Artem; Thompson, Michael; Choi, Kyoung M; Sicard, Delphine; Baek, Kwanghyun; Kim, Dong Hyun; Tschumperlin, Daniel J; Prakash, Y S; Kong, Hyunjoon

    2015-06-01

    Multiple pulmonary conditions are characterized by an abnormal misbalance between various tissue components, for example, an increase in the fibrous connective tissue and loss/increase in extracellular matrix proteins (ECM). Such tissue remodeling may adversely impact physiological function of airway smooth muscle cells (ASMCs) responsible for contraction of airways and release of a variety of bioactive molecules. However, few efforts have been made to understand the potentially significant impact of tissue remodeling on ASMCs. Therefore, this study reports how ASMCs respond to a change in mechanical stiffness of a matrix, to which ASMCs adhere because mechanical stiffness of the remodeled airways is often different from the physiological stiffness. Accordingly, using atomic force microscopy (AFM) measurements, we found that the elastic modulus of the mouse bronchus has an arithmetic mean of 23.1 ± 14 kPa (SD) (median 18.6 kPa). By culturing ASMCs on collagen-conjugated polyacrylamide hydrogels with controlled elastic moduli, we found that gels designed to be softer than average airway tissue significantly increased cellular secretion of vascular endothelial growth factor (VEGF). Conversely, gels stiffer than average airways stimulated cell proliferation, while reducing VEGF secretion and agonist-induced calcium responses of ASMCs. These dependencies of cellular activities on elastic modulus of the gel were correlated with changes in the expression of integrin-β1 and integrin-linked kinase (ILK). Overall, the results of this study demonstrate that changes in matrix mechanics alter cell proliferation, calcium signaling, and proangiogenic functions in ASMCs.

  1. The genus Prevotella in cystic fibrosis airways.

    Science.gov (United States)

    Field, Tyler R; Sibley, Christopher D; Parkins, Michael D; Rabin, Harvey R; Surette, Michael G

    2010-08-01

    Airway disease resulting from chronic bacterial colonization and consequential inflammation is the leading cause of morbidity and mortality in patients with Cystic Fibrosis (CF). Although traditionally considered to be due to only a few pathogens, recent re-examination of CF airway microbiology has revealed that polymicrobial communities that include many obligate anaerobes colonize lower airways. The purpose of this study was to examine Prevotella species in CF airways by quantitative culture and phenotypic characterization. Expectorated sputum was transferred to an anaerobic environment immediately following collection and examined by quantitative microbiology using a variety of culture media. Isolates were identified as facultative or obligate anaerobes and the later group was identified by 16S rRNA sequencing. Prevotella spp. represented the majority of isolates. Twelve different species of Prevotella were recovered from 16 patients with three species representing 65% of isolates. Multiple Prevotella species were often isolated from the same sputum sample. These isolates were biochemically characterized using Rapid ID 32A kits (BioMérieux), and for their ability to produce autoinducer-2 and beta-lactamases. Considerable phenotypic variability between isolates of the same species was observed. The quantity and composition of Prevotella species within a patients' airway microbiome varied over time. Our results suggest that the diversity and dynamics of Prevotella in CF airways may contribute to airway disease.

  2. Use of a positive pressure endoscopic mask to assist with positive pressure ventilation in a morbidly obese patient during fiberoptic intubation: a case report.

    Science.gov (United States)

    De Jarnett, Dewi

    2013-08-01

    Airway management in the morbidly obese, anesthetized patient can be especially challenging. Difficulties in fiberoptic intubation (FOI) can be experienced due to alterations in airway anatomy associated with morbid obesity and the effects of anesthesia. The loss of upper airway muscle tone that occurs during anesthesia compromises the structure of the pharynx, causing a tendency toward airway collapse. This collapsibility can prevent the identification of anatomical structures during FOI, making this advanced airway technique difficult or impossible. The application of positive pressure via endoscopic mask ventilation during FOI can help to stent open collapsible airways and reestablish airway anatomy in morbidly obese patients. Although drawbacks exist, the endoscopic mask may be most effective at accomplishing this goal.

  3. Airway smooth muscle growth in asthma: proliferation, hypertrophy, and migration.

    Science.gov (United States)

    Bentley, J Kelley; Hershenson, Marc B

    2008-01-01

    Increased airway smooth muscle mass is present in fatal and non-fatal asthma. However, little information is available regarding the cellular mechanism (i.e., hyperplasia vs. hypertrophy). Even less information exists regarding the functional consequences of airway smooth muscle remodeling. It would appear that increased airway smooth muscle mass would tend to increase airway narrowing and airflow obstruction. However, the precise effects of increased airway smooth muscle mass on airway narrowing are not known. This review will consider the evidence for airway smooth muscle cell proliferation and hypertrophy in asthma, potential functional effects, and biochemical mechanisms.

  4. Pharmacology of airway afferent nerve activity

    Directory of Open Access Journals (Sweden)

    Carr Michael J

    2001-05-01

    Full Text Available Abstract Afferent nerves in the airways serve to regulate breathing pattern, cough, and airway autonomic neural tone. Pharmacologic agents that influence afferent nerve activity can be subclassified into compounds that modulate activity by indirect means (e.g. bronchial smooth muscle spasmogens and those that act directly on the nerves. Directly acting agents affect afferent nerve activity by interacting with various ion channels and receptors within the membrane of the afferent terminals. Whether by direct or indirect means, most compounds that enter the airspace will modify afferent nerve activity, and through this action alter airway physiology.

  5. Involvement of glutamate in transmission of afferent constrictive inputs from the airways to the nucleus tractus solitarius in ferrets.

    Science.gov (United States)

    Haxhiu, M A; Yamamoto, B; Dreshaj, I A; Bedol, D; Ferguson, D G

    2000-04-12

    In this study, we identified the neurons within nucleus tractus solitarius (nTS) activated by stimulation of airway sensory systems and examined the expression of AMPA receptor subtype(s) by these cells. We also investigated the possible involvement of endogenously released glutamate and AMPA receptors in the transmission of excitatory inputs from the sensory system of the respiratory tract to the neurons of the nTS. In these experiments we used: (1) immunodetection of c-fos encoded protein (cFos) expression to identify the nTS neurons activated by the stimulation of the airway sensory system; (2) receptor immunochemistry and confocal microscopy to determine the receptor(s) expressed by activated nTS neurons; (3) microdialysis to measure glutamate release, and (4) physiological measurements to examine the effects of selective receptor blockers, and thereby define the role of the glutamate and AMPA glutamatergic receptor subtype(s) in reflexly induced airway constriction. The results showed that activation of airway sensory receptors, by inhalation of aerosolized histamine or capsaicin, induced cFos expression in a subset of nTS neurons that also expressed the AMPA subtype of glutamate receptors. Furthermore, activation of sensory bronchoconstrictive receptors induced glutamate release within nTS, and blockade of the AMPA receptor subtype within nTS inhibited reflexly increased cholinergic outflow to the airways. These data indicate for the first time that glutamate and AMPA receptor signaling pathways are involved in the transmission of afferent inputs from the airways to the nTS, and in mediating reflex airway constriction.

  6. Increased upper airway collapsibility in a mouse model of Marfan syndrome.

    Science.gov (United States)

    da Palma, Renata Kelly; Farré, Ramon; Montserrat, Josep Maria; Gorbenko Del Blanco, Darya; Egea, Gustavo; de Oliveira, Luís Vicente Franco; Navajas, Daniel; Almendros, Isaac

    2015-02-01

    Marfan syndrome (MFS) is a genetic disorder caused by mutations in the FBN1 gene that codifies for fibrilin-1. MFS affects elastic fiber formation and the resulting connective tissue shows abnormal tissue laxity and organization. Although an increased prevalence of obstructive sleep apnea among patients with MFS has been described, the potential effects of this genetic disease on the collapsible properties of the upper airway are unknown. The aim of this study was to assess the collapsible properties of the upper airway in a mouse model of MFS Fbn1((C1039G/+)) that is representative of most of the clinical manifestations observed in human patients. The upper airway in wild-type and Marfan mice was cannulated and its critical pressure (Pcrit) was measured in vivo by increasing the negative pressure through a controlled pressure source. Pcrit values from MFS mice were higher (less negative) compared to wild-type mice (-3.1±0.9cmH2O vs. -7.8±2.0cm H2O) suggesting that MFS increases the upper airway collapsibility, which could in turn explain the higher prevalence of OSA in MFS patients.

  7. Pressão expiratória positiva nas vias aéreas não reproduz as respostas de frequência cardíaca à manobra de Valsalva em homens jovens saudáveis Expiratory positive airway pressure does not reproduce heart rate responses to Valsalva maneuver in healthy young men

    Directory of Open Access Journals (Sweden)

    Isabella Gracindo Pissinato

    2012-06-01

    Full Text Available A pressão expiratória positiva nas vias aéreas (EPAP é um recurso terapêutico que compreende uma inspiração seguida de expiração contra resistência. Sua aplicação promove ajustes no sistema cardiovascular, de maneira similar ao observado durante a manobra de Valsalva (MV. O objetivo deste estudo foi analisar a resposta da frequência cardíaca (FC à MV e às diferentes formas de aplicação de EPAP a fim de identificar se e em qual condição esta técnica reproduz a resposta da FC observada na MV, em homens jovens aparentemente saudáveis. Foram estudados 10 sujeitos (24±3 anos; 25±3 kg/m² que realizaram os procedimentos de MV e EPAP, aleatoriamente em dias diferentes. Na MV o esforço expiratório foi sustentado por 15 s (pressão oral de 40 mmHg [53,4 cmH2O]. Empregou-se duas técnicas de EPAP (isolada e terapêutica contra 3 níveis de pressão (10, 15 e 20 cmH2O, aplicados aleatoriamente. As manobras foram repetidas três vezes com intervalo de cinco minutos. Considerou-se o maior valor de variação da FC (DFC de cada manobra para análise. Empregou-se o teste Shapiro-Wilk para verificar a distribuição dos dados e ANOVA para medidas repetidas, com post-hoc de Fisher, considerando-se αThe expiratory positive airway pressure (EPAP is a therapeutic resource that comprises an inspiration followed by expiration against resistance. During its application there were adjustments in the cardiovascular system, similar to those observed during the Valsalva maneuver (VM. The aim of this study was to analyze the heart rate (HR response to VM and to different ways of EPAP application to identify if and in which condition this technique reproduces the HR response observed in the VM, in apparently healthy young men. Ten subjects (24±3 years, 25±3 kg/m² performed randomly the VM and EPAP procedures on different days. The expiratory effort in VM was sustained for 15 s (oral pressure of 40 mmHg [53.4cm H2O]. Two EPAP techniques were

  8. Valores de presión espiratoria mantenida en la vía aérea como indicador de tolerancia al uso de válvula de fonación en pacientes traqueostomizados Maintained expiratory airway pressure values as an indicator of tolerance of speaking valve in tracheostomized patients

    Directory of Open Access Journals (Sweden)

    Gregory Villarroel S

    2012-06-01

    Full Text Available Introducción: La válvula de fonación (VF, es un dispositivo de flujo unidireccional instalado sobre la cánula de traqueostomía posibilitando la fonación. La tolerancia a este dispositivo depende de la permeabilidad de la vía aérea superior (VAS, pudiendo ser valorada indirectamente a través de la medición de la presión espiratoria mantenida (PEMant en vía aérea. Objetivo: Estudiar esta técnica como indicador clínico de tolerancia a la VF. Método: Se evaluaron 23 pacientes traqueostomizados (mediana de edad 22 meses con un manómetro aneroide durante 15 minutos, registrando PEMant, saturación arterial de oxígeno (SaO2, frecuencia cardiaca, frecuencia respiratoria, uso de musculatura accesoria y sibilancias para valorar la dificultad respiratoria. Resultados: Valores de PEMant menores a 10 cmH2O se asocian con tolerancia a la VFy valores sobre 20 cmH2O a intolerancia a ésta. Conclusión: Valores bajo 10cmH2O de PEMant pueden ser indicadores de tolerancia al uso de VF.Introduction: Speaking valve (SV is an unidirectional flow device installed over the tracheostomy tube allowing phonation. Tolerance to this device depends on the permeability of the upper airway (UA, which may be indirectly assessed by measuring UA maintained expiratory pressure (PEMant. Objective: To evaluate the usefulness of the maintained expiratory pressure as a clinical indicator of tolerance to the SV. Method: Twenty three tracheostomized patients (median age 22 months-old were evaluated with an aneroid manometer during 15 minutes, recording PEMant, arterial oxygen saturation (SaO2,heart rate, respiratory rate, accessory muscle use and wheezing as signs of respiratory distress Results: PEMant values less than 10 cmH2O are associated with tolerance of the SV and values over 20 cmH2O are associated with intolerance. Conclusion: Values under 10 cmH2O of PEMant can be used as an indicator of tolerance to VF.

  9. Airway resistance at maximum inhalation as a marker of asthma and airway hyperresponsiveness

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    O'Connor George T

    2011-07-01

    Full Text Available Abstract Background Asthmatics exhibit reduced airway dilation at maximal inspiration, likely due to structural differences in airway walls and/or functional differences in airway smooth muscle, factors that may also increase airway responsiveness to bronchoconstricting stimuli. The goal of this study was to test the hypothesis that the minimal airway resistance achievable during a maximal inspiration (Rmin is abnormally elevated in subjects with airway hyperresponsiveness. Methods The Rmin was measured in 34 nonasthmatic and 35 asthmatic subjects using forced oscillations at 8 Hz. Rmin and spirometric indices were measured before and after bronchodilation (albuterol and bronchoconstriction (methacholine. A preliminary study of 84 healthy subjects first established height dependence of baseline Rmin values. Results Asthmatics had a higher baseline Rmin % predicted than nonasthmatic subjects (134 ± 33 vs. 109 ± 19 % predicted, p = 0.0004. Sensitivity-specificity analysis using receiver operating characteristic curves indicated that baseline Rmin was able to identify subjects with airway hyperresponsiveness (PC20 min % predicted, FEV1 % predicted, and FEF25-75 % predicted, respectively. Also, 80% of the subjects with baseline Rmin min > 145% predicted had hyperresponsive airways, regardless of clinical classification as asthmatic or nonasthmatic. Conclusions These findings suggest that baseline Rmin, a measurement that is easier to perform than spirometry, performs as well as or better than standard spirometric indices in distinguishing subjects with airway hyperresponsiveness from those without hyperresponsive airways. The relationship of baseline Rmin to asthma and airway hyperresponsiveness likely reflects a causal relation between conditions that stiffen airway walls and hyperresponsiveness. In conjunction with symptom history, Rmin could provide a clinically useful tool for assessing asthma and monitoring response to treatment.

  10. Treatment of upper airway resistance syndrome in adults: Where do we stand?☆

    Science.gov (United States)

    de Godoy, Luciana B.M.; Palombini, Luciana O.; Guilleminault, Christian; Poyares, Dalva; Tufik, Sergio; Togeiro, Sonia M.

    2015-01-01

    Objective: To evaluate the available literature regarding Upper Airway Resistance Syndrome (UARS) treatment. Methods: Keywords “Upper Airway Resistance Syndrome,” “Sleep-related Breathing Disorder treatment,” “Obstructive Sleep Apnea treatment” and “flow limitation and sleep” were used in main databases. Results: We found 27 articles describing UARS treatment. Nasal continuous positive airway pressure (CPAP) has been the mainstay therapy prescribed but with limited effectiveness. Studies about surgical treatments had methodological limitations. Oral appliances seem to be effective but their efficacy is not yet established. Conclusion: Randomized controlled trials with larger numbers of patients and long-term follow-up are important to establish UARS treatment options. PMID:26483942

  11. Treatment of upper airway resistance syndrome in adults: Where do we stand?

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    Luciana B.M. de Godoy

    2015-01-01

    Full Text Available Objective: To evaluate the available literature regarding Upper Airway Resistance Syndrome (UARS treatment. Methods: Keywords “Upper Airway Resistance Syndrome,” “Sleep-related Breathing Disorder treatment,” “Obstructive Sleep Apnea treatment” and “flow limitation and sleep” were used in main databases. Results: We found 27 articles describing UARS treatment. Nasal continuous positive airway pressure (CPAP has been the mainstay therapy prescribed but with limited effectiveness. Studies about surgical treatments had methodological limitations. Oral appliances seem to be effective but their efficacy is not yet established. Conclusion: Randomized controlled trials with larger numbers of patients and long-term follow-up are important to establish UARS treatment options.

  12. 底板巷水力冲孔卸压增透技术的研究与应用%Study and Application on Pressure Releasing and Permeability Improved Technology with Hydraulic Flushing in Floor Gateway

    Institute of Scientific and Technical Information of China (English)

    徐东方; 黄渊跃; 罗治顺; 杨献东

    2013-01-01

    In order to investigate the effect of the pressure releasing and permeability improved technology with hydraulic flushing in floor gateway to improve the seam permeability and to improve the gas drainage rate, a trial was conducted on the pressure releasing and permeability improved technology with hydraulic flushing in No. 1259(3) floor gateway of Puxijing.The results showed that the radius of the pressure releasing and permeability improvement with the hydraulic flushing borehole could reach 4~5 m and would be 1.6~2.0 times higher than the influence radius of the gas drainage with a conventional borehole. Within half month after the hydraulic flushing measures conducted, the average gas drainage concentration of the borehole was 2.77 times higher than the conventional borehole,the average gas flow value was 3.43 times higher than the conventional borehole,the effect of the pressure releasing and permeability improvement was relatively remarkable , the seam permeability was improved and the outburst danger was reduced.%为了考察底板巷水力冲孔卸压增透技术对增加煤层透气性,提高瓦斯抽采效果,在浦溪井1259(3)底板巷实施水力冲孔卸压增透技术试验.结果表明:水力冲孔卸压增透半径达到4~5m,为普通钻孔抽采影响半径的1.6~2.0倍;采取水力冲孔措施的半个月内,钻孔的平均瓦斯抽采浓度是普通钻孔的2.77倍,平均瓦斯流量是普通钻孔的3.43倍,卸压增透效果比较明显,提高了煤层透气性,降低了突出危险性.

  13. Allergic rhinitis and asthma: inflammation in a one-airway condition

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    Haahtela Tari

    2006-11-01

    Full Text Available Abstract Background Allergic rhinitis and asthma are conditions of airway inflammation that often coexist. Discussion In susceptible individuals, exposure of the nose and lungs to allergen elicits early phase and late phase responses. Contact with antigen by mast cells results in their degranulation, the release of selected mediators, and the subsequent recruitment of other inflammatory cell phenotypes. Additional proinflammatory mediators are released, including histamine, prostaglandins, cysteinyl leukotrienes, proteases, and a variety of cytokines, chemokines, and growth factors. Nasal biopsies in allergic rhinitis demonstrate accumulations of mast cells, eosinophils, and basophils in the epithelium and accumulations of eosinophils in the deeper subepithelium (that is, lamina propria. Examination of bronchial tissue, even in mild asthma, shows lymphocytic inflammation enriched by eosinophils. In severe asthma, the predominant pattern of inflammation changes, with increases in the numbers of neutrophils and, in many, an extension of the changes to involve smaller airways (that is, bronchioli. Structural alterations (that is, remodeling of bronchi in mild asthma include epithelial fragility and thickening of its reticular basement membrane. With increasing severity of asthma there may be increases in airway smooth muscle mass, vascularity, interstitial collagen, and mucus-secreting glands. Remodeling in the nose is less extensive than that of the lower airways, but the epithelial reticular basement membrane may be slightly but significantly thickened. Conclusion Inflammation is a key feature of both allergic rhinitis and asthma. There are therefore potential benefits for application of anti-inflammatory strategies that target both these anatomic sites.

  14. Treatment of Foreign Body Obstruction of the Upper Airway

    Science.gov (United States)

    Hoffman, Jerome R.

    1982-01-01

    The treatment of foreign body obstruction of the upper airway has been the subject of considerable attention and controversy. Current recommendations from the National Academy of Sciences, the American Red Cross and the American Heart Association include the use of back blows, abdominal thrusts (Heimlich maneuver) or chest thrusts (or both) and finger probes, until definitive therapy by trained medical and paramedical personnel becomes available. Nevertheless, a number of authorities on this subject have claimed that these approaches are dangerous, and that abdominal thrusts should be the first and only first-aid technique used in this situation. There are only limited data on which to make recommendations regarding this issue. Clinical evidence is scanty and of a highly anecdotal and unscientific nature. The data that are available suggest that a combination of maneuvers is in fact preferable to any single maneuver. Experimental physiologic data on both humans and animals tend to support this concept and suggest that back blows, which generate high initial pressures, may dislodge objects from the larynx enough to allow subsequent thrust maneuvers, which generate more sustained increases in intrathoracic pressure, to move the object out of the larynx. At this time, in the absence of definitive data, it seems reasonable to teach as many lay citizens as possible to recognize upper airway obstruction due to foreign body and to perform any and all of these techniques (preferably in combination), as well as external cardiopulmonary resuscitation (CPR) where appropriate, on choking victims. PMID:7072236

  15. The effect of a trunk release maneuver on Peak Pressure Index, trunk displacement and perceived discomfort in older adults seated in a high Fowler’s position: a randomized controlled trial

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    Best Krista L

    2012-11-01

    Full Text Available Abstract Background Pressure ulcers pose significant negative individual consequences and financial burden on the healthcare system. Prolonged sitting in High Fowler’s position (HF is common clinical practice for older adults who spend extended periods of time in bed. While HF aids in digestion and respiration, being placed in a HF may increase perceived discomfort and risk of pressure ulcers due to increased pressure magnitude at the sacral and gluteal regions. It is likely that shearing forces could also contribute to risk of pressure ulcers in HF. The purpose of this study was to evaluate the effect of a low-tech and time-efficient Trunk Release Manuever (TRM on sacral and gluteal pressure, trunk displacement and perceived discomfort in ambulatory older adults. Method A randomized controlled trial was used. We recruited community-living adults who were 60 years of age and older using posters, newspaper advertisements and word-of-mouth. Participants were randomly allocated to either the intervention or control group. The intervention group (n = 59 received the TRM, while the control group (n = 58 maintained the standard HF position. Results The TRM group had significantly lower mean (SD PPI values post-intervention compared to the control group, 59.6 (30.7 mmHg and 79.9 (36.5 mmHg respectively (p = 0.002. There was also a significant difference in trunk displacement between the TRM and control groups, +3.2 mm and −5.8 mm respectively (p = 0.005. There were no significant differences in perceived discomfort between the groups. Conclusion The TRM was effective for reducing pressure in the sacral and gluteal regions and for releasing the trunk at the point of contact between the skin and the support surface, but did not have an effect on perceived discomfort. The TRM is a simple method of repositioning which may have important clinical application for the prevention of pressure ulcers that may occur as a result of HF.

  16. Numerical simulation for the upper airway flow characteristics of Chinese patients with OSAHS using CFD models.

    Science.gov (United States)

    Tan, Jie; Huang, Jianmin; Yang, Jianguo; Wang, Desheng; Liu, Jianzhi; Liu, Jingbo; Lin, Shuchun; Li, Chen; Lai, Haichun; Zhu, Hongyu; Hu, Xiaohua; Chen, Dongxu; Zheng, Longxiang

    2013-03-01

    OSAHS is a common disease with many factors related to the etiology. Airflow plays an important role in the pathogenesis of OSAHS. Previous research has not yielded a sufficient understanding of the relationship between airflow in upper airway and the pathophysiology of OSAHS. Therefore, a better understanding of the flow inside the upper airway in an OSAHS patient is necessary. In this study, ten Chinese adults with OSAHS were recruited. We used the software MIMICS 13.1 to construct 3-dimensional (3-D) models based on the computer tomography scans of them. The numerical simulations were carried out using the software ANSYS 12.0. We found that during the inhalation phase, the vortices and turbulences were located in both the anterior part of the cavity and nasopharynx. But there is no vortex in the whole nasal cavity during the expiratory phase. The airflow velocity is much higher than that of the normal models. The distributions of pressure and wall shear stress are different in two phases. The maximum velocity, pressure and wall shear stress (WSS) are located in velopharynx. It is notable that a strong negative pressure region is found in pharyngeal airway. The maximum velocity is 19.26 ± 12.4 and 19.46 ± 13.1 m/s; the average pressure drop is 222.71 ± 208.84 and 238.5 ± 218.56 Pa and the maximum average WSS is 0.72 ± 0.58 and 1.01 ± 0.61 Pa in inspiratory and expiratory, respectively. The changes of airflow due to the structure changes play an important role in the occurrence of collapse and obstruction of the upper airway, especially, the abnormal pressure changes in velopharyngeal during both inspiratory and expiratory phases. We can say that the airway narrowing in the pharynx may be one of the most important factors driving airway collapse. In addition, the most collapsible region of the pharyngeal airway of the patient with OSAHS may be the velopharynx and oropharynx. In spite of limitations, our results can provide a basis for the further research

  17. Upper airway finding on CT scan with and without nasal CPAP in obstructive sleep apnea patients

    Energy Technology Data Exchange (ETDEWEB)

    Akashiba, Tsuneto; Sasaki, Iwao; Kurashina, Keiji; Yoshizawa, Takayuki; Otsuka, Kenzo; Horie, Takashi (Nihon Univ., Tokyo (Japan). School of Medicine)

    1991-04-01

    The area of upper airway (from the nasopharynx to the hypopharynx) was measured by means of computed tomography (CT) scan in 15 confirmed cases of obstructive sleep apnea (OSA) and in 4 normal controls while they were awake. The minimum cross-sectional area (MA) of the upper airway was 14.7+-20.0 mm{sup 2} in OSA patients and 80.0+-33.1 mm{sup 2} in normal controls and the difference was statistically significant (p<0.01). In OSA patients, MA did not correlate with age, body weight, apnea index, desaturation index, mean nadir-SO{sub 2} and lowest SO{sub 2}. MA was also measured with OSA patients while nasal continuous positive airway pressure (NCPAP) of 10 cmH{sub 2}O was applied and it was found that MA was significantly widened when NCPAP therapy was performed. We conclude that upper airway narrowing is consistent finding in OSA patients but the degree of narrowing does not correlate with parameters of apnea and gas exchange during sleep, and NCPAP is effective to widen the area of upper airway in OSA patients. (author).

  18. Correlation among regional ventilation, airway resistance and particle deposition in normal and severe asthmatic lungs

    Science.gov (United States)

    Choi, Sanghun; Hoffman, Eric A.; Tawhai, Merryn H.; Lin, Ching-Long

    2012-11-01

    Computational fluid dynamic simulations are performed to investigate flow characteristics and quantify particle deposition with normal and severe asthmatic lungs. Continuity and Navier-Stokes equations are solved with unstructured meshes and finite element method; a large eddy simulation model is adopted to capture turbulent and/or transitional flows created in the glottis. The human airway models are reconstructed from CT volumetric images, and the subject-specific boundary condition is imposed to the 3D ending branches with the aid of an image registration technique. As a result, several constricted airways are captured in CT images of severe asthmatic subjects, causing significant pressure drop with high air speed because the constriction of airways creates high flow resistance. The simulated instantaneous velocity fields obtained are then employed to track transport and deposition of 2.5 μm particles. It is found that high flow resistance regions are correlated with high particle-deposition regions. In other words, the constricted airways can induce high airway resistance and subsequently increase particle deposition in the regions. This result may be applied to understand the characteristics of deposition of pharmaceutical aerosols or bacteria. This work was supported in part by NIH grants R01-HL094315 and S10-RR022421.

  19. The shape of the epiglottis reflects improvement in upper airway obstruction after weight loss.

    Science.gov (United States)

    Gazayerli, Mohamed; Bleibel, Wissam; Elhorr, Ali; Elakkary, Ehab

    2006-07-01

    Obstructive sleep apnea (OSA) is a sleep disorder characterized by recurrent episodes of closure of the upper airway during sleep, and is highly prevalent among overweight individuals. A significant percentage of patients with OSA remain undiagnosed. This condition creates chronic nighttime hypoxemia that can result in significant complications including systemic and pulmonary hypertension, cor pulmonale, and stroke. Polysomnography is still the most widely used method for diagnosing OSA. Studies have shown that in the majority of patients with OSA the airway obstruction involves the retroglossal region. Upon performing esophagogastroduodenoscopy on patients with a wide range of body mass indices (from 21 to 63), we noticed a gradual increase in the concavity of the posterior epiglottal surface as the BMI increases. Upon following some of the patients who underwent laparoscopic gastric banding and lost significant weight, we noticed a dramatic change in the shape of the epiglottis. This reflects a relief in the pressure on the epiglottis created by the collapsing airways in periods of apnea. Thus, the deformity in the shape of the epiglottis reflects the chronic airway collapse in obese patients, and improvement in this deformity after weight loss indicates a relief of the chronic upper airway obstruction.

  20. Predictors of Airway Hyperresponsiveness in Elite Athletes

    DEFF Research Database (Denmark)

    Toennesen, Louise L; Porsbjerg, Celeste; Pedersen, Lars;

    2015-01-01

    INTRODUCTION: Elite athletes frequently suffer from asthma and airway hyperresponsiveness (AHR). We aimed to investigate predictors of airway pathophysiology in a group of unselected elite summer-sport athletes, training for the summer 2008 Olympic Games, including markers of airway inflammation......, systemic inflammation and training intensity. METHODS: 57 Danish elite summer-sport athletes with and without asthma symptoms all gave a blood sample for measurements of high sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), interleukin-8 (IL-8) and tumor necrosis factor alpha (TNF....... In these subjects, no association was found between the levels of AHR to mannitol and methacholine (r=0.032, p=0.91). CONCLUSION: Airway hyperresponsiveness in elite athletes is related to the amount of weekly training and the level of serum TNF-α. No association was found between the level of AHR to mannitol...

  1. Safety And Efficacy Of Proseal Laryngeal Mask Airway Versus Classic Laryngeal Mask Airway And Endo Tracheal Tube During Elective surgery

    Directory of Open Access Journals (Sweden)

    Soad A. Mansour , Wafaa G.Ahmed , Kawthar A. Azzam ,Tarek M. EL said

    2005-12-01

    Full Text Available The present study was performed to compare safety , efficacy of Proseal Laryngeal Mask Airway (PLMA, classic Laryngeal mask airway (LMA and cuffed Endo Tracheal Tube (ETT as a ventilatory device during controlled positive pressure ventilation and airway management , Haemodynamic response to insertion and removal, gastric tube insertion through either device, air leak detection and assessment of position by fiberoptic bronchoscope . Forty five ASA I or II patients aged between 18-55 years old , were divided equally into three groups of fifteen patients each , and airway management either through PLMA(groupI,classic LMA (groupIIand ETT (group III . All patients were premedicated by zantac hydrochloride 150 mg orally at mid night and two hours before the operation ­ Anaesthesia was induced with fentanyl 2 ug/kg and propofol 2.5 mg /kg and maintenance was with a mixture of 50% N2O , 50% O2 and isoflurane 1 - 1.5 % and rocuronium 0.5 mg /kg followed by continous infusion of rocuronium 0.3-0.6 mg/kg/hr A proper size PLMA , classic LMA or ETT was selected oxygenation and ventilation were optimal in 100% in group I and III while in group II 80% optimal and suboptimal in 13.3% and failed in 6.7 % . Haemodynamic parameters showed that significantly increase in HR and MAP in the three studied groups especially at insertion and removal of the airway device with statisticaly significant difference between group I,II in comparison to group III, comparison of gastric tube insertion showed that positive insertion was 86.7% in group I and in 46.7% in group II, while in group III positive insertion was 100% air leak was detected by epigastric auscultation which signified lower leakage in PLMA group than LMA group . Position assessment by fiberoptic bronchoscope in PLMA group was grade 4 in 5 patients , grade 3 in 5 patients , grade2 in 4 patients and grade 1 in 1 patient while in LMA group it was grade 4 in 7 patients , grade 3 in 6 patients , grade 2 in 2

  2. Central airways remodeling in COPD patients

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    Pini L

    2014-09-01

    Full Text Available Laura Pini,1 Valentina Pinelli,2 Denise Modina,1 Michela Bezzi,3 Laura Tiberio,4 Claudio Tantucci1 1Unit of Respiratory Medicine, Department of Clinical and Experimental Sciences, University of Brescia, 2Department of Respiratory Medicine, Spedali Civili di Brescia, 3Department Bronchoscopy, Spedali Civili di Brescia, 4Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy Background: The contribution to airflow obstruction by the remodeling of the peripheral airways in chronic obstructive pulmonary disease (COPD patients has been well documented, but less is known about the role played by the large airways. Few studies have investigated the presence of histopathological changes due to remodeling in the large airways of COPD patients. Objectives: The aim of this study was to verify the presence of airway remodeling in the central airways of COPD patients, quantifying the airway smooth muscle (ASM area and the extracellular matrix (ECM protein deposition, both in the subepithelial region and in the ASM, and to verify the possible contribution to airflow obstruction by the above mentioned histopathological changes. Methods: Biopsies of segmental bronchi spurs were performed in COPD patients and control smoker subjects and immunostained for collagen type I, versican, decorin, biglycan, and alpha-smooth muscle actin. ECM protein deposition was measured at both subepithelial, and ASM layers. Results: The staining for collagen I and versican was greater in the subepithelial layer of COPD patients than in control subjects. An inverse correlation was found between collagen I in the subepithelial layer and both forced expiratory volume in 1 second and ratio between forced expiratory volume in 1 second and forced vital capacity. A statistically significant increase of the ASM area was observed in the central airways of COPD patients versus controls. Conclusion: These findings indicate that airway remodeling also affects

  3. Cigarette smoke-induced damage-associated molecular pattern release from necrotic neutrophils triggers proinflammatory mediator release.

    Science.gov (United States)

    Heijink, Irene H; Pouwels, Simon D; Leijendekker, Carin; de Bruin, Harold G; Zijlstra, G Jan; van der Vaart, Hester; ten Hacken, Nick H T; van Oosterhout, Antoon J M; Nawijn, Martijn C; van der Toorn, Marco

    2015-05-01

    Cigarette smoking, the major causative factor for the development of chronic obstructive pulmonary disease, is associated with neutrophilic airway inflammation. Cigarette smoke (CS) exposure can induce a switch from apoptotic to necrotic cell death in airway epithelium. Therefore, we hypothesized that CS promotes neutrophil necrosis with subsequent release of damage-associated molecular patterns (DAMPs), including high mobility group box 1 (HMGB1), alarming the innate immune system. We studied the effect of smoking two cigarettes on sputum neutrophils in healthy individuals and of 5-day CS or air exposure on neutrophil counts, myeloperoxidase, and HMGB1 levels in bronchoalveolar lavage fluid of BALB/c mice. In human peripheral blood neutrophils, mitochondrial membrane potential, apoptosis/necrosis markers, caspase activity, and DAMP release were studied after CS exposure. Finally, we assessed the effect of neutrophil-derived supernatants on the release of chemoattractant CXCL8 in normal human bronchial epithelial cells. Cigarette smoking caused a significant decrease in sputum neutrophil numbers after 3 hours. In mice, neutrophil counts were significantly increased 16 hours after repeated CS exposure but reduced 2 hours after an additional exposure. In vitro, CS induced necrotic neutrophil cell death, as indicated by mitochondrial dysfunction, inhibition of apoptosis, and DAMP release. Supernatants from CS-treated neutrophils significantly increased the release of CXCL8 in normal human bronchial epithelial cells. Together, these observations show, for the first time, that CS exposure induces neutrophil necrosis, leading to DAMP release, which may amplify CS-induced airway inflammation by promoting airway epithelial proinflammatory responses.

  4. Avaliação da ventilação não-invasiva com dois níveis de pressão positiva nas vias aéreas após cirurgia cardíaca Assessment of noninvasive ventilation with two levels of positive airway pressure in patients after cardiac surgery

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    Aline Marques Franco

    2011-12-01

    respiratory therapy the patients were subjected to 30 minutes of ventilation by two levels twice a day. The conventional respiratory therapy was held in both groups, twice a day. All patients were evaluated for vital capacity, airway permeability, maximal respiratory pressures, oxygen saturation, heart rate, respiratory frequency, Volume Minute, tidal volume, systolic and diastolic blood pressure. Evaluations were performed during hospitalization preoperatively, immediately after extubation, 24h and 48h after extubation. RESULTS: In CG 61.5% of patients had some degree of atelectasias, in comparison to 54% of BG (P=0.691. The vital capacity was higher in the GB postoperatively (P<0.015. All the other ventilometric, gasometric, hemodynamic and manometric parameters were similar between groups. CONCLUSION: Coronary artery bypass grafting leads to deterioration of respiratory function postoperatively, and the application of positive pressure ventilation (BiPAP® may be beneficial to restore lung function more quickly, especially vital capacity, safely, and well accepted by patients due to greater comfort with the sensation of pain during the execution of respiratory therapy.

  5. Environmental and genetical factors in airway allergies

    OpenAIRE

    Katarzyna Idzik

    2012-01-01

    It is estimated that approximately 23% of the European population is clinically diagnosed with allergies. In the past three decades, an increase in the incidence of respiratory allergies was noted. At the beginning of the 20th century allergic inflammations affected only around 1% of the world population. Medical symptoms of allergic airway inflammation are variable for different patients. Airways allergy are complex phenotypes, which are determined by both genetic and...

  6. Comparison of Five 2nd-Generation Supraglottic Airway Devices for Airway Management Performed by Novice Military Operators

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    Tomas Henlin

    2015-01-01

    Full Text Available Objectives. Five different second-generation supraglottic airway devices, ProSeal LMA, Supreme LMA, i-gel, SLIPA, and Laryngeal Tube Suction-D, were studied. Operators were inexperienced users with a military background, combat lifesavers, nurses, and physicians. Methods. This was a prospective, randomized, single-blinded study. Devices were inserted in the operating room in low light conditions after induction of general anesthesia. Primary outcome was successful insertion on the first attempt while secondary aims were insertion time, number of attempts, oropharyngeal seal pressure, ease of insertion, fibre optic position of device, efficacy of ventilation, and intraoperative trauma or regurgitation of gastric contents. Results. In total, 505 patients were studied. First-attempt insertion success rate was higher in the Supreme LMA (96%, i-gel (87.9%, and ProSeal LMA (85.9% groups than in the Laryngeal Tube Suction-D (80.6% and SLIPA (69.4% groups. Insertion time was shortest in the Supreme LMA (70.4 ± 32.5 s and i-gel (74.4 ± 41.1 s groups (p<0.001. Oropharyngeal seal pressures were higher in the Laryngeal Tube Suction-D and ProSeal LMA groups than in other three devices. Conclusions. Most study parameters for the Supreme LMA and i-gel were found to be superior to the other three tested supraglottic airway devices when inserted by novice military operators.

  7. Protease-activated receptor 2 activation of myeloid dendritic cells regulates allergic airway inflammation

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    Dienger Krista

    2011-09-01

    Full Text Available Abstract Background A common characteristic of allergens is that they contain proteases that can activate protease-activated receptor (PAR-2; however the mechanism by which PAR-2 regulates allergic airway inflammation is unclear. Methods Mice (wild type and PAR-2-deficient were sensitized using German cockroach (GC feces (frass, the isolated protease from GC frass, or through adoptive transfer of GC frass-treated bone marrow-derived dendritic cells (BMDC and measurements of airway inflammation (cellular infiltration, cytokine expression, and mucin production, serum IgE levels and airway hyperresponsiveness (AHR were assessed. BMDC were cultured, treated with GC frass and assessed for cytokine production. PAR-2 expression on pulmonary mDCs was determined by flow cytometry. Results Exposure to GC frass induced AHR and airway inflammation in wild type mice; however PAR-2-deficient mice had significantly attenuated responses. To directly investigate the role of the protease, we isolated the protease from GC frass and administered the endotoxin-free protease into the airways of mice in the presence of OVA. GC frass proteases were sufficient to promote the development of AHR, serum IgE, and Th2 cytokine production. PAR-2 expression on mDC was upregulated following GC frass exposure, but the presence of a functional PAR-2 did not alter antigen uptake. To determine if PAR-2 activation led to differential cytokine production, we cultured BMDC in the presence of GM-CSF and treated these cells ex vivo with GC frass. PAR-2-deficient BMDC released significantly less IL-6, IL-23 and TNFα compared to BMDC from wild type mice, suggesting PAR-2 activation was important in Th2/Th17 skewing cytokine production. To determine the role for PAR-2 on mDCs on the initiation of allergic airway inflammation, BMDCs from wild type and PAR-2-deficient mice were treated in the presence or absence of GC frass and then adoptively transferred into the airway of wild type mice

  8. Divergent Inhibitor Susceptibility among Airway Lumen-Accessible Tryptic Proteases.

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    Shilpa Nimishakavi

    Full Text Available Tryptic serine proteases of bronchial epithelium regulate ion flux, barrier integrity, and allergic inflammation. Inhibition of some of these proteases is a strategy to improve mucociliary function in cystic fibrosis and asthmatic inflammation. Several inhibitors have been tested in pre-clinical animal models and humans. We hypothesized that these inhibitors inactivate a variety of airway protease targets, potentially with bystander effects. To establish relative potencies and modes of action, we compared inactivation of human prostasin, matriptase, airway trypsin-like protease (HAT, and β-tryptase by nafamostat, camostat, bis(5-amidino-2-benzimidazolylmethane (BABIM, aprotinin, and benzamidine. Nafamostat achieved complete, nearly stoichiometric and very slowly reversible inhibition of matriptase and tryptase, but inhibited prostasin less potently and was weakest versus HAT. The IC50 of nafamostat's leaving group, 6-amidino-2-naphthol, was >104-fold higher than that of nafamostat itself, consistent with suicide rather than product inhibition as mechanisms of prolonged inactivation. Stoichiometric release of 6-amidino-2-naphthol allowed highly sensitive fluorometric estimation of active-site concentration in preparations of matriptase and tryptase. Camostat inactivated all enzymes but was less potent overall and weakest towards matriptase, which, however was strongly inhibited by BABIM. Aprotinin exhibited nearly stoichiometric inhibition of prostasin and matriptase, but was much weaker towards HAT and was completely ineffective versus tryptase. Benzamidine was universally weak. Thus, each inhibitor profile was distinct. Nafamostat, camostat and aprotinin markedly reduced tryptic activity on the apical surface of cystic fibrosis airway epithelial monolayers, suggesting prostasin as the major source of such activity and supporting strategies targeting prostasin for inactivation.

  9. Ultrasound: A novel tool for airway imaging

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    Siddharthkumar Bhikhabhai Parmar

    2014-01-01

    Full Text Available Context: The scope of ultrasound is emerging in medical science, particularly outside traditional areas of radiology practice. Aims: We designed this study to evaluate feasibility of bedside sonography as a tool for airway assessment and to describe sonographic anatomy of airway. Settings and Design: A prospective, clinical study. Materials and Methods: We included 100 adult, healthy volunteers of either sex to undergo airway imaging systemically starting from floor of the mouth to the sternal notch in anterior aspect of neck by sonography. Results: We could visualize mandible and hyoid bone as a bright hyperechoic structure with hypoechoic acoustic shadow underneath. Epiglottis, thyroid cartilage, cricoid cartilage, and tracheal rings appeared hypoechoic. Vocal cords were visualized through thyroid cartilage. Interface between air and mucosa lining the airway produced a bright hyperechoic linear appearance. Artifacts created by intraluminal air prevented visualization of posterior pharynx, posterior commissure, and posterior wall of trachea. Conclusions: Ultrasound is safe, quick, noninvasive, repeatable, and bedside tool to assess the airway and can provide real-time dynamic images relevant for several aspects of airway management.

  10. Link between vitamin D and airway remodeling

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    Berraies A

    2014-04-01

    Full Text Available Anissa Berraies, Kamel Hamzaoui, Agnes HamzaouiPediatric Respiratory Diseases Department, Abderrahmen Mami Hospital, Ariana, and Research Unit 12SP15 Tunis El Manar University, Tunis, TunisiaAbstract: In the last decade, many epidemiologic studies have investigated the link between vitamin D deficiency and asthma. Most studies have shown that vitamin D deficiency increases the risk of asthma and allergies. Low levels of vitamin D have been associated with asthma severity and loss of control, together with recurrent exacerbations. Remodeling is an early event in asthma described as a consequence of production of mediators and growth factors by inflammatory and resident bronchial cells. Consequently, lung function is altered, with a decrease in forced expiratory volume in one second and exacerbated airway hyperresponsiveness. Subepithelial fibrosis and airway smooth muscle cell hypertrophy are typical features of structural changes in the airways. In animal models, vitamin D deficiency enhances inflammation and bronchial anomalies. In severe asthma of childhood, major remodeling is observed in patients with low vitamin D levels. Conversely, the antifibrotic and antiproliferative effects of vitamin D in smooth muscle cells have been described in several experiments. In this review, we briefly summarize the current knowledge regarding the relationship between vitamin D and asthma, and focus on its effect on airway remodeling and its potential therapeutic impact for asthma.Keywords: vitamin D, asthma, airway remodeling, airway smooth muscle, supplementation

  11. Molecular modulation of airway epithelial ciliary response to sneezing.

    Science.gov (United States)

    Zhao, Ke-Qing; Cowan, Andrew T; Lee, Robert J; Goldstein, Natalia; Droguett, Karla; Chen, Bei; Zheng, Chunquan; Villalon, Manuel; Palmer, James N; Kreindler, James L; Cohen, Noam A

    2012-08-01

    Our purpose was to evaluate the effect of the mechanical force of a sneeze on sinonasal cilia function and determine the molecular mechanism responsible for eliciting the ciliary response to a sneeze. A novel model was developed to deliver a stimulation simulating a sneeze (55 mmHg for 50 ms) at 26°C to the apical surface of mouse and human nasal epithelial cells. Ciliary beating was visualized, and changes in ciliary beat frequency (CBF) were determined. To interrogate the molecular cascades driving sneeze-induced changes of CBF, pharmacologic manipulation of intra- and extracellular calcium, purinergic, PKA, and nitric oxide (NO) signaling were performed. CBF rapidly increases by ≥150% in response to a sneeze, which is dependent on the release of adenosine triphosphate (ATP), calcium influx, and PKA activation. Furthermore, apical release of ATP is independent of calcium influx, but calcium influx and subsequent increase in CBF are dependent on the ATP release. Lastly, we observed a blunted ciliary response in surgical specimens derived from patients with chronic rhinosinusitis compared to control patients. Apical ATP release with subsequent calcium mobilization and PKA activation are involved in sinonasal ciliary response to sneezing, which is blunted in patients with upper-airway disease.

  12. Negative Pressure Pulmonary Edema After Extubation in Appendectomy: Case Report

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    Tarik Purtuloglu

    2016-01-01

    Full Text Available Negative pressure pulmonary edema (NPPE is a rare complication that can occur after acute upper airway obstruction or secondary to relax chronic upper airway obstruction and a life-threatening fatal condition. The first cause in the etiology of NPPE is developed laryngospasm after intubation or extubation, while the other causes are epiglottitis, croup, hiccups, foreign body aspiration, pharyngeal hematoma and oropharyngeal tumors. Supportive therapy is usually the only treatment. The fundamental principle of treatment is early diagnosis and to provide adequate oxygenation. Application of positive airway pressure is often provided with CPAP in most of patients, but sometimes re-intubation and mechanical ventilation may be required.

  13. PAR-2 activation, PGE2, and COX-2 in human asthmatic and nonasthmatic airway smooth muscle cells

    NARCIS (Netherlands)

    Chambers, Linda S.; Black, Judith L.; Ge, Qi; Carlin, Stephen M.; Au, Wendy W.; Poniris, Maree; Thompson, Joanne; Johnson, Peter R.; Burgess, Janette K.

    2003-01-01

    The protease-activated receptor-2 (PAR-2) is present on human airway smooth muscle (ASM) cells and can be activated by mast cell tryptase, trypsin, or an activating peptide (AP). Trypsin induced significant increases in PGE 2 release from human ASM cells after 6 and 24 h and also induced cyclooxygen

  14. PAR-2 activation, PGE2, and COX-2 in human asthmatic and nonasthmatic airway smooth muscle cells

    NARCIS (Netherlands)

    Chambers, Linda S; Black, Judith L; Ge, Qi; Carlin, Stephen M; Au, Wendy W; Poniris, Maree; Thompson, Joanne; Johnson, Peter R; Burgess, Janette K

    2003-01-01

    The protease-activated receptor-2 (PAR-2) is present on human airway smooth muscle (ASM) cells and can be activated by mast cell tryptase, trypsin, or an activating peptide (AP). Trypsin induced significant increases in PGE2 release from human ASM cells after 6 and 24 h and also induced cyclooxygena

  15. Study on Seam Deformation and Permeability Improved Effect of Pressure Released Mining in Protective Seam%保护层卸压开采煤层变形与增透效应研究

    Institute of Scientific and Technical Information of China (English)

    涂敏; 袁亮; 缪协兴; 刘泽功; 徐乃忠; 付宝杰

    2013-01-01

    为了研究高瓦斯赋存煤层卸压增透效应,以达到提高低渗透性松软煤层瓦斯抽采率,降低工作面瓦斯突出危险性,采用RFPA2D-Gasflow软件分析下保护层卸压开采后上覆煤岩采动裂隙发育、应力分布特征及由此产生的卸压煤层增透效应.结果表明:卸压开采煤层的透气性系数增大200倍左右,增透效果显著.利用该研究结果在顾桥矿沿空留巷内布置斜向上长短穿层钻孔,代替传统的底板巷内布置向上穿层钻孔抽采本层采空区内和上覆卸压煤层内瓦斯,可使沿空留巷中回风流和上隅角瓦斯体积分数均控制在0.5%以下,平均瓦斯抽采率达50% ~ 70%,保证了工作面的安全回采.%In order to study the pressure released and permeability improved effect of the high gas content seam and to reach the targets to improve the gas drainage rate of the low permeability soft seam and to reduce the gas outburst danger of the coal mining face,the RFPA -Gasflow software was applied to analyze the mining crack development and the stress distribution features of the overburden coal and rock and thus created pressure released and permeability effect after the pressure released mining in the underneath protective seam.The results showed that the permeability coefficient of the pressure released mining seam could be increased about 200 times and the permeability improved effect was obvious.The study results were applied to the layout of the inclined upward long and short boreholes in the gateway retained along goaf in Guqiao Mine to replace the layout of the inclined upward borehole in the conventional floor gateway for the gas drainage in the mining goaf and the overburden pressure released seam.Thus the gas volume fractions of the air returning flow in the gateway retained and the gas in the upper corner both could be controlled below 0. 5%, the average gas drainage rate could be 50% ~ 70% and the safety mining of the coal mining face

  16. A randomised comparison of the self-pressurised air-QTM intubating laryngeal airway with the LMA Unique™ in children.

    Science.gov (United States)

    Jagannathan, N; Sohn, L E; Sawardekar, A; Shah, R; Ryan, K; Jagannathan, R; Anderson, K

    2012-09-01

    We conducted a randomised trial comparing the self-pressurised air-Q™ intubating laryngeal airway (air-Q SP) with the LMA-Unique in 60 children undergoing surgery. Outcomes measured were airway leak pressure, ease and time for insertion, fibreoptic examination, incidence of gastric insufflation and complications. Median (IQR [range]) time to successful device placement was faster with the air-Q SP (12 (10-15 [5-18])) s than with the LMA-Unique (14 (12-17 [6-22]) s; p=0.05). There were no statistically significant differences between the air-Q SP and LMA-Unique in initial airway leak pressures (16 (14-18 [10-29]) compared with 18 (15-20 [10-30]) cmH2 O, p=0.12), an airway leak pressures at 10 min (19 (16-22 [12-30]) compared with 20 (16-22 [10-30]) cmH2 O, p=0.81); fibreoptic position, incidence of gastric insufflation, or complications. Both devices provided effective ventilation without the need for airway manipulation. The air-Q SP is an alternative to the LMA-Unique should the clinician prefer a device not requiring cuff monitoring during anaesthesia.

  17. Effects of lung inflation on airway heterogeneity during histaminergic bronchoconstriction.

    Science.gov (United States)

    Kaczka, David W; Mitzner, Wayne; Brown, Robert H

    2013-09-01

    Lung inflation has been shown to dilate airways by altering the mechanical equilibrium between opposing airway and parenchymal forces. However, it is not known how heterogeneously such dilation occurs throughout the airway tree. In six anesthetized dogs, we measured the diameters of five to six central airway segments using high-resolution computed tomography, along with respiratory input impedance (Zrs) during generalized aerosol histamine challenge, and local histamine challenge in which the agonist was instilled directly onto the epithelia of the imaged central airways. Airway diameters and Zrs were measured at 12 and 25 cmH2O. The Zrs spectra were fitted with a model that incorporated continuous distributions of airway resistances. Airway heterogeneity was quantified using the coefficient of variation for predefined airway distribution functions. Significant reductions in average central airway diameter were observed at 12 cmH2O for both aerosolized and local challenges, along with significant increases upon inflation to 25 cmH2O. No significant differences were observed for the coefficient of variation of airway diameters under any condition. Significant increases in effective airway resistance as measured by Zrs were observed only for the aerosolized challenge at 12 cmH2O, which was completely reversed upon inflation. We conclude that the lung periphery may be the most dominant contributor to increases in airway resistance and tissue elastance during bronchoconstriction induced by aerosolized histamine. However, isolated constriction of only a few central airway segments may also affect tissue stiffness via interdependence with their surrounding parenchyma.

  18. PROSPECTIVE COMPARATIVE STUDY OF HAEMODYNAMIC CHANGES DURING INSERTION OF LARYNGEAL MASK AIRWAY VERSUS ENDOTRACHEAL TUBE IN PAEDIATRIC PATIENTS

    Directory of Open Access Journals (Sweden)

    Roshith Thomas

    2016-06-01

    Full Text Available BACKGROUND & METHODS This study was conducted to determine and compare the pressor responses associated with insertion of a laryngeal mask airway with endotracheal tube during elective surgical procedures under general anaesthesia in paediatric patients. 64 patients of age between 2-12 years weighing between 10–40 kg, belonging to ASA grade I and II, scheduled for elective surgeries under general anaesthesia were included in the study. Patients belonging to ASA grade III and IV, those scheduled for emergency surgeries and patients with anticipated difficult airway were excluded from the study. The patients were randomised into two groups of 32 each, by computer generated software. For patients in group-L, airway was secured with laryngeal mask airway. Patients in group-E, airway was secured with endotracheal tube. Heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure and SpO2 were recorded just before induction and subsequently at 1, 3, 5 & 10 minutes. Mean heart rate increase at 1, 3 & 5 minutes was much less when compared to Group-E (p=significant. Mean systolic blood pressure of Group-L is significantly less at 1, 3, 5 & 10 minutes than that of Group-E (p=significant. Mean diastolic blood pressure of Group-L is significantly less at 1, 3 & 10 minutes compared to Group-E (p=significant. RESULTS & CONCLUSION Complications like sore throat, blood staining and coughing at the end of the procedure were seen less in Group-L than in group-E. In this study, we concluded that the pressor responses were less with LMA than with endotracheal tube. Based on our conclusion, we can say that LMA can be used as an alternative to endotracheal tube in maintaining an intact airway under general anaesthesia.

  19. Airway Inflammation in Chronic Rhinosinusitis with Nasal Polyps and Asthma: The United Airways Concept Further Supported

    DEFF Research Database (Denmark)

    Håkansson, Kåre; Bachert, Claus; Konge, Lars;

    2015-01-01

    Background It has been established that patients with chronic rhinosinusitis with nasal polyps (CRSwNP) often have co-existing asthma. Objective We aimed to test two hypotheses: (i) upper and lower airway inflammation in CRSwNP is uniform in agreement with the united airways concept; and (ii) bro...

  20. Full Airway Drainage by Fiber Bronchoscopy Through Artificial Airway in the Treatment of Occult Traumatic Atelectasis.

    Science.gov (United States)

    Zhao, Xue Hong; Zhang, Yun; Liang, Zhong Yan; Zhang, Shao Yang; Yu, Wen Qiao; Huang, Fang-Fang

    2015-12-01

    The objective of this study is to investigate the effects of full airway drainage by fiber bronchoscopy through artificial airway in the treatment of traumatic atelectasis with occult manifestations. From May 2006 to May 2011, 40 cases of occult traumatic atelectasis were enrolled into our prospective study. Group A (n = 18) received drainage by nasal bronchoscope; group B underwent airway drainage by fiber bronchoscopy through artificial airway (n = 22). The effects of treatment were evaluated by the incidence of adult respiratory distress syndrome (ARDS), lung abscess, and the average length of hospital stay. Compared with nasal fiber-optic treatment, airway drainage by fiber bronchoscopy through artificial airway reduced the incidence of ARDS (p = 0.013) and lung abscess (p = 0.062) and shortened the mean length of stay (p = 0.018). Making the decision to create an artificial airway timely and carry out lung lavage by fiber bronchoscopy through artificial airway played a significant role in the treatment of occult traumatic atelectasis.

  1. 75 FR 13079 - Action Affecting Export Privileges; MAHAN AIRWAYS; Mahan Airways, Mahan Tower, No. 21, Azadegan...

    Science.gov (United States)

    2010-03-18

    ... Secretary Jackson issued an Order adding Blue Airways FZE and Blue Airways, both of Dubai, United Arab... conduct illustrates its refusal to comply with the TDO or U.S. export control laws.\\6\\ \\6\\ My findings are... full written statement in support of the appeal with the Office of the Administrative Law Judge,...

  2. Airway Inflammation in Chronic Rhinosinusitis with Nasal Polyps and Asthma: The United Airways Concept Further Supported

    DEFF Research Database (Denmark)

    Håkansson, Kåre; Bachert, Claus; Konge, Lars;

    2015-01-01

    Background It has been established that patients with chronic rhinosinusitis with nasal polyps (CRSwNP) often have co-existing asthma. Objective We aimed to test two hypotheses: (i) upper and lower airway inflammation in CRSwNP is uniform in agreement with the united airways concept; and (ii...

  3. Lipocalin2 protects against airway inflammation and hyperresponsiveness in a murine model of allergic airway disease

    DEFF Research Database (Denmark)

    Dittrich, A M; Krokowski, M; Meyer, H-A;

    2010-01-01

    Allergen-induced bronchial asthma is a chronic airway disease that involves the interplay of various genes with environmental factors triggering different inflammatory pathways.......Allergen-induced bronchial asthma is a chronic airway disease that involves the interplay of various genes with environmental factors triggering different inflammatory pathways....

  4. Different regulation of cigarette smoke induced inflammation in upper versus lower airways

    Directory of Open Access Journals (Sweden)

    Bracke Ken R

    2010-07-01

    Full Text Available Abstract Background Cigarette smoke (CS is known to initiate a cascade of mediator release and accumulation of immune and inflammatory cells in the lower airways. We investigated and compared the effects of CS on upper and lower airways, in a mouse model of subacute and chronic CS exposure. Methods C57BL/6 mice were whole-body exposed to mainstream CS or air, for 2, 4 and 24 weeks. Bronchoalveolar lavage fluid (BAL was obtained and tissue cryosections from nasal turbinates were stained for neutrophils and T cells. Furthermore, we evaluated GCP-2, KC, MCP-1, MIP-3α, RORc, IL-17, FoxP3, and TGF-β1 in nasal turbinates and lungs by RT-PCR. Results In both upper and lower airways, subacute CS-exposure induced the expression of GCP-2, MCP-1, MIP-3α and resulted in a neutrophilic influx. However, after chronic CS-exposure, there was a significant downregulation of inflammation in the upper airways, while on the contrary, lower airway inflammation remained present. Whereas nasal FoxP3 mRNA levels already increased after 2 weeks, lung FoxP3 mRNA increased only after 4 weeks, suggesting that mechanisms to suppress inflammation occur earlier and are more efficient in nose than in lungs. Conclusions Altogether, these data demonstrate that CS induced inflammation may be differently regulated in the upper versus lower airways in mice. Furthermore, these data may help to identify new therapeutic targets in this disease model.

  5. Long acting β2-agonist and corticosteroid restore airway glandular cell function altered by bacterial supernatant

    Directory of Open Access Journals (Sweden)

    Nawrocki-Raby Béatrice

    2010-01-01

    Full Text Available Abstract Background Staphylococcus aureus releases virulence factors (VF that may impair the innate protective functions of airway cells. The aim of this study was to determine whether a long-acting β2 adrenergic receptor agonist (salmeterol hydroxynaphthoate, Sal combined with a corticosteroid (fluticasone propionate, FP was able to regulate ion content and cytokine expression by airway glandular cells after exposure to S. aureus supernatant. Methods A human airway glandular cell line was incubated with S. aureus supernatant for 1 h and then treated with the combination Sal/FP for 4 h. The expression of actin and CFTR proteins was analyzed by immunofluorescence. Videomicroscopy was used to evaluate chloride secretion and X-ray microanalysis to measure the intracellular ion and water content. The pro-inflammatory cytokine expression was assessed by RT-PCR and ELISA. Results When the cells were incubated with S. aureus supernatant and then with Sal/FP, the cellular localisation of CFTR was apical compared to the cytoplasmic localisation in cells incubated with S. aureus supernatant alone. The incubation of airway epithelial cells with S. aureus supernatant reduced by 66% the chloride efflux that was fully restored by Sal/FP treatment. We also observed that Sal/FP treatment induced the restoration of ion (Cl and S and water content within the intracellular secretory granules of airway glandular cells and reduced the bacterial supernatant-dependent increase of pro-inflammatory cytokines IL8 and TNFα. Conclusions Our results demonstrate that treatment with the combination of a corticosteroid and a long-acting β2 adrenergic receptor agonist after bacterial infection restores the airway glandular cell function. Abnormal mucus induced by defective ion transport during pulmonary infection could benefit from treatment with a combination of β2 adrenergic receptor agonist and glucocorticoid.

  6. Impacto da umidificação aquecida com pressão positiva automática em vias aéreas na terapia do síndroma de apneia obstrutiva do sono Impact of heated humidification with automatic positive airway pressure in obstructive sleep apnea therapy

    Directory of Open Access Journals (Sweden)

    Sara Moreira da Silva Trindade Salgado

    2008-09-01

    Full Text Available OBJETIVO: Avaliar o impacto da umidificação aquecida introduzida no início da terapia com pressão positiva automática em vias aéreas (APAP, do inglês automatic positive airway pressure na adesão e efeitos secundários. MÉTODOS: Foram randomizados 39 doentes com síndroma de apneia obstrutiva do sono sem terapia prévia em dois grupos de tratamento com APAP: com umidificação aquecida (grupo APAPcom; e sem umidificação (grupo APAPsem. Os doentes foram avaliados 7 e 30 dias após a colocação de APAP. Os parâmetros analisados foram a adesão ao tratamento (número médio de horas/noite, efeitos secundários (secura nasal ou da boca, obstrução nasal e rinorreia, sonolência diurna (escore da escala de sonolência de Epworth e o conforto subjectivo (escala visual analógica. Foram ainda avaliados o índice de apneia-hipopneia (IAH residual, pressões e fugas médias registados nos ventiladores. RESULTADOS: Os dois grupos de doentes estudados eram semelhantes no que respe