Sample records for regional lung ventilation

  1. Regional tidal lung strain in mechanically ventilated normal lungs.

    Paula, Luis Felipe; Wellman, Tyler J; Winkler, Tilo; Spieth, Peter M; Güldner, Andreas; Venegas, Jose G; Gama de Abreu, Marcelo; Carvalho, Alysson R; Vidal Melo, Marcos F


    Parenchymal strain is a key determinant of lung injury produced by mechanical ventilation. However, imaging estimates of volumetric tidal strain (ε = regional tidal volume/reference volume) present substantial conceptual differences in reference volume computation and consideration of tidally recruited lung. We compared current and new methods to estimate tidal volumetric strains with computed tomography, and quantified the effect of tidal volume (VT) and positive end-expiratory pressure (PEEP) on strain estimates. Eight supine pigs were ventilated with VT = 6 and 12 ml/kg and PEEP = 0, 6, and 12 cmH2O. End-expiratory and end-inspiratory scans were analyzed in eight regions of interest along the ventral-dorsal axis. Regional reference volumes were computed at end-expiration (with/without correction of regional VT for intratidal recruitment) and at resting lung volume (PEEP = 0) corrected for intratidal and PEEP-derived recruitment. All strain estimates demonstrated vertical heterogeneity with the largest tidal strains in middependent regions (P < 0.01). Maximal strains for distinct estimates occurred at different lung regions and were differently affected by VT-PEEP conditions. Values consistent with lung injury and inflammation were reached regionally, even when global measurements were below critical levels. Strains increased with VT and were larger in middependent than in nondependent lung regions. PEEP reduced tidal-strain estimates referenced to end-expiratory lung volumes, although it did not affect strains referenced to resting lung volume. These estimates of tidal strains in normal lungs point to middependent lung regions as those at risk for ventilator-induced lung injury. The different conditions and topography at which maximal strain estimates occur allow for testing the importance of each estimate for lung injury.

  2. Spontaneous breathing during high-frequency oscillatory ventilation improves regional lung characteristics in experimental lung injury

    van Heerde, M.; Roubik, K.; Kopelent, V.; Kneyber, M. C. J.; Markhorst, D. G.


    Background Maintenance of spontaneous breathing is advocated in mechanical ventilation. This study evaluates the effect of spontaneous breathing on regional lung characteristics during high-frequency oscillatory (HFO) ventilation in an animal model of mild lung injury. Methods Lung injury was

  3. Spontaneous breathing during high-frequency oscillatory ventilation improves regional lung characteristics in experimental lung injury

    van Heerde, M.; Roubik, K.; Kopelent, V.; Kneyber, M. C. J.; Markhorst, D. G.


    Background Maintenance of spontaneous breathing is advocated in mechanical ventilation. This study evaluates the effect of spontaneous breathing on regional lung characteristics during high-frequency oscillatory (HFO) ventilation in an animal model of mild lung injury. Methods Lung injury was induce

  4. Prediction of postoperative loss of lung function in patients with malignant lung mass. Quantitative regional ventilation-perfusion scanning

    Ryo, U.Y. (Univ. of Kentucky College of Medicine, Lexington (USA))


    The quantitative measurement of regional ventilation and perfusion distribution is simply and reliably accomplished by using routinely available radioactive gas and perfusion lung scanning agents, and a large field-of-view gamma camera with an on-line computer. The preoperative prediction of postsurgical loss in lung function can be made accurately by using the quantitative ventilation-perfusion lung scan technique. Either a regional ventilation study or perfusion study may be used for the prediction, but analysis of regional ventilation distribution appears to be a better parameter than that of perfusion distribution for the prediction of postoperative loss of FEV1. In the rare case of a patient with a marked ventilation-perfusion deficit, quantitative distribution of both ventilation and perfusion may be needed for an accurate assessment of postsurgical lung function. 18 references.

  5. Effect of regional lung inflation on ventilation heterogeneity at different length scales during mechanical ventilation of normal sheep lungs.

    Wellman, Tyler J; Winkler, Tilo; Costa, Eduardo L V; Musch, Guido; Harris, R Scott; Venegas, Jose G; Vidal Melo, Marcos F


    Heterogeneous, small-airway diameters and alveolar derecruitment in poorly aerated regions of normal lungs could produce ventilation heterogeneity at those anatomic levels. We modeled the washout kinetics of (13)NN with positron emission tomography to examine how specific ventilation (sV) heterogeneity at different length scales is influenced by lung aeration. Three groups of anesthetized, supine sheep were studied: high tidal volume (Vt; 18.4 ± 4.2 ml/kg) and zero end-expiratory pressure (ZEEP) (n = 6); low Vt (9.2 ± 1.0 ml/kg) and ZEEP (n = 6); and low Vt (8.2 ± 0.2 ml/kg) and positive end-expiratory pressure (PEEP; 19 ± 1 cmH(2)O) (n = 4). We quantified fractional gas content with transmission scans, and sV with emission scans of infused (13)NN-saline. Voxel (13)NN-washout curves were fit with one- or two-compartment models to estimate sV. Total heterogeneity, measured as SD[log(10)(sV)], was divided into length-scale ranges by measuring changes in variance of log(10)(sV), resulting from progressive filtering of sV images. High-Vt ZEEP showed higher sV heterogeneity at 36-mm (r = -0.72) length scales (P < 0.001). We conclude that sV heterogeneity at length scales <60 mm increases in poorly aerated regions of mechanically ventilated normal lungs, likely due to heterogeneous small-airway narrowing and alveolar derecruitment. PEEP reduces sV heterogeneity by maintaining lung expansion and airway patency at those small length scales.

  6. Gravity effects on regional lung ventilation determined by functional EIT during parabolic flights.

    Frerichs, I; Dudykevych, T; Hinz, J; Bodenstein, M; Hahn, G; Hellige, G


    Gravity-dependent changes of regional lung function were studied during normogravity, hypergravity, and microgravity induced by parabolic flights. Seven healthy subjects were followed in the right lateral and supine postures during tidal breathing, forced vital capacity, and slow expiratory vital capacity maneuvers. Regional 1) lung ventilation, 2) lung volumes, and 3) lung emptying behavior were studied in a transverse thoracic plane by functional electrical impedance tomography (EIT). The results showed gravity-dependent changes of regional lung ventilation parameters. A significant effect of gravity on regional functional residual capacity with a rapid lung volume redistribution during the gravity transition phases was established. The most homogeneous functional residual capacity distribution was found at microgravity. During vital capacity and forced vital capacity in the right lateral posture, the decrease in lung volume on expiration was larger in the right lung region at all gravity phases. During tidal breathing, the differences in ventilation magnitudes between the right and left lung regions were not significant in either posture or gravity phase. A significant nonlinearity of lung emptying was determined at normogravity and hypergravity. The pattern of lung emptying was homogeneous during microgravity.

  7. A multiscale MDCT image-based breathing lung model with time-varying regional ventilation

    Yin, Youbing, E-mail: [Department of Mechanical and Industrial Engineering, The University of Iowa, Iowa City, IA 52242 (United States); IIHR-Hydroscience and Engineering, The University of Iowa, Iowa City, IA 52242 (United States); Department of Radiology, The University of Iowa, Iowa City, IA 52242 (United States); Choi, Jiwoong, E-mail: [Department of Mechanical and Industrial Engineering, The University of Iowa, Iowa City, IA 52242 (United States); IIHR-Hydroscience and Engineering, The University of Iowa, Iowa City, IA 52242 (United States); Hoffman, Eric A., E-mail: [Department of Radiology, The University of Iowa, Iowa City, IA 52242 (United States); Department of Biomedical Engineering, The University of Iowa, Iowa City, IA 52242 (United States); Department of Internal Medicine, The University of Iowa, Iowa City, IA 52242 (United States); Tawhai, Merryn H., E-mail: [Auckland Bioengineering Institute, The University of Auckland, Auckland (New Zealand); Lin, Ching-Long, E-mail: [Department of Mechanical and Industrial Engineering, The University of Iowa, Iowa City, IA 52242 (United States); IIHR-Hydroscience and Engineering, The University of Iowa, Iowa City, IA 52242 (United States)


    A novel algorithm is presented that links local structural variables (regional ventilation and deforming central airways) to global function (total lung volume) in the lung over three imaged lung volumes, to derive a breathing lung model for computational fluid dynamics simulation. The algorithm constitutes the core of an integrative, image-based computational framework for subject-specific simulation of the breathing lung. For the first time, the algorithm is applied to three multi-detector row computed tomography (MDCT) volumetric lung images of the same individual. A key technique in linking global and local variables over multiple images is an in-house mass-preserving image registration method. Throughout breathing cycles, cubic interpolation is employed to ensure C{sub 1} continuity in constructing time-varying regional ventilation at the whole lung level, flow rate fractions exiting the terminal airways, and airway deformation. The imaged exit airway flow rate fractions are derived from regional ventilation with the aid of a three-dimensional (3D) and one-dimensional (1D) coupled airway tree that connects the airways to the alveolar tissue. An in-house parallel large-eddy simulation (LES) technique is adopted to capture turbulent-transitional-laminar flows in both normal and deep breathing conditions. The results obtained by the proposed algorithm when using three lung volume images are compared with those using only one or two volume images. The three-volume-based lung model produces physiologically-consistent time-varying pressure and ventilation distribution. The one-volume-based lung model under-predicts pressure drop and yields un-physiological lobar ventilation. The two-volume-based model can account for airway deformation and non-uniform regional ventilation to some extent, but does not capture the non-linear features of the lung.

  8. Estimation of Lung Ventilation

    Ding, Kai; Cao, Kunlin; Du, Kaifang; Amelon, Ryan; Christensen, Gary E.; Raghavan, Madhavan; Reinhardt, Joseph M.

    Since the primary function of the lung is gas exchange, ventilation can be interpreted as an index of lung function in addition to perfusion. Injury and disease processes can alter lung function on a global and/or a local level. MDCT can be used to acquire multiple static breath-hold CT images of the lung taken at different lung volumes, or with proper respiratory control, 4DCT images of the lung reconstructed at different respiratory phases. Image registration can be applied to this data to estimate a deformation field that transforms the lung from one volume configuration to the other. This deformation field can be analyzed to estimate local lung tissue expansion, calculate voxel-by-voxel intensity change, and make biomechanical measurements. The physiologic significance of the registration-based measures of respiratory function can be established by comparing to more conventional measurements, such as nuclear medicine or contrast wash-in/wash-out studies with CT or MR. An important emerging application of these methods is the detection of pulmonary function change in subjects undergoing radiation therapy (RT) for lung cancer. During RT, treatment is commonly limited to sub-therapeutic doses due to unintended toxicity to normal lung tissue. Measurement of pulmonary function may be useful as a planning tool during RT planning, may be useful for tracking the progression of toxicity to nearby normal tissue during RT, and can be used to evaluate the effectiveness of a treatment post-therapy. This chapter reviews the basic measures to estimate regional ventilation from image registration of CT images, the comparison of them to the existing golden standard and the application in radiation therapy.

  9. Single-Lung Transplant Results in Position Dependent Changes in Regional Ventilation: An Observational Case Series Using Electrical Impedance Tomography

    Kollengode Ramanathan


    Full Text Available Background. Lung transplantation is the optimal treatment for end stage lung disease. Donor shortage necessitates single-lung transplants (SLT, yet minimal data exists regarding regional ventilation in diseased versus transplanted lung measured by Electrical Impedance Tomography (EIT. Method. We aimed to determine regional ventilation in six SLT outpatients using EIT. We assessed end expiratory volume and tidal volumes. End expiratory lung impedance (EELI and Global Tidal Variation of Impedance were assessed in supine, right lateral, left lateral, sitting, and standing positions in transplanted and diseased lungs. A mixed model with random intercept per subject was used for statistical analysis. Results. EELI was significantly altered between diseased and transplanted lungs whilst lying on right and left side. One patient demonstrated pendelluft between lungs and was therefore excluded for further comparison of tidal variation. Tidal variation was significantly higher in the transplanted lung for the remaining five patients in all positions, except when lying on the right side. Conclusion. Ventilation to transplanted lung is better than diseased lung, especially in lateral positions. Positioning in patients with active unilateral lung pathologies will be implicated. This is the first study demonstrating changes in regional ventilation, associated with changes of position between transplanted and diseased lung.

  10. Correlation of measures of regional lung ventilation from 4DCT vs. hyperpolarized helium-3 MR

    Ding, Kai; Cao, Kunlin; Miller, Wilson; Christensen, Gary; Reinhardt, Joseph; Benedict, Stanley; Libby, Bruce; Sheng, Ke


    Radiation induced pulmonary diseases can change the tissue material properties of lung parenchyma and the mechanics of the respiratory system. Recent advances in multi-detector-row CT (MDCT), 4DCT respiratory gating methods, and image processing techniques enable us to follow and measure those changes noninvasively during radiation therapy at a regional level. This study compares the 4DCT based ventilation measurement with the results from hyperpolarized helium-3 MR using the cumulative distribution function maps and the relative overlap (RO) statistic. We show that the similarity between the two measurements increases as the increase of the B-Spline grid spacing and Laplacian weighting which result a smoother ventilation map. The best similarity is found with weighting of 0.5 for linear elasticity and B-Spline grid spacing of 32 mm. Future work is to improve the lung image registration algorithm by incorporating hyperpolarized helium-3 MR information so as to improve its physiological modeling of the lung tissue deformation.

  11. Investigation of four-dimensional computed tomography-based pulmonary ventilation imaging in patients with emphysematous lung regions.

    Yamamoto, Tokihiro; Kabus, Sven; Klinder, Tobias; Lorenz, Cristian; von Berg, Jens; Blaffert, Thomas; Loo, Billy W; Keall, Paul J


    A pulmonary ventilation imaging technique based on four-dimensional (4D) computed tomography (CT) has advantages over existing techniques. However, physiologically accurate 4D-CT ventilation imaging has not been achieved in patients. The purpose of this study was to evaluate 4D-CT ventilation imaging by correlating ventilation with emphysema. Emphysematous lung regions are less ventilated and can be used as surrogates for low ventilation. We tested the hypothesis: 4D-CT ventilation in emphysematous lung regions is significantly lower than in non-emphysematous regions. Four-dimensional CT ventilation images were created for 12 patients with emphysematous lung regions as observed on CT, using a total of four combinations of two deformable image registration (DIR) algorithms: surface-based (DIR(sur)) and volumetric (DIR(vol)), and two metrics: Hounsfield unit (HU) change (V(HU)) and Jacobian determinant of deformation (V(Jac)), yielding four ventilation image sets per patient. Emphysematous lung regions were detected by density masking. We tested our hypothesis using the one-tailed t-test. Visually, different DIR algorithms and metrics yielded spatially variant 4D-CT ventilation images. The mean ventilation values in emphysematous lung regions were consistently lower than in non-emphysematous regions for all the combinations of DIR algorithms and metrics. V(HU) resulted in statistically significant differences for both DIR(sur) (0.14 ± 0.14 versus 0.29 ± 0.16, p = 0.01) and DIR(vol) (0.13 ± 0.13 versus 0.27 ± 0.15, p Jac) resulted in non-significant differences for both DIR(sur) (0.15 ± 0.07 versus 0.17 ± 0.08, p = 0.20) and DIR(vol) (0.17 ± 0.08 versus 0.19 ± 0.09, p = 0.30). This study demonstrated the strong correlation between the HU-based 4D-CT ventilation and emphysema, which indicates the potential for HU-based 4D-CT ventilation imaging to achieve high physiologic accuracy. A further study is needed to confirm these results.

  12. Comparison of Image Registration Based Measures of Regional Lung Ventilation from Dynamic Spiral CT with Xe-CT

    Ding, Kai; Fuld, Matthew K; Du, Kaifang; Christensen, Gary E; Hoffman, Eric A; Reinhardt, Joseph M


    Purpose: Regional lung volume change as a function of lung inflation serves as an index of parenchymal and airway status as well as an index of regional ventilation and can be used to detect pathologic changes over time. In this article, we propose a new regional measure of lung mechanics --- the specific air volume change by corrected Jacobian. Methods: 4DCT and Xe-CT data sets from four adult sheep are used in this study. Nonlinear, 3D image registration is applied to register an image acquired near end inspiration to an image acquired near end expiration. Approximately 200 annotated anatomical points are used as landmarks to evaluate registration accuracy. Three different registration-based measures of regional lung mechanics are derived and compared: the specific air volume change calculated from the Jacobian (SAJ); the specific air volume change calculated by the corrected Jacobian (SACJ); and the specific air volume change by intensity change (SAI). Results: After registration, the mean registration err...

  13. Assessment of regional lung ventilation by electrical impedance tomography in a patient with unilateral bronchial stenosis and a history of tuberculosis.

    Marinho, Liégina Silveira; Sousa, Nathalia Parente de; Barros, Carlos Augusto Barbosa da Silveira; Matias, Marcelo Silveira; Monteiro, Luana Torres; Beraldo, Marcelo do Amaral; Costa, Eduardo Leite Vieira; Amato, Marcelo Britto Passos; Holanda, Marcelo Alcantara


    Bronchial stenosis can impair regional lung ventilation by causing abnormal, asymmetric airflow limitation. Electrical impedance tomography (EIT) is an imaging technique that allows the assessment of regional lung ventilation and therefore complements the functional assessment of the lungs. We report the case of a patient with left unilateral bronchial stenosis and a history of tuberculosis, in whom regional lung ventilation was assessed by EIT. The EIT results were compared with those obtained by ventilation/perfusion radionuclide imaging. The patient was using nasal continuous positive airway pressure (CPAP) for the treatment of obstructive sleep apnea syndrome. Therefore, we studied the effects of postural changes and of the use of nasal CPAP. The EIT revealed heterogeneous distribution of regional lung ventilation, the ventilation being higher in the right lung, and this distribution was influenced by postural changes and CPAP use. The EIT assessment of regional lung ventilation produced results similar to those obtained with the radionuclide imaging technique and had the advantage of providing a dynamic evaluation without radiation exposure.

  14. Regional deposition of particles in an image-based airway model: large-eddy simulation and left-right lung ventilation asymmetry.

    Lambert, Andrew R; O'Shaughnessy, Patrick; Tawhai, Merryn H; Hoffman, Eric A; Lin, Ching-Long


    Regional deposition and ventilation of particles by generation, lobe and lung during steady inhalation in a computed tomography (CT) based human airway model are investigated numerically. The airway model consists of a seven-generation human airway tree, with oral cavity, pharynx and larynx. The turbulent flow in the upper respiratory tract is simulated by large-eddy simulation. The flow boundary conditions at the peripheral airways are derived from CT images at two lung volumes to produce physiologically-realistic regional ventilation. Particles with diameter equal to or greater than 2.5 microns are selected for study because smaller particles tend to penetrate to the more distal parts of the lung. The current generational particle deposition efficiencies agree well with existing measurement data. Generational deposition efficiencies exhibit similar dependence on particle Stokes number regardless of generation, whereas deposition and ventilation efficiencies vary by lobe and lung, depending on airway morphology and airflow ventilation. In particular, regardless of particle size, the left lung receives a greater proportion of the particle bolus as compared to the right lung in spite of greater flow ventilation to the right lung. This observation is supported by the left-right lung asymmetry of particle ventilation observed in medical imaging. It is found that the particle-laden turbulent laryngeal jet flow, coupled with the unique geometrical features of the airway, causes a disproportionate amount of particles to enter the left lung.

  15. Spatial and temporal heterogeneity of regional lung ventilation determined by electrical impedance tomography during pulmonary function testing.

    Vogt, Barbara; Pulletz, Sven; Elke, Gunnar; Zhao, Zhanqi; Zabel, Peter; Weiler, Norbert; Frerichs, Inéz


    Electrical impedance tomography (EIT) is a functional imaging modality capable of tracing continuously regional pulmonary gas volume changes. The aim of our study was to determine if EIT was able to assess spatial and temporal heterogeneity of ventilation during pulmonary function testing in 14 young (37 ± 10 yr, mean age ± SD) and 12 elderly (71 ± 9 yr) subjects without lung disease and in 33 patients with chronic obstructive pulmonary disease (71 ± 9 yr). EIT and spirometry examinations were performed during tidal breathing and a forced vital capacity (FVC) maneuver preceded by full inspiration to total lung capacity. Regional inspiratory vital capacity (IVC); FVC; forced expiratory volume in 1 s (FEV(1)); FEV(1)/FVC; times required to expire 25%, 50%, 75%, and 90% of FVC (t(25), t(50), t(75), t(90)); and tidal volume (V(T)) were determined in 912 EIT image pixels in the chest cross section. Coefficients of variation (CV) were calculated from all pixel values of IVC, FVC, FEV(1), and V(T) to characterize the ventilation heterogeneity. The highest values were found in patients, and no differences existed between the healthy young and elderly subjects. Receiver-operating characteristics curves showed that CV of regional IVC, FVC, FEV(1), and V(T) discriminated the young and elderly subjects from the patients. Frequency distributions of pixel FEV(1)/FVC, t(25), t(50), t(75), and t(90) identified the highest ventilation heterogeneity in patients but distinguished also the healthy young from the elderly subjects. These results indicate that EIT may provide additional information during pulmonary function testing and identify pathologic and age-related spatial and temporal heterogeneity of regional lung function.

  16. Single-lung ventilation in pediatric anesthesia.

    Choudhry, Dinesh K


    Single-lung ventilation is requested for an increasing spectrum of surgical procedures in infants and children. A clear understanding of the physiology of single-lung ventilation, the techniques of lung separation, and the technical skill necessary to apply these techniques are essential for an anesthesiologist practicing thoracic anesthesia. This article focuses on various devices available for single-lung ventilation in the pediatric age group, the relevant respiratory physiology, and the strategies that optimize oxygenation during one-lung anesthesia.

  17. Correlation among regional ventilation, airway resistance and particle deposition in normal and severe asthmatic lungs

    Choi, Sanghun; Hoffman, Eric A.; Tawhai, Merryn H.; Lin, Ching-Long


    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.

  18. Lung-protective ventilation in neonatology.

    van Kaam, Anton


    Ventilator-induced lung injury (VILI) is considered an important risk factor in the development of bronchopulmonary dysplasia (BPD) and is primarily caused by overdistension (volutrauma) and repetitive opening and collapse (atelectrauma) of terminal lung units. Lung-protective ventilation should therefore aim to reduce tidal volumes, and recruit and stabilize atelectatic lung units (open lung ventilation strategy). This review will summarize the available evidence on lung-protective ventilation in neonatology, discussing both high-frequency ventilation (HFV) and positive pressure ventilation (PPV). It shows that HFV does not appear to have a clear benefit over PPV, although most studies failed to apply a true open lung ventilation strategy during HFV. The evidence on the optimal tidal volume, positive end-expiratory pressure and the role for lung recruitment during lung-protective PPV is extremely limited. Volume-targeted ventilation seems to be a promising mode in terms of lung protection, but more studies are needed. Due to the lack of convincing evidence, lung-protective ventilation and modes seem to be implemented in daily clinical practice at a slow pace.

  19. Ventilation-induced Alterations in Lung Development

    A.A. Kroon (André)


    textabstractMechanical ventilation is a lifesaving treatment in critically ill neonates. However, mechanical ventilation is also one of the most important risk factors (Table 1) of Bronchopulmonary dysplasia (BPD), the most common chronic lung disease in infancy with long-term pulmonary and neurolog

  20. Potential Role of Lung Ventilation Scintigraphy in the Assessment of COPD

    Cukic, Vesna; Begic, Amela


    Objective: To highlight the importance of the lung ventilation scintigraphy (LVS) to study the regional distribution of lung ventilation and to describe most frequent abnormal patterns of lung ventilation distribution obtained by this technique in COPD and to compare the information obtained by LVS with the that obtained by traditional lung function tests. Material and methods: The research was done in 20 patients with previously diagnosed COPD who were treated in Intensive care unit of Clini...

  1. New evidence in one-lung ventilation.

    Meleiro, H; Correia, I; Charco Mora, P


    Mechanical ventilation in thoracic surgery has undergone significant changes in recent years due to the implementation of the protective ventilation. This review will analyze recent ventilatory strategies in one-lung ventilation. A MEDLINE research was performed using Mesh term "One-Lung Ventilation" including randomized clinical trials, metanalysis, reviews and systematic reviews published in the last 6 years. Search was performed on 21st March 2017. A total of 75 articles were initially found. After title and abstract review 14 articles were included. Protective ventilation is not simply synonymous of low tidal volume ventilation, but it also includes routine use of PEEP and alveolar recruitment maneuver. New techniques are still in discussion namely PEEP adjustment, ratio inspiration:expiration, ideal type of anesthesia during one-lung ventilation and hypercapnic ventilation. Copyright © 2017 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  2. Partial liquid ventilation improves lung function in ventilation-induced lung injury

    G.F. Vazquez de Anda; R.A. Lachmann; S.J.C. Verbrugge (Serge); D.A.M.P.J. Gommers (Diederik); J.J. Haitsma (Jack); B.F. Lachmann (Burkhard)


    textabstractDisturbances in lung function and lung mechanics are present after ventilation with high peak inspiratory pressures (PIP) and low levels of positive end-expiratory pressure (PEEP). Therefore, the authors investigated whether partial liquid ventilation can re-establish l

  3. Comparison of 133 xenon ventilation equilibrium scan (XV) and 99m technetium transmission (TT) scan for use in regional lung analysis by 2D gamma scintigraphy in healthy and cystic fibrosis lungs.

    Zeman, Kirby L; Wu, Jihong; Donaldson, Scott H; Bennett, William D


    Quantification of particle deposition in the lung by gamma scintigraphy requires a reference image for location of regions of interest (ROIs) and normalization to lung thickness. In various laboratories, the reference image is made by a transmission scan ((57)Co or (99m)Tc) or gas ventilation scan ((133)Xe or (81)Kr). There has not been a direct comparison of measures from the two methods. We compared (99m)Tc transmission scans to (133)Xe equilibrium ventilation scans as reference images for 38 healthy subjects and 14 cystic fibrosis (CF) patients for their effects on measures of regional particle deposition: the central-to-peripheral ratio of lung counts (C/P); and ROI area versus forced vital capacity. Whole right lung ROI was based on either an isocontour threshold of three times the soft tissue transmission (TT) or a threshold of 20% of peak xenon ventilation counts (XV). We used a central ROI drawn to 50% of height and of width of the whole right lung ROI and placed along the left lung margin and centered vertically. In general, the correlation of normalized C/P (nC/P) between the two methods was strong. However, the value of nC/P was significantly smaller for the XV method than the TT method. Regression equations for the relationship of nC/P between the two methods were, for healthy subjects, y=0.75x+0.61, R(2)=0.64 using rectangular ROIs and y=0.76x+0.45, R(2)=0.66 using isocontour ROIs; and for CF patients, y=0.94x+0.46, R(2)=0.43 and y=0.85x+0.42, R(2)=0.41, respectively. (1) A transmission scan with an isocontour outline in combination with a rectangular central region to define the lung borders may be more useful than a ventilation scan. (2) Close correlation of nC/Ps measured by transmission or gas ventilation should allow confident comparison of values determined by the two methods.

  4. Evaluation of total and regional lung function using {sup 133}Xe dynamic ventilation SPECT and a comparison with the lung function test

    Kan, Yongjin; Shinozuka, Akira; Takenaka, Hiroki; Munechika, Hirotsugu [Showa Univ., Tokyo (Japan). School of Medicine


    A lung dynamic SPECT study using {sup 133}Xe gas was performed a functional map created be region. The time activity curve (TAC) of each voxel was obtained from subsequent SPECT data. Washout rate (K) was calculated from TAC. The product of K and counter weighted voxel volume was defined as the lung function index (LFI). Using these 3 parameters (functional volume, K, and LFI) a function map was created. The sum of LFI was defined as total lung functional index (TLFI). Five healthy volunteers and 20 patients with various lung diseases were investigated. TLFI correlated well with FEV{sub 1.0} and MMF, and mean K with FEV{sub 1.0}%. The results indicate that a functional map obtained from lung dynamic SPECT is useful in estimating both resional and whole lung function. (author)

  5. TU-G-BRA-04: Changes in Regional Lung Function Measured by 4D-CT Ventilation Imaging for Thoracic Radiotherapy

    Nakajima, Y; Kadoya, N [Tohoku University School of Medicine, Sendai, Miyagi (Japan); Kabus, S [Philips Research Europe, Hamburg, Hamburg (Germany); Loo, B [Stanford University, Stanford, CA (United States); Keall, P [University of Sydney, Camperdown (Australia); Yamamoto, T [University of California Davis School of Medicine, Sacramento, CA (United States)


    Purpose: To test the hypothesis: 4D-CT ventilation imaging can show the known effects of radiotherapy on lung function: (1) radiation-induced ventilation reductions, and (2) ventilation increases caused by tumor regression. Methods: Repeat 4D-CT scans (pre-, mid- and/or post-treatment) were acquired prospectively for 11 thoracic cancer patients in an IRB-approved clinical trial. A ventilation image for each time point was created using deformable image registration and the Hounsfield unit (HU)-based or Jacobian-based metric. The 11 patients were divided into two subgroups based on tumor volume reduction using a threshold of 5 cm{sup 3}. To quantify radiation-induced ventilation reduction, six patients who showed a small tumor volume reduction (<5 cm{sup 3}) were analyzed for dose-response relationships. To investigate ventilation increase caused by tumor regression, two of the other five patients were analyzed to compare ventilation changes in the lung lobes affected and unaffected by the tumor. The remaining three patients were excluded because there were no unaffected lobes. Results: Dose-dependent reductions of HU-based ventilation were observed in a majority of the patient-specific dose-response curves and in the population-based dose-response curve, whereas no clear relationship was seen for Jacobian-based ventilation. The post-treatment population-based dose-response curve of HU-based ventilation demonstrated the average ventilation reductions of 20.9±7.0% at 35–40 Gy (equivalent dose in 2-Gy fractions, EQD2), and 40.6±22.9% at 75–80 Gy EQD2. Remarkable ventilation increases in the affected lobes were observed for the two patients who showed an average tumor volume reduction of 37.1 cm{sup 3} and re-opening airways. The mid-treatment increase in HU-based ventilation of patient 3 was 100.4% in the affected lobes, which was considerably greater than 7.8% in the unaffected lobes. Conclusion: This study has demonstrated that 4D-CT ventilation imaging shows

  6. Lung Injury After One-Lung Ventilation: A Review of the Pathophysiologic Mechanisms Affecting the Ventilated and the Collapsed Lung.

    Lohser, Jens; Slinger, Peter


    Lung injury is the leading cause of death after thoracic surgery. Initially recognized after pneumonectomy, it has since been described after any period of 1-lung ventilation (OLV), even in the absence of lung resection. Overhydration and high tidal volumes were thought to be responsible at various points; however, it is now recognized that the pathophysiology is more complex and multifactorial. All causative mechanisms known to trigger ventilator-induced lung injury have been described in the OLV setting. The ventilated lung is exposed to high strain secondary to large, nonphysiologic tidal volumes and loss of the normal functional residual capacity. In addition, the ventilated lung experiences oxidative stress, as well as capillary shear stress because of hyperperfusion. Surgical manipulation and/or resection of the collapsed lung may induce lung injury. Re-expansion of the collapsed lung at the conclusion of OLV invariably induces duration-dependent, ischemia-reperfusion injury. Inflammatory cytokines are released in response to localized injury and may promote local and contralateral lung injury. Protective ventilation and volatile anesthesia lessen the degree of injury; however, increases in biochemical and histologic markers of lung injury appear unavoidable. The endothelial glycocalyx may represent a common pathway for lung injury creation during OLV, because it is damaged by most of the recognized lung injurious mechanisms. Experimental therapies to stabilize the endothelial glycocalyx may afford the ability to reduce lung injury in the future. In the interim, protective ventilation with tidal volumes of 4 to 5 mL/kg predicted body weight, positive end-expiratory pressure of 5 to 10 cm H2O, and routine lung recruitment should be used during OLV in an attempt to minimize harmful lung stress and strain. Additional strategies to reduce lung injury include routine volatile anesthesia and efforts to minimize OLV duration and hyperoxia.

  7. APRV Mode in Ventilator Induced Lung Injury (VILI

    Ata Mahmoodpoor


    Full Text Available Ventilator-Induced Lung Injury (VILI, being a significant iatrogenic complication in the ICU patients, is associated with high morbidity and mortality. Numerous approaches, protocols and ventilation modes have been introduced and examined to decrease the incidence of VILI in the ICU patients. Airway pressure release ventilation (APRV, firstly introduced by Stock and Downs in 1987, applies higher Continuous Positive Airway Pressure (CPAP levels in prolonged periods (P and T high in order to preserve satisfactory lung volume and consequently alveolar recruitment. This mode benefits a time-cycled release phase to a lower set of pressure for a short period of time (P and T low i.e. release time (1,2. While some advantages have been introduced for APRV such as efficiently recruited alveoli over time, more homogeneous ventilation, less volutrauma, probable stabilization of patent alveoli and reduction in atelectrauma, protective effects of APRV on lung damage only seem to be substantial if spontaneous breathing responds to more than 30% of total minute ventilation (3. APRV in ARDS patients should be administered cautiously; T low<0.6 seconds, for recruiting collapsed alveoli; however overstretching of alveoli especially during P high should not be neglected and appropriate sedation considered. The proposed advantages for APRV give the impression of being outstanding; however, APRV, as a non-physiologic inverse ratio mode of ventilation, might result in inflammation mainly due to impaired patient-ventilator interaction explaining the negative or minimally desirable effects of APRV on inflammation (4. Consequently, continuous infusion of neuromuscular blocking drugs during ARDS has been reported to reduce mortality (5. There are insufficient confirming data on the superiority of APRV above other ventilatory methods in regard to oxygenation, hemodynamics, regional blood flow, patient comfort and length of mechanical ventilation. Based on current findings

  8. Short-term effects of neuromuscular blockade on global and regional lung mechanics, oxygenation and ventilation in pediatric acute hypoxemic respiratory failure

    Wilsterman, Marlon E. F.; de Jager, Pauline; Blokpoel, Robert; Frerichs, Inez; Dijkstra, Sandra K.; Albers, Marcel J. I. J.; Burgerhof, Johannes G.M.; Markhorst, Dick G; Kneyber, Martin C. J.


    Background Neuromuscular blockade (NMB) has been shown to improve outcome in acute respiratory distress syndrome (ARDS) in adults, challenging maintaining spontaneous breathing when there is severe lung injury. We tested in a prospective physiological study the hypothesis that continuous administration of NMB agents in mechanically ventilated children with severe acute hypoxemic respiratory failure (AHRF) improves the oxygenation index without a redistribution of tidal volume V T toward non-d...

  9. TLR2 deficiency aggravates lung injury caused by mechanical ventilation

    Kuipers, Maria Theresa; Jongsma, Geartsje; Hegeman, Maria A; Tuip-de Boer, Anita M; Wolthuis, Esther K; Choi, Goda; Bresser, Paul; van der Poll, Tom; Schultz, Marcus J; Wieland, Catharina W


    Innate immunity pathways are found to play an important role in ventilator-induced lung injury. We analyzed pulmonary expression of Toll-like receptor 2 (TLR2) in humans and mice and determined the role of TLR2 in the pathogenesis of ventilator-induced lung injury in mice. Toll-like receptor 2 gene

  10. Independent lung ventilation in a newborn with asymmetric acute lung injury due to respiratory syncytial virus: a case report

    Di Nardo Matteo


    Full Text Available Abstract Introduction Independent lung ventilation is a form of protective ventilation strategy used in adult asymmetric acute lung injury, where the application of conventional mechanical ventilation can produce ventilator-induced lung injury and ventilation-perfusion mismatch. Only a few experiences have been published on the use of independent lung ventilation in newborn patients. Case presentation We present a case of independent lung ventilation in a 16-day-old infant of 3.5 kg body weight who had an asymmetric lung injury due to respiratory syncytial virus bronchiolitis. We used independent lung ventilation applying conventional protective pressure controlled ventilation to the less-compromised lung, with a respiratory frequency proportional to the age of the patient, and a pressure controlled high-frequency ventilation to the atelectatic lung. This was done because a single tube conventional ventilation protective strategy would have exposed the less-compromised lung to a high mean airways pressure. The target of independent lung ventilation is to provide adequate gas exchange at a safe mean airways pressure level and to expand the atelectatic lung. Independent lung ventilation was accomplished for 24 hours. Daily chest radiograph and gas exchange were used to evaluate the efficacy of independent lung ventilation. Extubation was performed after 48 hours of conventional single-tube mechanical ventilation following independent lung ventilation. Conclusion This case report demonstrates the feasibility of independent lung ventilation with two separate tubes in neonates as a treatment of an asymmetric acute lung injury.

  11. [One-lung ventilation using dexmedetomidine in an emphysema patient with pneumothorax due to metastatic lung cancer].

    Ono, Naomi; Komasawa, Nobuyasu; Nakano, Shoko; Tatsumi, Shinichi; Nakao, Kenta; Minami, Toshiaki


    We report a case of double-lumen tube intubation and intraoperative one-lung ventilation under spontaneous breathing with continuous dexmedetomidine administration. A 61-year-old man developed pneumothorax due to multiple metastatic cancer, had multiple bilateral bullae, and underwent bullae resection under general anesthesia. An epidural catheter was placed at T8-9. Under dexmedetomidine sedation and regional anesthesia with lidocaine, a double-lumen tube was inserted with a Macintosh laryngoscope. The patient was under one-lung ventilation with spontaneous breathing during the operation. There were no complications from one-lung ventilation and the patient was extubated in the operating room. One-lung ventilation, which preserves spontaneous breathing, under dexmedetomidine sedation is considered effective for preventing barotrauma in patients with multiple metastatic cancer.

  12. Lung recruitment and endotracheal suction in ventilated preterm infants measured with electrical impedance tomography.

    Hough, Judith L; Shearman, Andrew D; Liley, Helen; Grant, Caroline A; Schibler, Andreas


    Although suctioning is a standard airway maintenance procedure, there are significant associated risks, such as loss of lung volume due to high negative suction pressures. This study aims to assess the extent and duration of change in end-expiratory level (EEL) resulting from endotracheal tube (ETT) suction and to examine the relationship between EEL and regional lung ventilation in ventilated preterm infants with respiratory distress syndrome. A prospective observational clinical study of the effect of ETT suction on 20 non-muscle-relaxed preterm infants with respiratory distress syndrome (RDS) on conventional mechanical ventilation was conducted in a neonatal intensive care unit. Ventilation distribution was measured with regional impedance amplitudes and EEL using electrical impedance tomography. ETT suction resulted in a significant increase in EEL post-suction (P suction, suggesting heterogeneity. Tidal volume was significantly lower in volume-guarantee ventilation compared with pressure-controlled ventilation (P = 0.04). ETT suction in non-muscle-relaxed and ventilated preterm infants with RDS results in significant lung volume increase that is maintained for at least 90 min. Regional differences in distribution of ventilation with ETT suction suggest that the behaviour of the lung is heterogeneous in nature. © 2014 The Authors. Journal of Paediatrics and Child Health © 2014 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

  13. Simultaneous in vivo synchrotron radiation computed tomography of regional ventilation and blood volume in rabbit lung using combined K-edge and temporal subtraction

    Suhonen, H [Department of Physical Sciences, University of Helsinki (Finland); Porra, L [Department of Physical Sciences, University of Helsinki (Finland); Bayat, S [Universite de Picardie Jules Verne, Faculte de Medecine, PERITOX (EA-INI RIS) and Cardiologie et Pneumo-Allerglogie Pediatriques, CHU Amiens (France); Sovijaervi, A R A [Department of Clinical Physiology and Nuclear Medicine, Helsinki University Central Hospital, Helsinki (Finland); Suortti, P [Department of Physical Sciences, University of Helsinki (Finland)


    In K-edge subtraction (KES) imaging with synchrotron radiation computed tomography (SRCT), two images are taken simultaneously using energies above and below the K-absorption edge of a contrast agent. A logarithmic difference image reveals the contrast agent concentration with good accuracy. Similarly, in temporal subtraction imaging (TSI) the reference image is taken before the introduction of the contrast agent. Quantitative comparisons of in vivo images of rabbit lung indicated that similar results for concentrations of iodine in blood vessels and xenon in airways are obtained by KES and TSI, but the level of noise and artifacts was higher in the latter. A linear fit showed that in the lung parenchyma {rho}{sub TSI} = (0.97 {+-} 0.03){rho}{sub KES} + (0.00 {+-} 0.05) for xenon and {rho}{sub TSI} = (1.21 {+-} 0.15){rho}{sub KES} + (0.0 {+-} 0.1) for iodine. For xenon the calculation of time constant of ventilation gave compatible values for both of the methods. The two methods are combined for the simultaneous determination of the xenon concentration (by KES) and the iodine concentration (by TSI) in lung imaging, which will allow simultaneous in vivo determination of ventilation and perfusion.

  14. Potential Role of Lung Ventilation Scintigraphy in the Assessment of COPD

    Cukic, Vesna; Begic, Amela


    Objective: To highlight the importance of the lung ventilation scintigraphy (LVS) to study the regional distribution of lung ventilation and to describe most frequent abnormal patterns of lung ventilation distribution obtained by this technique in COPD and to compare the information obtained by LVS with the that obtained by traditional lung function tests. Material and methods: The research was done in 20 patients with previously diagnosed COPD who were treated in Intensive care unit of Clinic for pulmonary diseases and TB “Podhrastovi” Clinical Center, University of Sarajevo in exacerbation of COPD during first three months of 2014. Each patient was undergone to testing of pulmonary function by body plethysmography and ventilation/perfusion lung scintigraphy with radio pharmaceutics Technegas, 111 MBq Tc -99m-MAA. We compared the results obtained by these two methods. Results: All patients with COPD have a damaged lung function tests examined by body plethysmography implying airflow obstruction, but LVS indicates not only airflow obstruction and reduced ventilation, but also indicates the disorders in distribution in lung ventilation. Conclusion: LVS may add further information to the functional evaluation of COPD to that provided by traditional lung function tests and may contribute to characterizing the different phenotypes of COPD. PMID:25132709

  15. Linking Ventilation Heterogeneity Quantified via Hyperpolarized 3He MRI to Dynamic Lung Mechanics and Airway Hyperresponsiveness.

    Lui, Justin K; Parameswaran, Harikrishnan; Albert, Mitchell S; Lutchen, Kenneth R


    Advancements in hyperpolarized helium-3 MRI (HP 3He-MRI) have introduced the ability to render and quantify ventilation patterns throughout the anatomic regions of the lung. The goal of this study was to establish how ventilation heterogeneity relates to the dynamic changes in mechanical lung function and airway hyperresponsiveness in asthmatic subjects. In four healthy and nine mild-to-moderate asthmatic subjects, we measured dynamic lung resistance and lung elastance from 0.1 to 8 Hz via a broadband ventilation waveform technique. We quantified ventilation heterogeneity using a recently developed coefficient of variation method from HP 3He-MRI imaging. Dynamic lung mechanics and imaging were performed at baseline, post-challenge, and after a series of five deep inspirations. AHR was measured via the concentration of agonist that elicits a 20% decrease in the subject's forced expiratory volume in one second compared to baseline (PC20) dose. The ventilation coefficient of variation was correlated to low-frequency lung resistance (R = 0.647, P ventilation heterogeneity. Also, the degree of AHR appears to be dependent on the degree to which baseline airway constriction creates baseline ventilation heterogeneity. HP 3He-MRI imaging may be a powerful predictor of the degree of AHR and in tracking the efficacy of therapy.

  16. Chest trauma: A case for single lung ventilation.

    Pandharikar, Nagaraj; Sachdev, Anil; Gupta, Neeraj; Gupta, Suresh; Gupta, Dhiren


    Chest trauma is one of the important causes of mortality and morbidity in pediatric trauma patients. The complexity, magnitude, and type of lung injury make it extremely challenging to provide optimal oxygenation and ventilation while protecting the lung from further injury due to mechanical ventilation. Independent lung ventilation is used sporadically in these patients who do not respond to these conventional ventilatory strategies using double-lumen endotracheal tubes, bronchial blocker balloons, etc. However, this equipment may not be easily available in developing countries, especially for pediatric patients. Here, we present a case of severe chest trauma with pulmonary contusion, flail chest, and bronchopleural fistula, who did not respond to conventional lung protective strategies. She was successfully managed with bronchoscopy-guided unilateral placement of conventional endotracheal tube followed by single lung ventilation leading to resolution of a chest injury.

  17. Chest trauma: A case for single lung ventilation

    Nagaraj Pandharikar


    Full Text Available Chest trauma is one of the important causes of mortality and morbidity in pediatric trauma patients. The complexity, magnitude, and type of lung injury make it extremely challenging to provide optimal oxygenation and ventilation while protecting the lung from further injury due to mechanical ventilation. Independent lung ventilation is used sporadically in these patients who do not respond to these conventional ventilatory strategies using double-lumen endotracheal tubes, bronchial blocker balloons, etc. However, this equipment may not be easily available in developing countries, especially for pediatric patients. Here, we present a case of severe chest trauma with pulmonary contusion, flail chest, and bronchopleural fistula, who did not respond to conventional lung protective strategies. She was successfully managed with bronchoscopy-guided unilateral placement of conventional endotracheal tube followed by single lung ventilation leading to resolution of a chest injury.

  18. Simulating ventilation distribution in heterogenous lung injury using a binary tree data structure.

    Colletti, Ashley A; Amini, Reza; Kaczka, David W


    To determine the impact of mechanical heterogeneity on the distribution of regional flows and pressures in the injured lung, we developed an anatomic model of the canine lung comprised of an asymmetric branching airway network, which can be stored as binary tree data structure. The entire tree can be traversed using a recursive flow divider algorithm, allowing for efficient computation of acinar flow and pressure distributions in a mechanically heterogeneous lung. These distributions were found to be highly dependent on ventilation frequency and the heterogeneity of tissue elastances, reflecting the preferential distribution of ventilation to areas of lower regional impedance.

  19. TU-A-12A-02: Novel Lung Ventilation Imaging with Single Energy CT After Single Inhalation of Xenon: Comparison with SPECT Ventilation Images

    Negahdar, M [Stanford University School of Medicine, Stanford, CA (United States); Yamamoto, T [UC Davis School of Medicine, Sacramento, CA (United States); Shultz, D; Gable, L; Shan, X; Mittra, E; Loo, B; Maxim, P [Stanford University, Stanford, CA (United States); Diehn, M [Stanford University, Palo Alto, CA (United States)


    Purpose: We propose a novel lung functional imaging method to determine the spatial distribution of xenon (Xe) gas in a single inhalation as a measure of regional ventilation. We compare Xe-CT ventilation to single-photon emission CT (SPECT) ventilation, which is the current clinical reference. Regional lung ventilation information may be useful for the diagnosis and monitoring of pulmonary diseases such as COPD, radiotherapy planning, and assessing the progression of toxicity after radiation therapy. Methods: In an IRB-approved clinical study, Xe-CT and SPECT ventilation scans were acquired for three patients including one patient with severe emphysema and two lung cancer patients treated with radiotherapy. For Xe- CT, we acquired two breath-hold single energy CT images of the entire lung with inspiration of 100% O2 and a mixture of 70% Xe and 30% O2, respectively. A video biofeedback system was used to achieve reproducible breath-holds. We used deformable image registration to align the breathhold images with each other to accurately subtract them, producing a map of the distribution of Xe as a surrogate of lung ventilation. We divided each lung into twelve parts and correlated the Hounsfield unit (HU) enhancement at each part with the SPECT ventilation count of the corresponding part of the lung. Results: The mean of the Pearson linear correlation coefficient values between the Xe-CT and ventilation SPECT count for all three patients were 0.62 (p<0.01). The Xe-CT image had a higher resolution than SPECT, and did not show central airway deposition artifacts that were present in the SPECT image. Conclusion: We developed a rapid, safe, clinically practical, and potentially widely accessible method for regional lung functional imaging. We demonstrated strong correlations between the Xe-CT ventilation image and SPECT ventilation image as the clinical reference. This ongoing study will investigate more patients to confirm this finding.

  20. Cellular Stress Failure in Ventilator-injured Lungs

    Vlahakis, Nicholas E.; Hubmayr, Rolf D.


    The clinical and experimental literature has unequivocally established that mechanical ventilation with large tidal volumes is injurious to the lung. However, uncertainty about the micromechanics of injured lungs and the numerous degrees of freedom in ventilator settings leave many unanswered questions about the biophysical determinants of lung injury. In this review we focus on experimental evidence for lung cells as injury targets and the relevance of these studies for human ventilator-associated lung injury. In vitro, the stress-induced mechanical interactions between matrix and adherent cells are important for cellular remodeling as a means for preventing compromise of cell structure and ultimately cell injury or death. In vivo, these same principles apply. Large tidal volume mechanical ventilation results in physical breaks in alveolar epithelial and endothelial plasma membrane integrity and subsequent triggering of proinflammatory signaling cascades resulting in the cytokine milieu and pathologic and physiologic findings of ventilator-associated lung injury. Importantly, though, alveolar cells possess cellular repair and remodeling mechanisms that in addition to protecting the stressed cell provide potential molecular targets for the prevention and treatment of ventilator-associated lung injury in the future. PMID:15695492

  1. Heliox Improves Carbon Dioxide Removal during Lung Protective Mechanical Ventilation

    Beurskens, Charlotte J; Brevoord, Daniel; Lagrand, Wim K; van den Bergh, Walter M; Vroom, Margreeth B; Preckel, Benedikt; Horn, Janneke; Juffermans, Nicole P


    Introduction. Helium is a noble gas with low density and increased carbon dioxide (CO2) diffusion capacity. This allows lower driving pressures in mechanical ventilation and increased CO2 diffusion. We hypothesized that heliox facilitates ventilation in patients during lung-protective mechanical ven

  2. Spontaneous one-lung ventilation increases the lung inflammatory response : an experimental pilot study

    Machado, Humberto S; Sá, Paula; Nunes, Catarina S; Couceiro, António; Silva, Álvaro Moreira da; Águas, Artur


    Study objective: The purpose of this study was to investigate if spontaneous one-lung ventilation would induce any type of inflammatory lung response when compared to spontaneous two-lung ventilation and its intensity, by quantification of inflammatory cells in lung histology at the end of the procedure. Design: In vivo prospective randomised animal study Setting: University research laboratory Subjects: New Zealand rabbits Interventions: Rabbits (n=20) were randomly assigned to 4 groups (n=5...

  3. [Ventilation in acute respiratory distress. Lung-protective strategies].

    Bruells, C S; Rossaint, R; Dembinski, R


    Ventilation of patients suffering from acute respiratory distress syndrome (ARDS) with protective ventilator settings is the standard in patient care. Besides the reduction of tidal volumes, the adjustment of a case-related positive end-expiratory pressure and preservation of spontaneous breathing activity at least 48 h after onset is part of this strategy. Bedside techniques have been developed to adapt ventilatory settings to the individual patient and the different stages of ARDS. This article reviews the pathophysiology of ARDS and ventilator-induced lung injury and presents current evidence-based strategies for ventilator settings in ARDS.

  4. CT-measured regional specific volume change reflects regional ventilation in supine sheep.

    Fuld, Matthew K; Easley, R Blaine; Saba, Osama I; Chon, Deokiee; Reinhardt, Joseph M; Hoffman, Eric A; Simon, Brett A


    Computer tomography (CT) imaging techniques permit the noninvasive measurement of regional lung function. Regional specific volume change (sVol), determined from the change in lung density over a tidal breath, should correlate with regional ventilation and regional lung expansion measured with other techniques. sVol was validated against xenon (Xe)-CT-specific ventilation (sV) in four anesthetized, intubated, mechanically ventilated sheep. Xe-CT used expiratory gated axial scanning during the washin and washout of 55% Xe. sVol was measured from the tidal changes in tissue density (H, houndsfield units) of lung regions using the relationship sVol = [1,000(Hi - He)]/[He(1,000 + Hi)], where He and Hi are expiratory and inspiratory regional density. Distinct anatomical markings were used to define corresponding lung regions of interest between inspiratory, expiratory, and Xe-CT images, with an average region of interest size of 1.6 +/- 0.7 ml. In addition, sVol was compared with regional volume changes measured directly from the positions of implanted metal markers in an additional animal. A linear relationship between sVol and sV was demonstrated over a wide range of regional sV found in the normal supine lung, with an overall correlation coefficient (R(2)) of 0.66. There was a tight correlation (R(2) = 0.97) between marker-measured volume changes and sVol. Regional sVol, which involves significantly reduced exposure to radiation and Xe gas compared with the Xe-CT method, represents a safe and efficient surrogate for measuring regional ventilation in experimental studies and patients.

  5. Dependent Lung Tension Pneumothorax During 1-Lung Ventilation: Treatment by Transmediastinal Thoracentesis.

    Kenta, Okitsu; Shoko, Arimoto; Takeshi, Iritakenishi; Satoshi, Hagihira; Yuji, Fujino; Yasushi, Shintani; Masato, Minami; Meinoshin, Okumura


    Contralateral tension pneumothorax during 1-lung ventilation is rare but life threatening. We report the case of a patient who developed tension pneumothorax of the dependent lung during 1-lung ventilation while the surgeon was anastomosing the bronchi after sleeve lobectomy. Ventilation was not possible in either the dependent or nondependent lung, leading to severe desaturation and cardiac arrest. While the surgeons were administering direct cardiac compression, we suspected tension pneumothorax. As soon as the surgeons pierced the mediastinal pleura, adequate circulation was restored. Immediate diagnosis and treatment is important for this complication.

  6. Relationship between airway narrowing, patchy ventilation and lung mechanics in asthmatics.

    Tgavalekos, N T; Musch, G; Harris, R S; Vidal Melo, M F; Winkler, T; Schroeder, T; Callahan, R; Lutchen, K R; Venegas, J G


    Bronchoconstriction in asthma results in patchy ventilation forming ventilation defects (VDefs). Patchy ventilation is clinically important because it affects obstructive symptoms and impairs both gas exchange and the distribution of inhaled medications. The current study combined functional imaging, oscillatory mechanics and theoretical modelling to test whether the degrees of constriction of airways feeding those units outside VDefs were related to the extent of VDefs in bronchoconstricted asthmatic subjects. Positron emission tomography was used to quantify the regional distribution of ventilation and oscillatory mechanics were measured in asthmatic subjects before and after bronchoconstriction. For each subject, ventilation data was mapped into an anatomically based lung model that was used to evaluate whether airway constriction patterns, consistent with the imaging data, were capable of matching the measured changes in airflow obstruction. The degree and heterogeneity of constriction of the airways feeding alveolar units outside VDefs was similar among the subjects studied despite large inter-subject variability in airflow obstruction and the extent of the ventilation defects. Analysis of the data amongst the subjects showed an inverse relationship between the reduction in mean airway conductance, measured in the breathing frequency range during bronchoconstriction, and the fraction of lung involved in ventilation defects. The current data supports the concept that patchy ventilation is an expression of the integrated system and not just the sum of independent responses of individual airways.

  7. Predicting Delayed Ventilator Weaning after Lung Transplantation: The Role of Body Mass Index

    Sarah Soh


    CONCLUSIONS: Low BMI might be associated with delayed ventilator weaning in lung transplantation patients. In addition, instead of the traditional weaning predictors of RSBI and RR, TV might be a better predictor for ventilator weaning after lung transplantation.

  8. Evaluation of Fractional Regional Ventilation Using 4D-CT and Effects of Breathing Maneuvers on Ventilation

    Mistry, Nilesh N., E-mail: [Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland (United States); Diwanji, Tejan; Shi, Xiutao [Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland (United States); Pokharel, Sabin [Morgan State University, Baltimore, Maryland (United States); Feigenberg, Steven [Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland (United States); Scharf, Steven M. [Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland (United States); D' Souza, Warren D. [Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland (United States)


    Purpose: Current implementations of methods based on Hounsfield units to evaluate regional lung ventilation do not directly incorporate tissue-based mass changes that occur over the respiratory cycle. To overcome this, we developed a 4-dimensional computed tomography (4D-CT)-based technique to evaluate fractional regional ventilation (FRV) that uses an individualized ratio of tidal volume to end-expiratory lung volume for each voxel. We further evaluated the effect of different breathing maneuvers on regional ventilation. The results from this work will help elucidate the relationship between global and regional lung function. Methods and Materials: Eight patients underwent 3 sets of 4D-CT scans during 1 session using free-breathing, audiovisual guidance, and active breathing control. FRV was estimated using a density-based algorithm with mass correction. Internal validation between global and regional ventilation was performed by use of the imaging data collected during the use of active breathing control. The impact of breathing maneuvers on FRV was evaluated comparing the tidal volume from 3 breathing methods. Results: Internal validation through comparison between the global and regional changes in ventilation revealed a strong linear correlation (slope of 1.01, R{sup 2} of 0.97) between the measured global lung volume and the regional lung volume calculated by use of the “mass corrected” FRV. A linear relationship was established between the tidal volume measured with the automated breathing control system and FRV based on 4D-CT imaging. Consistently larger breathing volumes were observed when coached breathing techniques were used. Conclusions: The technique presented improves density-based evaluation of lung ventilation and establishes a link between global and regional lung ventilation volumes. Furthermore, the results obtained are comparable with those of other techniques of functional evaluation such as spirometry and hyperpolarized-gas magnetic

  9. Marked pericardial inhomogeneity of specific ventilation at total lung capacity and beyond

    Sun, Yanping; Butler, James P; Lindholm, Peter


    We measured regional ventilation at 1l above functional residual capacity (FRC+1L) and total lung capacity (TLC) in three normal subjects and four elite breath-hold divers, and above TLC after glossopharyngeal insufflation (TLC+GI) in the divers. Hyperpolarized (3)He MRI was used to map the local...

  10. Increased Interleukin-8 in Epithelial Lining Fluid of Collapsed Lungs During One-Lung Ventilation for Thoracotomy

    Komatsu, Yoshimichi; Yamamoto, Hiroshi; Tsushima, Kenji; Furuya, Shino; Yoshikawa, Sumiko; Yasuo, Masanori; Kubo, Keishi; Yamazaki, Yoshitaka; Hasegawa, Joh; Eguchi, Takashi; Kondo, Ryuichi; Yoshida, Kazuo; Koizumi, Tomonobu


    The present study was designed to evaluate inflammatory changes in collapsed lungs during one-lung ventilation using the assistance of a bronchoscopic microsampling probe. Serial albumin and interleukin (IL)-8 concentrations in epithelial lining fluid (ELF) were measured in seven patients undergoing resection of lung tumors. The samples were taken after induction of anesthesia (baseline), 30 min after one-lung ventilation was started (point 2), just before resuming two-lung ventilation (point...

  11. Mitogen-Activated Protein Kinases Regulate Susceptibility to Ventilator-Induced Lung Injury


    BACKGROUND: Mechanical ventilation causes ventilator-induced lung injury in animals and humans. Mitogen-activated protein kinases have been implicated in ventilator-induced lung injury though their functional significance remains incomplete. We characterize the role of p38 mitogen-activated protein kinase/mitogen activated protein kinase kinase-3 and c-Jun-NH(2)-terminal kinase-1 in ventilator-induced lung injury and investigate novel independent mechanisms contributing to lung injury during ...

  12. Heliox Improves Carbon Dioxide Removal during Lung Protective Mechanical Ventilation

    Charlotte J. Beurskens


    Full Text Available Introduction. Helium is a noble gas with low density and increased carbon dioxide (CO2 diffusion capacity. This allows lower driving pressures in mechanical ventilation and increased CO2 diffusion. We hypothesized that heliox facilitates ventilation in patients during lung-protective mechanical ventilation using low tidal volumes. Methods. This is an observational cohort substudy of a single arm intervention study. Twenty-four ICU patients were included, who were admitted after a cardiac arrest and mechanically ventilated for 3 hours with heliox (50% helium; 50% oxygen. A fixed protective ventilation protocol (6 mL/kg was used, with prospective observation for changes in lung mechanics and gas exchange. Statistics was by Bonferroni post-hoc correction with statistical significance set at P<0.017. Results. During heliox ventilation, respiratory rate decreased (25±4 versus 23±5 breaths min−1, P=0.010. Minute volume ventilation showed a trend to decrease compared to baseline (11.1±1.9 versus 9.9±2.1 L min−1, P=0.026, while reducing PaCO2 levels (5.0±0.6 versus 4.5±0.6 kPa, P=0.011 and peak pressures (21.1±3.3 versus 19.8±3.2 cm H2O, P=0.024. Conclusions. Heliox improved CO2 elimination while allowing reduced minute volume ventilation in adult patients during protective mechanical ventilation.

  13. Comparison of actual tidal volume in neonatal lung model volume control ventilation using three ventilators.

    Toyama, H; Endo, Y; Ejima, Y; Matsubara, M; Kurosawa, S


    In neonates, small changes in tidal volumes (V(T)) may lead to complications. Previous studies have shown a significant difference between ventilator-measured tidal volume and tidal volume delivered (actual V(T)). We evaluated the accuracy of three different ventilators to deliver small V(T) during volume-controlled ventilation. We tested Servo 300, 840 ventilator and Evita 4 Neoflow ventilators with lung models simulating normal and injured neonatal lung compliance models. Gas volume delivered from the ventilator into the test circuit (V(TV)) and actual V(T) to the test lung were measured using Ventrak respiration monitors at set V(T) (30 ml). The gas volume increase of the breathing circuit was then calculated. Tidal volumes of the SV300 and PB840 in both lung models were similar to the set V(T) and the actual tidal volumes in the injured model (20.7 ml and 19.8 ml, respectively) were significantly less than that in the normal model (27.4 ml and 23.4 ml). PB840 with circuit compliance compensation could not improve the actual V(T). V(TV) of the EV4N in the normal and the injured models (37.8 ml and 46.6 ml) were markedly increased compared with set V(T), and actual V(T) were similar to set V(T) in the normal and injured model (30.2 ml and 31.9 ml, respectively). EV4N measuring V(T) close to the lung could match actual V(T) to almost the same value as the set V(T) however the gas volume of the breathing circuit was increased. If an accurate value for the patient's actual V(T) is needed, this V(T) must be measured by a sensor located between the Y-piece and the tracheal tube.

  14. MO-A-BRD-05: Evaluation of Composed Lung Ventilation with 4DCT and Image Registration

    Du, K; Bayouth, J [University of Wisconsin Madison, Madison, WI (United States); Reinhardt, J; Christensen, G; Zhao, B [University of Iowa, Iowa City, IA (United States); Ding, K [Johns Hopkins University, Baltimore, MD (United States)


    Purpose: Regional pulmonary function can be derived using fourdimensional computed tomography (4DCT) combined with deformable image registration. However, only peak inhale and exhale phases have been used thus far while the lung ventilation during intermediate phases is not considered. In our previous work, we have investigated the spatiotemporal heterogeneity of lung ventilation and its dependence on respiration effort. In this study, composed ventilation is introduced using all inspiration phases and compared to direct ventilation. Both methods are evaluated against Xe-CT derived ventilation. Methods: Using an in-house tissue volume preserving deformable image registration, unlike the direct ventilation method, which computes from end expiration to end inspiration, Jacobian ventilation maps were computed from one inhale phase to the next and then composed from all inspiration steps. The two methods were compared in both patients prior to RT and mechanically ventilated sheep subjects. In addition, they wereassessed for the correlation with Xe-CT derived ventilation in sheep subjects. Annotated lung landmarks were used to evaluate the accuracy of original and composed deformation field. Results: After registration, the landmark distance for composed deformation field was always higher than that for direct deformation field (0IN to 100IN average in human: 1.03 vs 1.53, p=0.001, and in sheep: 0.80 vs0.94, p=0.009), and both increased with longer phase interval. Direct and composed ventilation maps were similar in both sheep (gamma pass rate 87.6) and human subjects (gamma pass rate 71.9),and showed consistent pattern from ventral to dorsal when compared to Xe-CT derived ventilation. Correlation coefficient between Xe-CT and composed ventilation was slightly better than the direct method but not significant (average 0.89 vs 0.85, p=0.135). Conclusion: More strict breathing control in sheep subjects may explain higher similarity between direct and composed ventilation

  15. Carbon monoxide transfer in pig lungs during mechanical ventilation

    F.C.A.M. te Nijenhuis (Frances)


    textabstractThis thesis comprises studies of gas transfer in the lungs during mechanical ventilation, which have been obtained in healthy pigs. The objectives of this thesis were: I) to adapt the breath-holding teclmique, as used during spontaneous breathing for estimation of gas transfer, to condit

  16. Recurrent recruitment manoeuvres improve lung mechanics and minimize lung injury during mechanical ventilation of healthy mice.

    Lucy Kathleen Reiss

    Full Text Available INTRODUCTION: Mechanical ventilation (MV of mice is increasingly required in experimental studies, but the conditions that allow stable ventilation of mice over several hours have not yet been fully defined. In addition, most previous studies documented vital parameters and lung mechanics only incompletely. The aim of the present study was to establish experimental conditions that keep these parameters within their physiological range over a period of 6 h. For this purpose, we also examined the effects of frequent short recruitment manoeuvres (RM in healthy mice. METHODS: Mice were ventilated at low tidal volume V(T = 8 mL/kg or high tidal volume V(T = 16 mL/kg and a positive end-expiratory pressure (PEEP of 2 or 6 cm H(2O. RM were performed every 5 min, 60 min or not at all. Lung mechanics were followed by the forced oscillation technique. Blood pressure (BP, electrocardiogram (ECG, heart frequency (HF, oxygen saturation and body temperature were monitored. Blood gases, neutrophil-recruitment, microvascular permeability and pro-inflammatory cytokines in bronchoalveolar lavage (BAL and blood serum as well as histopathology of the lung were examined. RESULTS: MV with repetitive RM every 5 min resulted in stable respiratory mechanics. Ventilation without RM worsened lung mechanics due to alveolar collapse, leading to impaired gas exchange. HF and BP were affected by anaesthesia, but not by ventilation. Microvascular permeability was highest in atelectatic lungs, whereas neutrophil-recruitment and structural changes were strongest in lungs ventilated with high tidal volume. The cytokines IL-6 and KC, but neither TNF nor IP-10, were elevated in the BAL and serum of all ventilated mice and were reduced by recurrent RM. Lung mechanics, oxygenation and pulmonary inflammation were improved by increased PEEP. CONCLUSIONS: Recurrent RM maintain lung mechanics in their physiological range during low tidal volume ventilation of healthy mice by

  17. Airway pressure release ventilation and successful lung donation.

    Hanna, Kenny; Seder, Christopher W; Weinberger, Jeffrey B; Sills, Patty A; Hagan, Michael; Janczyk, Randy J


    Donor management with airway pressure release ventilation (APRV) improves oxygenation and increases lung donation while maintaining equivalent graft survival. Retrospective case series. Private, tertiary care, level I trauma center. Forty-five consecutive organ donors. Management with assist/control ventilation (ACV) or APRV. Demographic characteristics, medical history, mode of brain death, and partial pressure of arterial oxygen (Pao(2))/fraction of inspired oxygen (Fio(2)) ratios on admission and after 100% oxygen challenge, percentage of lungs transplanted, and graft survival. Twenty potential donors were managed with ACV and 25 were managed with APRV during the study period. The APRV patients were younger than the ACV patients (mean [SD] age, 34 [11] vs 41 [12] years, respectively; P = .05). Otherwise, there was no difference between the ACV and APRV groups with respect to demographic characteristics, medical history, or mode of brain death. Although the ACV and APRV groups had similar Pao(2)/Fio(2) ratios on admission and the mean time on the ventilator was the same, the APRV group had a higher Pao(2)/Fio(2) ratio than the ACV group (mean [SD], 498 [43] vs 334 [104] mm Hg, respectively; P ACV group ultimately donated 7 of 40 potential lungs (18%) compared with 42 of 50 potential lungs (84%) in the APRV group (P ACV compared favorably with national averages. The use of APRV prior to procurement may increase the rate of successful lung donation.

  18. [Lung-brain interaction in the mechanically ventilated patient].

    López-Aguilar, J; Fernández-Gonzalo, M S; Turon, M; Quílez, M E; Gómez-Simón, V; Jódar, M M; Blanch, L


    Patients with acute lung injury or acute respiratory distress syndrome (ARDS) admitted to the ICU present neuropsychological alterations, which in most cases extend beyond the acute phase and have an important adverse effect upon quality of life. The aim of this review is to deepen in the analysis of the complex interaction between lung and brain in critically ill patients subjected to mechanical ventilation. This update first describes the neuropsychological alterations occurring both during the acute phase of ICU stay and at discharge, followed by an analysis of lung-brain interactions during mechanical ventilation, and finally explores the etiology and mechanisms leading to the neurological disorders observed in these patients. The management of critical patients requires an integral approach focused on minimizing the deleterious effects over the short, middle or long term. Copyright © 2012 Elsevier España, S.L. y SEMICYUC. All rights reserved.

  19. Effects of surfactant depletion on regional pulmonary metabolic activity during mechanical ventilation.

    de Prost, Nicolas; Costa, Eduardo L; Wellman, Tyler; Musch, Guido; Winkler, Tilo; Tucci, Mauro R; Harris, R Scott; Venegas, Jose G; Vidal Melo, Marcos F


    Inflammation during mechanical ventilation is thought to depend on regional mechanical stress. This can be produced by concentration of stresses and cyclic recruitment in low-aeration dependent lung. Positron emission tomography (PET) with (18)F-fluorodeoxyglucose ((18)F-FDG) allows for noninvasive assessment of regional metabolic activity, an index of neutrophilic inflammation. We tested the hypothesis that, during mechanical ventilation, surfactant-depleted low-aeration lung regions present increased regional (18)F-FDG uptake suggestive of in vivo increased regional metabolic activity and inflammation. Sheep underwent unilateral saline lung lavage and were ventilated supine for 4 h (positive end-expiratory pressure = 10 cmH(2)O, tidal volume adjusted to plateau pressure = 30 cmH(2)O). We used PET scans of injected (13)N-nitrogen to compute regional perfusion and ventilation and injected (18)F-FDG to calculate (18)F-FDG uptake rate. Regional aeration was quantified with transmission scans. Whole lung (18)F-FDG uptake was approximately two times higher in lavaged than in nonlavaged lungs (2.9 ± 0.6 vs. 1.5 ± 0.3 10(-3)/min; P < 0.05). The increased (18)F-FDG uptake was topographically heterogeneous and highest in dependent low-aeration regions (gas fraction 10-50%, P < 0.001), even after correction for lung density and wet-to-dry lung ratios. (18)F-FDG uptake in low-aeration regions of lavaged lungs was higher than that in low-aeration regions of nonlavaged lungs (P < 0.05). This occurred despite lower perfusion and ventilation to dependent regions in lavaged than nonlavaged lungs (P < 0.001). In contrast, (18)F-FDG uptake in normally aerated regions was low and similar between lungs. Surfactant depletion produces increased and heterogeneously distributed pulmonary (18)F-FDG uptake after 4 h of supine mechanical ventilation. Metabolic activity is highest in poorly aerated dependent regions, suggesting local increased inflammation.

  20. Increasing inspiratory time exacerbates ventilator-induced lung injury during high-pressure/high-volume mechanical ventilation.

    Casetti, Alfredo V; Bartlett, Robert H; Hirschl, Ronald B


    Ventilator-induced lung injury may be caused by overdistension of alveoli during high-pressure ventilation. In this study, we examined the effects of increasing inspiratory time on ventilator-induced lung injury. Sprague-Dawley rats were divided into four different groups with ten animals per group. Each group was then ventilated for 30 mins with one of four ventilator strategies. All groups were ventilated with an Fio2 of 1.0 and a positive end-expiratory pressure of 0 cm H2O. Group LoP was the negative control group and was ventilated with low pressures (peak inspiratory pressure = 12 cm H2O, rate = 30, and inspiratory time = 0.5 secs). Groups iT = 0.5, iT = 1.0, and iT = 1.5 were the experimental groups and were ventilated with high pressures (peak inspiratory pressure = 45 cm H2O, rate = 10, and inspiratory times = 0.5 secs, iT = 1.0 sec, and iT = 1.5 secs, respectively). Outcome measures included lung compliance, Pao /Fio ratio, wet/dry lung weight, and dry lung/body weight. Final static lung compliance (p =.0002) and Pao2/Fio2 (p =.001) decreased as inspiratory time increased. Wet/dry lung weights (p <.0001) and dry lung/body weights (p <.0001) increased as inspiratory time increased. Light microscopy revealed evidence of intra-alveolar edema and hemorrhage in the iT = 1.0 and iT = 1.5 animals but not the LoP and iT = 0.5 animals. Increasing inspiratory time during high-pressure/high-volume mechanical ventilation is associated with an increase in variables of lung injury.

  1. Protective ventilation of preterm lambs exposed to acute chorioamnionitis does not reduce ventilation-induced lung or brain injury.

    Samantha K Barton

    Full Text Available The onset of mechanical ventilation is a critical time for the initiation of cerebral white matter (WM injury in preterm neonates, particularly if they are inadvertently exposed to high tidal volumes (VT in the delivery room. Protective ventilation strategies at birth reduce ventilation-induced lung and brain inflammation and injury, however its efficacy in a compromised newborn is not known. Chorioamnionitis is a common antecedent of preterm birth, and increases the risk and severity of WM injury. We investigated the effects of high VT ventilation, after chorioamnionitis, on preterm lung and WM inflammation and injury, and whether a protective ventilation strategy could mitigate the response.Pregnant ewes (n = 18 received intra-amniotic lipopolysaccharide (LPS 2 days before delivery, instrumentation and ventilation at 127±1 days gestation. Lambs were either immediately euthanased and used as unventilated controls (LPSUVC; n = 6, or were ventilated using an injurious high VT strategy (LPSINJ; n = 5 or a protective ventilation strategy (LPSPROT; n = 7 for a total of 90 min. Mean arterial pressure, heart rate and cerebral haemodynamics and oxygenation were measured continuously. Lungs and brains underwent molecular and histological assessment of inflammation and injury.LPSINJ lambs had poorer oxygenation than LPSPROT lambs. Ventilation requirements and cardiopulmonary and systemic haemodynamics were not different between ventilation strategies. Compared to unventilated lambs, LPSINJ and LPSPROT lambs had increases in pro-inflammatory cytokine expression within the lungs and brain, and increased astrogliosis (p<0.02 and cell death (p<0.05 in the WM, which were equivalent in magnitude between groups.Ventilation after acute chorioamnionitis, irrespective of strategy used, increases haemodynamic instability and lung and cerebral inflammation and injury. Mechanical ventilation is a potential contributor to WM injury in infants exposed

  2. VEGF Production by Ly6C+high Monocytes Contributes to Ventilator-Induced Lung Injury

    Shi, Chung-Sheng; Huang, Tzu-Hsiung; Lin, Chin-Kuo; Li, Jhy-Ming; Chen, Mei-Hsin; Tsai, Mei-Ling; Chang, Chih-Ching


      Background Mechanical ventilation is a life-saving procedure for patients with acute respiratory failure, although it may cause pulmonary vascular inflammation and leakage, leading to ventilator-induced lung injury (VILI). Ly6C...

  3. The receptor for advanced glycation end products in ventilator-induced lung injury

    Kuipers, Maria T; Aslami, Hamid; Tuinman, Pieter Roel; Tuip-de Boer, Anita M; Jongsma, Geartsje; van der Sluijs, Koenraad F; Choi, Goda; Wolthuis, Esther K; Roelofs, Joris Jth; Bresser, Paul; Schultz, Marcus J; van der Poll, Tom; Wieland, Catharina W


    BACKGROUND: Mechanical ventilation (MV) can cause ventilator-induced lung injury (VILI). The innate immune response mediates this iatrogenic inflammatory condition. The receptor for advanced glycation end products (RAGE) is a multiligand receptor that can amplify immune and inflammatory responses.

  4. Functional MRI using Fourier decomposition of lung signal: Reproducibility of ventilation- and perfusion-weighted imaging in healthy volunteers

    Lederlin, Mathieu, E-mail: [Department of Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg (Germany); Department of Thoracic and Cardiovascular Imaging, University Hospital of Bordeaux, Av de Magellan, 33600 Pessac (France); Bauman, Grzegorz, E-mail: [Division of Medical Physics in Radiology, German Cancer Research Center, Im Neuenheimer Feld 280, 69120 Heidelberg (Germany); Eichinger, Monika, E-mail: [Division of Radiology, German Cancer Research Center, Im Neuenheimer Feld 280, 69120 Heidelberg (Germany); Dinkel, Julien, E-mail: [Division of Radiology, German Cancer Research Center, Im Neuenheimer Feld 280, 69120 Heidelberg (Germany); Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114 (United States); Brault, Mathilde, E-mail: [Methodological Unit of Support for Research (USMR), University Bordeaux Segalen, 146 rue Léo Saignat, 33076 Bordeaux (France); Biederer, Jürgen, E-mail: [Department of Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg (Germany); Puderbach, Michael, E-mail: [Division of Radiology, German Cancer Research Center, Im Neuenheimer Feld 280, 69120 Heidelberg (Germany); Chest Clinics at the University of Heidelberg, Clinics for Interventional and Diagnostic Radiology, Amalienstr. 5, 69126 Heidelberg (Germany)


    Purpose: To assess the reproducibility of Fourier decomposition (FD) based ventilation- and perfusion-weighted lung MRI. Methods: Sixteen healthy volunteers were examined on a 1.5 T whole-body MR-scanner with 4–6 sets of coronal slices over the chest volume with a non-contrast enhanced steady-state free precession sequence. The identical protocol was repeated after 24 h. Reconstructed perfusion- and ventilation-weighted images were obtained through non-rigid registration and FD post-processing of images. Analysis of signal in segmented regions of interest was performed for both native and post-processed data. Two blinded chest radiologists rated image quality of perfusion- and ventilation-weighted images using a 3-point scale. Results: Reproducibility of signal between the two time points was very good with intra-class correlation coefficients of 0.98, 0.94 and 0.86 for native, perfusion- and ventilation-weighted images, respectively. Perfusion- and ventilation-weighted images were of overall good quality with proportions of diagnostic images of 87–95% and 69–75%, respectively. Lung signal decreased from posterior to anterior slices with image quality of ventilation-weighted images in anterior areas rated worse than in posterior or perfusion-weighted images. Inter- and intra-observer agreement of image quality was good for perfusion and ventilation. Conclusions: The study demonstrates high reproducibility of ventilation- and perfusion-weighted FD lung MRI.

  5. Ventilator-induced Lung Injury : Similarity and Differences between Children and Adults

    Kneyber, Martin C.J.; Zhang, Haibo; Slutsky, Arthur S.


    It is well established that mechanical ventilation can injure the lung, producing an entity known as ventilator-induced lung injury (VILI). There are various forms of VILI, including volutrauma (i.e., injury caused by overdistending the lung), atelectrauma (injury due to repeated opening/closing of

  6. “High Frequency/Small Tidal Volume Differential Lung Ventilation”: A Technique of Ventilating the Nondependent Lung of One Lung Ventilation for Robotically Assisted Thoracic Surgery

    Bassam M. Shoman


    Full Text Available With the introduction of new techniques and advances in the thoracic surgery fields, challenges to the anesthesia techniques had became increasingly exponential. One of the great improvements that took place in the thoracic surgical field was the use of the robotically assisted thoracic surgical procedure and minimally invasive endoscopic thoracic surgery. One lung ventilation technique represents the core anesthetic management for the success of those surgical procedures. Even with the use of effective one lung ventilation, the patient hemodynamics and respiratory parameters could be deranged and could not be tolerating the procedure that could compromise the end result of surgery. We are presenting our experience in managing one patient who suffered persistent hypoxia and hemodynamic instability with one lung ventilation for robotically assisted thymectomy procedure and how it was managed till the completion of the surgery successfully.

  7. Mitogen-activated protein kinases regulate susceptibility to ventilator-induced lung injury.

    Tamás Dolinay

    Full Text Available BACKGROUND: Mechanical ventilation causes ventilator-induced lung injury in animals and humans. Mitogen-activated protein kinases have been implicated in ventilator-induced lung injury though their functional significance remains incomplete. We characterize the role of p38 mitogen-activated protein kinase/mitogen activated protein kinase kinase-3 and c-Jun-NH(2-terminal kinase-1 in ventilator-induced lung injury and investigate novel independent mechanisms contributing to lung injury during mechanical ventilation. METHODOLOGY AND PRINCIPLE FINDINGS: C57/BL6 wild-type mice and mice genetically deleted for mitogen-activated protein kinase kinase-3 (mkk-3(-/- or c-Jun-NH(2-terminal kinase-1 (jnk1(-/- were ventilated, and lung injury parameters were assessed. We demonstrate that mkk3(-/- or jnk1(-/- mice displayed significantly reduced inflammatory lung injury and apoptosis relative to wild-type mice. Since jnk1(-/- mice were highly resistant to ventilator-induced lung injury, we performed comprehensive gene expression profiling of ventilated wild-type or jnk1(-/- mice to identify novel candidate genes which may play critical roles in the pathogenesis of ventilator-induced lung injury. Microarray analysis revealed many novel genes differentially expressed by ventilation including matrix metalloproteinase-8 (MMP8 and GADD45alpha. Functional characterization of MMP8 revealed that mmp8(-/- mice were sensitized to ventilator-induced lung injury with increased lung vascular permeability. CONCLUSIONS: We demonstrate that mitogen-activated protein kinase pathways mediate inflammatory lung injury during ventilator-induced lung injury. C-Jun-NH(2-terminal kinase was also involved in alveolo-capillary leakage and edema formation, whereas MMP8 inhibited alveolo-capillary protein leakage.

  8. Nicotinamide exacerbates hypoxemia in ventilator-induced lung injury independent of neutrophil infiltration.

    Heather D Jones

    Full Text Available Ventilator-induced lung injury is a form of acute lung injury that develops in critically ill patients on mechanical ventilation and has a high degree of mortality. Nicotinamide phosphoribosyltransferase is an enzyme that is highly upregulated in ventilator-induced lung injury and exacerbates the injury when given exogenously. Nicotinamide (vitamin B3 directly inhibits downstream pathways activated by Nicotinamide phosphoribosyltransferase and is protective in other models of acute lung injury.We administered nicotinamide i.p. to mice undergoing mechanical ventilation with high tidal volumes to study the effects of nicotinamide on ventilator-induced lung injury. Measures of injury included oxygen saturations and bronchoalveolar lavage neutrophil counts, protein, and cytokine levels. We also measured expression of nicotinamide phosophoribosyltransferase, and its downstream effectors Sirt1 and Cebpa, Cebpb, Cebpe. We assessed the effect of nicotinamide on the production of nitric oxide during ventilator-induced lung injury. We also studied the effects of ventilator-induced lung injury in mice deficient in C/EBPε.Nicotinamide treatment significantly inhibited neutrophil infiltration into the lungs during ventilator-induced lung injury, but did not affect protein leakage or cytokine production. Surprisingly, mice treated with nicotinamide developed significantly worse hypoxemia during mechanical ventilation. This effect was not linked to increases in nitric oxide production or alterations in expression of Nicotinamide phosphoribosyl transferase, Sirt1, or Cebpa and Cebpb. Cebpe mRNA levels were decreased with either nicotinamide treatment or mechanical ventilation, but mice lacking C/EBPε developed the same degree of hypoxemia and ventilator-induced lung injury as wild-type mice.Nicotinamide treatment during VILI inhibits neutrophil infiltration of the lungs consistent with a strong anti-inflammatory effect, but paradoxically also leads to the

  9. Nicotinamide Exacerbates Hypoxemia in Ventilator-Induced Lung Injury Independent of Neutrophil Infiltration

    Jones, Heather D.; Yoo, Jeena; Crother, Timothy R.; Kyme, Pierre; Ben-Shlomo, Anat; Khalafi, Ramtin; Tseng, Ching W.; Parks, William C.; Arditi, Moshe


    Background Ventilator-induced lung injury is a form of acute lung injury that develops in critically ill patients on mechanical ventilation and has a high degree of mortality. Nicotinamide phosphoribosyltransferase is an enzyme that is highly upregulated in ventilator-induced lung injury and exacerbates the injury when given exogenously. Nicotinamide (vitamin B3) directly inhibits downstream pathways activated by Nicotinamide phosphoribosyltransferase and is protective in other models of acute lung injury. Methods We administered nicotinamide i.p. to mice undergoing mechanical ventilation with high tidal volumes to study the effects of nicotinamide on ventilator-induced lung injury. Measures of injury included oxygen saturations and bronchoalveolar lavage neutrophil counts, protein, and cytokine levels. We also measured expression of nicotinamide phosophoribosyltransferase, and its downstream effectors Sirt1 and Cebpa, Cebpb, Cebpe. We assessed the effect of nicotinamide on the production of nitric oxide during ventilator-induced lung injury. We also studied the effects of ventilator-induced lung injury in mice deficient in C/EBPε. Results Nicotinamide treatment significantly inhibited neutrophil infiltration into the lungs during ventilator-induced lung injury, but did not affect protein leakage or cytokine production. Surprisingly, mice treated with nicotinamide developed significantly worse hypoxemia during mechanical ventilation. This effect was not linked to increases in nitric oxide production or alterations in expression of Nicotinamide phosphoribosyl transferase, Sirt1, or Cebpa and Cebpb. Cebpe mRNA levels were decreased with either nicotinamide treatment or mechanical ventilation, but mice lacking C/EBPε developed the same degree of hypoxemia and ventilator-induced lung injury as wild-type mice. Conclusions Nicotinamide treatment during VILI inhibits neutrophil infiltration of the lungs consistent with a strong anti-inflammatory effect, but

  10. High-frequency oscillatory ventilation is not superior to conventional mechanical ventilation in surfactant-treated rabbits with lung injury

    D.A.M.P.J. Gommers (Diederik); A. Hartog (Anneke); R. Schnabel; A. de Jaegere (Anne); B.F. Lachmann (Burkhard)


    textabstractThe aim of this study was to compare high-frequency oscillatory ventilation (HFOV) with conventional mechanical ventilation (CMV) with and without surfactant in the treatment of surfactant-deficient rabbits. A previously described saline lung lavage model of

  11. The patient simulator for training of anesthesia residents in the management of one lung ventilation.

    Hassan, Zaki-Udin; Dorfling, Johannes; McLarney, John T; Sloan, Paul A


    Simulators are used extensively for the training of medical personnel. All anesthesia providers should be prepared and trained in the management of one lung ventilation for pulmonary surgery, yet familiarization with one lung ventilation may not be possible on a routine basis in the operating room. Therefore, this reports details the first use of the patient simulator (PS) to enhance the training of anesthesia residents in the management of one lung ventilation. A detailed report of our computer program for simulating one lung ventilation is included.

  12. Effects of minimal lipopolysaccharide-instilled lungs on ventilator-induced lung injury in rats

    LI Ke-zhong; WANG Qiu-jun; SUN Tao; YAO Shang-long


    @@ Mechanical ventilation (MV) may aggravate lung injury induced by a variety of injuries, including intratracheal hydrochloric acid instillation,1 intratracheal lipopolysaccharide (LPS) instillation with or without concurrent saline lavage,2 intravenous LPS,3 or intravenous oleic acid.4 However, the mechanism for this detrimental effect of MV is unclear.

  13. [Design of a lung simulator for teaching lung mechanics in mechanical ventilation].

    Heili-Frades, Sarah; Peces-Barba, Germán; Rodríguez-Nieto, María Jesús


    Over the last 10 years, noninvasive ventilation has become a treatment option for respiratory insufficiency in pulmonology services. The technique is currently included in pulmonology teaching programs. Physicians and nurses should understand the devices they use and the interaction between the patient and the ventilator in terms of respiratory mechanics, adaptation, and synchronization. We present a readily assembled lung simulator for teaching purposes that is reproducible and interactive. Based on a bag-in-box system, this model allows the concepts of respiratory mechanics in mechanical ventilation to be taught simply and graphically in that it reproduces the patterns of restriction, obstruction, and the presence of leaks. It is possible to demonstrate how each ventilation parameter acts and the mechanical response elicited. It can also readily simulate asynchrony and demonstrate how this problem can be corrected.

  14. Dynamic ventilation 3He MRI for the quantification of disease in the rat lung.

    Kyriazis, Angelos; Rodriguez, I; Nin, N; Izquierdo-Garcia, J L; Lorente, J A; Perez-Sanchez, J M; Pesic, J; Olsson, L E; Ruiz-Cabello, J


    Pulmonary diseases are known to be largely inhomogeneous. To evaluate such inhomogeneities, we are testing an image-based method to measure gas flow in the lung regionally. Dynamic, spin-density-weighted hyperpolarized (3)He MR images performed during slow inhalation of this gas were analyzed to quantify regional inflation rate. This parameter was measured in regions of interest (ROIs) that were defined by a rectangular grid that covered the entire rat lung and grew dynamically with it during its inflation. We used regional inflation rate to quantify elastase-induced emphysema and to differentiate healthy (n = 8) from elastase-treated (n = 9) rat lungs as well as healthy from elastase-treated areas of one rat unilaterally treated with elastase in the left lung. Emphysema was also assessed by gold standard morphological and well-established hyperpolarized (3)He MRI diffusion measurements. Mean values of regional inflation rates were significantly different for healthy and elastase-treated animals and correlated well with the apparent diffusion coefficient of (3)He and morphological measurements. The image-based biomarker inflation rate may be useful for the assessment of regional lung ventilation.

  15. Effectiveness of ventilation of nondependent lung for a brief period in improving arterial oxygenation during one-lung ventilation: A prospective study

    Keerthi Chigurupati


    Full Text Available Background: Hypoxemia is common during one-lung ventilation(OLV, predominantly due to transpulmonary shunt. None of the strategies tried showed consistent results. We evaluated the effectiveness of ventilating the operated, non-dependent lung (NDL with small tidal volumes in improving the oxygenation during OLV. Methods: 30 ASA 1 and 2 patients undergoing elective, open thoracotomy were studied. After standard induction of anesthesia, lung seperation was acheived with left sided DLT. The ventilatory settings for two lung ventilation (TLV were: FiO 2 of 0.5, tidal volume of 8-10ml/kg and respiratory rate of 10-12/min. After initiating OLV, the dependent lung alone was ventilated with the above settings for 15 minutes and an arterial blood gas (ABG analysis was done. Then the NDL was ventilated with a separate ventilator, with FiO 2 of 1, tidal volume of 70 ml, I:E ratio of 1:10 and respiratory rate of 6/min for 15 minutes. The NDL ventilation was started early if the patients desaturated to <95%. ABG was done at 5 and 15 mins of NDL ventilation. We compared the PaO 2 values. Results: The mean PaO 2 decreased from 232.2 ± 67.2 mm of Hg (TLV-ABG1 to 91.2 ± 31.7 mm of Hg on OLV (OLV-ABG1. The ABG after 5 minutes and 15 minutes after institution of NDL ventilation during OLV showed a PaO2 of 145.7 ± 50.2 mm of Hg and 170.6 ± 50.4 mm of Hg which were significantly higher compared to the one lung ventilation values.

  16. Comparison and planar and SPECT ventilation/perfusion lung scanning

    Eberl, S.; Uren, R.; Bautovich, G.; Dugal, T.; Forster, J. [Royal Prince Alfred Hospital, Camperdown, NSW (Australia). Department of PET and Nuclear Medicine


    Full text: Ventilation/perfusion (V/Q) lung scanning, using multiple planar views, is an accepted technique for diagnosing pulmonary embolism (PE). Under PIOPED criteria, there are a substantial number of indeterminate results due to confounding factors such as CAL, unusual anatomy or superimposed activity in the planar image. Our aim was to investigate if SPECT could improve the diagnostic accuracy of V/Q scanning in the diagnosis of PE. Both planar and SPECT images were acquired on a dual or a triple head gamma camera following inhalation of {sup 99m}Tc-Technegas and after injection of {sup 99m}Tc-MAA. Total acquisition time for SPECT studies was 7.5 min for ventilation and 5 min for perfusion. SPECT studies were reconstructed with an accelerated iterative reconstruction (OSEM) and ventilation slices and perfusion slices were registered with an automated image registration package. Total processing time was 5 min. We have now performed more than 600 planar and SPECT studies. A subset of 50 sequential patients and 10 cases with pulmonary angiography were scored blinded by experienced nuclear medicine physicians. Scores ranged from 0 (no PE) to 5 (definite PE). A score of 3 indicated indeterminate for PE. In the 60 patients analysed, planar and SPECT scores were equal in 27 patients, SPECT was more definite in 16 and less definite in 7 patients. In 8 patients, SPECT indicated PE and planar imaging low probability of PE. In 1 patient planar imaging was scored as PE and SPECT as low probability. Indeterminate rate was reduced from 8 to 1 with SPECT. In the 10 patients with angiography, SPECT studies agreed with angiography findings in 8 patients, while planar studies agreed with angiography findings in 5 patients. Our preliminary data suggest that SPECT V/Q lung scanning can: i) provide a significant improvement over planar imaging for the diagnosis of PE, and ii) our short acquisition time for V/Q SPECT is clinically practicable

  17. Alternating versus synchronous ventilation of left and right lungs in piglets

    A. Versprille (Adrian); V. Hrachovina (V.); J.R.C. Jansen (Jos)


    textabstractObjective: We tested whether alternating ventilation (AV) of each lung (i.e. with a phase difference of half a ventilatory cycle) would decrease central venous pressure and so increase cardiac output when compared with simultaneous ventilation (SV) of both lungs. Theory: If, during AV,

  18. Cytokines and biotrauma in ventilator-induced lung injury: a critical review of the literature.

    Halbertsma, F.J.; Vaneker, M.; Scheffer, G.J.; Hoeven, J.G. van der


    BACKGROUND: Mechanical ventilation is known to induce and aggravate lung injury. One of the underlying mechanisms is biotrauma, an inflammatory response in which cytokines play a crucial role. OBJECTIVE: To review the literature on the role of cytokines in ventilator-induced lung injury (VILI) and

  19. A metabolomic approach to the pathogenesis of ventilator-induced lung injury

    Izquierdo García, José L.; Naz, Shama; Nin, Nicolás; Rojas, Yeny; Erazo, Marcela; Martínez Caro, Leticia; García, Antonia; De Paula, Marta; Fernández Segoviano, P.; Casals, Cristina; Esteban, Andrés; Ruíz Cabello, Jesús; Barbas, Coral; Lorente Balanza, José Ángel


    Global metabolic profiling using quantitative nuclear magnetic resonance spectroscopy (MRS) and mass spectrometry (MS) is useful for biomarker discovery. The objective of this study was to discover biomarkers of acute lung injury induced by mechanical ventilation (ventilator-induced lung injury [VILI]), by using MRS and MS. 5.879 JCR (2014) Q1, 1/30 Anesthesiology UEM

  20. Ventilation/Perfusion Positron Emission Tomography—Based Assessment of Radiation Injury to Lung

    Siva, Shankar, E-mail: [Department of Radiation Oncology, Peter MacCallum Cancer Centre, East Melbourne (Australia); Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville (Australia); Hardcastle, Nicholas [Department of Physical Sciences, Peter MacCallum Cancer Centre, East Melbourne (Australia); Centre for Medical Radiation Physics, University of Wollongong, Wollongong (Australia); Kron, Tomas [Department of Physical Sciences, Peter MacCallum Cancer Centre, East Melbourne (Australia); Bressel, Mathias [Department of Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, East Melbourne (Australia); Callahan, Jason [Centre for Molecular Imaging, Cancer Imaging, Peter MacCallum Cancer Centre, East Melbourne (Australia); MacManus, Michael P.; Shaw, Mark; Plumridge, Nikki [Department of Radiation Oncology, Peter MacCallum Cancer Centre, East Melbourne (Australia); Hicks, Rodney J. [Centre for Molecular Imaging, Cancer Imaging, Peter MacCallum Cancer Centre, East Melbourne (Australia); Department of Medicine, University of Melbourne, Parkville (Australia); Steinfort, Daniel [Department of Medicine, University of Melbourne, Parkville (Australia); Department of Cancer Medicine, Peter MacCallum Cancer Centre, East Melbourne (Australia); Ball, David L. [Department of Radiation Oncology, Peter MacCallum Cancer Centre, East Melbourne (Australia); Hofman, Michael S. [Centre for Molecular Imaging, Cancer Imaging, Peter MacCallum Cancer Centre, East Melbourne (Australia); Department of Medicine, University of Melbourne, Parkville (Australia)


    Purpose: To investigate {sup 68}Ga-ventilation/perfusion (V/Q) positron emission tomography (PET)/computed tomography (CT) as a novel imaging modality for assessment of perfusion, ventilation, and lung density changes in the context of radiation therapy (RT). Methods and Materials: In a prospective clinical trial, 20 patients underwent 4-dimensional (4D)-V/Q PET/CT before, midway through, and 3 months after definitive lung RT. Eligible patients were prescribed 60 Gy in 30 fractions with or without concurrent chemotherapy. Functional images were registered to the RT planning 4D-CT, and isodose volumes were averaged into 10-Gy bins. Within each dose bin, relative loss in standardized uptake value (SUV) was recorded for ventilation and perfusion, and loss in air-filled fraction was recorded to assess RT-induced lung fibrosis. A dose-effect relationship was described using both linear and 2-parameter logistic fit models, and goodness of fit was assessed with Akaike Information Criterion (AIC). Results: A total of 179 imaging datasets were available for analysis (1 scan was unrecoverable). An almost perfectly linear negative dose-response relationship was observed for perfusion and air-filled fraction (r{sup 2}=0.99, P<.01), with ventilation strongly negatively linear (r{sup 2}=0.95, P<.01). Logistic models did not provide a better fit as evaluated by AIC. Perfusion, ventilation, and the air-filled fraction decreased 0.75 ± 0.03%, 0.71 ± 0.06%, and 0.49 ± 0.02%/Gy, respectively. Within high-dose regions, higher baseline perfusion SUV was associated with greater rate of loss. At 50 Gy and 60 Gy, the rate of loss was 1.35% (P=.07) and 1.73% (P=.05) per SUV, respectively. Of 8/20 patients with peritumoral reperfusion/reventilation during treatment, 7/8 did not sustain this effect after treatment. Conclusions: Radiation-induced regional lung functional deficits occur in a dose-dependent manner and can be estimated by simple linear models with 4D-V/Q PET

  1. Speed of collapse of the non-ventilated lung during single-lung ventilation for thoracoscopic surgery: the effect of transient increases in pleural pressure on the venting of gas from the non-ventilated lung.

    Pfitzner, J; Peacock, M J; Harris, R J


    A study of 10 anaesthetised patients placed in the lateral position for thoracoscopic surgery assessed whether transient increases in pleural pressure on the side of the non-ventilated lung might increase the speed at which gas vents from that lung. The transient increases in pleural pressure were generated by the mediastinal displacement that occurs with each inspiratory phase of positive pressure ventilation of the dependent lung. When combined with a unidirectional valve allowing gas to flow out of the non-ventilated lung, and a second valve allowing ambient airflow into, but not out of, the thoracic cavity via an initial thoracoscopy access site, this mediastinal displacement could conceivably serve to 'pump' gas out of the non-ventilated lung. Using the four different combinations of valve inclusion or omission, the volume of gas that vented from the non-ventilated lung into a measuring spirometer was recorded during a 120-s measurement sequence. It was found that the speed of venting was not increased by the transient increases in pleural pressure, and that in all but one of a total of 34 measurement sequences, venting had ceased by the end of the sequence. Gas venting was a mean (SD) of 85.5 (11.9)% complete in 25 s (five breaths), and 96.6 (6.1)% complete in 60 s. This prompt partial lung collapse very likely reflected the passive elastic recoil of the lung, while the failure of transient increases in pleural pressure to result in ongoing venting of gas was probably a consequence of airways closure as the lung collapsed. It is concluded that techniques that aim to speed lung collapse by increasing pleural pressure are unlikely to be effective.

  2. High bias gas flows increase lung injury in the ventilated preterm lamb.

    Katinka P Bach

    Full Text Available BACKGROUND: Mechanical ventilation of preterm babies increases survival but can also cause ventilator-induced lung injury (VILI, leading to the development of bronchopulmonary dysplasia (BPD. It is not known whether shear stress injury from gases flowing into the preterm lung during ventilation contributes to VILI. METHODS: Preterm lambs of 131 days' gestation (term = 147 d were ventilated for 2 hours with a bias gas flow of 8 L/min (n = 13, 18 L/min (n = 12 or 28 L/min (n = 14. Physiological parameters were measured continuously and lung injury was assessed by measuring mRNA expression of early injury response genes and by histological analysis. Control lung tissue was collected from unventilated age-matched fetuses. Data were analysed by ANOVA with a Tukey post-hoc test when appropriate. RESULTS: High bias gas flows resulted in higher ventilator pressures, shorter inflation times and decreased ventilator efficiency. The rate of rise of inspiratory gas flow was greatest, and pulmonary mRNA levels of the injury markers, EGR1 and CTGF, were highest in lambs ventilated with bias gas flows of 18 L/min. High bias gas flows resulted in increased cellular proliferation and abnormal deposition of elastin, collagen and myofibroblasts in the lung. CONCLUSIONS: High ventilator bias gas flows resulted in increased lung injury, with up-regulation of acute early response genes and increased histological lung injury. Bias gas flows may, therefore, contribute to VILI and BPD.

  3. High Bias Gas Flows Increase Lung Injury in the Ventilated Preterm Lamb

    Bach, Katinka P.; Kuschel, Carl A.; Hooper, Stuart B.; Bertram, Jean; McKnight, Sue; Peachey, Shirley E.; Zahra, Valerie A.; Flecknoe, Sharon J.; Oliver, Mark H.; Wallace, Megan J.; Bloomfield, Frank H.


    Background Mechanical ventilation of preterm babies increases survival but can also cause ventilator-induced lung injury (VILI), leading to the development of bronchopulmonary dysplasia (BPD). It is not known whether shear stress injury from gases flowing into the preterm lung during ventilation contributes to VILI. Methods Preterm lambs of 131 days’ gestation (term = 147 d) were ventilated for 2 hours with a bias gas flow of 8 L/min (n = 13), 18 L/min (n = 12) or 28 L/min (n = 14). Physiological parameters were measured continuously and lung injury was assessed by measuring mRNA expression of early injury response genes and by histological analysis. Control lung tissue was collected from unventilated age-matched fetuses. Data were analysed by ANOVA with a Tukey post-hoc test when appropriate. Results High bias gas flows resulted in higher ventilator pressures, shorter inflation times and decreased ventilator efficiency. The rate of rise of inspiratory gas flow was greatest, and pulmonary mRNA levels of the injury markers, EGR1 and CTGF, were highest in lambs ventilated with bias gas flows of 18 L/min. High bias gas flows resulted in increased cellular proliferation and abnormal deposition of elastin, collagen and myofibroblasts in the lung. Conclusions High ventilator bias gas flows resulted in increased lung injury, with up-regulation of acute early response genes and increased histological lung injury. Bias gas flows may, therefore, contribute to VILI and BPD. PMID:23056572

  4. SU-D-BRB-01: 4D-CT Lung Ventilation Images Vary with 4D-CT Sorting Techniques.

    Yamamoto, T; Kabus, S; Lorenz, C; Johnston, E; Maxim, P; Loo, B; Keall, P


    4D-CT ventilation imaging is a novel promising technique for lung functional imaging and has potential as a biomarker for radiation pneumonitis, but has not been validated in human subjects. The current 4D- CT technique with phase-based sorting results in artifacts at an alarmingly high frequency (90%), which may introduce variations into ventilation calculations. The purpose of this study was to quantify the variability of 4D- CT ventilation imaging to 4D-CT sorting techniques. Two 4D-CT images were generated from the same data set by: (1) phase-based; (2) anatomic similarity- and abdominal displacement-based sorting for five patients. Two ventilation image sets (V_phase and V_anat) were then calculated by deformable image registration of peak-exhale and peak-inhale4D-CT images and quantification of regional volume change based on Hounsfield unit change. The variability of 4D-CT ventilation imaging wasquantified using the voxel-based Spearman rank correlation coefficients and Dice similarity coefficients (DSC) for the spatial overlap of segmented low- functional lung regions. The relationship between the abdominal motionrange variation and ventilation variation was also assessed using linearregression. Furthermore, the correlations between V_phase or V_anat and SPECT ventilation images (assumed ground-truth) were compared. In general, displacement- and anatomic similarity-based sorting reduced 4D- CT artifacts compared to phase-based sorting. The voxel-based correlationsbetween V_phase and V_anat were only moderate (range, 0.57-0.77). The DSCs for the low-functional lung regions were moderate to substantial (0.58-0.70). The relationship between the motion range variation and ventilation variation was strong on average (R2=0.79±0.25), suggesting that ventilation variations are related to 4D-CT artifacts. Vanat was found to improve correlations with SPECT ventilation images compared to V_phase. 4D-CT ventilation images vary markedly with 4D-CT sorting techniques. 4

  5. Prevention of reperfusion lung injury by lidocaine in isolated rat lung ventilated with higher oxygen levels.

    Das K


    Full Text Available BACKGROUND: Lidocaine, an antiarrhythmic drug has been shown to be effective against post-ischaemic reperfusion injury in heart. However, its effect on pulmonary reperfusion injury has not been investigated. AIMS: We investigated the effects of lidocaine on a postischaemic reperfused rat lung model. MATERIALS AND METHODS: Lungs were isolated and perfused at constant flow with Krebs-Henseilet buffer containing 4% bovine serum albumin, and ventilated with 95% oxygen mixed with 5% CO2. Lungs were subjected to ischaemia by stopping perfusion for 60 minutes followed by reperfusion for 10 minutes. Ischaemia was induced in normothermic conditions. RESULTS: Postischaemic reperfusion caused significant (p < 0.0001 higher wet-to-dry lung weight ratio, pulmonary arterial pressure and peak airway pressure compared to control lungs. Lidocaine, at a dose of 5mg/Kg b.w. was found to significantly (p < 0.0001 attenuate the increase in the wet-to-dry lung weight ratio, pulmonary arterial pressure and peak airway pressure observed in post-ischaemic lungs. CONCLUSION: Lidocaine is effective in preventing post-ischaemic reperfusion injury in isolated, perfused rat lung.

  6. Pressure Dynamic Characteristics of Pressure Controlled Ventilation System of a Lung Simulator

    Yan Shi


    Full Text Available Mechanical ventilation is an important life support treatment of critically ill patients, and air pressure dynamics of human lung affect ventilation treatment effects. In this paper, in order to obtain the influences of seven key parameters of mechanical ventilation system on the pressure dynamics of human lung, firstly, mechanical ventilation system was considered as a pure pneumatic system, and then its mathematical model was set up. Furthermore, to verify the mathematical model, a prototype mechanical ventilation system of a lung simulator was proposed for experimental study. Last, simulation and experimental studies on the air flow dynamic of the mechanical ventilation system were done, and then the pressure dynamic characteristics of the mechanical system were obtained. The study can be referred to in the pulmonary diagnostics, treatment, and design of various medical devices or diagnostic systems.

  7. Effect of intermittent ventilation pretreatment on one-lung ventilation-induced lung injury in radical operation for lung cancer as well as HIF-1α/HO-1 expression

    Wen-Xiong Liu; Min Gao; Xiao-Hong Pang


    Objective:To study the effect of intermittent ventilation pretreatment on one-lung ventilation-induced lung injury in radical operation for lung cancer as well as HIF-1α/ HO-1 expression. Methods: A total of 60 patients undergoing selective radical operation for lung cancer in our hospital from March 2011 to December 2015 were selected and divided into intermittent ventilation group and conventional ventilation group, intraoperative airway function and alveolar oxygenation function were analyzed, serum was collected to determine the levels of lung injury-related molecules, and non-ventilation-side lung tissue was collected to determine the levels of lung injury-related molecules and endoplasmic reticulum stress-related molecules as well as the expression levels of HIF-1α/HO-1.Results:Ppeak, Pplat, Raw and PaO2 at T0, T1 and T2 were not significantly different between two groups, Ppeak, Pplat and Raw of intermittent ventilation group at T3 were significantly lower than those of conventional ventilation group and PaO2 was significantly higher than that of conventional ventilation group; KL-6, sRAGE and SP-A levels in serum as well as MPO, XOD, GRP78, CHOP, XBP1, ATF4, ATF6, PERK, HIF-1α and HO-1 levels in lung tissue of intermittent ventilation group were significantly lower than those of control group.Conclusion:Intermittent ventilation pretreatment can reduce one-lung ventilation-induced lung injury in radical operation for lung cancer, improve airway function and alveolar oxygenation function, and inhibit endoplasmic reticulum stress and the expression of HIF-1α/HO-1.

  8. Advanced lung ventilation system (ALVS) with linear respiratory mechanics assumption for waveform optimization of dual-controlled ventilation.

    Montecchia, F; Guerrisi, M; Canichella, A


    The present paper describes the functional features of an advanced lung ventilation system (ALVS) properly designed for the optimization of conventional dual-controlled ventilation (DCV), i.e. with pressure-controlled ventilation with ensured tidal or minute volume. Considering the particular clinical conditions of patients treated with controlled ventilation the analysis and synthesis of ALVS control have been performed assuming a linear respiratory mechanics. Moreover, new airways pressure waveforms with more physiological shape can be tested on simulators of respiratory system in order to evaluate their clinical application. This is obtained through the implementation of a compensation procedure making the desired airways pressure waveform independent on patient airways resistance and lung compliance variations along with a complete real-time monitoring of respiratory system parameters leading the ventilator setting. The experimental results obtained with a lung simulator agree with the theoretical ones and show that ALVS performance is useful for the research activity aiming at the improvement of both diagnostic evaluation and therapeutic outcome relative to mechanical ventilation treatments.

  9. Ventilation imaging of the lung: comparison of hyperpolarized helium-3 MR imaging with Xe-133 scintigraphy.

    Altes, Talissa A; Rehm, Patrice K; Harrell, Frank; Salerno, Michael; Daniel, Thomas M; De Lange, Eduard E


    To compare hyperpolarized helium-3 (HHe) magnetic resonance imaging (MRI) of the lung with standard Xe-133 lung ventilation scintigraphy. We performed a retrospective review of 15 subjects who underwent HHe MRI and Xe-133 lung ventilation imaging. Coronal MRI sections were acquired after a single inhalation of HHe gas, and standard posterior planar lung ventilation scintigraphy was performed during continuous breathing of Xe-133 gas. The first breath scintigram of each patient was compared with a composite MR image composed of the sum of the individual MR images and with the individual helium-3 MR images. Ventilation defects on the two imaging modalities were compared for size, conspicuity, and concordance in presence and location. Assessment was done separately for each of four lung quadrants. Comparing the composite HHe MR images with Xe-133 scintigraphy, ventilation defect size, conspicuity and concordance were the same in 67% (40/60), 63% (38/60), and 62% (37/60) quadrants, respectively. Comparing the individual HHe MR image sections with the Xe-133 ventilation scan, there was concordance between the ventilation defects in 27% (16/60) of quadrants. More defects were identified on the individual HHe MR images in 62% (37/60) of quadrants. There was good agreement between composite HHe MR image and first breath Xe-133 scintigraphic images, supporting the widely held assumption that HHe MRI likely depicts first breath lung ventilation.

  10. Increased interleukin-8 in epithelial lining fluid of collapsed lungs during one-lung ventilation for thoracotomy.

    Komatsu, Yoshimichi; Yamamoto, Hiroshi; Tsushima, Kenji; Furuya, Shino; Yoshikawa, Sumiko; Yasuo, Masanori; Kubo, Keishi; Yamazaki, Yoshitaka; Hasegawa, Joh; Eguchi, Takashi; Kondo, Ryuichi; Yoshida, Kazuo; Koizumi, Tomonobu


    The present study was designed to evaluate inflammatory changes in collapsed lungs during one-lung ventilation using the assistance of a bronchoscopic microsampling probe. Serial albumin and interleukin (IL)-8 concentrations in epithelial lining fluid (ELF) were measured in seven patients undergoing resection of lung tumors. The samples were taken after induction of anesthesia (baseline), 30 min after one-lung ventilation was started (point 2), just before resuming two-lung ventilation (point 3), and 30 min after two-lung ventilation was restarted (point 4). The albumin and IL-8 concentrations in ELF were significantly increased at point 2 and point 3, respectively, and remained to be high, compared to the baseline. The increase in IL-8 at point 3 was correlated with the interval of one-lung ventilation; however, none developed specific acute lung injury. These findings suggest that inflammatory changes can occur on the epithelium of a collapsed lung even in patients who underwent successful and standard thoracic surgery.

  11. Narcoanalysis of pneumonorestion with video-assisted thoracic surgery during one-lung ventilation

    Lairong Sun; Lianbing Gu


    Objective: The aim of our study was to analyze the anesthesia of pneumonoresection in lung cancer patients with video-assisted thoracic surgery during one-lung ventilation. Methods: After fast-speed venous induced anesthesia, double-lumen bronchial catheter or endobronchial blocker tube were intubated in 551 patients, the position of double-lumen endobronchial tube or single lumen tube + endobronchial blocker tube was confirmed with fiber-optic bronchoscope after intubation. Interstitial positive pressure ventilation were used in all patients with video-assisted thoracic surgery (VATS) interstitial positive pressure ventilation, positive end expiratory pressure and continuous positive airway pressure in collapse lobers of lung were used in one lung ventilation, and ventilation parameters were adjusted necessarily. Results: 541 cases double-tubes bronchial catheter intubation and endobronchial blocker tube used by fiberscope were located very well. The level of SPO2, PEtCO2 could be maintained normal. Ten cases were forced to converse video-assisted thoracic surgery to thoracotomy because of 4 cases pulmonary adhesion, 4 cases severe pulmonary dysfunction hard to correct hyoxemia and 2 case abnormal anatomy respectively. Conclusion: Anesthesia key of video-assisted thoracic surgery is that double lung must separated completely. Effective management of one lung ventilation could make patients to pass perioperation smoothly. Long-time one lung ventilation such as pulmonary adhesion, severe pulmonary dysfunction should be considered to be relative contraindication.

  12. “High Frequency/Small Tidal Volume Differential Lung Ventilation”: A Technique of Ventilating the Nondependent Lung of One Lung Ventilation for Robotically Assisted Thoracic Surgery

    Shoman, Bassam M.; Hany O. Ragab; Ammar Mustafa; Rashid Mazhar


    With the introduction of new techniques and advances in the thoracic surgery fields, challenges to the anesthesia techniques had became increasingly exponential. One of the great improvements that took place in the thoracic surgical field was the use of the robotically assisted thoracic surgical procedure and minimally invasive endoscopic thoracic surgery. One lung ventilation technique represents the core anesthetic management for the success of those surgical procedures. Even with the use o...

  13. Lung mechanics in the TIMP3 null mouse and its response to mechanical ventilation.

    Martin, Erica L; Truscott, Emily A; Bailey, Timothy C; Leco, Kevin J; McCaig, Lynda A; Lewis, James F; Veldhuizen, Ruud A W


    Tissue inhibitor of metalloproteinase-3 (TIMP3) null mice develop emphysema-like airspace enlargement due to an enzymatic imbalance. This study investigates how these abnormalities alter lung mechanics and the response to 2 different mechanical ventilation strategies. Phenotypically, TIMP3 null mice had increased compliance, and decreased resistance, tissue damping, and tissue elastance over wild-type controls. Decreased compliance and increased resistance were observed following the injurious ventilation strategy; however, the TIMP3 null response to both ventilation strategies was similar to wild-type mice. In conclusion, TIMP3 null mice have significant alterations in lung mechanics; however, this does not affect their response to ventilation.

  14. The effect of open lung ventilation on right ventricular and left ventricular function in lung-lavaged pigs

    D.R. Miranda; L. Klompe; F. Cademartiri (Filippo); J.J. Haitsma (Jack); A. Palumbo (Alessandro); B.F. Lachmann (Burkhard); A.J.J.C. Bogers (Ad); D.A.M.P.J. Gommers (Diederik); J.J.M. Takkenberg (Hanneke)


    textabstractINTRODUCTION: Ventilation according to the open lung concept (OLC) consists of recruitment maneuvers, followed by low tidal volume and high positive end-expiratory pressure, aiming at minimizing atelectasis. The minimization of atelectasis reduces the right ventricular

  15. Experimental study of acute lung injury induced by different tidal volume ventilation in rats

    ZHANG Xin-ri; DU Yong-cheng; JIANG Hong-ying; XU Jian-ying; XU Yong-jian


    @@ Mechanical ventilation (MV) is a dual blade sward which if misused could lead to lung injury, called ventilator induced lung injury (VILI). Pathogenesis of VILI is very complex with various manifestations, which is the focus in MV field in recent years.1 In our research, the rats were ventilated with different tidal volume, then the pathological changes of the lungs were observed under macroscopy, light and electronic microscope, and various laboratory tests in blood and bronchoalveolar lavage fluid (BALF) were also carried out in order to probe further the pathologic characteristics and the pathogenesis of VILI.

  16. Bronchoalveolar lavage alterations during prolonged ventilation of patients without acute lung injury.

    Tsangaris, I; Lekka, M E; Kitsiouli, E; Constantopoulos, S; Nakos, G


    Mechanical ventilation deteriorates previously injured lung, but little is known about its effect on healthy human lung. This work was designed to assess the effect of prolonged mechanical ventilation on bronchoalveolar lavage (BAL) fluid composition of patients without acute lung injury. Twenty-two ventilated patients (tidal volume 8-10 mL x kg(-1), positive end-expiratory pressure 3-5 cmH2O) without lung injury, who did not develop any complication from the respiratory system during the 2-week study period, were studied. They were subjected to three consecutive BALs, the first during 36 h from intubation, the second at the end of the first week of mechanical ventilation and the third at the end of the second week of mechanical ventilation. Total BAL protein increased during mechanical ventilation (148 +/- 62, 381 +/- 288, 353 +/- 215 microg x mL(-1) BAL for the first, second and third BAL, respectively). In contrast, BAL phospholipids decreased (2.7 +/- 1.1, 1.4 +/- 0.6, 1.2 +/- 0.7 microg x mL(-1) BAL, respectively). Large surfactant aggregates were reduced and inflammatory markers, such as platelet activating factor (PAF), PAF-acetylhydrolase and neutrophils, significantly increased after 1 week, but partially remitted after 2 weeks of mechanical ventilation. In summary, this study demonstrates that prolonged mechanical ventilation even of patients without acute lung injury is associated with the presence of inflammatory markers and surfactant alterations.

  17. [A complete ventilation-perfusion mismatch following one-sided lung transplantation and postoperative hemothorax].

    Jellinek, H; Klepetko, W; Hiesmayr, M


    Eight days after single-lung transplantation for pulmonary hypertension, a patient presented with a hemothorax on the side of the transplanted lung that required acute thoracotomy. Pulmonary artery pressure had decreased from 78/32/58 mmHg prior to the transplant to 42/18/27 mmHg on the 2nd postoperative day. Therefore, a predominance of perfusion to the transplanted lung was expected. During induction of anesthesia, in spite of ventilation with pure oxygen the patient developed a hypoxic cardiac arrest (paO2 26 mmHg, 40% saturation measured by pulse oximetry) requiring external chest compression. Auscultation and chest movements suggested that the transplanted lung was not ventilated. Because blood flow went mainly to the transplanted lung, ventilation of the native lung was almost totally dead-space ventilation. To enable ventilation of the compressed transplanted lung, the patient was intubated using a single-lumen bronchial blocker tube to block the mainstem bronchus of the native lung. The transplanted lung could then be ventilated. Saturation increased and epinephrine re-established a stable circulation; 2500 ml blood were removed from the pleura without further complications. On the 7th postoperative day the patient was discharged from the intensive care unit without neurological deficits. A perfusion scan 28 days post-transplant revealed 89% of the perfusion going to the transplanted lung. Atelectasis of this lung resulted in a large intrapulmonary right-to-left shunt. Hypoxic pulmonary vasoconstriction could not ameliorate the shunt because of the high pulmonary vascular resistance of the native lung.(ABSTRACT TRUNCATED AT 250 WORDS)

  18. Ventilation and Perfusion Lung Scintigraphy of Allergen-Induced Airway Responses in Atopic Asthmatic Subjects

    Krishnan Parameswaran


    Full Text Available BACKGROUND: Both ventilation (V and perfusion (Q of the lungs are altered in asthma, but their relationships with allergen-induced airway responses and gas exchange are not well described.

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

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


    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

  20. Prolonged mechanical ventilation induces cell cycle arrest in newborn rat lung

    Kroon, A.A.; Wang, J.; Kavanagh, B.; Huang, Z.; Kuliszewski, M.; van Goudoever, J.B.; Post, M.


    The molecular mechanism(s) by which mechanical ventilation disrupts alveolar development, a hallmark of bronchopulmonary dysplasia, is unknown. To determine the effect of 24 h of mechanical ventilation on lung cell cycle regulators, cell proliferation and alveolar formation in newborn rats.

  1. Prolonged mechanical ventilation induces cell cycle arrest in newborn rat lung

    A.A. Kroon (Abraham); J. Wang (Jinxia); B. Kavanagh (Brian); Z. Huang (Zhen); M. Kuliszewski (Maciej); J.B. van Goudoever (Hans); M.R. Post (Martin)


    textabstractRationale: The molecular mechanism(s) by which mechanical ventilation disrupts alveolar development, a hallmark of bronchopulmonary dysplasia, is unknown. Objective: To determine the effect of 24 h of mechanical ventilation on lung cell cycle regulators, cell proliferation and alveolar f

  2. The receptor for advanced glycation end products in ventilator-induced lung injury

    Kuipers, Maria T; Aslami, Hamid; Tuinman, Pieter Roel; Tuip-de Boer, Anita M; Jongsma, Geartsje; van der Sluijs, Koenraad F; Choi, Goda; Wolthuis, Esther K; Roelofs, Joris Jth; Bresser, Paul; Schultz, Marcus J; van der Poll, Tom; Wieland, Catharina W


    BACKGROUND: Mechanical ventilation (MV) can cause ventilator-induced lung injury (VILI). The innate immune response mediates this iatrogenic inflammatory condition. The receptor for advanced glycation end products (RAGE) is a multiligand receptor that can amplify immune and inflammatory responses. W

  3. 单肺通气期间通气策略的研究进展%Progress of the lung protective ventilation strategy during one-lung ventilation

    王稳; 李成辉


    Background The lung protective ventilation strategy (LPVS) is a kind of mechanical ventilation strategies put forward in recent years.Thus,anesthesiologists have gradually attached importance to its role in one-lung ventilation (OLV).Objective To promote the understanding of LPVS during OLV in recent years.Content To review the progress of the LPVS during OLV in recent years.Trend The LPVS would be beneficial to clinical anesthesia during OLV.%背景 保护性肺通气策略(lung protective ventilation strategy,LPVS)是近几年提出的一种机械通气策略,近年来该策略在单肺通气(one-lung ventilation,OLV)中的应用正逐渐受到麻醉医师的重视. 目的 推进近年来对OLV期间保护性通气策略的认识. 内容 分析近年来OLV期间不同LPVS的研究进展. 趋向 为临床麻醉中OLV期间通气策略的选择提供一定的参考.

  4. A comparison of biologically variable ventilation to recruitment manoeuvres in a porcine model of acute lung injury

    Rector Edward S


    Full Text Available Abstract Background Biologically variable ventilation (return of physiological variability in rate and tidal volume using a computer-controller was compared to control mode ventilation with and without a recruitment manoeuvre – 40 cm H2O for 40 sec performed hourly; in a porcine oleic acid acute lung injury model. Methods We compared gas exchange, respiratory mechanics, and measured bronchoalveolar fluid for inflammatory cytokines, cell counts and surfactant function. Lung injury was scored by light microscopy. Pigs received mechanical ventilation (FIO2 = 0.3; PEEP 5 cm H2O in control mode until PaO2 decreased to 60 mm Hg with oleic acid infusion (PaO2/FIO2 2O was added after injury. Animals were randomized to one of the 3 modes of ventilation and followed for 5 hr after injury. Results PaO2 and respiratory system compliance was significantly greater with biologically variable ventilation compared to the other 2 groups. Mean and mean peak airway pressures were also lower. There were no differences in cell counts in bronchoalveolar fluid by flow cytometry, or interleukin-8 and -10 levels between groups. Lung injury scoring revealed no difference between groups in the regions examined. No differences in surfactant function were seen between groups by capillary surfactometry. Conclusions In this porcine model of acute lung injury, various indices to measure injury or inflammation did not differ between the 3 approaches to ventilation. However, when using a low tidal volume strategy with moderate levels of PEEP, sustained improvements in arterial oxygen tension and respiratory system compliance were only seen with BVV when compared to CMV or CMV with a recruitment manoeuvre.

  5. Detection of early subclinical lung disease in children with cystic fibrosis by lung ventilation imaging with hyperpolarised gas MRI.

    Marshall, Helen; Horsley, Alex; Taylor, Chris J; Smith, Laurie; Hughes, David; Horn, Felix C; Swift, Andrew J; Parra-Robles, Juan; Hughes, Paul J; Norquay, Graham; Stewart, Neil J; Collier, Guilhem J; Teare, Dawn; Cunningham, Steve; Aldag, Ina; Wild, Jim M


    Hyperpolarised (3)He ventilation-MRI, anatomical lung MRI, lung clearance index (LCI), low-dose CT and spirometry were performed on 19 children (6-16 years) with clinically stable mild cystic fibrosis (CF) (FEV1>-1.96), and 10 controls. All controls had normal spirometry, MRI and LCI. Ventilation-MRI was the most sensitive method of detecting abnormalities, present in 89% of patients with CF, compared with CT abnormalities in 68%, LCI 47% and conventional MRI 22%. Ventilation defects were present in the absence of CT abnormalities and in patients with normal physiology, including LCI. Ventilation-MRI is thus feasible in young children, highly sensitive and provides additional information about lung structure-function relationships. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  6. Reducing ventilator-induced lung injury and other organ injury by the prone position

    Suter, Peter M


    Mechanical ventilation can cause structural and functional disturbances in the lung, as well as other vital organ dysfunctions. Apoptosis is thought to be a histological sign of distant organ damage in ventilator-induced lung injury (VILI). Nakos and colleagues observed a protective effect of prone positioning against VILI in normal sheep. Less alteration in the lung architecture and function and in liver transaminases, and lower indices for apoptosis in the liver, the diaphragm and the lung were noted in the prone position compared with the supine position. If confirmed, these data open a new hypothesis for pathogenesis and prevention of VILI and its extrapulmonary complications. PMID:16677405

  7. Variability in EIT Images of Lung Ventilation as a Function of Electrode Planes and Body Positions.

    Zhang, Jie; Patterson, Robert


    This study is aimed at investigating the variability in resistivity changes in the lung region as a function of air volume, electrode plane and body position. Six normal subjects (33.8 ± 4.7 years, range from 26 to 37 years) were studied using the Sheffield Electrical Impedance Tomography (EIT) portable system. Three transverse planes at the level of second intercostal space, the level of the xiphisternal joint, and midway between upper and lower locations were chosen for measurements. For each plane, sixteen electrodes were uniformly positioned around the thorax. Data were collected with the breath held at end expiration and after inspiring 0.5, 1.0, or 1.5 liters of air from end expiration, with the subject in both the supine and sitting position. The average resistivity change in five regions, two 8x8 pixel local regions in the right lung, entire right, entire left and total lung regions, were calculated. The results show the resistivity change averaged over electrode positions and subject positions was 7-9% per liter of air, with a slightly larger resistivity change of 10 % per liter air in the lower electrode plane. There was no significant difference (p>0.05) between supine and sitting. The two 8x8 regions show a larger inter individual variability (coefficient of variation, CV, is from 30% to 382%) compared to the entire left, entire right and total lung (CV is from 11% to 51%). The results for the global regions are more consistent. The large inter individual variability appears to be a problem for clinical applications of EIT, such as regional ventilation. The variability may be mitigated by choosing appropriate electrode plane, body position and region of interest for the analysis.

  8. Comparison of the effect of lps and pam3 on ventilated lungs

    Goldmann Torsten


    Full Text Available Abstract Background While lipopolysaccharide (LPS from Gram-negative bacteria has been shown to augment inflammation in ventilated lungs information on the effect of Gram-positive bacteria is lacking. Therefore the effect of LPS and a lipopetide from Gram-positive bacteria, PAM3, on ventilated lungs were investigated. Methods C57/Bl6 mice were mechanically ventilated. Sterile saline (sham and different concentrations of LPS (1 μg and 5 μg and PAM3 (50 nM and 200 nM were applied intratracheally. Lung function parameters and expression of MIP-2 and TNFα as well as influx of neutrophils were measured. Results Mechanical ventilation increased resistance and decreased compliance over time. PAM3 but not LPS significantly increased resistance compared to sham challenge (P Conclusions These data suggest that PAM3 similar to LPS enhances ventilator-induced inflammation. Moreover, PAM3 but not LPS increases pulmonary resistance in ventilated lungs. Further studies are warranted to define the role of lipopetides in ventilator-associated lung injury.

  9. Total liquid ventilation reduces oleic acid-induced lung injury in piglets

    ZHU Yao-bin; LIU Dong-hai; ZHANG Yan-bo; LIU Ai-jun; FAN Xiang-ming; QIAO Chen-hui; WANG Qiang


    Background Pediatric patients are susceptible to lung injury that does not respond to traditional therapies.Total liquid ventilation has been developed as an alternative ventilatory strategy for severe lung injury.The aim of this study is to investigate the effect of total liquid ventilation on oleic acid (OA)-induced lung injury in piglets.Methods Twelve Chinese immature piglets were induced acute lung injury by OA.Twelve piglets were randomly treated with conventional gas ventilation (control group) or total liquid ventilation (study group) for 240 minutes.Samples for blood gas analysis were collected before,and at 60-minute intervals after OA-induced lung injury.The degree of lung injury was quantified by histologic examination.The inflammatory cells and the levels of IL-1β,IL-6,IL-10 and TNF-α in plasma,tissue and bronchoalveolar lavage were analyzed.Results Neutrophil and macrophage counts in bronchoalveolar lavage were significantly decreased in the study group (P<0.05).The total lung injury score was also reduced in the study group (P<0.05).The cconcentrations of IL-1β,IL-6,IL-10and TNF-α in plasma,tissue and bronchoalveolar lavage were significantly reduced in the study group (P<0.05).Conclusions Total liquid ventilation reduces biochemical and histologic OA-induced lung injury in piglets.

  10. Reporting ventilation-perfusion lung scintigraphy: impact on subsequent use of anticoagulation therapy.

    Kaboli, P.; Buscombe, J. R.; Ell, P J


    Ventilation and perfusion lung scintigraphy is an established and safe noninvasive technique which has been used for nearly 30 years to establish the diagnosis of pulmonary embolism. Recently, in common with other diagnostic tests, there has arisen the need to reassess the effectiveness of this test in the clinical setting. A retrospective analysis of 244 patients undergoing ventilation-perfusion lung scintigraphy was performed. A total of 203 case notes were available. It was found that the ...

  11. Regional lung perfusion estimated by electrical impedance tomography in a piglet model of lung collapse.

    Borges, João Batista; Suarez-Sipmann, Fernando; Bohm, Stephan H; Tusman, Gerardo; Melo, Alexandre; Maripuu, Enn; Sandström, Mattias; Park, Marcelo; Costa, Eduardo L V; Hedenstierna, Göran; Amato, Marcelo


    The assessment of the regional match between alveolar ventilation and perfusion in critically ill patients requires simultaneous measurements of both parameters. Ideally, assessment of lung perfusion should be performed in real-time with an imaging technology that provides, through fast acquisition of sequential images, information about the regional dynamics or regional kinetics of an appropriate tracer. We present a novel electrical impedance tomography (EIT)-based method that quantitatively estimates regional lung perfusion based on first-pass kinetics of a bolus of hypertonic saline contrast. Pulmonary blood flow was measured in six piglets during control and unilateral or bilateral lung collapse conditions. The first-pass kinetics method showed good agreement with the estimates obtained by single-photon-emission computerized tomography (SPECT). The mean difference (SPECT minus EIT) between fractional blood flow to lung areas suffering atelectasis was -0.6%, with a SD of 2.9%. This method outperformed the estimates of lung perfusion based on impedance pulsatility. In conclusion, we describe a novel method based on EIT for estimating regional lung perfusion at the bedside. In both healthy and injured lung conditions, the distribution of pulmonary blood flow as assessed by EIT agreed well with the one obtained by SPECT. The method proposed in this study has the potential to contribute to a better understanding of the behavior of regional perfusion under different lung and therapeutic conditions.

  12. Analysis of the dynamic states of pulmonary ventilation and perfusion in bronchial asthmatics using (133)Xe gas ventilation scintigraphy and (99m)Tc-MAA lung perfusion scintigraphy



    To clarify the organic changes and pathophysiology of the lungs in intractable asthmatics, the dynamic states of pulmonary ventilation and perfusion were analyzed in 15 bronchial asthmatic in the stable state using (133)Xe gas ventilation scintigraphy and (99m)Tc-MAA lung perfusion scintigraphy, respectively. Dysfunction of pulmonary ventilation and impairment of pulmonary perfusin were significantly severer in intractable asthmatics than in non-intractable asthmatics (p

  13. Lung Motion Model Validation Experiments, Free-Breathing Tissue Densitometry, and Ventilation Mapping using Fast Helical CT Imaging

    Dou, Hsiang-Tai

    The uncertainties due to respiratory motion present significant challenges to accurate characterization of cancerous tissues both in terms of imaging and treatment. Currently available clinical lung imaging techniques are subject to inferior image quality and incorrect motion estimation, with consequences that can systematically impact the downstream treatment delivery and outcome. The main objective of this thesis is the development of the techniques of fast helical computed tomography (CT) imaging and deformable image registration for the radiotherapy applications in accurate breathing motion modeling, lung tissue density modeling and ventilation imaging. Fast helical CT scanning was performed on 64-slice CT scanner using the shortest available gantry rotation time and largest pitch value such that scanning of the thorax region amounts to just two seconds, which is less than typical breathing cycle in humans. The scanning was conducted under free breathing condition. Any portion of the lung anatomy undergoing such scanning protocol would be irradiated for only a quarter second, effectively removing any motion induced image artifacts. The resulting CT data were pristine volumetric images that record the lung tissue position and density in a fraction of the breathing cycle. Following our developed protocol, multiple fast helical CT scans were acquired to sample the tissue positions in different breathing states. To measure the tissue displacement, deformable image registration was performed that registers the non-reference images to the reference one. In modeling breathing motion, external breathing surrogate signal was recorded synchronously with the CT image slices. This allowed for the tissue-specific displacement to be modeled as parametrization of the recorded breathing signal using the 5D lung motion model. To assess the accuracy of the motion model in describing tissue position change, the model was used to simulate the original high-pitch helical CT scan

  14. Effect of Minimally Invasive Surfactant Therapy on Lung Volume and Ventilation in Preterm Infants.

    van der Burg, Pauline S; de Jongh, Frans H; Miedema, Martijn; Frerichs, Inez; van Kaam, Anton H


    To assess the changes in (regional) lung volume and gas exchange during minimally invasive surfactant therapy (MIST) in preterm infants with respiratory distress syndrome. In this prospective observational study, infants requiring a fraction of inspired oxygen (FiO2) ≥ 0.30 during nasal continuous positive airway pressure of 6 cmH2O were eligible for MIST. Surfactant (160-240 mg/kg) was administered in supine position in 1-3 minutes via an umbilical catheter placed 2 cm below the vocal cords. Changes in end-expiratory lung volume (EELV), tidal volume, and its distribution were recorded continuously with electrical impedance tomography before and up to 60 minutes after MIST. Changes in transcutaneous oxygen saturation (SpO2) and partial carbon dioxide pressure, FiO2, respiratory rate, and minute ventilation were recorded. A total of 16 preterm infants were included. One patient did not finish study protocol because of severe apnea 10 minutes after MIST. In the remaining infants (gestational age 29.8 ± 2.8 weeks, body weight 1545 ± 481 g) EELV showed a rapid and sustained increase, starting in the dependent lung regions, followed by the nondependent regions approximately 5 minutes later. Oxygenation, expressed as the SpO2/FiO2 ratio, increased from 233 (IQR 206-257) to 418 (IQR 356-446) after 60 minutes (P transcutaneous partial carbon dioxide pressure was comparable with pre-MIST values. Ventilation distribution remained unchanged. MIST results in a rapid and homogeneous increase in EELV, which is associated with an improvement in oxygenation. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Adult patient with pulmonary agenesis: focusing on one-lung ventilation during general anesthesia.

    Yu, Yuetian; Zhu, Cheng; Qian, Xiaozhe; Gao, Yuan; Zhang, Zhongheng


    Congenital pulmonary agenesis is a rare condition with high mortality. Mechanical ventilation in these patients is challenging and there has no such case been reported in the literature. We reported a 61-year-old female with lung agenesis who presented to our hospital with pneumonia and pelvic mass. In the past, she had undergone repairing of atrial septal defect and mitral valve forming surgery at 6-year-old. Thereafter she had remained asymptomatic until this time of hospital admission. The patient underwent operation for the pelvic mass with one-lung ventilation (OLV) under general anesthesia. We highlighted the use of protective ventilation (PV) strategy during OLV.

  16. One lung ventilation strategies for infants and children undergoing video assisted thoracoscopic surgery

    Teddy Suratos Fabila


    Full Text Available The advantages of video assisted thoracoscopic surgery (VATS in children have led to its increased usage over the years. VATS, however, requires an efficient technique for one lung ventilation. Today, there is an increasing interest in developing the technique for lung isolation to meet the anatomic and physiologic variations in infants and children. This article aims to provide an updated and comprehensive review on one-lung ventilation strategies for infants and children undergoing VATS. Search of terms such as ′One lung ventilation for infants and children′, ′Video assisted thoracoscopic surgery for infants and children′, and ′Physiologic changes during one lung ventilation for infants and children′ were used. The search mechanics and engines for this review included the following: Kandang Kerbau Hospital (KKH eLibrary, PubMed, Ovid Medline, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews. During the search the author focused on significant current and pilot randomized control trials, case reports, review articles, and editorials. Critical decision making on what device to use based on the age, weight, and pathology of the patient; and how to use it for lung isolation are discussed in this article. Furthermore, additional information regarding the advantages, limitations, techniques of insertion and maintenance of each device for one lung ventilation in infants and children were the highlights in this article.

  17. SU-E-J-149: Establishing the Relationship Between Pre-Treatment Lung Ventilation, Dose, and Toxicity Outcome

    Mistry, N; D' Souza, W [University of Maryland School of Medicine, Baltimore, MD (United States); Sornsen de Koste, J; Senan, S [VU University Medical Center, Amsterdam, MB (Netherlands)


    Purpose: Recently, there has been an interest in incorporating functional information in treatment planning especially in thoracic tumors. The rationale is that healthy lung regions need to be spared from radiation if possible to help achieve better control on toxicity. However, it is still unclear whether high functioning regions need to be spared or have more capacity to deal with the excessive radiation as compared to the compromised regions of the lung. Our goal with this work is to establish the tools by which we can establish a relationship between pre-treatment lung function, dose, and radiographic outcomes of lung toxicity. Methods: Treatment planning was performed using a single phase of a 4DCT scan, and follow-up anatomical CT scans were performed every 3 months for most patients. In this study, we developed the pipeline of tools needed to analyze such a large dataset, while trying to establish a relationship between function, dose, and outcome. Pre-treatment lung function was evaluated using a recently published technique that evaluates Fractional Regional Ventilation (FRV). All images including the FRV map and the individual follow-up anatomical CT images were all spatially matched to the planning CT using a diffusion based Demons image registration algorithm. Change in HU value was used as a metric to capture the effects of lung toxicity. To validate the findings, a radiologist evaluated the follow-up anatomical CT images and scored lung toxicity. Results: Initial experience in 1 patient shows a relationship between the pre-treatment lung function, dose and toxicity outcome. The results are also correlated to the findings by the radiologist who was blinded to the analysis or dose. Conclusion: The pipeline we have established to study this enables future studies in large retrospective studies. However, the tools are dependent on the fidelity of 4DCT reconstruction for accurate evaluation of regional ventilation. Patent Pending for the technique

  18. Distribution of ventilation/perfusion ratios in pulmonary embolism: an adjunct to the interpretation of ventilation/perfusion lung scans.

    Itti, Emmanuel; Nguyen, Séverine; Robin, Fabrice; Desarnaud, Serge; Rosso, Jean; Harf, Alain; Meignan, Michel


    Diagnosis of pulmonary embolism (PE) by visual interpretation of ventilation/perfusion (V/Q) scans is limited by the high percentages of patients classified in the intermediate- and low-probability categories. This study proposes a quantitative analysis of the distribution of V/Q ratios to better identify patients with PE. We studied 99 consecutive patients who underwent dual-isotope (81m)Kr/(99m)Tc-macroaggregate V/Q scanning and arterial blood gas analysis within 48 h. The 8-view V/Q scans were visually analyzed by 2 observers according to the revised criteria of the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) (normal scan or low, intermediate, or high probability of PE). Quantitative analysis of the posterior-view distribution histogram of V/Q ratios was performed using dedicated software. Briefly, regions of interest were drawn around the lungs on the matched V/Q images, smooth filtering was applied, normalized regional V/Q ratios were calculated within each pixel, and a distribution histogram was built. Patients with normal scans (n = 16) had a predominance of V/Q ratios (63.3% +/- 13.0%) between 0.8 and 1.2. They had only 9.8% +/- 5.8% of ratios > 1.2, and the remaining 26.9% +/- 7.5% of ratios were 1.2) and a significant increase (34.5% +/- 8.2%, P = 0.003) in low V/Q ratios (PIOPED probability of PE, 21.3% +/- 11.0% and 37.5% +/- 9.2%, respectively. Within the nondiagnostic group (intermediate- + low-probability scans, n = 58), 17 patients were finally diagnosed with PE. Analysis of the distribution histogram in this group allowed the identification of 5 patients with PE (specificity, 78%). A quantitative approach to lung scan interpretation, based on the distribution histogram of V/Q ratios, may be helpful for categorizing patients with suspected PE.

  19. Suspended animation inducer hydrogen sulfide is protective in an in vivo model of ventilator-induced lung injury

    Aslami, H.; Heinen, A.; Roelofs, J.J.T.H.; Zuurbier, C.J.; Schultz, M.J.; Juffermans, N.P.


    Acute lung injury is characterized by an exaggerated inflammatory response and a high metabolic demand. Mechanical ventilation can contribute to lung injury, resulting in ventilator-induced lung injury (VILI). A suspended-animation-like state induced by hydrogen sulfide (H2S) protects against hypoxi

  20. Suspended animation inducer hydrogen sulfide is protective in an in vivo model of ventilator-induced lung injury

    Aslami, H.; Heinen, A.; Roelofs, J.J.T.H.; Zuurbier, C.J.; Schultz, M.J.; Juffermans, N.P.


    Acute lung injury is characterized by an exaggerated inflammatory response and a high metabolic demand. Mechanical ventilation can contribute to lung injury, resulting in ventilator-induced lung injury (VILI). A suspended-animation-like state induced by hydrogen sulfide (H2S) protects against

  1. Genetic targets of hydrogen sulfide in ventilator-induced lung injury--a microarray study.

    Sashko Spassov

    Full Text Available Recently, we have shown that inhalation of hydrogen sulfide (H2S protects against ventilator-induced lung injury (VILI. In the present study, we aimed to determine the underlying molecular mechanisms of H2S-dependent lung protection by analyzing gene expression profiles in mice. C57BL/6 mice were subjected to spontaneous breathing or mechanical ventilation in the absence or presence of H2S (80 parts per million. Gene expression profiles were determined by microarray, sqRT-PCR and Western Blot analyses. The association of Atf3 in protection against VILI was confirmed with a Vivo-Morpholino knockout model. Mechanical ventilation caused a significant lung inflammation and damage that was prevented in the presence of H2S. Mechanical ventilation favoured the expression of genes involved in inflammation, leukocyte activation and chemotaxis. In contrast, ventilation with H2S activated genes involved in extracellular matrix remodelling, angiogenesis, inhibition of apoptosis, and inflammation. Amongst others, H2S administration induced Atf3, an anti-inflammatory and anti-apoptotic regulator. Morpholino mediated reduction of Atf3 resulted in elevated lung injury despite the presence of H2S. In conclusion, lung protection by H2S during mechanical ventilation is associated with down-regulation of genes related to oxidative stress and inflammation and up-regulation of anti-apoptotic and anti-inflammatory genes. Here we show that Atf3 is clearly involved in H2S mediated protection.

  2. Nitric oxide synthase 3 contributes to ventilator-induced lung injury

    Vaporidi, Katerina; Francis, Roland C.; Bloch, Kenneth D.


    Nitric oxide synthase (NOS) depletion or inhibition reduces ventilator-induced lung injury (VILI), but the responsible mechanisms remain incompletely defined. The aim of this study was to elucidate the role of endothelial NOS, NOS3, in the pathogenesis of VILI in an in vivo mouse model. Wild-type and NOS3-deficient mice were ventilated with high-tidal volume (HVT; 40 ml/kg) for 4 h, with and without adding NO to the inhaled gas. Additional wild-type mice were pretreated with tetrahydrobiopterin and ascorbic acid, agents that can prevent NOS-generated superoxide production. Arterial blood gas tensions, histology, and lung mechanics were evaluated after 4 h of HVT ventilation. The concentration of protein, IgM, cytokines, malondialdehyde, and 8-isoprostane were measured in bronchoalveolar lavage fluid (BALF). Myeloperoxidase activity, total and oxidized glutathione levels, and NOS-derived superoxide production were measured in lung tissue homogenates. HVT ventilation induced VILI in wild-type mice, as reflected by decreased lung compliance, increased concentrations of protein and cytokines in BALF, and oxidative stress. All indices of VILI were ameliorated in NOS3-deficient mice. Augmenting pulmonary NO levels by breathing NO during mechanical ventilation did not increase lung injury in NOS3-deficient mice. HVT ventilation increased NOS-inhibitable superoxide production in lung extracts from wild-type mice but not in those from NOS3-deficient mice. Administration of tetrahydrobiopterin and ascorbic acid ameliorated VILI in wild-type mice. Our results indicate that NOS3 contributes to ventilator-induced lung injury via increased production of superoxide. PMID:20453164

  3. Perfusion and ventilation filters for Fourier-decomposition MR lung imaging.

    Wujcicki, Artur; Corteville, Dominique; Materka, Andrzej; Schad, Lothar R


    MR imaging without the use of contrast agents has recently been used for creating perfusion and ventilation functional lung images. The technique incorporates frequency- or wavelet-domain filters to separate the MR signal components. This paper presents a new, subject-adaptive algorithm for perfusion and ventilation filters design. The proposed algorithm uses a lung signal model for separation of the signal components in the frequency domain. Non-stationary lung signals are handled by a short time Fourier transform. This method was applied to sets of 192 and 90 co-registered non-contrast MR lung images measured for five healthy subjects at the rate of 3,33 images per second, using different slice thicknesses. In each case, the resulted perfusion and ventilation images showed a smaller amount of mutual information, when compared to those obtained using the known lowpass/highpass filter approach.

  4. Perfusion and ventilation filters for Fourier-decomposition MR lung imaging

    Wujcicki, Artur; Materka, Andrzej [Lodz University of Technology (Poland). Inst. of Electronics; Corteville, Dominique; Schad, Lothar R. [Heidelberg Univ., Mannheim (Germany). Computer Assisted Clinical Medicine


    MR imaging without the use of contrast agents has recently been used for creating perfusion and ventilation functional lung images. The technique incorporates frequency- or wavelet-domain filters to separate the MR signal components. This paper presents a new, subject-adaptive algorithm for perfusion and ventilation filters design. The proposed algorithm uses a lung signal model for separation of the signal components in the frequency domain. Non-stationary lung signals are handled by a short time Fourier transform. This method was applied to sets of 192 and 90 co-registered non-contrast MR lung images measured for five healthy subjects at the rate of 3,33 images per second, using different slice thicknesses. In each case, the resulted perfusion and ventilation images showed a smaller amount of mutual information, when compared to those obtained using the known lowpass/highpass filter approach.

  5. Effect of low tidal volume ventilation on lung function and inflammation in mice

    Goldmann Torsten


    Full Text Available Abstract Background A large number of studies have investigated the effects of high tidal volume ventilation in mouse models. In contrast data on very short term effects of low tidal volume ventilation are sparse. Therefore we investigated the functional and structural effects of low tidal volume ventilation in mice. Methods 38 Male C57/Bl6 mice were ventilated with different tidal volumes (Vt 5, 7, and 10 ml/kg without or with application of PEEP (2 cm H2O. Four spontaneously breathing animals served as controls. Oxygen saturation and pulse rate were monitored. Lung function was measured every 5 min for at least 30 min. Afterwards lungs were removed and histological sections were stained for measurement of infiltration with polymorphonuclear leukocytes (PMN. Moreover, mRNA expression of macrophage inflammatory protein (MIP-2 and tumor necrosis factor (TNFα in the lungs was quantified using real time PCR. Results Oxygen saturation did not change significantly over time of ventilation in all groups (P > 0.05. Pulse rate dropped in all groups without PEEP during mechanical ventilation. In contrast, in the groups with PEEP pulse rate increased over time. These effects were not statistically significant (P > 0.05. Tissue damping (G and tissue elastance (H were significantly increased in all groups after 30 min of ventilation (P 0.05. Mechanical ventilation significantly increased infiltration of the lungs with PMN (P Conclusions Our data show that very short term mechanical ventilation with lower tidal volumes than 10 ml/kg did not reduce inflammation additionally. Formation of atelectasis and inadequate oxygenation with very low tidal volumes may be important factors. Application of PEEP attenuated inflammation.

  6. Frequency dependence of lung volume changes during superimposed high-frequency jet ventilation and high-frequency jet ventilation.

    Sütterlin, R; Priori, R; Larsson, A; LoMauro, A; Frykholm, P; Aliverti, A


    Superimposed high-frequency jet ventilation (SHFJV) has proved to be safe and effective in clinical practice. However, it is unclear which frequency range optimizes ventilation and gas exchange. The aim of this study was to systematically compare high-frequency jet ventilation (HFJV) with HFJV by assessing chest wall volume variations (ΔEEV(CW)) and gas exchange in relation to variable high frequency. SHFJV or HFJV were used alternatively to ventilate the lungs of 10 anaesthetized pigs (21-25 kg). The low-frequency component was kept at 16 min(-1) in SHFJV. In both modes, high frequencies ranging from 100 to 1000 min(-1) were applied in random order and ventilation was maintained for 5 min in all modalities. Chest wall volume variations were obtained using opto-electronic plethysmography. Airway pressures and arterial blood gases were measured repeatedly. SHFJV increased ΔEEV(CW) compared with HFJV; the difference ranged from 43 to 68 ml. Tidal volume (V(T)) was always >240 ml during SHFJV whereas during HFJV ranged from 92 ml at the ventilation frequency of 100 min(-1) to negligible values at frequencies >300 min(-1). We observed similar patterns for Pa(O₂) and Pa(CO₂). SHFJV provided generally higher, frequency-independent oxygenation (Pa(O₂) at least 32.0 kPa) and CO₂ removal (Pa(CO₂) ∼5.5 kPa), whereas HFJV led to hypoxia and hypercarbia at higher rates (Pa(O₂) 10 kPa at f(HF)>300 min(-1)). In a porcine model, SHFJV was more effective in increasing end-expiratory volume than single-frequency HFJV, but both modes may provide adequate ventilation in the absence of airway obstruction and respiratory disease, except for HFJV at frequencies ≥300 min(-1).

  7. Anesthesia in an adult patient with tracheal hemangiomas: one-lung ventilation for lung lobectomy.

    Tsujikawa, Shogo; Okutani, Ryu; Oda, Yutaka


    Primary tracheal tumors are rare in adults, and careful airway management is required during anesthesia for affected patients. We report the case of a patient with tracheal hemangiomas undergoing nontracheal operation. A 61-year-old woman was scheduled for a lung operation. During preoperative examination, hemangiomas were detected on the tracheal mucosa. As she was asymptomatic and the degree of airway stenosis was small, treatment was not required for the hemangiomas, and left upper lobectomy for lung cancer was scheduled. After induction of general anesthesia, a regular tracheal tube was inserted under fiberoptic bronchoscopy, with care taken to prevent damage to the hemangiomas. An endobronchial blocker was inserted for one-lung ventilation. The operation was performed uneventfully, and the tracheal tube was replaced postoperatively with a laryngeal mask airway while the patient was under deep anesthesia and neuromuscular blockade. The mask was removed after confirming lack of bleeding from the hemangiomas. No hypoxia or other complications occurred during or after the operation.

  8. Measurement of lung tissue dynamics in artificially ventilated rats with optical coherence tomography

    Schnabel Christian


    Full Text Available Diseases of lung tissue and the airways become a major task for medical care and health care systems in modern industrial countries in the future. Suitable treatment methods and strategies for lung support and artificial ventilation are of dare need. Besides the obvious importance as life-saving intervention, the effects of usually used over-pressure ventilation onto the sensitive alveolar tissue are insufficiently understood. Therefore, it is of great interest to characterize lung tissue during artificial ventilation at the alveolar level. Those measurements can be used to link micromechanics of alveolar structures to mechanical properties of the whole lung like compliance and resistance measured at the ventilator device. This can be done only in animal experiments due to the fact that imaging techniques used in human diagnostics like CT or MRT fail to resolve alveolar tissue structures. The disadvantage of high-resolution techniques like optical coherence tomography (OCT or intravital microscopy (IVM is the need of a surgical access to the lung due to the limitation in penetration depth of these techniques. Furthermore, imaging dynamic processes with high-resolution imaging techniques during uninterrupted artificial ventilation is a challenging task. In this study, we present a measurement setup for combined imaging of conventional pressure-controlled ventilated rats and the visualization of volume changes of alveolar structures during one cycle of breath. A custom-made OCT system in combination with a triggered scanning algorithm was used to acquire time-resolved 3D OCT image data. Furthermore, this system was combined with a self-adapting autofocus function for intravital microscopy to track the lung surface keeping the tissue in focal plane. The combination of new dynamic measurement modes for OCT and IVM allows new insights into alveolar tissue and will promote the understanding of mechanical behavior during artificial ventilation.

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

    Dongkai Shen


    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.

  10. Salidroside Attenuates Ventilation Induced Lung Injury via SIRT1-Dependent Inhibition of NLRP3 Inflammasome

    Yan Wang


    Full Text Available Background: Salidroside (SDS is the main effective ingredient of Rhodiola rosea L with a variety of pharmacologic properties. We aim to investigate the effects of SDS on ventilation induced lung injury (VILI and explore the possible underlying molecular mechanism. Methods: Lung injury was induced in male ICR mice via mechanical ventilation (30 ml/kg for 4h. The mice were divided in four groups:(1 Control group; (2 Ventilation group; (3 SDS group; (4 Ventilation with SDS group. SDS (50 mg/kg was injected intraperitoneally 1h before operation. Mouse lung vascular endothelial cells (MLVECs were subjected to cyclic stretch for 4h. Results: It was found that SDS attenuated VILI as shown in HE staining, cell count and protein content levels in BAL fluid, W/D and Evans blue dye leakage into the lung tissue. SDS treatment inhibited the activation of NLRP3 inflammasome and subsequent caspase-1 cleavage as well as interleukin (IL-1β secretion both in vivo and in vitro. Moreover, SDS administration up-regulated SIRT1 expression. Importantly, knockdown of SIRT1 reversed the inhibitory effect of SDS on NLRP3 inflammasome activation. Conclusions: Taken together, these findings indicate that SDS may confer protection against ventilation induced lung injury via SIRT1-de-pendent inhibition of NLRP3 inflammasome activation.

  11. An alternative method to achieve one-lung ventilation by surgical pneumothorax in difficult lung isolation patient: a case report.

    Yeh, Pin-Hung; Hsu, Po-Kai


    It is challenging to establish one-lung ventilation in difficult airway patients. Surgical pneumothorax under spontaneous breathing to obtain well-collapsed lung is a feasible method for thoracic surgery. A 76-year-old man with right empyema was scheduled for decortication. The patient had limited mouth opening due to facial cellulitis extending from the left cheek to neck. Generally, lung isolation is achieved by double-lumen endotracheal tube or bronchial blocker. Double-lumen tube insertion is difficult for patients with limited mouth opening and right-side placement of bronchial blocker usually causes insufficient deflation. We introduce an alternative lung isolation technique by surgical pneumothorax under spontaneous breathing simply with an endotracheal tube placement. This technique has never been applied into the management of difficult one-lung ventilation. By this method, we provide an ideal surgical condition with safer, less time-consuming, and less skill-demanding anesthesia. It would be an alternative choice for management of one-lung ventilation in the difficult lung isolation patient.

  12. Dynamic measures of regional lung air volume using phase contrast x-ray imaging

    Kitchen, M J; Lewis, R A; Morgan, M J; Siu, K K W; Habib, A [School of Physics, Monash University, Melbourne VIC 3800 (Australia); Wallace, M J; Siew, M L; Hooper, S B [Department of Physiology, Monash University, Melbourne VIC 3800 (Australia); Fouras, A [Division of Biological Engineering, Monash University, Melbourne VIC 3800 (Australia); Yagi, N; Uesugi, K [SPring-8/JASRI, Sayo, Hyogo 679-5198 (Japan)], E-mail:


    Phase contrast x-ray imaging can provide detailed images of lung morphology with sufficient spatial resolution to observe the terminal airways (alveoli). We demonstrate that quantitative functional and anatomical imaging of lung ventilation can be achieved in vivo using two-dimensional phase contrast x-ray images with high contrast and spatial resolution (<100 {mu}m) in near real time. Changes in lung air volume as small as 25 {mu}L were calculated from the images of term and preterm rabbit pup lungs (n = 28) using a single-image phase retrieval algorithm. Comparisons with plethysmography and computed tomography showed that the technique provided an accurate and robust method of measuring total lung air volumes. Furthermore, regional ventilation was measured by partitioning the phase contrast images, which revealed differences in aeration for different ventilation strategies.

  13. The role of endocrine mechanisms in ventilator-associated lung injury in critically ill patients.

    Penesova, A; Galusova, A; Vigas, M; Vlcek, M; Imrich, R; Majek, M


    The critically ill subjects are represented by a heterogeneous group of patients suffering from a life-threatening event of different origin, e.g. trauma, cardiopulmonary failure, surgery or sepsis. The majority of these patients are dependent on the artificial lung ventilation, which means a life-saving chance for them. However, the artificial lung ventilation may trigger ventilation-associated lung injury (VALI). The mechanical ventilation at higher volumes (volutrauma) and pressure (barotrauma) can cause histological changes in the lungs including impairments in the gap and adherens junctions and desmosomes. The injured lung epithelium may lead to an impairment of the surfactant production and function, and this may not only contribute to the pathophysiology of VALI but also to acute respiratory distress syndrome. Other components of VALI are atelectrauma and toxic effects of the oxygen. Collectively, all these effects may result in a lung inflammation associated with a subsequent profibrotic changes, endothelial dysfunction, and activation of the local and systemic endocrine responses such as the renin-angiotensin system (RAS). The present review is aimed to describe some of the pathophysiologic aspects of VALI providing a basis for novel therapeutic strategies in the critically ill patients.

  14. Prolonged mechanical ventilation induces cell cycle arrest in newborn rat lung.

    Andreas A Kroon

    Full Text Available RATIONALE: The molecular mechanism(s by which mechanical ventilation disrupts alveolar development, a hallmark of bronchopulmonary dysplasia, is unknown. OBJECTIVE: To determine the effect of 24 h of mechanical ventilation on lung cell cycle regulators, cell proliferation and alveolar formation in newborn rats. METHODS: Seven-day old rats were ventilated with room air for 8, 12 and 24 h using relatively moderate tidal volumes (8.5⁻¹. MEASUREMENT AND MAIN RESULTS: Ventilation for 24 h (h decreased the number of elastin-positive secondary crests and increased the mean linear intercept, indicating arrest of alveolar development. Proliferation (assessed by BrdU incorporation was halved after 12 h of ventilation and completely arrested after 24 h. Cyclin D1 and E1 mRNA and protein levels were decreased after 8-24 h of ventilation, while that of p27(Kip1 was significantly increased. Mechanical ventilation for 24 h also increased levels of p57(Kip2, decreased that of p16(INK4a, while the levels of p21(Waf/Cip1 and p15(INK4b were unchanged. Increased p27(Kip1 expression coincided with reduced phosphorylation of p27(Kip1 at Thr¹⁵⁷, Thr¹⁸⁷ and Thr¹⁹⁸ (p<0.05, thereby promoting its nuclear localization. Similar -but more rapid- changes in cell cycle regulators were noted when 7-day rats were ventilated with high tidal volume (40⁻¹ and when fetal lung epithelial cells were subjected to a continuous (17% elongation cyclic stretch. CONCLUSION: This is the first demonstration that prolonged (24 h of mechanical ventilation causes cell cycle arrest in newborn rat lungs; the arrest occurs in G₁ and is caused by increased expression and nuclear localization of Cdk inhibitor proteins (p27(Kip1, p57(Kip2 from the Kip family.

  15. Partial Liquid Ventilation: Animal Studies on Lung Function

    A.S. Tutuncu


    textabstractVarious mechanical ventilation techniques have been investigated, both experimentally and clinically, to improve outcome from acute respiratory failure. As an alternative means of respiratory support, perfluorocarbon (PFC) liquids have gained Interest first in liquid breathing applicatio

  16. Integrative understanding of hypoxic pulmonary vasoconstriction using in vitro models: from ventilated/perfused lung to single arterial myocyte

    Hae Young Yoo


    Full Text Available Contractile response of a pulmonary artery (PA to hypoxia (hypoxic pulmonary vasoconstriction; HPV is a unique physiological reaction. HPV is beneficial for the optimal distribution of blood flow to differentially ventilated alveolar regions in the lung, thereby preventing systemic hypoxemia. Numerous in vitro studies have been conducted to elucidate the mechanisms underlying HPV. These studies indicate that PA smooth muscle cells (PASMCs sense lowers the oxygen partial pressure (PO2 and contract under hypoxia. As for the PO2-sensing molecules, a variety of ion channels in PASMCs had been suggested. Nonetheless, the modulator(s of the ion channels alone cannot mimic HPV in the experiments using PA segments and/or isolated organs. We compared the hypoxic responses of PASMCs, PAs, lung slices, and total lungs using a variety of methods (e.g., patch-clamp technique, isometric contraction measurement, video analysis of precision-cut lung slices, and PA pressure measurement in ventilated/perfused lungs. In this review, the relevant results are compared to provide a comprehensive understanding of HPV. Integration of the influences from surrounding tissues including blood cells as well as the hypoxic regulation of ion channels in PASMCs are indispensable for insights into HPV and other related clinical conditions.

  17. Perioperative lung-protective ventilation strategy reduces postoperative pulmonary complications in patients undergoing thoracic and major abdominal surgery


    The occurrence of postoperative pulmonary complications is strongly associated with increased hospital mortality and prolonged postoperative hospital stays. Although protective lung ventilation is commonly used in the intensive care unit, low tidal volume ventilation in the operating room is not a routine strategy. Low tidal volume ventilation, moderate positive end-expiratory pressure, and repeated recruitment maneuvers, particularly for high-risk patients undergoing major abdominal surgery, can reduce postoperative pulmonary complications. Facilitating perioperative bundle care by combining prophylactic and postoperative positive-pressure ventilation with intraoperative lung-protective ventilation may be helpful to reduce postoperative pulmonary complications. PMID:26885294

  18. Abolished ventilation and perfusion of lung caused by blood clot in the left main bronchus

    Afzelius, P; Bergmann, A; Henriksen, J H


    /Q) scintigraphy with single-photon emission CT (SPECT)/CT. V/Q SPECT/CT demonstrated abolished ventilation due to obstruction of the left main bronchus and markedly reduced perfusion of the entire left lung, a condition that was completely reversed after removal of a blood clot. We present the first pictorially......It is generally assumed that the lungs possess arterial autoregulation associated with bronchial obstruction. A patient with pneumonia and congestive heart failure unexpectedly developed frequent haemoptysis. High-resolution CT and diagnostic CT were performed as well as ventilation/perfusion (V...

  19. Abdominal Muscle Activity during Mechanical Ventilation Increases Lung Injury in Severe Acute Respiratory Distress Syndrome.

    Xianming Zhang

    Full Text Available It has proved that muscle paralysis was more protective for injured lung in severe acute respiratory distress syndrome (ARDS, but the precise mechanism is not clear. The purpose of this study was to test the hypothesis that abdominal muscle activity during mechanically ventilation increases lung injury in severe ARDS.Eighteen male Beagles were studied under mechanical ventilation with anesthesia. Severe ARDS was induced by repetitive oleic acid infusion. After lung injury, Beagles were randomly assigned into spontaneous breathing group (BIPAPSB and abdominal muscle paralysis group (BIPAPAP. All groups were ventilated with BIPAP model for 8h, and the high pressure titrated to reached a tidal volume of 6ml/kg, the low pressure was set at 10 cmH2O, with I:E ratio 1:1, and respiratory rate adjusted to a PaCO2 of 35-60 mmHg. Six Beagles without ventilator support comprised the control group. Respiratory variables, end-expiratory volume (EELV and gas exchange were assessed during mechanical ventilation. The levels of Interleukin (IL-6, IL-8 in lung tissue and plasma were measured by qRT-PCR and ELISA respectively. Lung injury scores were determined at end of the experiment.For the comparable ventilator setting, as compared with BIPAPSB group, the BIPAPAP group presented higher EELV (427±47 vs. 366±38 ml and oxygenation index (293±36 vs. 226±31 mmHg, lower levels of IL-6(216.6±48.0 vs. 297.5±71.2 pg/ml and IL-8(246.8±78.2 vs. 357.5±69.3 pg/ml in plasma, and lower express levels of IL-6 mRNA (15.0±3.8 vs. 21.2±3.7 and IL-8 mRNA (18.9±6.8 vs. 29.5±7.9 in lung tissues. In addition, less lung histopathology injury were revealed in the BIPAPAP group (22.5±2.0 vs. 25.2±2.1.Abdominal muscle activity during mechanically ventilation is one of the injurious factors in severe ARDS, so abdominal muscle paralysis might be an effective strategy to minimize ventilator-induce lung injury.

  20. Successful one-lung ventilation in a patient with the Fontan circulation undergoing thoracoscopic procedure.

    Cvetkovic, Draginja; Ramzy, Wassim; Vitale, Salvatore; Malekan, Ramin; Warsy, Irfan


    Over the course of the past 4 decades, the survival of patients with the Fontan circulation has improved and today they often present for noncardiac surgery anesthesia care. In patients with the Fontan circulation, pulmonary blood flow is passive and anesthetic management is directed at reducing pulmonary vascular resistance and maintaining adequate cardiac output. One-lung ventilation can have unfavorable effects on the Fontan circulation due to hypoxia, hypercarbia, and increased airway pressure. We present a case of successful one-lung ventilation in a patient with the Fontan circulation and describe the perioperative anesthetic management.

  1. Membrane translocation of IL-33 receptor in ventilator induced lung injury.

    Shih-Hsing Yang

    Full Text Available Ventilator-induced lung injury is associated with inflammatory mechanism and causes high mortality. The objective of this study was to discover the role of IL-33 and its ST2 receptor in acute lung injury induced by mechanical ventilator (ventilator-induced lung injury; VILI. Male Wistar rats were intubated after tracheostomy and received ventilation at 10 cm H2O of inspiratory pressure (PC10 by a G5 ventilator for 4 hours. The hemodynamic and respiratory parameters were collected and analyzed. The morphological changes of lung injury were also assessed by histological H&E stain. The dynamic changes of lung injury markers such as TNF-α and IL-1β were measured in serum, bronchoalveolar lavage fluid (BALF, and lung tissue homogenization by ELISA assay. During VILI, the IL-33 profile change was detected in BALF, peripheral serum, and lung tissue by ELISA analysis. The Il-33 and ST2 expression were analyzed by immunohistochemistry staining and western blot analysis. The consequence of VILI by H&E stain showed inducing lung congestion and increasing the expression of pro-inflammatory cytokines such as TNF-α and IL-1β in the lung tissue homogenization, serum, and BALF, respectively. In addition, rats with VILI also exhibited high expression of IL-33 in lung tissues. Interestingly, the data showed that ST2L (membrane form was highly accumulated in the membrane fraction of lung tissue in the PC10 group, but the ST2L in cytosol was dramatically decreased in the PC10 group. Conversely, the sST2 (soluble form was slightly decreased both in the membrane and cytosol fractions in the PC10 group compared to the control group. In conclusion, these results demonstrated that ST2L translocation from the cytosol to the cell membranes of lung tissue and the down-expression of sST2 in both fractions can function as new biomarkers of VILI. Moreover, IL-33/ST2 signaling activated by mechanically responsive lung injury may potentially serve as a new therapy target.

  2. Automated lung outline reconstruction in ventilation-perfusion scans using principal component analysis techniques.

    Serpen, G; Iyer, R; Elsamaloty, H M; Parsai, E I


    The present work addresses the development of an automated software-based system utilized in order to create an outline reconstruction of lung images from ventilation-perfusion scans for the purpose of diagnosing pulmonary embolism. The proposed diagnostic software procedure would require a standard set of digitized ventilation-perfusion scans in addition to correlated chest X-rays as key components in the identification of an ideal template match used to approximate and reconstruct the outline of the lungs. These reconstructed lung images would then be used to extract the necessary PIOPED-compliant features which would warrant a pulmonary embolism diagnosis. In order to evaluate this issue, two separate principal component analysis (PCA) algorithms were employed independently, including Eigenlungs, which was adapted from the Eigenfaces method, and an artificial neural network. The results obtained through MATLAB(TM) simulation indicated that lung outline reconstruction through the PCA approach carries significant viability.

  3. Activation of nicotinic cholinergic receptors prevents ventilator-induced lung injury in rats.

    Fabienne Brégeon

    Full Text Available Respiratory distress syndrome is responsible for 40 to 60 percent mortality. An over mortality of about 10 percent could result from additional lung injury and inflammation due to the life-support mechanical ventilation, which stretches the lung. It has been recently demonstrated, in vitro, that pharmacological activation of the alpha 7 nicotinic receptors (α7-nAChR could down regulate intracellular mediators involved in lung cell inflammatory response to stretch. Our aim was to test in vivo the protective effect of the pharmacological activation of the α7-nAChR against ventilator-induced lung injury (VILI. Anesthetized rats were ventilated for two hours with a high stretch ventilation mode delivering a stroke volume large enough to generate 25-cmH(2O airway pressure, and randomly assigned to four groups: pretreated with parenteral injection of saline or specific agonist of the α7-nAChR (PNU-282987, or submitted to bilateral vagus nerve electrostimulation while pre-treated or not with the α7-nAChR antagonist methyllycaconitine (MLA. Controls ventilated with a conventional stroke volume of 10 mL/kg gave reference data. Physiological indices (compliance of the respiratory system, lung weight, blood oxygenation, arterial blood pressure and lung contents of inflammatory mediators (IL-6 measured by ELISA, substance P assessed using HPLC were severely impaired after two hours of high stretch ventilation (sham group. Vagal stimulation was able to maintain the respiratory parameters close to those obtained in Controls and reduced lung inflammation except when associated to nicotinic receptor blockade (MLA, suggesting the involvement of α7-nAChR in vagally-mediated protection against VILI. Pharmacological pre-treatment with PNU-282987 strongly decreased lung injury and lung IL-6 and substance P contents, and nearly abolished the increase in plasmatic IL-6 levels. Pathological examination of the lungs confirmed the physiological differences observed

  4. Wind-Induced Ventilation Based on the Separated Flow Region

    Mostafa Rahimi


    Full Text Available An experimental investigation was conducted to study the potential use of the pressure reduction within the separated flow region followed by the wake at the leeward direction of a solid surface in natural ventilation of buildings. Air flow with mean velocity up to 7 m/s was directed onto a solid surface (circular plate and a semi-spherical surface behind which the top end of a vertical vent pipe had been placed. Pressure reduction at the exit section of the pipe, which was well inside the separated flow region, induced an air flow within the pipe. This air flow rate from the stagnant surroundings into the wake region was measured under different geometrical configurations and for various wind velocities. The study revealed that the pressure reduction within the separated flow region would be applicable for natural ventilation of different spaces at least as an auxiliary system. The spaces include; sanitary places, crop protection stocks, industrial workshops and other spaces where no regular ventilation is required.

  5. Composite pseudocolor images: a technique to enhance the visual correlation between ventilation-perfusion lung images

    Vaz de Carvalho, Carlos; Costa, Antonio A.; Seixas, M.; Ferreira, F. N.; Guedes, M. A.; Amaral, I.


    Lung ventilation and perfusion raw nuclear medicine images obtained from a gamma camera can be difficult to analyze on a per si basis. A method to optimize the visual correlation between these images was established through the use of new combination images: Composite Pseudo-Color (CPC) images. The major topic of this study is the assessment of the usefulness of this method in the detection of lung malfunction.

  6. Positive end-expiratory pressure and variable ventilation in lung-healthy rats under general anesthesia.

    Luciana M Camilo

    Full Text Available OBJECTIVES: Variable ventilation (VV seems to improve respiratory function in acute lung injury and may be combined with positive end-expiratory pressure (PEEP in order to protect the lungs even in healthy subjects. We hypothesized that VV in combination with moderate levels of PEEP reduce the deterioration of pulmonary function related to general anesthesia. Hence, we aimed at evaluating the alveolar stability and lung protection of the combination of VV at different PEEP levels. DESIGN: Randomized experimental study. SETTING: Animal research facility. SUBJECTS: Forty-nine male Wistar rats (200-270 g. INTERVENTIONS: Animals were ventilated during 2 hours with protective low tidal volume (VT in volume control ventilation (VCV or VV and PEEP adjusted at the level of minimum respiratory system elastance (Ers, obtained during a decremental PEEP trial subsequent to a recruitment maneuver, and 2 cmH2O above or below of this level. MEASUREMENTS AND MAIN RESULTS: Ers, gas exchange and hemodynamic variables were measured. Cytokines were determined in lung homogenate and plasma samples and left lung was used for histologic analysis and diffuse alveolar damage scoring. A progressive time-dependent increase in Ers was observed independent on ventilatory mode or PEEP level. Despite of that, the rate of increase of Ers and lung tissue IL-1 beta concentration were significantly lower in VV than in VCV at the level of the PEEP of minimum Ers. A significant increase in lung tissue cytokines (IL-6, IL-1 beta, CINC-1 and TNF-alpha as well as a ventral to dorsal and cranial to caudal reduction in aeration was observed in all ventilated rats with no significant differences among groups. CONCLUSIONS: VV combined with PEEP adjusted at the level of the PEEP of minimal Ers seemed to better prevent anesthesia-induced atelectasis and might improve lung protection throughout general anesthesia.

  7. Methylene Blue in Ventilator-Induced Lung Injury after Pneumonectomy: an Experimental Study

    Ye. V Suborov


    Full Text Available Objective: to study the expediency and efficiency of using methylene blue (MB on a model of pneumectomy (PE and subsequent ventilator-induced lung injury (VILI in sheep. Materials and methods. The study was conducted at the Research Laboratory of University of Tromse. The experiment included 23 sheep weighing 41.0±4.9 kg. Thoracotomy and right-sided pneumonectomy were performed in the animals under general anesthesia and controlled artificial ventilation. After measurement of the parameters of systemic hemodynamics and extravascular water of the lung (EVWL, the animals were divided into 3 groups: 1 a control group (CG, n=7 with a tidal volume (TV of 6 ml/kg and an end-expiratory positive pressure (PEEP of 2 cm H2O; 2 a VILI group (n=9 with a TV of 12 ml/kg and a PEEP of 0 cm H2O; 3 a group of MB (n=7 that was given in parallel with a damaging ventilation mode. The thermodilution technique (using a Cold Z-021 monitor, (Pulsion, Germany was employed to measure volumetric parameters and EVWL. The parameters of pulmonary hemodynamics, respiratory mechanics, and blood gas composition were recorded. Results: After its reduction at PE, EVWL index increased during damaging ventilation in the VILI and MB groups. In addition, there was an increase in pulmonary artery wedge pressure after PE in the MB and VILI groups. In the latter group, arterial hypoxemia was observed at the end of the experiment. Along with this, after PE pulmonary compliance decreased and airway pressure elevated in the VILI and MB groups. Conclusion: In the presented model of VILI, MB does not prevent the development of postp-neumectomic edema of the lung. Key words: thermochromodilution, acute lung injury, pneumectomy, ventilator-induced lung injury, postpneumectomic edema of the lung, methylene blue.

  8. Ventilation patterns of the songbird lung/air sac system during different behaviors.

    Mackelprang, Rebecca; Goller, Franz


    Unidirectional, continuous airflow through the avian lung is achieved through an elaborate air sac system with a sequential, posterior to anterior ventilation pattern. This classical model was established through various approaches spanning passively ventilated systems to mass spectrometry analysis of tracer gas flow into various air sacs during spontaneous breathing in restrained ducks. Information on flow patterns in other bird taxa is missing, and these techniques do not permit direct tests of whether the basic flow pattern can change during different behaviors. Here we use thermistors implanted into various locations of the respiratory system to detect small pulses of tracer gas (helium) to reconstruct airflow patterns in quietly breathing and behaving (calling, wing flapping) songbirds (zebra finch and yellow-headed blackbird). The results illustrate that the basic pattern of airflow in these two species is largely consistent with the model. However, two notable differences emerged. First, some tracer gas arrived in the anterior set of air sacs during the inspiration during which it was inhaled, suggesting a more rapid throughput through the lung than previously assumed. Second, differences in ventilation between the two anterior air sacs emerged during calling and wing flapping, indicating that adjustments in the flow pattern occur during dynamic behaviors. It is unclear whether this modulation in ventilation pattern is passive or active. This technique for studying ventilation patterns during dynamic behaviors proves useful for establishing detailed timing of airflow and modulation of ventilation in the avian respiratory system.

  9. Teaching Ventilation/Perfusion Relationships in the Lung

    Glenny, Robb W.


    This brief review is meant to serve as a refresher for faculty teaching respiratory physiology to medical students. The concepts of ventilation and perfusion matching are some of the most challenging ideas to learn and teach. Some strategies to consider in teaching these concepts are, first, to build from simple to more complex by starting with a…

  10. Teaching Ventilation/Perfusion Relationships in the Lung

    Glenny, Robb W.


    This brief review is meant to serve as a refresher for faculty teaching respiratory physiology to medical students. The concepts of ventilation and perfusion matching are some of the most challenging ideas to learn and teach. Some strategies to consider in teaching these concepts are, first, to build from simple to more complex by starting with a…

  11. Mechanical ventilation injury and repair in extremely and very preterm lungs.

    Nadine Brew

    Full Text Available BACKGROUND: Extremely preterm infants often receive mechanical ventilation (MV, which can contribute to bronchopulmonary dysplasia (BPD. However, the effects of MV alone on the extremely preterm lung and the lung's capacity for repair are poorly understood. AIM: To characterise lung injury induced by MV alone, and mechanisms of injury and repair, in extremely preterm lungs and to compare them with very preterm lungs. METHODS: Extremely preterm lambs (0.75 of term were transiently exposed by hysterotomy and underwent 2 h of injurious MV. Lungs were collected 24 h and at 15 d after MV. Immunohistochemistry and morphometry were used to characterise injury and repair processes. qRT-PCR was performed on extremely and very preterm (0.85 of term lungs 24 h after MV to assess molecular injury and repair responses. RESULTS: 24 h after MV at 0.75 of term, lung parenchyma and bronchioles were severely injured; tissue space and myofibroblast density were increased, collagen and elastin fibres were deformed and secondary crest density was reduced. Bronchioles contained debris and their epithelium was injured and thickened. 24 h after MV at 0.75 and 0.85 of term, mRNA expression of potential mediators of lung repair were significantly increased. By 15 days after MV, most lung injury had resolved without treatment. CONCLUSIONS: Extremely immature lungs, particularly bronchioles, are severely injured by 2 h of MV. In the absence of continued ventilation these injured lungs are capable of repair. At 24 h after MV, genes associated with injurious MV are unaltered, while potential repair genes are activated in both extremely and very preterm lungs.


    V. K. Kosenok


    Full Text Available Lung cancer incidence in the Omsk region was studied. Advanced lung cancer was shown to be commonly detected in patients of the 30 to 49 age group. For this patient group, adenocarcinoma was the most common histological type of lung cancer. The highest incidence of lung cancer was observed in both men and women aged 45–47 years. Thus, to improve early detection of lung cancer, the optimal age for lung cancer screening should be in the age range of 40–50 years.

  13. MRI methods for pulmonary ventilation and perfusion imaging; Methoden der MRT zur Ventilations- und Perfusionsbildgebung der Lunge

    Sommer, G. [Universitaetsspital Basel, Klinik fuer Radiologie und Nuklearmedizin, Basel (Switzerland); Bauman, G. [Universitaetsspital Basel, Klinik fuer Radiologie und Nuklearmedizin - Radiologische Physik, Basel (Switzerland)


    Separate assessment of respiratory mechanics, gas exchange and pulmonary circulation is essential for the diagnosis and therapy of pulmonary diseases. Due to the global character of the information obtained clinical lung function tests are often not sufficiently specific in the differential diagnosis or have a limited sensitivity in the detection of early pathological changes. The standard procedures of pulmonary imaging are computed tomography (CT) for depiction of the morphology as well as perfusion/ventilation scintigraphy and single photon emission computed tomography (SPECT) for functional assessment. Magnetic resonance imaging (MRI) with hyperpolarized gases, O{sub 2}-enhanced MRI, MRI with fluorinated gases and Fourier decomposition MRI (FD-MRI) are available for assessment of pulmonary ventilation. For assessment of pulmonary perfusion dynamic contrast-enhanced MRI (DCE-MRI), arterial spin labeling (ASL) and FD-MRI can be used. Imaging provides a more precise insight into the pathophysiology of pulmonary function on a regional level. The advantages of MRI are a lack of ionizing radiation, which allows a protective acquisition of dynamic data as well as the high number of available contrasts and therefore accessible lung function parameters. Sufficient clinical data exist only for certain applications of DCE-MRI. For the other techniques, only feasibility studies and case series of different sizes are available. The clinical applicability of hyperpolarized gases is limited for technical reasons. The clinical application of the techniques described, except for DCE-MRI, should be restricted to scientific studies. (orig.) [German] Die separate Beurteilung von Atemmechanik, Gasaustauschprozessen und Lungenzirkulation ist wesentlich fuer die Diagnose und Therapie von Lungenerkrankungen. Klinische Lungenfunktionstests sind aufgrund ihrer zumeist nur globalen Aussage oft nicht hinreichend spezifisch in der Differenzialdiagnostik oder eingeschraenkt sensitiv bei der

  14. The value of ventilation scintigraphy after single lung transplantation

    Ouwens, JP; van der Bij, W; van der Mark, TW; Piers, DA; Koeter, GH

    Background: A decrease in forced expiratory volume in 1 second (FEV1) as a diagnostic criterion for bronchiolitis obliterans syndrome (BOS) after single lung transplantation may be influenced significantly by the presence of the native lung. To quantify and to discriminate between the relative

  15. Rap1 mediates protective effects of iloprost against ventilator-induced lung injury

    Birukova, Anna A.; Fu, Panfeng; Xing, Junjie


    Prostaglandin I2 (PGI2) has been shown to attenuate vascular constriction, hyperpermeability, inflammation, and acute lung injury. However, molecular mechanisms of PGI2 protective effects on pulmonary endothelial cells (EC) are not well understood. We tested a role of cAMP-activated Epac-Rap1 pathway in the barrier protective effects of PGI2 analog iloprost in the murine model of ventilator-induced lung injury. Mice were treated with iloprost (2 μg/kg) after onset of high tidal volume ventilation (30 ml/kg, 4 h). Bronchoalveolar lavage, histological analysis, and measurements of Evans blue accumulation were performed. In vitro, microvascular EC barrier function was assessed by morphological analysis of agonist-induced gap formation and monitoring of Rho pathway activation and EC permeability. Iloprost reduced bronchoalveolar lavage protein content, neutrophil accumulation, capillary filtration coefficient, and Evans blue albumin extravasation caused by high tidal volume ventilation. Small-interfering RNA-based Rap1 knockdown inhibited protective effects of iloprost. In vitro, iloprost increased barrier properties of lung microvascular endothelium and alleviated thrombin-induced EC barrier disruption. In line with in vivo results, Rap1 depletion attenuated protective effects of iloprost in the thrombin model of EC permeability. These data describe for the first time protective effects for Rap1-dependent signaling against ventilator-induced lung injury and pulmonary endothelial barrier dysfunction. PMID:19850733

  16. Mechanical ventilation enhances lung inflammation and caspase activity in a model of mouse pneumovirus infection

    R.A. Bem; J.B.M. van Woensel; A.P. Bos; A. Koski; A.W. Farnand; J.B. Domachowske; H.F. Rosenberg; T.R. Martin; G. Matute-Bello


    Severe infection with respiratory syncytial virus (RSV) in children can progress to respiratory distress and acute lung injury (ALI). Accumulating evidence suggests that mechanical ventilation (MV) is an important cofactor in the development of ALI by modulating the host immune responses to bacteria

  17. Complement activation contributes to ventilator-induced lung injury in rats

    B. Petersen; T. Busch; J. Gaertner; J.J. Haitsma (Jack); S.C. Krabbendam (Stefan); M. Ebsen (Michael); B.F. Lachmann (Burkhard); U.X. Kaisers


    textabstractThe complement system contributes to ventilator induced lung injury (VILI). We hypothesized that pretreatment with the C1 esterase inhibitor (C1INH) Berinert® constrains complement activation consecutively inducing improvements in arterial oxygenation and histological pulmonary damage. A

  18. Hemodynamic effects of partial liquid ventilation with perfluorocarbon in acute lung injury

    R.J.M. Houmes (Robert Jan); S.J.C. Verbrugge (Serge); E. Hendrik (Edwin); B.F. Lachmann (Burkhard)


    textabstractObjective: To assess the effect of partial liquid ventilation with perfluorocarbons on hemodynamics and gas exchange in large pigs with induced acute lung injury (ALI). Design: Randomized, prospective, double-control, experimental study. Setting: Experimental intensive care unit of a uni

  19. Lung volume, breathing pattern and ventilation inhomogeneity in preterm and term infants.

    Philipp Latzin

    Full Text Available BACKGROUND: Morphological changes in preterm infants with bronchopulmonary dysplasia (BPD have functional consequences on lung volume, ventilation inhomogeneity and respiratory mechanics. Although some studies have shown lower lung volumes and increased ventilation inhomogeneity in BPD infants, conflicting results exist possibly due to differences in sedation and measurement techniques. METHODOLOGY/PRINCIPAL FINDINGS: We studied 127 infants with BPD, 58 preterm infants without BPD and 239 healthy term-born infants, at a matched post-conceptional age of 44 weeks during quiet natural sleep according to ATS/ERS standards. Lung function parameters measured were functional residual capacity (FRC and ventilation inhomogeneity by multiple breath washout as well as tidal breathing parameters. Preterm infants with BPD had only marginally lower FRC (21.4 mL/kg than preterm infants without BPD (23.4 mL/kg and term-born infants (22.6 mL/kg, though there was no trend with disease severity. They also showed higher respiratory rates and lower ratios of time to peak expiratory flow and expiratory time (t(PTEF/t(E than healthy preterm and term controls. These changes were related to disease severity. No differences were found for ventilation inhomogeneity. CONCLUSIONS: Our results suggest that preterm infants with BPD have a high capacity to maintain functional lung volume during natural sleep. The alterations in breathing pattern with disease severity may reflect presence of adaptive mechanisms to cope with the disease process.

  20. FCT (functional computed tomography) evaluation of the lung volumes at different PEEP (positive-end expiratory pressure) ventilation pattern, in mechanical ventilated patients

    Papi, M.G.; Di Segni, R.; Mazzetti, G.; Staffa, F. [Dept. of Radiology, S. Giovanni HS, Rome (Italy); Conforto, F.; Calimici, R.; Salvi, A. [Dept. of Anesthesiology, S. Giovanni HS, Rome (Italy); Matteucci, G. [Dept. of Pneumology, S. Giovanni HS, Rome (Italy)


    Purpose To evaluate with FCT (functional computed tomography) total lung volume and fractional lung volumes at different PEEP (positive end expiratory pressure) values in acute mechanically ventilated patients. Methods Nine ICU (intensive care unity) patients (1 lung pneumonia, 2 polytrauma, 2 sepsis, 3 brain surgery, 1 pulmonary embolism); mean age 48 {+-} 15 years, 6 male, 3 female; GE 16 MDCT scan was performed with acquisition from apex to diaphragma in seven seca at different PEEP values. Raw CT data were analysed by an advantage workstation to obtain volume density masks and histograms of both lungs and each lung and these density ranges were applied: - 1000 - 950 = hyper-ventilated lung, -900 - 650 well aerated lung, -950 - 500 all aerated lung, -500 + 200 lung tissue. Total and fractional lung volumes, Hounsfield unit (HU) were calculated and compared at different PEEP values (0, 5, 10, 15 cm H{sub 2}O). In four patients lung volumes were compared between the more and the less involved lung at increased PEEP. Statistic analysis: comparison means-medians tests. Results Data calculated at five PEEP showed unexpected decrease of total lung volume and increase of lung density (HU); proportionally no significant improvement of oxigenation. (orig.)

  1. Conventional mechanical ventilation of healthy lungs induced pro-inflammatory cytokine gene transcription.

    Brégeon, Fabienne; Roch, Antoine; Delpierre, Stéphane; Ghigo, Eric; Autillo-Touati, Amapola; Kajikawa, Osamu; Martin, Thomas R; Pugin, Jérôme; Portugal, Henry; Auffray, Jean-Pierre; Jammes, Yves


    We investigated the potential inflammatory reaction induced by mechanical ventilation (MV) using 10 ml/kg tidal volume and no positive end-expiratory pressure (PEEP) in control (C, n = 8), spontaneously breathing (SB, n = 12) and mechanically ventilated (MV, n = 12) rabbits with normal lungs. After 6 h (MV and SB groups) or immediately (C group), lungs were removed for measurement of wet-to-dry (W/D) weight ratio and for bronchoalveolar lavage (BAL). Pulmonary mechanics were also studied. MV animals developed a modest but significant (P transcription (mRNAs), without significant elevation of the corresponding protein cytokines in the BAL supernatant, except for MCP-1 (P < 0.05). These data suggest that MV, even using moderate tidal volume, elicits a pro-inflammatory stimulus to the lungs.

  2. Chest tubes, lung entrapment, and failure to wean from the ventilator. Report of three patients with quadriplegia.

    Peterson, W P; Whiteneck, G G; Gerhart, K A


    The cases of three patients with traumatic quadriplegia who had been treated with chest tubes are described. Each had been injured at a neurologic level that typically allows weaning from the ventilator, yet none was able to clear refractory atelectasis or become ventilator free. Each underwent surgery during which lung adhesions, entrapment, or deformation at the former chest tube site were identified and corrected. Subsequently, each patient cleared his atelectasis and weaned from the ventilator. These cases suggest the importance of ruling out lung deformity in individuals with ventilator-dependent quadriplegia who have had chest tubes and unexpectedly fail to wean.

  3. Effect of high tidal volume ventilation and lipopolysaccharide on mitogen-activated protein kinase in rat lung tissue


    @@ Mechanical ventilation, a crucial therapy to acute respiratory distress syndrome (ARDS), could exacerbate lung injury, and even result in ventilator-induced lung injury (VILI) if misused in some condition1. Over-activating inflammatory cells and expanding inflammatory responses, which are induced by infection, are fundamental reasons for ARDS. Among them, mitogen-activated protein kinase (MAPK) intracellular signal transduction pathways are key processes. This study aimed to investigate the time course of MAPK activation in rat lung tissue after high tidal volume (VT) ventilation and the role of lipopolysaccharide (LPS) in high-sensitivity, and to elucidate the effect of the pathway on VILI.

  4. Successful Lung Transplantation Using a Deceased Donor Mechanically Ventilated for Ten Months.

    Tanaka, Shin; Miyoshi, Kentaroh; Sugimoto, Seiichiro; Yamane, Masaomi; Kobayashi, Motomu; Oto, Takahiro


    A successful outcome after lung transplant was achieved using lungs donated from a teenage boy who underwent prolonged mechanical ventilation. The donor experienced hypoxic brain damage and was declared brain dead 324 days after tracheal intubation. At the time of referral, the donor's lungs revealed diffuse radiologic infiltration and atelectasis but excellent function, with a PaO2/FiO2 ratio of 450. The lungs were transplanted to a 10-year-old girl with bronchiolitis obliterans. She developed grade 2 primary graft dysfunction, but recovered quickly. She is doing well and has not experienced any other critical adverse events 12 months after lung transplantation. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  5. Sustained inflation at birth did not alter lung injury from mechanical ventilation in surfactant-treated fetal lambs.

    Noah H Hillman

    Full Text Available BACKGROUND: Sustained inflations (SI are used with the initiation of ventilation at birth to rapidly recruit functional residual capacity and may decrease lung injury and the need for mechanical ventilation in preterm infants. However, a 20 second SI in surfactant-deficient preterm lambs caused an acute phase injury response without decreasing lung injury from subsequent mechanical ventilation. HYPOTHESIS: A 20 second SI at birth will decrease lung injury from mechanical ventilation in surfactant-treated preterm fetal lambs. METHODS: The head and chest of fetal sheep at 126±1 day GA were exteriorized, with tracheostomy and removal of fetal lung fluid prior to treatment with surfactant (300 mg in 15 ml saline. Fetal lambs were randomized to one of four 15 minute interventions: 1 PEEP 8 cmH2O; 2 20 sec SI at 40 cmH2O, then PEEP 8 cmH2O; 3 mechanical ventilation with 7 ml/kg tidal volume; or 4 20 sec SI then mechanical ventilation at 7 ml/kg. Fetal lambs remained on placental support for the intervention and for 30 min after the intervention. RESULTS: SI recruited a mean volume of 6.8±0.8 mL/kg. SI did not alter respiratory physiology during mechanical ventilation. Heat shock protein (HSP 70, HSP60, and total protein in lung fluid similarly increased in both ventilation groups. Modest pro-inflammatory cytokine and acute phase responses, with or without SI, were similar with ventilation. SI alone did not increase markers of injury. CONCLUSION: In surfactant treated fetal lambs, a 20 sec SI did not alter ventilation physiology or markers of lung injury from mechanical ventilation.

  6. Effect of methacholine on peripheral lung mechanics and ventilation heterogeneity in asthma.

    Downie, Sue R; Salome, Cheryl M; Verbanck, Sylvia; Thompson, Bruce R; Berend, Norbert; King, Gregory G


    The forced oscillation technique (FOT) and multiple-breath nitrogen washout (MBNW) are noninvasive tests that are potentially sensitive to peripheral airways, with MBNW indexes being especially sensitive to heterogeneous changes in ventilation. The objective was to study methacholine-induced changes in the lung periphery of asthmatic patients and determine how changes in FOT variables of respiratory system reactance (Xrs) and resistance (Rrs) and frequency dependence of resistance (Rrs5-Rrs19) can be linked to changes in ventilation heterogeneity. The contributions of air trapping and airway closure, as extreme forms of heterogeneity, were also investigated. Xrs5, Rrs5, Rrs19, Rrs5-Rrs19, and inspiratory capacity (IC) were calculated from the FOT. Ventilation heterogeneity in acinar and conducting airways, and trapped gas (percent volume of trapped gas at functional residual capacity/vital capacity), were calculated from the MBNW. Measurements were repeated following methacholine. Methacholine-induced airway closure (percent change in forced vital capacity) and hyperinflation (change in IC) were also recorded. In 40 mild to moderate asthmatic patients, increase in Xrs5 after methacholine was predicted by increases in ventilation heterogeneity in acinar airways and forced vital capacity (r(2) = 0.37, P ventilation heterogeneity in conducting airway increase or IC decrease. Increases in Rrs5 and Rrs5-Rrs19 after methacholine were not correlated with increases in ventilation heterogeneity, trapped gas, hyperinflation, or airway closure. Increased reactance in asthmatic patients after methacholine was indicative of heterogeneous changes in the lung periphery and airway closure. By contrast, increases in resistance and frequency dependence of resistance were not related to ventilation heterogeneity or airway closure and were more indicative of changes in central airway caliber than of heterogeneity.

  7. Analysis of regional compliance in a porcine model of acute lung injury.

    Czaplik, Michael; Biener, Ingeborg; Dembinski, Rolf; Pelosi, Paolo; Soodt, Thomas; Schroeder, Wolfgang; Leonhardt, Steffen; Marx, Gernot; Rossaint, Rolf; Bickenbach, Johannes


    Lung protective ventilation in acute lung injury (ALI) focuses on using low tidal volumes and adequate levels of positive end-expiratory pressure (PEEP). Identifying optimal pressure is difficult because pressure-volume (PV) relations differ regionally. Precise analysis demands local measurements of pressures and related alveolar morphologies. In a porcine model of surfactant depletion (n=24), we combined measuring static pressures with endoscopic microscopy and electrical impedance tomography (EIT) to examine regional PV loops and morphologic heterogeneities between healthy (control group; CON) and ALI lungs ventilated with low (LVT) or high tidal volumes (HVT). Quantification included indices for microscopy (Volume Air Index (VAI), Heterogeneity and Circularity Index), EIT analysis and calculation of regional compliances due to generated PV loops. We found that: (1) VAI decreased in lower lobe after ALI, (2) electrical impedance decreased in dorsal regions and (3) PV loops differed regionally. Further studies should prove the potentials of these techniques on individual respiratory settings and clinical outcome.

  8. The role of the acute phase protein PTX3 in the ventilator-induced lung injury

    JM Real


    Full Text Available The pentraxin 3 (PTX3 is an acute phase proinflammatory protein produced by fibroblasts and alveolar epithelial cells. We have previously demonstrated that PTX3 is a key modulator of inflammation. Mechanical ventilation (MV is a life saving therapeutic approach for patients with acute lung injury that, nevertheless could lead to an inflammatory response and tissue injury (ventilator-induced lung injury: VILI, representing a major cause of iatrogenic lung damage in intensive units. Our objective was to investigate the role of PTX3 in VILI. PTX3 transgenic, knockout and Wt control mice (n = 12/group were ventilated (45ml·kg–1 until respiratory system Elastance increased 50% (Ers150%, an indicator of VILI. Histological analysis demonstrated that using a Ers150% was appropriate for our analysis since identical degrees of inflammation were observed in Tg, KO and Wt mice as assessed by leukocyte infiltration, oedema, alveolar collapse and number of breaks in alveolar septa. However, Tg mice reached Ers150% faster than Wt controls (p = 0.0225. We also showed that the lack of PTX3 does not abolish the occurrence of VILI in KOs. Gene expression profile of PTX3, IL-1beta, IL-6, KC, IFNgamma, TGFbeta and PCIII were investigated by QPCR. MV drastically up modulated PTX3 as well as IL-1beta, IL-6, IFNgamma and KC. Alternatively, mice were ventilated for 20, 40 and 60 min. The faster kinetics of Tg mice to reach Ers150% was accompanied by an earlier augmentation of IL-1b and PTX3 expression. The kinetics of local PTX3 expression in the lungs of ventilated mice strongly suggests the involvement of this pentraxin in the pathogenesis of VILI.

  9. Changes in Functional Lung Regions During the Course of Radiation Therapy and Their Potential Impact on Lung Dosimetry for Non-Small Cell Lung Cancer

    Meng, Xue [Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (United States); Department of Radiation Oncology, Shandong Cancer Hospital, Shandong University, Jinan (China); Frey, Kirk [Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, Michigan (United States); Matuszak, Martha; Paul, Stanton; Ten Haken, Randall [Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (United States); Yu, Jinming [Department of Radiation Oncology, Shandong Cancer Hospital, Shandong University, Jinan (China); Kong, Feng-Ming, E-mail: [Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (United States); Department of Radiation Oncology, Georgia Regents University, Augusta, Georgia (United States)


    Purpose: To study changes in functional activity on ventilation (V)/perfusion (Q) single-photon emission computed tomography (SPECT) during radiation therapy (RT) and explore the impact of such changes on lung dosimetry in patients with non-small cell lung cancer (NSCLC). Methods and Materials: Fifteen NSCLC patients with centrally located tumors were enrolled. All patients were treated with definitive RT dose of ≥60 Gy. V/Q SPECT-CT scans were performed prior to and after delivery of 45 Gy of fractionated RT. SPECT images were used to define temporarily dysfunctional regions of lung caused by tumor or other potentially reversible conditions as B3. The functional lung (FL) was defined on SPECT by 2 separate approaches: FL1, a threshold of 30% of the maximum uptake of the patient's lung; and FL2, FL1 plus B3 region. The impact of changes in FL between initiation of RT and delivery of 45 Gy on lung dosimetry were analyzed. Results: Fourteen patients (93%) had larger FL2 volumes than FL1 pre-RT (P<.001). Dysfunctional lung became functional in 11 patients (73%) on V SPECT and in 10 patients (67%) on Q SPECT. The dosimetric parameters generated from CT-based anatomical lung had significantly lower values in FL1 than FL2, with a median reduction in the volume of lung receiving a dose of at least 20 Gy (V{sub 20}) of 3%, 5.6%, and mean lung dose of 0.95 and 1.55 on V and Q SPECT respectively. Conclusions: Regional ventilation and perfusion function improve significantly during RT in centrally located NSCLC. Lung dosimetry values vary notably between different definitions of functional lung.

  10. Ventilator „Chirana Aura V“ In Two Models Of Neonatal Acute Lung Injury - A Pilot Study

    Tomclkova L.


    Full Text Available In severe respiratory insufficiency, neonatal and pediatric patients should be ventilated artificially by a ventilator. Aim of this experimental study was to evaluate whether the newly developed ventilator Chirana Aura V may effectively ventilate the lungs of animals with two different models of acute lung injury: acute respiratory distress syndrome (ARDS induced by repetitive saline lavage and meconium aspiration syndrome (MAS induced by intratracheal instillation of neonatal meconium. The experiments were performed on 10 adult rabbits (New Zealand white. In ARDS group (n=5, the lungs were repetitively lavaged with saline (30 ml/kg until partial pressure of oxygen (PaO2 in arterial blood was under 26.7 kPa at inspiratory fraction of oxygen FiO2=1.0. In MAS group (n=5, animals were instilled 4 ml/kg of suspension of human meconium (25 mg/ml. When the model of acute lung injury was developed, animals were ventilated for additional 2 hours with pressure control ventilation (PCV regime by ventilator Chirana Aura V. Ventilatory parameters, blood gases, acid-base balance, end-tidal CO2, O2 saturation of hemoglobin, oxygenation indexes, ventilation efficiency index, dynamic lung compliance, and right-to-left pulmonary shunts were measured and calculated in regular time intervals. In both experimental groups, used ventilatory settings provided acceptable gas exchange within the period of observation. Thus, the results indicate that ventilator Chirana Aura V might be suitable for ventilation of animal models of acute lung injury. However, further pre-clinical investigation is needed before its use may be recommended in neonatal and/or pediatric patients with acute lung injury.

  11. Histopathological changes and mRNA expression in lungs of horses after inhalation anaesthesia with different ventilation strategies.

    Hopster, K; Jacobson, B; Hopster-Iversen, C; Rohn, K; Kästner, S B R


    Inappropriate mechanical ventilation can lead to ventilator-induced lung injury (VILI). Aim of this study was to evaluate the effects of inhalation anaesthesia and ventilation with and without recruitment (RM) and PEEP titration on alveolar integrity in horses. Twenty-three horses were divided into 4 groups (group OLC ventilated with OLC, group IPPV ventilated with intermittent positive pressure ventilation, group NV non-ventilated, and group C non-anaesthetized control group). After sedation with xylazine and induction with diazepam and ketamine anaesthetized horses were under isoflurane anaesthesia for 5.5h. The horses were euthanized and tissue samples of the dependent and non-dependent lung areas were collected. Histopathological examinations of the lung tissue as well as relative quantification of mRNA of IL-1β, IL-6, iNOS, MMP1 and MMP9 by PCR were performed. Horses of group OLC had significantly less alveolar congestion and atelectasis but greater alveolar overdistension compared to groups NV and IPPV. In groups OLC and group IPPV an increase in IL-1β/6 and MMP1/9 was detected compared to groups NV and C. In conclusion, in breathing spontaneously or IPPV-ventilated horses a higher degree of atelectasis was detected, whereas in OLC-ventilated horses a higher degree of overdistention was present. Elevated levels in IL and MMP might be early signs of VILI in ventilated horses.

  12. Application of CO2 waveform in the alveolar recruitment maneuvers of hypoxemic patients during one-lung ventilation.

    Dong, Chunshan; Yu, Junma; Liu, Qi; Wu, Chao; Lu, Yao


    Deterioration of gas exchange during one-lung ventilation (OLV) is caused by both total collapse of the nondependent lung and partial collapse of the dependent lung. Alveolar recruitment maneuver improves lung function during general anesthesia. The objective of this study was to investigate whether there is an indirect relationship between the changes of CO2 expirogram and the selective lung recruitment. To further improve the oxygenation and gas exchange, we compare adjust setting of ventilated parameters based on CO2 expirogram and a preset setting of ventilated parameters during OLV in patients undergoing right-side thoracic surgery.Thirty patients met the requirements criteria that were studied at 3 time points: during two-lung ventilation (TLV), during OLV with preset ventilation parameters (OLV-PP), and during OLV with adjustable ventilation parameters (OLV-AP) that are in accordance with CO2 expirogram. Adjustable ventilation parameters such as tidal volume (VT), respiratory rate (RR), positive end-expiratory pressure (PEEP), and the ratio of inspiratory to expiratory were adjusted by utilizing the phase III slopes of CO2 expirogram, which together with the relationship between the changes of CO2 expirogram and the selective lung recruitment.During OLV, the phase III slopes of CO2 expirogram in patients with pulse oxymetry (SpO2) decreased less than 93% after the OLV-PP, and were absolutely different from that during TLV. After OLV-AP, the phase III slopes of CO2 expirogram and SpO2 were similar to those during TLV. During OLV, however, parameters of ventilation setting in both OLV-PP and OLV-AP are obviously different.This study indicates that alveolar recruitment by utilizing CO2 expirogram probably improves SpO2 level during one-lung ventilation.

  13. Independent lung ventilation combined with HFOV for a patient suffering from tracheo-gastric roll fistula.

    Ichinose, Maki; Sakai, Hiroaki; Miyazaki, Ikuo; Muraoka, Akihiro; Aizawa, Miyuki; Igarashi, Kaigen; Okazaki, Atsushi


    This case report describes the difficult respiratory management of an esophageal cancer patient with acute respiratory distress syndrome (ARDS) and systemic inflammatory response syndrome (SIRS) caused by a postoperative tracheogastric roll fistula. A single-lumen tracheal tube could not seal the fistula, and therefore a double-lumen tracheal tube (DLT) for the left side was used. Although the proximal cuff of the DLT failed to seal the fistula, independent lung ventilation (ILV) improved blood gas levels. During right thoracotomy, the left lung was ventilated conventionally with 5 cmH2O positive end-expiratory pressure (PEEP), and in addition, high-frequency oscillation ventilation (HFOV) to the right lung was employed. This combination allowed the maintenance of adequate oxygenation, and the HFOV to the right lung decreased the PaCO2 level during surgery without interruption of the surgical field. These techniques provided the opportunity to successfully remove a necrotic gastric roll and achieve closure of the fistula using an intercostal muscle flap. This report documents and discusses the difficulty of performing appropriate anesthetic management of a patient with these complex complications after esophageal surgery.

  14. Ventilation heterogeneity in the acinar and conductive zones of the normal ageing lung.

    Verbanck, Sylvia; Thompson, Bruce R; Schuermans, Daniel; Kalsi, Harpal; Biddiscombe, Martyn; Stuart-Andrews, Chris; Hanon, Shane; Van Muylem, Alain; Paiva, Manuel; Vincken, Walter; Usmani, Omar


    Small airways function studies in lung disease have used three promising multiple breath washout (MBW) derived indices: indices of ventilation heterogeneity in the acinar (S(acin)) and conductive (S(cond)) lung zones, and the lung clearance index (LCI). Since peripheral lung structure is known to change with age, ventilation heterogeneity is expected to be affected too. However, the age dependence of the MBW indices of ventilation heterogeneity in the normal lung is unknown. The authors systematically investigated S(acin), S(cond) or LCI as a function of age, testing also the robustness of these relationships across two laboratories. MBW tests were performed by never-smokers (50% men) in the age range 25-65 years, with data gathered across two laboratories (n=120 and n=60). For comparison with the literature, the phase III slopes from classical single breath washout tests were also acquired in one group (n=120). All three MBW indices consistently increased with age, representing a steady worsening of ventilation heterogeneity in the age range 25-65. Age explained 7-16% of the variability in S(acin) and S(cond) and 36% of the variability in LCI. There was a small but significant gender difference only for S(acin). Classical single breath washout phase III slopes also showed age dependencies, with gender effects depending on the normalisation method used. With respect to the clinical response, age is a small but consistent effect that needs to be factored in when using the MBW indices for the detection of small airways abnormality in disease.

  15. Relative Tissue Factor Deficiency Attenuates Ventilator-Induced Coagulopathy but Does Not Protect against Ventilator-Induced Lung Injury in Mice

    Esther K. Wolthuis


    Full Text Available Preventing tissue-factor-(TF- mediated systemic coagulopathy improves outcome in models of sepsis. Preventing TF-mediated pulmonary coagulopathy could attenuate ventilator-induced lung injury (VILI. We investigated the effect of relative TF deficiency on pulmonary coagulopathy and inflammation in a murine model of VILI. Heterozygous TF knockout (TF+/− mice and their wild-type (TF+/+ littermates were sedated (controls or sedated, tracheotomized, and mechanically ventilated with either low or high tidal volumes for 5 hours. Mechanical ventilation resulted in pulmonary coagulopathy and inflammation, with more injury after mechanical ventilation with higher tidal volumes. Compared with TF+/+ mice, TF+/− mice demonstrated significantly lower pulmonary thrombin-antithrombin complex levels in both ventilation groups. There were, however, no differences in lung wet-to-dry ratio, BALF total protein levels, neutrophil influx, and lung histopathology scores between TF+/− and TF+/+ mice. Notably, pulmonary levels of cytokines were significantly higher in TF+/− as compared to TF+/+ mice. Systemic levels of cytokines were not altered by the relative absence of TF. TF deficiency is associated with decreased pulmonary coagulation independent of the ventilation strategy. However, relative TF deficiency does not reduce VILI and actually results in higher pulmonary levels of inflammatory mediators.

  16. Regional ventilation/perfusion mismatch pattern in patient with Swyer James (MacLeod′s syndrome

    Sait Sager


    Full Text Available Swyer James (McLeod′s syndrome (SJMS is an uncommon disease, which occurs as a result of childhood bronchiolitis obliterans. Patients may not be diagnosed until later in their life. A 46-year-old man underwent ventilation/perfusion scintigraphy for acute onset of dyspnea. The scan showed markedly diminished ventilation and perfusion unilaterally on the right middle and inferior lobes. However, mismatched ventilation-perfusion pattern was shown on the upper right lobe, which was consistent with pulmonary embolism. Unilaterally matched ventilation/perfusion defect can see in SJMS in lung scintigraphy; however, when pulmoner embolism may accompany, scintigraphy should be carefully examined.

  17. Lung ventilation during treadmill locomotion in a semi-aquatic turtle, Trachemys scripta.

    Landberg, Tobias; Mailhot, Jeffrey D; Brainerd, Elizabeth L


    It is reasonable to presume that locomotion should have a mechanical effect on breathing in turtles. The turtle shell is rigid, and when the limbs protract and retract, air in the lungs should be displaced. This expectation was met in a previous study of the green sea turtle, Chelonia mydas; breathing completely ceased during terrestrial locomotion (Jackson and Prange, 1979. J Comp Physiol 134:315-319). In contrast, another study found no direct effect of locomotion on ventilation in the terrestrial box turtle, Terrapene carolina (Landberg et al., 2003. J Exp Biol 206:3391-3404). In this study we measured lung ventilation during treadmill locomotion in a semi-aquatic turtle, the red-eared slider, Trachemys scripta. Sliders breathed almost continuously during locomotion and during brief pauses between locomotor bouts. Tidal volume was relatively small (approximately 1 mL) during locomotion and approximately doubled during pauses. Minute ventilation was, however, not significantly smaller during locomotion because breath frequency was higher than that during the pauses. We found no consistent evidence for phase coupling between breathing and locomotion indicating that sliders do not use locomotor movements to drive breathing. We also found no evidence for a buccal-pump mechanism. Sliders, like box turtles, appear to use abdominal musculature to breathe during locomotion. Thus, locomotion affects lung ventilation differently in the three turtle species studied to date: the terrestrial Te. carolina shows no measurable effect of locomotion on ventilation; the semi-aquatic Tr. scripta breathes with smaller tidal volumes during locomotion; and the highly aquatic C. mydas stops breathing completely during terrestrial locomotion. (c) 2008 Wiley-Liss, Inc.

  18. A novel quantitative dual-isotope method for simultaneous ventilation and perfusion lung SPET

    Sanchez-Crespo, Alejandro; Larsson, Stig A. [Section of Nuclear Medicine, Department of Hospital Physics, Karolinska Hospital, Stockholm (Sweden); Medical Radiation Physics, Department of Oncology-Pathology, Stockholm University and Karolinska Institute, Stockholm (Sweden); Petersson, Johan; Mure, Margareta; Lindahl, Sten G.E. [Department of Anaesthesiology and Intensive Care, Karolinska Hospital, Stockholm (Sweden); Nyren, Sven [Department of Radiology, Karolinska Hospital, Stockholm (Sweden); Glenny, Robb W. [University of Washington School of Medicine, Seattle (United States); Thorell, Jan-Olov [Karolinska Pharmacy, Stockholm (Sweden); Jacobsson, Hans [Section of Nuclear Medicine, Department of Hospital Physics, Karolinska Hospital, Stockholm (Sweden); Department of Radiology, Karolinska Hospital, Stockholm (Sweden)


    A quantitative dual-isotope single-photon emission tomography (SPET) technique for the assessment of lung ventilation (V) and perfusion (Q) using, respectively, technetium-99m labelled Technegas (140 keV) and indium-113m labelled macro-aggregated albumin (392 keV), is presented, validated and clinically tested in a healthy volunteer. In order to assess V, Q and V/Q distributions in quantitative terms, algorithms which correct for down scattering, photon scattering and attenuation, as well as an organ outline algorithm, were implemented. Scatter and down-scatter correction were made in the spatial domain by pixel-wise image subtraction of projection-dependent global scattering factors obtained from the energy domain. The attenuation correction was based on an iterative projection/back-projection method. All studies were made on a three-headed SPET system (Trionix) with medium-energy parallel-hole collimators. The set of input data for quantification was based on SPET acquisition of emission data in four separate energy windows, the associated cumulative energy spectra and transmission data. The attenuation correction routine as well as the edge detection algorithm utilized data from {sup 99m}Tc transmission tomography. Attenuation data for {sup 113m}In were obtained by linear scaling of the {sup 99m}Tc attenuation maps. The correction algorithms were experimentally validated with a stack phantom system and applied on a healthy volunteer. The mean difference between the corrected SPET data of the dense stack lung phantom and those obtained from the corresponding scatter- and attenuation-''free'' version was only 1.9% for {sup 99m}Tc and 0.9% for {sup 113m}In. The estimated fractional V/Q distribution in the 3-D lung phantom volume had its peak at V/Q=1, with a width (FWHM) of 0.31 due to noise, particularly in the {sup 113m}In images, and to partial volume effects. For a healthy volunteer, the corresponding values were 0.9 and 0.35, respectively

  19. SU-E-J-120: Comparing 4D CT Computed Ventilation to Lung Function Measured with Hyperpolarized Xenon-129 MRI

    Neal, B; Chen, Q [University of Virginia, Charlottesville, VA (United States)


    Purpose: To correlate ventilation parameters computed from 4D CT to ventilation, profusion, and gas exchange measured with hyperpolarized Xenon-129 MRI for a set of lung cancer patients. Methods: Hyperpolarized Xe-129 MRI lung scans were acquired for lung cancer patients, before and after radiation therapy, measuring ventilation, perfusion, and gas exchange. In the standard clinical workflow, these patients also received 4D CT scans before treatment. Ventilation was computed from 4D CT using deformable image registration (DIR). All phases of the 4D CT scan were registered using a B-spline deformable registration. Ventilation at the voxel level was then computed for each phase based on a Jacobian volume expansion metric, yielding phase sorted ventilation images. Ventilation based upon 4D CT and Xe-129 MRI were co-registered, allowing qualitative visual comparison and qualitative comparison via the Pearson correlation coefficient. Results: Analysis shows a weak correlation between hyperpolarized Xe-129 MRI and 4D CT DIR ventilation, with a Pearson correlation coefficient of 0.17 to 0.22. Further work will refine the DIR parameters to optimize the correlation. The weak correlation could be due to the limitations of 4D CT, registration algorithms, or the Xe-129 MRI imaging. Continued development will refine parameters to optimize correlation. Conclusion: Current analysis yields a minimal correlation between 4D CT DIR and Xe-129 MRI ventilation. Funding provided by the 2014 George Amorino Pilot Grant in Radiation Oncology at the University of Virginia.

  20. Effects of a nasal ventilator restriction device on lung ventilation and gas exchange during exercise in healthy subjects

    José Luis González-Montesinos

    Full Text Available Introduction and objectives: A device called FeelBreathe® (FB has been designed, developed and patented for inspiratory muscle training (IMT. In order to examine the effects of FB on lung ventilation and gas exchange during exercise, 27 trained male healthy volunteers (age: 32.5 ± 7.2 years were measured. Methods: Maximum static inspiratory pressure (PImax and spirometry to determine lung capacity were measured at baseline. We continued with an incremental cycloergometer to determine the VO2 peak. Three days later, each subject performed randomly three identical submaximal cycloergometer tests at 50% between ventilatory thresholds under three different breathing conditions: a oronasal breathing (ONB, b nasal breathing (NB and c nasal breathing through the FB. Results: FB trial showed lower minute ventilation (VE and breathing frequency (BF than NB, which had lower BF, but similar VE than ONB (p < 0.001. Despite this, FB had similar values of VO2, respiratory exchange ratio (RER, heart rate (HR and peripheral capillary oxygen saturation (SpO2 compared to NB and ONB. The latter can occur partly due to increased tidal volume (VT and expiration time (Tex in FB until same level than NB, which were in both trials 15% and 14% respectively higher than ONB (p < 0.001. The percentage of inspiration time (Ti/Tot was 7% greater in FB compared to NB and ONB (p < 0.001. Increased end-tidal pressure of CO2 (P ET CO2 and reduced end-tidal pressure of O2 (P ET O2 and fraction of O2 expiration (FEO2 were found only in FB. Conclusions: FeelBreathe is a new nasal restriction device that stimulates the inspiratory muscles to produce a breathing pattern more efficiency during exercise in well-trained humans.

  1. Coupling Effect of Double Lungs on a VCV Ventilator with Automatic Secretion Clearance Function.

    Shi, Yan; Zhang, Bolun; Cai, Maolin; Xu, Weiqing


    For patients with mechanical ventilation, secretions in airway are harmful and sometimes even mortal, it's of great significance to clear secretion timely and efficiently. In this paper, a new secretion clearance method for VCV (volume-controlled ventilation) ventilator is put forward, and a secretion clearance system with a VCV ventilator and double lungs is designed. Furthermore, the mathematical model of the secretion clearance system is built and verified via experimental study. Finally, to illustrate the influence of key parameters of respiratory system and secretion clearance system on the secretion clearance characteristics, coupling effects of two lungs on VCV secretion clearance system are studied by an orthogonal experiment, it can be obtained that rise of tidal volume adds to efficiency of secretion clearance while effect of area, compliance and suction pressure on efficiency of secretion clearance needs further study. Rise of compliance improves bottom pressure of secretion clearance while rise of area, tidal volume and suction pressure decreases bottom pressure of secretion clearance. This paper can be referred to in researches of secretion clearance for VCV.

  2. Prone positioning ventilation for treatment of acute lung injury and acute respiratory distress syndrome

    LAN Mei-juan; HE Xiao-di


    Patients who are diagnosed with acute lung injury/acute respiratory distress syndrome (ALI/ARDS) usually have ventilation-perfusion mismatch, severe decrease in lung capacity, and gas exchange abnormalities. Health care work-ers have implemented various strategies in an attempt to compensate for these pathological alterations. By rotating patients with ALI/ARDS between the supine and prone position, it is possible to achieve a significant improvement in PaO2/FiO2, decrease shunting and therefore improve oxy-genation without use of expensive, invasive and experimen-tal procedures.

  3. Adult patient with pulmonary agenesis: focusing on one-lung ventilation during general anesthesia

    Yu, Yuetian; ZHU, CHENG; QIAN, XIAOZHE; Gao, Yuan; Zhang, Zhongheng


    Congenital pulmonary agenesis is a rare condition with high mortality. Mechanical ventilation in these patients is challenging and there has no such case been reported in the literature. We reported a 61-year-old female with lung agenesis who presented to our hospital with pneumonia and pelvic mass. In the past, she had undergone repairing of atrial septal defect and mitral valve forming surgery at 6-year-old. Thereafter she had remained asymptomatic until this time of hospital admission. The...

  4. Non-invasive mechanical ventilation in patients with diffuse interstitial lung diseases

    Aliberti, S.; Messinesi, G.; Gamberini, S; Maggiolini, S.; Visca, D.; Galavotti, V; Giuliani, F.; Cosentini, R; Brambilla, A M; Blasi, F; Scala, R; Carone, M.; Luisi, F; Harari, S.; Voza, A.


    Background To evaluate noninvasive ventilation (NIV) in diffuse interstitial lung diseases (DILD) patients with acute respiratory failure (ARF) according to baseline radiological patterns and the etiology of ARF. Methods In a multicenter, observational, retrospective study, consecutive DILD patients undergoing NIV because of an episode of ARF were evaluated in six Italian high dependency units. Three groups of patients were identified based on the etiology of ARF: those with pneumonia (Group ...

  5. Effects of hypercapnia and hypercapnic acidosis on attenuation of ventilator-associated lung injury.

    Ismaiel, N M; Henzler, D


    Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are associated with impaired gas exchange, severe inflammation and alveolar damage including cell death. Patients with ALI or ARDS typically experience respiratory failure and thus require mechanical ventilation for support, which itself can aggravate lung injury. Recent developments in this field have revealed several therapeutic strategies that improve gas exchange, increase survival and minimize the deleterious effects of mechanical ventilation. Among those strategies is the reduction in tidal volume and allowing hypercapnia to develop during ventilation, or actively inducing hypercapnia. Here, we provide an overview of hypercapnia and the hypercapnic acidosis that typically follows, as well as the therapeutic effects of hypercapnia and acidosis in clinical studies and experimental models of ALI. Specifically, we review the effects of hypercapnia and acidosis on the attenuation of pulmonary inflammation, reduction of apoptosis in alveolar epithelial cells, improvement in sepsis-induced ALI and the therapeutic effects on other organ systems, as well as the potentially harmful effects of these strategies. The clinical implications of hypercapnia and hypercapnic acidosis are still not entirely clear. However, future research should focus on the intracellular signaling pathways that mediate ALI development, potentially focusing on the role of reactive biological species in ALI pathogenesis. Future research can also elucidate how such pathways may be targeted by hypercapnia and hypercapnic acidosis to attenuate lung injury.

  6. The Clinical Study of the Safety Time Limitation with One-lung Ventilation

    QIN Haiqing; ZHAO Ruming; ZOU Xuechao; LIU Ji


    Objective To explore an extension of the safety time limitation during adult lung operations with one - lung ventilation(OLV). Methods Sixteen adult patients, all were introduced double lumen endobronchial tubes. Its demands were that counterpoints must be well. A compound solution of Procaine was dripped in vein to maintain anesthesia. Using anesthesia machine controlled ventilation: VT10ml/kg, RR 12b/min, FiO2 > 0.95, I:E = 1:2. Regularly sampling arterial blood made gases analysis from preanesthesia to the end of operations. Results PaO2 was the lowest at 30 minute after OLV in these patients. But it was still in the safety limitation. At 45 minute, it started to rise again and kept it at the high level to the end. Its length may attain four hours and a half. Meanwhile the circulation was stable. There were no postoperative anesthetic complication with hypoxemia during operations. Conclusion So long as the counterpoint of endobronchial tubes is accurate, ventilation properly managed, selectin from anesthetic suitable, circulatory function normal, the safety time limitation might last more than three hours and a half during adult lung operations with OLV.

  7. Manual ventilation and open suction procedures contribute to negative pressures in a mechanical lung model

    Nakstad, Espen Rostrup; Opdahl, Helge; Heyerdahl, Fridtjof; Borchsenius, Fredrik; Skjønsberg, Ole Henning


    Introduction Removal of pulmonary secretions in mechanically ventilated patients usually requires suction with closed catheter systems or flexible bronchoscopes. Manual ventilation is occasionally performed during such procedures if clinicians suspect inadequate ventilation. Suctioning can also be performed with the ventilator entirely disconnected from the endotracheal tube (ETT). The aim of this study was to investigate if these two procedures generate negative airway pressures, which may contribute to atelectasis. Methods The effects of device insertion and suctioning in ETTs were examined in a mechanical lung model with a pressure transducer inserted distal to ETTs of 9 mm, 8 mm and 7 mm internal diameter (ID). A 16 Fr bronchoscope and 12, 14 and 16 Fr suction catheters were used at two different vacuum levels during manual ventilation and with the ETTs disconnected. Results During manual ventilation with ETTs of 9 mm, 8 mm and 7 mm ID, and bronchoscopic suctioning at moderate suction level, peak pressure (PPEAK) dropped from 23, 22 and 24.5 cm H2O to 16, 16 and 15 cm H2O, respectively. Maximum suction reduced PPEAK to 20, 17 and 11 cm H2O, respectively, and the end-expiratory pressure fell from 5, 5.5 and 4.5 cm H2O to –2, –6 and –17 cm H2O. Suctioning through disconnected ETTs (open suction procedure) gave negative model airway pressures throughout the duration of the procedures. Conclusions Manual ventilation and open suction procedures induce negative end-expiratory pressure during endotracheal suctioning, which may have clinical implications in patients who need high PEEP (positive end-expiratory pressure). PMID:28725445

  8. Home kitchen ventilation, cooking fuels, and lung cancer risk in a prospective cohort of never smoking women in Shanghai, China.

    Kim, Christopher; Gao, Yu-Tang; Xiang, Yong-Bing; Barone-Adesi, Francesco; Zhang, Yawei; Hosgood, H Dean; Ma, Shuangge; Shu, Xiao-ou; Ji, Bu-Tian; Chow, Wong-Ho; Seow, Wei Jie; Bassig, Bryan; Cai, Qiuyin; Zheng, Wei; Rothman, Nathaniel; Lan, Qing


    Indoor air pollution (IAP) caused by cooking has been associated with lung cancer risk in retrospective case-control studies in developing and rural countries. We report the association of cooking conditions, fuel use, oil use, and risk of lung cancer in a developed urban population in a prospective cohort of women in Shanghai. A total of 71,320 never smoking women were followed from 1996 through 2009 and 429 incident lung cancer cases were identified. Questionnaires collected information on household living and cooking practices for the three most recent residences and utilization of cooking fuel and oil, and ventilation conditions. Cox proportional hazards regression estimated the association for kitchen ventilation conditions, cooking fuels, and use of cooking oils for the risk of lung cancer by hazard ratios (HR) with 95% confidence intervals (95% CI). Ever poor kitchen ventilation was associated with a 49% increase in lung cancer risk (HR: 1.49; 95% CI: 1.15-1.95) compared to never poor ventilation. Ever use of coal was not significantly associated. However, ever coal use with poor ventilation (HR: 1.69; 95% CI: 1.22-2.35) and 20 or more years of using coal with poor ventilation (HR: 2.03; 95% CI: 1.35-3.05) was significantly associated compared to no exposure to coal or poor ventilation. Cooking oil use was not significantly associated. These results demonstrate that IAP from poor ventilation of coal combustion increases the risk of lung cancer and is an important public health issue in cities across China where people may have lived in homes with inadequate kitchen ventilation.

  9. Effect of partial liquid ventilation on lung function in oleic acid-induced lung injury model of piglets

    ZHANG Ji-zhuo; LI Ling-ke; ZHANG Yan-bo; LI Gang; XU Yu-lin; ZHU Yao-bin


    Background Pediatric patients are susceptible to lung injury that does not respond to traditional therapies.Partial liquid ventilation (PLV) has been developed as an alternative ventilatory strategy for treating severe lung injury.The aim of this study is to investigate the effect of PLV on lung function in immature piglets.Methods Acute lung injury was induced in 12 Chinese immature piglets by oleic acid (OA).The animals were randomly assigned to two groups (n=6 each group):(1) conventional mechanical ventilation (MV) group and (2) PLV with FC-77 (10 ml/kg) group.Mean arterial blood pressure (MAP),mean pulmonary arterial pressure (MPAP),central venous pressure (CVP),left atrial pressure (LAP),systemic vascular resistance (SVR),pulmonary vascular resistance (PVR),cardiac output (CO),mean pressure of airway (Paw),dynamic lung compliance (Cydn),and arterial blood gases were measured during the observation period.Results No piglet died in either group with severe lung injury.After four hours of ventilation,pH in the MV group gradually decreased to lower than 7.20,while in the PLV group,pH also gradually decreased but remained higher than 7.20 (P <0.05).Partial pressure of oxygen in artery (PaO2) decreased in both groups,but with a significant difference between the PLV group and MV group (P <0.05).Partial pressure of carbon dioxide in artery (PaCO2) increased in both groups,but with a significant difference between the PLV group and MV group (P <0.05).Paw increased in both groups,but was not significantly different (P >0.05).Cydn decreased in both groups,but without a significant difference (P >0.05).At four hours,heart rate (HR) and MAP in both groups decreased.MPAP in both groups increased,and there was a significant difference between the two groups (P <0.05).CVP was stable in both groups.At four hours,PVR and LAP were increased in both groups.CO was decreased in both groups (P <0.05).SVR was stable during the observation time.Conclusion PLV did not

  10. Expression Changes of Early Response Genes in Lung Due to High Volume Ventilation

    WANG Yuelan; YAO Shanglong; XIONG Ping


    Summary: The expression changes of early response genes due to ventilation with high volume in adult rats in vivo were observed. Forty SD male rats were randomly divided into control and 30, 60, 90 and 120 min ventilation groups, respectively (n=8 in each group). The animals were ventilated with tidal volume of 42 ml/kg and a PEEP level of 0 cmH2O at a rate of 40 breaths per minute in room air with a ventilator was given to the small animals. The expression of Egr-1, C-jun and IL-1β mRNA and proteins was detected by RT-PCR and immunohistochemical technique, respectively. The pathological changes in lung tissues were examined by HE staining. The results indicated that the expression of Egr-1, C-jun and IL-1β mRNA was detectable at 30th min after overventilation, but there was no significant difference in comparison with that in control group until overventilation for 60 min. However, at 90 and 120 min there was a significent increase as compared with 30 min or control group (P<0.05). The expression of Egr-1, C-jun and IL-1β deteced by immunohistochemical assay also showed a similar tendency of the gradual increase. In the 120 min ventilation group, the expression intensity of Egr-1, C-jun and IL-1β proteins in lung cells was the strongest and the nuclear translocation was increased markedly in comparison with any other groups (P<0.05). HE staining suggested that the degree of lung injury was aggravated gradually with the ventialtion going on and had a similar tendency to the expression of these early response genes and proteins. The current data suggested that overventilation activated and upregulated the expression of early response genes and the expression of these genes may be taken as the early signal to predict the onset and degree of lung injury. These results may demonstrated partially that the expression of early response genes induced by the mechanical stretch is associated with biochamic lung injury.

  11. Effect of four resuscitation methods on lung ventilation of pigs with respiratory arrest

    Ya-hua LIU


    Full Text Available Objective To observe the effects of four cardiopulmonary resuscitation (CPR methods on lung ventilation of pigs with respiratory arrest. The four CPR methods included chest compression CPR (C-CPR, compression under the diaphragm CPR (D-CPR, abdominal compression CPR (A-CPR, and abdominal wall lifting and compression CPR (L-CPR. Methods  A total of 28 healthy domestic pigs were randomly divided into four groups. The pig respiratory arrest model was reproduced by intravenous injection of suxamethonium. Instantly after respiratory arrest, one of the 4 CPR methods was performed immediately on the groups of pigs respectively. After 2min of CPR, compression was stopped. The experimental pigs were given assisted respiration using a ventilator until autonomous respiration recovered. The tidal volume (VT in basic status and that during resuscitation by the four respective resuscitation methods was determined, and minute ventilation (MV was calculated. Furthermore, heart rate (HR, mean arterial blood pressure, and recovery time of autonomous respiration were compared between all the groups. Results In basic status, there was no statistical difference (P > 0.05 in VT and MV between the four groups. Approximately 2min after resuscitation, the VT and MV of D-CPR were higher than that of C-CPR; that of A-CPR was higher than that of D-CPR; and that of L-CPR was higher than that of A-CPR. The differences were statistically significant (P 0.05. HR in C-CPR and D-CPR were notably lower than the basic value (P < 0.01. Two minutes after resuscitation, mechanical ventilation was given, and HR in all the groups was close to the basic value 5 min after resuscitation. In the respiratory arrest pig model, L-CPR could provide more effective VT and MV than the other methods. Conclusion For the porcine respiratory arrest model, L-CPR can provide more effective lung ventilation than the other methods.

  12. Ventilation/perfusion lung scan probability category distributions in university and community hospitals.

    Lowe, V J; Bullard, A G; Coleman, R E


    The criteria used in the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) study for the interpretation of ventilation/perfusion scans are widely used and the probability of pulmonary embolism is determined from these criteria. The prevalence of pulmonary embolism in the PIOPED study was 33%. To investigate the similarity of patient populations who have ventilation/perfusion scans at one of the medical centers that participated in the PIOPED study and a small community hospital, the authors evaluated the probability category distributions of lung scans at the two institutions. They retrospectively interpreted 54 and 49 ventilation/perfusion lung scans selected from January, 1991, to June, 1992, at Duke University Medical Center and at Central Carolina Hospital, respectively. Studies were interpreted according to the PIOPED criteria. The percentage of studies assigned to each category at Duke University Medical Center and Central Carolina Hospital were 17% and 27% normal or very low probability, 31% and 59% low probability, 39% and 10% intermediate probability, and 13% and 4% high probability, respectively. The different distribution of probability categories between university and community hospitals suggests that the prevalence of disease may also be different. The post-test probability of pulmonary embolism is related to the prevalence of disease and the sensitivity and specificity of the ventilation/perfusion scan. Because these variables may differ in community hospital settings, the post-test probability of pulmonary embolism as determined by data from the PIOPED study should only be used in institutions with similar populations. Clinical management based upon the results of the PIOPED study may not be applicable to patients who have ventilation/perfusion scans performed in a community hospital.

  13. [Evaluation of lung perfusion scintigraphy without ventilation scintigraphy in the diagnosis of pulmonary thromboembolism].

    Jurkiene, Nemira


    The role of perfusion lung scintigraphy in the diagnosis of pulmonary embolism (PE) is reviewed. During the study 227 perfusion lung scans were obtained. The scans were grouped according to the PIOPED criteria into 5 groups: normal scans, very low, low, intermediate and high PE probability. The perfusion scans were analyzed according to the original PIOPED criteria, without ventilation scans. Evidence is provided that a normal perfusion scan excludes pulmonary embolism, and that a high probability lung scan, defined as a segmental perfusion defect with locally normal chest X-ray or findings in X-ray are smaller, sufficiently confirms the presence of pulmonary embolism in the majority of these patients (92.2%).

  14. Ventilation-perfusion lung scans in clinical practice: A challenge to PIOPED

    Rutland, M.; Que, Dr. L. [Auckland Hospital, Auckland (New Zealand)


    Full text: The prospective nature of the PIOPED project was intended to eliminate selection bias, so that the results would be directly applicable to the normal clinical use of lung scintigrams. A follow up study of 1192 ventilation-perfusion (VP) lung scans performed at Auckland Hospital during the years 1994-96 showed a different pattern of scan probabilities between the PIOPED research study and the routine clinical use of VP lung scans. The distribution of scan results shows that the patients in the PIOPED study bore as much resemblance to studies in which patients were selected for angiograms, as to studies in which all patients having scans were included. In addition, whereas PIOPED implies that only 61% of scan results are useful and 27% diagnostic, this study implies that in routine clinical practice 86% of scans will produce useful results and 46% diagnostic results 1 tab.

  15. Impact of ventilation frequency and parenchymal stiffness on flow and pressure distribution in a canine lung model.

    Amini, Reza; Kaczka, David W


    To determine the impact of ventilation frequency, lung volume, and parenchymal stiffness on ventilation distribution, we developed an anatomically-based computational model of the canine lung. Each lobe of the model consists of an asymmetric branching airway network subtended by terminal, viscoelastic acinar units. The model allows for empiric dependencies of airway segment dimensions and parenchymal stiffness on transpulmonary pressure. We simulated the effects of lung volume and parenchymal recoil on global lung impedance and ventilation distribution from 0.1 to 100 Hz, with mean transpulmonary pressures from 5 to 25 cm H2O. With increasing lung volume, the distribution of acinar flows narrowed and became more synchronous for frequencies below resonance. At higher frequencies, large variations in acinar flow were observed. Maximum acinar flow occurred at first antiresonance frequency, where lung impedance achieved a local maximum. The distribution of acinar pressures became very heterogeneous and amplified relative to tracheal pressure at the resonant frequency. These data demonstrate the important interaction between frequency and lung tissue stiffness on the distribution of acinar flows and pressures. These simulations provide useful information for the optimization of frequency, lung volume, and mean airway pressure during conventional ventilation or high frequency oscillation (HFOV). Moreover our model indicates that an optimal HFOV bandwidth exists between the resonant and antiresonant frequencies, for which interregional gas mixing is maximized.

  16. Efficiency of lung ventilation for people performing wind instruments

    Anna Brzęk


    Full Text Available Background: Wind instruments musicians are particularly prone to excessive respiratory efforts. Prolonged wind instruments performing may lead to changes in respiratory tracts and thus to respiratory muscles overload. It may result in decreasing lung tissue pliability and, as a consequence, in emphysema. Aim of the research has been to describe basic spirometric parameters for wind players and causes of potential changes. Material and Methods: Slow and forced spirometry with the use of Micro Lab Viasys (Micro Medical, Great Britain was conducted on 31 wind musicians (group A. A survey concerning playing time and frequency, weight of instruments, and education on diaphragmatic breathing was conducted. The control group included 34 healthy persons at similar age (group B. The results were statistically described using Excel and Statistica programmes. Results: The respiratory parameters were within the range of physiological norms and forced expiratory volume in 1 s to forced vital capacity (FEV1/FVC exceeded in both groups the values of 100%. Forced vital capacity and expiratory vital capacity (EVC values were significantly lower in the group of musicians than in the control group (p < 0.001. In 45% the group A used diaphragmatic breathing, in 31% of examinees mixed respiratory tract was observed. The significant discrepancy of individual parameters was obtained regarding age and the length of time when performing wind instrument. Conclusions: Spirometric parameters relative to standards may prove a good respiratory capacity. Peak expiratory flow (PEF and FEV1 may indicate that a proper technique of respiration during performance was acquired. The length of time when performing wind instrument may influence parameters of dynamic spirometry. Med Pr 2016;67(4:427–433

  17. Effect of desflurane-remifentanil vs. Propofol-remifentanil anesthesia on arterial oxygenation during one-lung ventilation for thoracoscopic surgery: a prospective randomized trial

    Cho, Youn Joung; Kim, Tae Kyong; Hong, Deok Man; Seo, Jeong-Hwa; Bahk, Jae-Hyon; Jeon, Yunseok


    Background One-lung ventilation during thoracic surgery frequently disturbs normal systemic oxygenation. However, the effect of anesthetics on arterial oxygenation during one-lung ventilation has not been well established in human study. In this clinical trial, we investigated whether a difference between desflurane-remifentanil and propofol-remifentanil anesthesia can be observed with regard to oxygenation during one-lung ventilation for thoracoscopic surgery. Methods Adult patients with lun...

  18. Mesenchymal Stem Cell Attenuates Neutrophil-predominant Inflammation and Acute Lung Injury in an In Vivo Rat Model of Ventilator-induced Lung Injury

    Tian-Shun Lai; Zhi-Hong Wang; Shao-Xi Cai


    Background:Subsequent neutrophil (polymorphonuclear neutrophil [PMN])-predominant inflammatory response is a predominant feature of ventilator-induced lung injury (VILI),and mesenchymal stem cell (MSC) can improve mice survival model of endotoxin-induced acute lung injury,reduce lung impairs,and enhance the repair of VILI.However,whether MSC could attenuate PMN-predominant inflammatory in the VILI is still unknown.This study aimed to test whether MSC intervention could attenuate the PMN-predominate inflammatory in the mechanical VILI.Methods:Sprague-Dawley rats were ventilated for 2 hours with large tidal volume (20 mL/kg).MSCs were given before or after ventilation.The inflammatory chemokines and gas exchange were observed and compared dynamically until 4 hours after ventilation,and pulmonary pathological change and activation of PMN were observed and compared 4 hours after ventilation.Results:Mechanical ventilation (MV) caused significant lung injury reflected by increasing in PMN pulmonary sequestration,inflammatory chemokines (tumor necrosis factor-alpha,interleukin-6 and macrophage inflammatory protein 2) in the bronchoalveolar lavage fluid,and injury score of the lung tissue.These changes were accompanied with excessive PMN activation which reflected by increases in PMN elastase activity,production of radical oxygen series.MSC intervention especially pretreatment attenuated subsequent lung injury,systemic inflammation response and PMN pulmonary sequestration and excessive PMN activation initiated by injurious ventilation.Conclusions:MV causes profound lung injury and PMN-predominate inflammatory responses.The protection effect of MSC in the VILI rat model is related to the suppression of the PMN activation.

  19. The effects of open lung ventilation on respiratory mechanics and haemodynamics in atelectatic infants after cardiopulmonary bypass.

    Cui, Q; Zhou, H; Zhao, R; Liu, J; Yang, X; Zhu, H; Zheng, Q; Gu, C; Yi, D


    Acute lung injury (ALI) frequently occurs in infants after cardiopulmonary bypass (CPB) surgery and it sometimes develops into acute respiratory distress syndrome in critically ill infants, which can be life threatening. This study investigated the effects of open lung ventilation on the haemodynamics and respiratory mechanics of 64 infants (34 males; 30 females) with a mean +/- SD age of 8.3 +/- 0.3 months who developed ALI following CPB surgery. Open lung ventilation significantly improved the respiratory mechanics and oxygenation parameters of the infants, including the partial pressure of oxygen in arterial blood (PaO(2)), the ratio of PaO(2)/FiO(2) (fraction of inspired oxygen), peak inspiratory pressure, static compliance and airway resistance. It is concluded that open lung ventilation can greatly improve oxygenation and respiratory mechanics in infants with ALI following CPB surgery.

  20. The ventilation strategy of one-lung ventilation for obese patients%肥胖患者单肺通气期间的通气策略

    陈旭; 谢言虎; 柴小青


    背景 肥胖人群比例不断升高,肥胖影响正常生理功能,给麻醉带来不少问题,尤其在单肺通气(one-lung ventilation,OLV)过程中. 目的 减少肥胖患者OLV过程对预后转归的影响,降低肥胖患者围手术期呼吸系统并发症的发生率. 内容 探讨肥胖患者围手术期OLV期间的通气策略,包括通气模式的选择、保护性通气策略、高碳酸血症、肺泡复张策略和吸氧浓度的选择. 趋向 肥胖患者OLV期间采用小潮气量联合呼气末正压通气(positive end-expiratory pressure, PEEP)、间断肺泡复张和低到中度Fi02等通气策略有助于改善氧合、降低肺不张发生率,高碳酸血症在无肺部疾病患者中是否具有肺保护作用尚待研究.%Background The proportion of obese people is rising.Obesity influences the normal physiological function,causing lots of problems in anesthesia,especially during one-lung ventilation (OLV).Objective To reduce the effect of one-lung ventilation on prognosis and decrease the incidence of perioperative respiratory complications in obese patients.Content To explore the ventilation strategies of OLV for obesity patients during perioperative period,including the choices of ventilation modes,protective ventilation strategy,hypercapnia,alveolar recruitment strategy and oxygen concentration selection.Trend Low tidal volume combined with positive end-expiratory pressure (PEEP),intermittent alveolar recruitment and low to moderate FiO2 help to improve oxygenation and reduce the incidence of atelectasis in obese patients during one-lung ventilation.Whether hypercapnia has a lung proctive effect on patients without lung disease or not,it remains to be investigated.

  1. Effect of Phenylephrine on Alveolar Fluid Clearance in Ventilator-induced Lung Injury

    Nai-jing Li; Xiu Gu; Wei Li; Yan Li; Sheng-qi Li; Ping He


    Objective To investigate the effect of phenylephrine (an α-adrenergic agonist) on alveolar fluid clearance (AFC) in ventilator-induced lung injury and the possible mechanism involved. Methods A total of 170 male Wistar rats were randomly allocated into 17 groups (n=10) using ran-dom number tables. Short-term (40 minutes) mechanical ventilation with high tidal volume (HVT) was per-formed to induce lung injury,impair active Na+ transport and lung liquid clearance in the rats. Unventilated rats served as controls. To demonstrate the effect of phenylephrine on AFC,phenylephrine at different con-centrations (1×10-5,1×10-6,1×10-7,1×10-8,and 1×10-9 mol/L) was injected into the alveolar space of the HVT ventilated rats. To identify the influence of adrenergic antagonists,Na+ channel,and microtubular sys-tem on the effect of phenylephrine,phenylephrine at 1×10-5 mol/L combined with prazosin (an α1-adrener-gic antagonist,1×10-4 mol/L),yohimbine (an α2-adrenergic antagonist,1×10-4 mol/L),atenolol (a β1-adrenergic antagonist,1×10-5 mol/L),ICI-118551 (an β2-adrenergic antagonist,1×10-5 mol/L),amiloride (a Na+ channel blocker,5×10-4 mol/L),ouabain (a Na+/K+-ATPase blocker,5×10-4 mol/L),colchicine (a mi-crotubular disrupting agent,0.25 mg/100 g body weight),or β-lumicolchicine (an isomer of colchicine,0.25 mg/100 g body weight) were perfused into the alveolar space of the rats ventilated with HVT for 40 minutes. AFC and total lung water content were measured. Results Basal AFC in control rats was (17.47±2.56)%/hour,which decreased to (9.64± 1.32)%/hour in HVT ventilated rats (P=0.003). The perfusion of phenylephrine at 1×10-8,1×10-7,1×10-6,and 1×10-5 mol/L significantly increased the AFC in HVT ventilated rats (all P<0.05). This effect of phenylephrine on AFC was suppressed by prazosin,atenolol,and ICI-118551 in HVT ventilated rats by 53%,31%,and 37%,respectively (all P<0.05). The AFC-stimulating effect of phenylephrine was lowered by 33% and 42% with

  2. Mechanical ventilation in acute respiratory distress syndrome: The open lung revisited.

    Amado-Rodríguez, L; Del Busto, C; García-Prieto, E; Albaiceta, G M


    Acute respiratory distress syndrome (ARDS) is still related to high mortality and morbidity rates. Most patients with ARDS will require ventilatory support. This treatment has a direct impact upon patient outcome and is associated to major side effects. In this regard, ventilator-associated lung injury (VALI) is the main concern when this technique is used. The ultimate mechanisms of VALI and its management are under constant evolution. The present review describes the classical mechanisms of VALI and how they have evolved with recent findings from physiopathological and clinical studies, with the aim of analyzing the clinical implications derived from them. Lastly, a series of knowledge-based recommendations are proposed that can be helpful for the ventilator assisted management of ARDS at the patient bedside. Copyright © 2017 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  3. Surfactant before the first inflation at birth improves spatial distribution of ventilation and reduces lung injury in preterm lambs.

    Tingay, David G; Wallace, Megan J; Bhatia, Risha; Schmölzer, Georg M; Zahra, Valerie A; Dolan, Melinda J; Hooper, Stuart B; Davis, Peter G


    The interrelationship between the role of surfactant and a sustained inflation (SI) to aid ex utero transition of the preterm lung is unknown. We compared the effect of surfactant administered before and after an initial SI on gas exchange, lung mechanics, spatial distribution of ventilation, and lung injury in preterm lambs. Gestational-age lambs (127 days; 9 per group) received 100 mg/kg of a surfactant (Curosurf) either prior (Surf+SI) or 10 min after birth (SI+Surf). At birth, a 20-s, 35 cmH2O SI was applied, followed by 70 min of positive pressure ventilation. Oxygenation, carbon dioxide removal, respiratory system compliance, end-expiratory thoracic volume (via respiratory inductive plethysmography), and distribution of end-expiratory volume and ventilation (via electrical impedance tomography) were measured throughout. Early markers of lung injury were analyzed using quantitative RT-PCR. During the first 15 min, oxygenation, carbon dioxide removal, and compliance were better in the Surf+SI group (all P ventilation was more uniform in the Surf+SI group throughout; 50.1 ± 10.9% of total ventilation in the left hemithorax at 70 min vs. 42.6 ± 11.1% in the SI+Surf group. Surf+SI resulted in lower mRNA levels of CYR61 and EGR1 compared with SI+Surf (P mechanical and injury response to a sustained inflation and ventilation by changing surface tension of the air/fluid interface.

  4. 99mTc technegas ventilation and perfusion lung scintigraphy for the diagnosis of pulmonary embolus.

    Howarth, D M; Lan, L; Thomas, P A; Allen, L W


    Lung scintigraphy is used widely for diagnosis of pulmonary embolus (PE). Technegas ventilation imaging has many advantages over other methods, but little outcome data exists on this technique. The aims of this study were to better define the role of lung scintigraphy in the management of patients with suspected PE and to evaluate technegas ventilation imaging by following patient outcomes. A group of 717 out of 834 consecutive patients, referred to a university teaching hospital for lung scintigraphy to confirm or refute the diagnosis of PE, was followed for 18-30 mo to determine clinical outcome. The follow-up endpoints were death as a result of PE, death as a result of hemorrhage after treatment for PE, uncomplicated survival, survival with subsequent PE, nonfatal hemorrhage after treatment for PE and recurrence of PE in treated patients. Ventilation imaging was performed using technegas, and perfusion imaging was performed using intravenous 99mTc macroaggregated albumin. The modified PIOPED (Prospective Investigation of Pulmonary Embolism Diagnosis) diagnostic criterion was used for interpretation of lung scintigraphy. Diagnostic results included 3.5% normal studies, 67.4% assessed as low probability for PE, 10% as moderate probability for PE and 19.1% as high probability for PE. A total of 231 patents received therapy with heparin, followed by warfarin, including those receiving anticoagulation therapy for other conditions. Ninety-six percent of patients with normal and low probability studies (n = 508) had good outcomes, 6 patients died as a result of PE and 12 subsequently developed PE. The odds ratio for death by PE in this group was 0.2. Of the 72 moderate probability studies, 39 patients were untreated. In this group there was 1 death due to PE, and PE subsequently developed in 2 patients. None of the remaining 33 treated patients died, but 4 patients experienced bleeding complications. The odds ratio for death by PE in the moderate probability group was

  5. Lung ventilation strategies for acute respiratory distress syndrome: a systematic review and network meta-analysis.

    Wang, Changsong; Wang, Xiaoyang; Chi, Chunjie; Guo, Libo; Guo, Lei; Zhao, Nana; Wang, Weiwei; Pi, Xin; Sun, Bo; Lian, Ailing; Shi, Jinghui; Li, Enyou


    To identify the best lung ventilation strategy for acute respiratory distress syndrome (ARDS), we performed a network meta-analysis. The Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, CINAHL, and the Web of Science were searched, and 36 eligible articles were included. Compared with higher tidal volumes with FiO2-guided lower positive end-expiratory pressure [PEEP], the hazard ratios (HRs) for mortality were 0.624 (95% confidence interval (CI) 0.419-0.98) for lower tidal volumes with FiO2-guided lower PEEP and prone positioning and 0.572 (0.34-0.968) for pressure-controlled ventilation with FiO2-guided lower PEEP. Lower tidal volumes with FiO2-guided higher PEEP and prone positioning had the greatest potential to reduce mortality, and the possibility of receiving the first ranking was 61.6%. Permissive hypercapnia, recruitment maneuver, and low airway pressures were most likely to be the worst in terms of all-cause mortality. Compared with higher tidal volumes with FiO2-guided lower PEEP, pressure-controlled ventilation with FiO2-guided lower PEEP and lower tidal volumes with FiO2-guided lower PEEP and prone positioning ventilation are associated with lower mortality in ARDS patients. Lower tidal volumes with FiO2-guided higher PEEP and prone positioning ventilation and lower tidal volumes with pressure-volume (P-V) static curve-guided individual PEEP are potential optimal strategies for ARDS patients.

  6. Theoretical Models for the Quantification of Lung Injury Using Ventilation and Perfusion Distributions

    B. S. Brook


    Full Text Available This paper describes two approaches to modelling lung disease: one based on a multi-compartment statistical model with a log normal distribution of ventilation perfusion ratio (V˙/Q˙ values; and the other on a bifurcating tree which emulates the anatomical structure of the lung. In the statistical model, the distribution becomes bimodal, when the V˙/Q˙ values of a randomly selected number of compartments are reduced by 85% to simulate lung disease. For the bifurcating tree model a difference in flow to the left and right branches coupled with a small random variation in flow ratio between generations results in a log normal distribution of flows in the terminal branches. Restricting flow through branches within the tree to simulate lung disease transforms this log normal distribution to a bi-modal one. These results are compatible with those obtained from experiments using the multiple inert gas elimination technique, where log normal distributions of V˙/Q˙ ratio become bimodal in the presence of lung disease.

  7. The Effects of Lung Protective Ventilation or Hypercapnic Acidosis on Gas Exchange and Lung Injury in Surfactant Deficient Rabbits.

    Helmut D Hummler

    Full Text Available Permissive hypercapnia has been shown to reduce lung injury in subjects with surfactant deficiency. Experimental studies suggest that hypercapnic acidosis by itself rather than decreased tidal volume may be a key protective factor.To study the differential effects of a lung protective ventilatory strategy or hypercapnic acidosis on gas exchange, hemodynamics and lung injury in an animal model of surfactant deficiency.30 anesthetized, surfactant-depleted rabbits were mechanically ventilated (FiO2 = 0.8, PEEP = 7cmH2O and randomized into three groups: Normoventilation-Normocapnia (NN-group: tidal volume (Vt = 7.5 ml/kg, target PaCO2 = 40 mmHg; Normoventilation-Hypercapnia (NH-group: Vt = 7.5 ml/kg, target PaCO2 = 80 mmHg by increasing FiCO2; and a Hypoventilation-Hypercapnia (HH-group: Vt = 4.5 ml/kg, target PaCO2 = 80 mmHg. Plasma lactate and interleukin (IL-8 were measured every 2 h. Animals were sacrificed after 6 h to perform bronchoalveolar lavage (BAL, to measure lung wet-to-dry weight, lung tissue IL-8, and to obtain lung histology.PaO2 was significantly higher in the HH-group compared to the NN-group (p<0.05, with values of the NH-group between the HH- and NN-groups. Other markers of lung injury (wet-dry-weight, BAL-Protein, histology-score, plasma-IL-8 and lung tissue IL-8 resulted in significantly lower values for the HH-group compared to the NN-group and trends for the NH-group towards lower values compared to the NN-group. Lactate was significantly lower in both hypercapnia groups compared to the NN-group.Whereas hypercapnic acidosis may have some beneficial effects, a significant effect on lung injury and systemic inflammatory response is dependent upon a lower tidal volume rather than resultant arterial CO2 tensions and pH alone.

  8. Alveolocapillary membrane permeability in experimental model of ventilator induced lung injury

    Наталья Александровна Решетняк


    Full Text Available Aim: to assess alveocapillary membrane permeability for the whole protein, middle molecular peptides and some lipoperoxidation markers depending on respiratory volume using in reproduction of ventilator induced lung injury model.Material and methods: Experiments were carried out on 15 laboratory rats- males (body mass 180–240 gr. of “Vistar” line. The mechanical pulmonary ventilation in rats was carried out using tracheostomy cannula ALV Hamilton G 5 apparatus during 2 hours under the total anesthesia with sodium thiopental at a rate of 40 mg|kg of animal body mass. The initial parameters of ventilation were equal in all animals: Inspiratory time = 0,5 seconds; respiratory rate = 60 – 76/minute; pressure at the end of expiration (PEE = 0 - 2 sm. of water column; inspiration-expiration ratio (I:E = 1:1 or 1:2. Depending on the size of respiratory volume (RV animal were divided into 3 groups (n=5. Animals with RV=7 ml/kg of body mass formed the first group (the control one. The second group included animals with RV = 20 ml/kg of body mass (the moderate volutrauma and the third one included animals with RV = 40 ml/kg of body mass (the heavy volutrauma. The bronchoalveolar lavage was carried out on isolated lungs with the volume of filling at a rate 5 ml of 0,9 % sodium chloride solution for 1 g of pulmonary tissue and there was received nearly 2,5+0,5 ml of lavage liquid (sodium chloride solution + bronchoalveolar liquid. The alveolocapillary membrane permeability was assessed by detecting in the received liquid of bronchoalveolar lavage the concentration of whole protein on Lowry, the content of middle mass molecules on extinction at wave lengths 238, 254, 260, and 280 nm; the level of diene conjugates on V.B. Gavrilov and catalase activity on M.A. Koroliuk. The received data were processed using methods of nonparametric statistics. The revealed intergroup differences were assessed on Kruskall-Wallis «ANOVA» criterion. The differences at

  9. Liquid Ventilation

    Qutaiba A. Tawfic


    Full Text Available Mammals have lungs to breathe air and they have no gills to breath liquids. When the surface tension at the air-liquid interface of the lung increases, as in acute lung injury, scientists started to think about filling the lung with fluid instead of air to reduce the surface tension and facilitate ventilation. Liquid ventilation (LV is a technique of mechanical ventilation in which the lungs are insufflated with an oxygenated perfluorochemical liquid rather than an oxygen-containing gas mixture. The use of perfluorochemicals, rather than nitrogen, as the inert carrier of oxygen and carbon dioxide offers a number of theoretical advantages for the treatment of acute lung injury. In addition, there are non-respiratory applications with expanding potential including pulmonary drug delivery and radiographic imaging. The potential for multiple clinical applications for liquid-assisted ventilation will be clarified and optimized in future. Keywords: Liquid ventilation; perfluorochemicals; perfluorocarbon; respiratory distress; surfactant.

  10. Dexamethasone attenuates VEGF expression and inflammation but not barrier dysfunction in a murine model of ventilator-induced lung injury.

    Maria A Hegeman

    Full Text Available BACKGROUND: Ventilator-induced lung injury (VILI is characterized by vascular leakage and inflammatory responses eventually leading to pulmonary dysfunction. Vascular endothelial growth factor (VEGF has been proposed to be involved in the pathogenesis of VILI. This study examines the inhibitory effect of dexamethasone on VEGF expression, inflammation and alveolar-capillary barrier dysfunction in an established murine model of VILI. METHODS: Healthy male C57Bl/6 mice were anesthetized, tracheotomized and mechanically ventilated for 5 hours with an inspiratory pressure of 10 cmH2O ("lower" tidal volumes of ∼7.5 ml/kg; LVT or 18 cmH2O ("higher" tidal volumes of ∼15 ml/kg; HVT. Dexamethasone was intravenously administered at the initiation of HVT-ventilation. Non-ventilated mice served as controls. Study endpoints included VEGF and inflammatory mediator expression in lung tissue, neutrophil and protein levels in bronchoalveolar lavage fluid, PaO2 to FiO2 ratios and lung wet to dry ratios. RESULTS: Particularly HVT-ventilation led to alveolar-capillary barrier dysfunction as reflected by reduced PaO2 to FiO2 ratios, elevated alveolar protein levels and increased lung wet to dry ratios. Moreover, VILI was associated with enhanced VEGF production, inflammatory mediator expression and neutrophil infiltration. Dexamethasone treatment inhibited VEGF and pro-inflammatory response in lungs of HVT-ventilated mice, without improving alveolar-capillary permeability, gas exchange and pulmonary edema formation. CONCLUSIONS: Dexamethasone treatment completely abolishes ventilator-induced VEGF expression and inflammation. However, dexamethasone does not protect against alveolar-capillary barrier dysfunction in an established murine model of VILI.

  11. Human mesenchymal stem cells attenuate early damage in a ventilated pig model of acute lung injury

    Yuben Moodley


    Full Text Available Acute lung injury/acute respiratory distress syndrome (ALI/ARDS is a major cause of global morbidity and mortality. Mesenchymal stem cells (MSC have shown promise in treating inflammatory lung conditions. We hypothesised that human MSC (hMSC can improve ALI/ARDS through their anti-inflammatory actions. We subjected pigs (n = 6 to intravenous oleic acid (OA injury, ventilation and hMSC infusion, while the controls (n = 5 had intravenous OA, ventilation and an infusion vehicle control. hMSC were infused 1 h after the administration of OA. The animals were monitored for additional 4 h. Nuclear translocation of nuclear factor-light chain enhancer of activated B cells (NF-κB, a transcription factor that mediates several inflammatory pathways was reduced in hMSC treated pigs compared to controls (p = 0.04. There was no significant difference in lung injury, assessed by histological scoring in hMSC treated pigs versus controls (p = 0.063. There was no difference in neutrophil counts between hMSC-treated pigs and controls. Within 4 h, there was no difference in the levels of IL-10 and IL-8 pre- and post-treatment with hMSC. In addition, there was no difference in hemodynamics, lung mechanics or arterial blood gases between hMSC treated animals and controls. Subsequent studies are required to determine if the observed decrease in inflammatory transcription factors will translate into improvement in inflammation and in physiological parameters over the long term.

  12. Measuring interfraction and intrafraction lung function changes during radiation therapy using four-dimensional cone beam CT ventilation imaging

    Kipritidis, John, E-mail:; Keall, Paul J. [Radiation Physics Laboratory, Sydney Medical School, University of Sydney, Sydney NSW 2006 (Australia); Hugo, Geoffrey; Weiss, Elisabeth; Williamson, Jeffrey [Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia 23298 (United States)


    Purpose: Adaptive ventilation guided radiation therapy could minimize the irradiation of healthy lung based on repeat lung ventilation imaging (VI) during treatment. However the efficacy of adaptive ventilation guidance requires that interfraction (e.g., week-to-week), ventilation changes are not washed out by intrafraction (e.g., pre- and postfraction) changes, for example, due to patient breathing variability. The authors hypothesize that patients undergoing lung cancer radiation therapy exhibit larger interfraction ventilation changes compared to intrafraction function changes. To test this, the authors perform the first comparison of interfraction and intrafraction lung VI pairs using four-dimensional cone beam CT ventilation imaging (4D-CBCT VI), a novel technique for functional lung imaging. Methods: The authors analyzed a total of 215 4D-CBCT scans acquired for 19 locally advanced non-small cell lung cancer (LA-NSCLC) patients over 4–6 weeks of radiation therapy. This set of 215 scans was sorted into 56 interfraction pairs (including first day scans and each of treatment weeks 2, 4, and 6) and 78 intrafraction pairs (including pre/postfraction scans on the same-day), with some scans appearing in both sets. VIs were obtained from the Jacobian determinant of the transform between the 4D-CBCT end-exhale and end-inhale images after deformable image registration. All VIs were deformably registered to their corresponding planning CT and normalized to account for differences in breathing effort, thus facilitating image comparison in terms of (i) voxelwise Spearman correlations, (ii) mean image differences, and (iii) gamma pass rates for all interfraction and intrafraction VI pairs. For the side of the lung ipsilateral to the tumor, we applied two-sided t-tests to determine whether interfraction VI pairs were more different than intrafraction VI pairs. Results: The (mean ± standard deviation) Spearman correlation for interfraction VI pairs was r{sup -}{sub Inter

  13. Quantitative measurement of regional lung gas volume by synchrotron radiation computed tomography

    Monfraix, Sylvie [European Synchrotron Radiation Facility, BP 220, F-38043 Grenoble (France); Bayat, Sam [European Synchrotron Radiation Facility, BP 220, F-38043 Grenoble (France); Porra, Liisa [Department of Physical Sciences, University of Helsinki, POB 64, FIN-00014 Helsinki (Finland); Berruyer, Gilles [European Synchrotron Radiation Facility, BP 220, F-38043 Grenoble (France); Nemoz, Christian [European Synchrotron Radiation Facility, BP 220, F-38043 Grenoble (France); Thomlinson, William [Canadian Light Source, 101 Perimeter Road, Saskatoon, SK S7N 0X4 (Canada); Suortti, Pekka [Department of Physical Sciences, University of Helsinki, POB 64, FIN-00014 Helsinki (Finland); Sovijaervi, Anssi R A [Department of Clinical Physiology and Nuclear Medicine, Helsinki University Central Hospital, POB 340, FIN-00029 HUS, Helsinki (Finland)


    The aim of this study was to assess the feasibility of a novel respiration-gated spiral synchrotron radiation computed tomography (SRCT) technique for direct quantification of absolute regional lung volumes, using stable xenon (Xe) gas as an inhaled indicator. Spiral SRCT with K-edge subtraction using two monochromatic x-ray beams was used to visualize and directly quantify inhaled Xe concentrations and airspace volumes in three-dimensional (3D) reconstructed lung images. Volume measurements were validated using a hollow Xe-filled phantom. Spiral images spanning 49 mm in lung height were acquired following 60 breaths of an 80% Xe-20% O{sub 2} gas mixture, in two anaesthetized and mechanically ventilated rabbits at baseline and after histamine aerosol inhalation. Volumetric images of 20 mm lung sections were obtained at functional residual capacity (FRC) and at end-inspiration. 3D images showed large patchy filling defects in peripheral airways and alveoli following histamine provocation. Local specific lung compliance was calculated based on FRC/end-inspiration images in normal lung. This study demonstrates spiral SRCT as a new technique for direct determination of regional lung volume, offering possibilities for non-invasive investigation of regional lung function and mechanics, with a uniquely high spatial resolution. An example of non-uniform volume distribution in rabbit lung following histamine inhalation is presented.

  14. [Measurement of the Minimum Pressure in the Bronchial Cuff during One-lung Ventilation Using a Capnometer].

    Okubo, Haruka; Kawasaki, Takashi; Shibayama, Aiko; Sata, Takeyoshi


    It is recommended to avoid overinflation of the bronchial cuff, leading to ischemic pressure damages to the respiratory mucosa and bronchial rupture. We investigated the minimum bronchial cuff pressure of 35 Fr double lumen tubes (DLTs) during one lung ventilation using a capnometer. We studied 50 patients who were scheduled to undergo thoracic surgery. General anesthesia was induced and the patients were intubated with 35 Fr left DLT. With a fiberoptic bronchoscope, the DLT was positioned appropriately. The bronchial cuff was inflated first with air 3-3.5 ml. Lung isolation was confirmed by auscultation. Measurements were performed with the patient in the lateral position. Ventilating one lung isolatedly for 5 minutes, we confirmed non ventilated condition with a capnometer displaying flat line. The bronchial cuff was deflated 0.5-ml steps just before displaying the respiratory pattern by the capnogram. The bronchial cuff pressure and volume were recorded at this point The minimum pressures of bronchial cuff (volume) for one lung ventilation are for male 5.46 ± 0.6 cmH2O (2.33?0.1 ml) and for female 1.5?0.5 cmH20 (1.09 ± 0.3 ml). These values are smaller than the recommended value (< 25 cmH2O). There was no case in which the collapse of the operated lung was insufficient. In this study, the bronchial pressure higher than 12 cmH2O was not necessary for one lung ventilation. If high intracuff pressure is necessary to seal the bronchus, there are possibilities of the incompatibility of the size of DLT and the herniation of the bronchial cuff to the proximal side. The method of confirmation of OLV using a capnometer can display the non ventilated condition on the monitor objectively. We can thus decrease troubles during operations.

  15. Application of natural ventilation of residential buildings in hot-humid regions

    喻伟; 沈艳; 丁勇


    The current ventilation condition of the hot and humid regions was analyzed through on-site investigation. It is found that residents in this region expect to improve indoor thermal environment through natural ventilation as much as possible. Then,it comes to a conclusion by the field test that natural ventilation has certain practical effect on improving indoor thermal environment. CFD simulation software is employed to verify the test result. Based on PMV modified model,and according to norms,geography and climate combined with the measured and simulated results,the application of the time and effectiveness of natural ventilation in hot and humid region were analyzed,to some extent,providing a basis for reducing the air-conditioner’s runtime with natural ventilation.

  16. Activation of the Wnt/β-catenin signaling pathway by mechanical ventilation is associated with ventilator-induced pulmonary fibrosis in healthy lungs.

    Jesús Villar

    Full Text Available BACKGROUND: Mechanical ventilation (MV with high tidal volumes (V(T can cause or aggravate lung damage, so-called ventilator induced lung injury (VILI. The relationship between specific mechanical events in the lung and the cellular responses that result in VILI remains incomplete. Since activation of Wnt/β-catenin signaling has been suggested to be central to mechanisms of lung healing and fibrosis, we hypothesized that the Wnt/β-catenin signaling plays a role during VILI. METHODOLOGY/PRINCIPAL FINDINGS: Prospective, randomized, controlled animal study using adult, healthy, male Sprague-Dawley rats. Animals (n = 6/group were randomized to spontaneous breathing or two strategies of MV for 4 hours: low tidal volume (V(T (6 mL/kg or high V(T (20 mL/kg. Histological evaluation of lung tissue, measurements of WNT5A, total β-catenin, non-phospho (Ser33/37/Thr41 β-catenin, matrix metalloproteinase-7 (MMP-7, cyclin D1, vascular endothelial growth factor (VEGF, and axis inhibition protein 2 (AXIN2 protein levels by Western blot, and WNT5A, non-phospho (Ser33/37/Thr41 β-catenin, MMP-7, and AXIN2 immunohistochemical localization in the lungs were analyzed. High-V(T MV caused lung inflammation and perivascular edema with cellular infiltrates and collagen deposition. Protein levels of WNT5A, non-phospho (Ser33/37/Thr41 β-catenin, MMP-7, cyclin D1, VEGF, and AXIN2 in the lungs were increased in all ventilated animals although high-V(T MV was associated with significantly higher levels of WNT5A, non-phospho (Ser33/37/Thr41 β-catenin, MMP-7, cyclin D1, VEGF, and AXIN2 levels. CONCLUSIONS/SIGNIFICANCE: Our findings demonstrate that the Wnt/β-catenin signaling pathway is modulated very early by MV in lungs without preexistent lung disease, suggesting that activation of this pathway could play an important role in both VILI and lung repair. Modulation of this pathway might represent a therapeutic option for prevention and/or management of VILI.

  17. Collateral Ventilation to Congenital Hyperlucent Lung Lesions Assessed on Xenon-Enhanced Dynamic Dual-Energy CT: an Initial Experience

    Goo, Hyun Woo; Yang, Dong Hyun; Kim, Nam Kug; Park, Seung Il; Kim, Dong Kwan; Kim, Ellen Ai Rhan [Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of)


    We wanted to evaluate the resistance to collateral ventilation in congenital hyperlucent lung lesions and to correlate that with the anatomic findings on xenon-enhanced dynamic dual-energy CT. Xenon-enhanced dynamic dual-energy CT was successfully and safely performed in eight children (median age: 5.5 years, 4 boys and 4 girls) with congenital hyperlucent lung lesions. Functional assessment of the lung lesions on the xenon map was done, including performing a time-xenon value curve analysis and assessing the amplitude of xenon enhancement (A) value, the rate of xenon enhancement (K) value and the time of arrival value. Based on the A value, the lung lesions were categorized into high or low (A value > 10 Hounsfi eld unit [HU]) resistance to collateral ventilation. In addition, the morphologic CT findings of the lung lesions, including cyst, mucocele and an accessory or incomplete fissure, were assessed on the weighted-average CT images. The xenon-enhanced CT radiation dose was estimated. Five of the eight lung lesions were categorized into the high resistance group and three lesions were categorized into the low resistance group. The A and K values in the normal lung were higher than those in the low resistance group. The time of arrival values were delayed in the low resistance group. Cysts were identified in five lesions, mucocele in four, accessory fissure in three and incomplete fissure in two. Either cyst or an accessory fissure was seen in four of the five lesions showing high resistance to collateral ventilation. The xenon-enhanced CT radiation dose was 2.3 {+-} 0.6 mSv. Xenon-enhanced dynamic dual-energy CT can help visualize and quantitate various degrees of collateral ventilation to congenital hyperlucent lung lesions in addition to assessing the anatomic details of the lung

  18. Pre-treatment with dexamethasone attenuates experimental ventilator-induced lung injury.

    Reis, Fernando Fonseca Dos; Reboredo, Maycon de Moura; Lucinda, Leda Marília Fonseca; Bianchi, Aydra Mendes Almeida; Rabelo, Maria Aparecida Esteves; Fonseca, Lídia Maria Carneiro da; Oliveira, Júlio César Abreu de; Pinheiro, Bruno Valle


    To evaluate the effects that administering dexamethasone before the induction of ventilator-induced lung injury (VILI) has on the temporal evolution of that injury. Wistar rats were allocated to one of three groups: pre-VILI administration of dexamethasone (dexamethasone group); pre-VILI administration of saline (control group); or ventilation only (sham group). The VILI was induced by ventilation at a high tidal volume. Animals in the dexamethasone and control groups were euthanized at 0, 4, 24, and 168 h after VILI induction. We analyzed arterial blood gases, lung edema, cell counts (total and differential) in the BAL fluid, and lung histology. At 0, 4, and 24 h after VILI induction, acute lung injury (ALI) scores were higher in the control group than in the sham group (p histologia de tecido pulmonar. Em 0, 4 e 24 h após LPIVM, os escores de lesão pulmonar aguda (LPA) foram maiores no grupo controle que no grupo sham (p < 0,05). A administração de dexametasona antes da LPIVM reduziu a gravidade da lesão pulmonar. Em 4 e 24 h após a indução, o escore de LPA no grupo dexametasona não foi significativamente diferente daquele observado no grupo sham e foi menor que o observado no grupo controle (p < 0,05). As contagens de neutrófilos no lavado broncoalveolar estavam aumentadas nos grupos controle e dexametasona, com pico em 4 h após LPIVM (p < 0,05). Entretanto, as contagens de neutrófilos foram menores no grupo dexametasona que no grupo controle em 4 e 24 h após LPIVM (p < 0,05). O pré-tratamento com dexametasona também impediu o comprometimento da oxigenação após a indução visto no grupo controle. A administração de dexametasona antes de LPIVM atenua os efeitos da lesão em ratos Wistar. Os mecanismos moleculares dessa lesão e o possível papel clínico dos corticosteroides na LPIVM ainda precisam ser elucidados.

  19. Mechanical ventilation strategies for intensive care unit patients without acute lung injury or acute respiratory distress syndrome: a systematic review and network meta-analysis

    Guo, Lei; Wang, Weiwei; Zhao, Nana; Guo, Libo; Chi, Chunjie; Hou, Wei; Wu, Anqi; Tong, Hongshuang; Wang, Yue; Wang, Changsong; Li, Enyou


    Background It has been shown that the application of a lung-protective mechanical ventilation strategy can improve the prognosis of patients with acute lung injury (ALI) or acute respiratory distress syndrome (ARDS). However, the optimal mechanical ventilation strategy for intensive care unit (ICU) patients without ALI or ARDS is uncertain. Therefore, we performed a network meta-analysis to identify the optimal mechanical ventilation strategy for these patients. Methods We searched the Cochra...

  20. Role of caveolin-1 expression in the pathogenesis of pulmonary edema in ventilator-induced lung injury

    Maniatis, Nikolaos A.; Kardara, Matina; Hecimovich, Dan; Letsiou, Eleftheria; Castellon, Maricela; Roussos, Charalambos; Shinin, Vasily; Votta-Vellis, E. Gina; Schwartz, David E.; Minshall, Richard D.


    Caveolin-1 is a key regulator of pulmonary endothelial barrier function. Here, we tested the hypothesis that caveolin-1 expression is required for ventilator-induced lung injury (VILI). Caveolin-1 gene-disrupted (Cav-1-/-) and age-, sex-, and strain-matched wild-type (WT) control mice were ventilated using two protocols: volume-controlled with protective (8 mL/kg) versus injurious (21 mL/Kg) tidal volume for up to 6 hours; and pressure-controlled with protective (airway pressure = 12 cm H2O) versus injurious (30 cm H2O) ventilation to induce lung injury. Lung microvascular permeability (whole-lung 125I-albumin accumulation, lung capillary filtration coefficient [Kf, c]) and inflammatory markers (bronchoalveolar lavage [BAL] cytokine levels and neutrophil counts) were measured. We also evaluated histologic sections from lungs, and the time course of Src kinase activation and caveolin-1 phosphorylation. VILI induced a 1.7-fold increase in lung 125I-albumin accumulation, fourfold increase in Kf, c, significantly increased levels of cytokines CXCL1 and interleukin-6, and promoted BAL neutrophilia in WT mice. Lung injury by these criteria was significantly reduced in Cav-1-/- mice but fully restored by i.v. injection of liposome/Cav-1 cDNA complexes that rescued expression of Cav-1 in lung microvessels. As thrombin is known to play a significant role in mediating stretch-induced vascular injury, we observed in cultured mouse lung microvascular endothelial cells (MLECs) thrombin-induced albumin hyperpermeability and phosphorylation of p44/42 MAP kinase in WT but not in Cav-1-/- MLECs. Thus, caveolin-1 expression is required for mechanical stretch-induced lung inflammation and endothelial hyperpermeability in vitro and in vivo. PMID:23372929

  1. Haemodynamic stability and pulmonary shunt during spontaneous breathing and mechanical ventilation in porcine lung collapse.

    Vimláti, L; Larsson, A; Hedenstierna, G; Lichtwarck-Aschoff, M


    We investigated the haemodynamic stability of a novel porcine model of lung collapse induced by negative pressure application (NPA). A secondary aim was to study whether pulmonary shunt correlates with cardiac output (CO). In 12 anaesthetized and relaxed supine piglets, lung collapse was induced by NPA (-50 kPa). Six animals resumed spontaneous breathing (SB) after 15 min; the other six animals were kept on mechanical ventilation (MV) at respiratory rate and tidal volume (V(T) ) that corresponded to SB. All animals were followed for 135 min with blood gas analysis and detailed haemodynamic monitoring. Haemodynamics and gas exchange were stable in both groups during the experiment with arterial oxygen tension (PaO(2) )/inspired fraction of oxygen (FiO(2) ) and pulmonary artery occlusion pressure being higher, venous admixture (Q(va) /Q(t) ) and pulmonary perfusion pressure being lower in the SB group. CO was similar in both groups, showing slight decrease over time in the SB group. During MV, Q(va) /Q(t) increased with CO (slope: 4.3 %min/l; P slope: 0.55 %min/l; P = 0.16). This porcine lung collapse model is reasonably stable in terms of haemodynamics for at least 2 h irrespective of the mode of ventilation. SB achieves higher PaO(2) /FiO(2) and lower Q(va) /Q(t) compared with MV. During SB, Q(va) /Q(t) seems to be less, if at all, affected by CO compared with MV. © 2012 The Authors. Acta Anaesthesiologica Scandinavica © 2012 The Acta Anaesthesiologica Scandinavica Foundation.

  2. Absence of TNF-α enhances inflammatory response in the newborn lung undergoing mechanical ventilation.

    Ehrhardt, Harald; Pritzke, Tina; Oak, Prajakta; Kossert, Melina; Biebach, Luisa; Förster, Kai; Koschlig, Markus; Alvira, Cristina M; Hilgendorff, Anne


    Bronchopulmonary dysplasia (BPD), characterized by impaired alveolarization and vascularization in association with lung inflammation and apoptosis, often occurs after mechanical ventilation with oxygen-rich gas (MV-O2). As heightened expression of the proinflammatory cytokine TNF-α has been described in infants with BPD, we hypothesized that absence of TNF-α would reduce pulmonary inflammation, and attenuate structural changes in newborn mice undergoing MV-O2 Neonatal TNF-α null (TNF-α(-/-)) and wild type (TNF-α(+/+)) mice received MV-O2 for 8 h; controls spontaneously breathed 40% O2 Histologic, mRNA, and protein analysis in vivo were complemented by in vitro studies subjecting primary pulmonary myofibroblasts to mechanical stretch. Finally, TNF-α level in tracheal aspirates from preterm infants were determined by ELISA. Although MV-O2 induced larger and fewer alveoli in both, TNF-α(-/-) and TNF-α(+/+) mice, it caused enhanced lung apoptosis (TUNEL, caspase-3/-6/-8), infiltration of macrophages and neutrophils, and proinflammatory mediator expression (IL-1β, CXCL-1, MCP-1) in TNF-α(-/-) mice. These differences were associated with increased pulmonary transforming growth factor-β (TGF-β) signaling, decreased TGF-β inhibitor SMAD-7 expression, and reduced pulmonary NF-κB activity in ventilated TNF-α(-/-) mice. Preterm infants who went on to develop BPD showed significantly lower TNF-α levels at birth. Our results suggest a critical balance between TNF-α and TGF-β signaling in the developing lung, and underscore the critical importance of these key pathways in the pathogenesis of BPD. Future treatment strategies need to weigh the potential benefits of inhibiting pathologic cytokine expression against the potential of altering key developmental pathways.

  3. 单肺通气中右美托咪定辅助麻醉对肺通气/血流的影响%Single Lung Ventilation of Dexmedetomidine Assisted Anesthesia on Pulmonary Ventilation/Blood Flow



    Objective Observed in single lung ventilation,right the microphones on auxiliary anesthesia hemodynamic, whether to help to improve the single lung ventilation lung ventilation/blood flow abnormalities.Methods 60 cases of esophageal cancer radical under one-lung ventilation were divided into control group and experimental group.Control group 0.9% saline injec-tion 10 mL after anesthesia induction,the experimental group after anesthesia induction right set beauty holds the mi 0.6 mu g/kg (input) 10 minutes.Observe two groups of related indicators: single lung ventilation time,operation time,airway pressure,oxygen partial pressure;Observe preoperative,15 minutes before intubation and after intubation and after intubation,cut skin,into the chest,single lung ventilation when 60 minutes,90 minutes of single lung ventilation,double lung ventilation 15 minutes time point of the mean arterial pressure (MAP),heart rate (HR);Observe preoperatively,single lung ventilation 60 minutes,90 minutes of one-lung ventilation and oxygen index.Results This study results show that the oxygen and index in preoperative point in time,the ex-perimental group there was no statistically significant difference compared with control group (P>0.05);Oxygen index and one-lung ventilation 60 minutes,single lung ventilation in 90 minutes,the experimental group compared with control group difference was sta-tistically significant(P0.05);氧和指数在单肺通气60 min、单肺通气90 min时间点,实验组与对照组比较差异有统计学意义(P<0.05),其机制可能就是减轻了单肺通气引起急性肺损伤。 HR、MAP在插管前、插管后、插管后15 min、切皮时、进胸、单肺通气60 min、单肺通气90 min、双肺通气15 min时间点,实验组与对照组比较差异有统计学意义(P<0.05)。结论在单肺通气中,右美托咪定辅助麻醉血流动力学更平稳,氧和指数增加,有助于改善单肺通气时的肺通气/血流异常。

  4. Effect of Electrode Belt and Body Positions on Regional Pulmonary Ventilation- and Perfusion-Related Impedance Changes Measured by Electric Impedance Tomography

    Ericsson, Elin; Tesselaar, Erik; Sjöberg, Folke


    Ventilator-induced or ventilator-associated lung injury (VILI/VALI) is common and there is an increasing demand for a tool that can optimize ventilator settings. Electrical impedance tomography (EIT) can detect changes in impedance caused by pulmonary ventilation and perfusion, but the effect of changes in the position of the body and in the placing of the electrode belt on the impedance signal have not to our knowledge been thoroughly evaluated. We therefore studied ventilation-related and perfusion-related changes in impedance during spontaneous breathing in 10 healthy subjects in five different body positions and with the electrode belt placed at three different thoracic positions using a 32-electrode EIT system. We found differences between regions of interest that could be attributed to changes in the position of the body, and differences in impedance amplitudes when the position of the electrode belt was changed. Ventilation-related changes in impedance could therefore be related to changes in the position of both the body and the electrode belt. Perfusion-related changes in impedance were probably related to the interference of major vessels. While these findings give us some insight into the sources of variation in impedance signals as a result of changes in the positions of both the body and the electrode belt, further studies on the origin of the perfusion-related impedance signal are needed to improve EIT further as a tool for the monitoring of pulmonary ventilation and perfusion. PMID:27253433

  5. Effect of Electrode Belt and Body Positions on Regional Pulmonary Ventilation- and Perfusion-Related Impedance Changes Measured by Electric Impedance Tomography.

    Elin Ericsson

    Full Text Available Ventilator-induced or ventilator-associated lung injury (VILI/VALI is common and there is an increasing demand for a tool that can optimize ventilator settings. Electrical impedance tomography (EIT can detect changes in impedance caused by pulmonary ventilation and perfusion, but the effect of changes in the position of the body and in the placing of the electrode belt on the impedance signal have not to our knowledge been thoroughly evaluated. We therefore studied ventilation-related and perfusion-related changes in impedance during spontaneous breathing in 10 healthy subjects in five different body positions and with the electrode belt placed at three different thoracic positions using a 32-electrode EIT system. We found differences between regions of interest that could be attributed to changes in the position of the body, and differences in impedance amplitudes when the position of the electrode belt was changed. Ventilation-related changes in impedance could therefore be related to changes in the position of both the body and the electrode belt. Perfusion-related changes in impedance were probably related to the interference of major vessels. While these findings give us some insight into the sources of variation in impedance signals as a result of changes in the positions of both the body and the electrode belt, further studies on the origin of the perfusion-related impedance signal are needed to improve EIT further as a tool for the monitoring of pulmonary ventilation and perfusion.

  6. Loss of p120 catenin aggravates alveolar edema of ventilation induced lung injury

    DAI Chen-yang; DAI Guo-feng; SUN Yu; WANG Yue-lan


    Background p120 catenin (p120ctn) is an adheren junction protein that regulates barrier function,but its role has not been explored in alveolar edema induced by ventilation.We measured stretch-induced cell gap formation in MLE 12 cells due to the loss of p120.We hypothesized that alveolar permeability was increased by high lung inflation associated with alveolar epithelia cell tight junctions being destroyed,which resulted from the loss of p120.Methods Cultured MLE12 cells were subjected to being stretched or un-stretched (control) and some cells were pretreated with pp2 (c-src inhibitor).After the end of stretching for 0,1,2,and 4 hours,the cells were lysed,and p120 expression and c-src activation was determined by Western blotting analysis.In vivo,SD rats were taken to different tidal volumes (Vt 7 ml/kg or 40 ml/kg,PEEP=0,respiratory rate 30-40 betas/min) for 0,1,2,and 4 hour and some were pretreated with pp2,and alveolar edema was calculated.Rerults It was found that p120 expression was reduced and c-src activation increased in a time-dependent and strain-dependent manner due to cyclic-stretch of the alveolar epithelial cells.These changes could be reversed by inhibition of c-src.We obtained similar changes in rats when they were subjected to large tidal volumes and the alveolar edema increased more than in rats in the low Vt group.Pretreated the rats with inhibition of c-src had less pulmonary edema induced by the high tidal volume ventilation.Conclusions Cyclic stretch MLE 12 cells induced the loss of p120 and may be the same reason by high tidal volume ventilation in rats can aggravate alveolar edema.Maintenance of p120 expression may be a novel therapeutic strategy for the prevention and treatment of ventilation induced lung injury (VILI).

  7. [High-frequency ventilation. I. Distribution of alveolar pressure amplitudes during high frequency oscillation in the lung model].

    Theissen, J; Lunkenheimer, P P; Niederer, P; Bush, E; Frieling, G; Lawin, P


    The pattern of intrapulmonary pressure distribution was studied during high-frequency ventilation in order to explain the inconsistent results reported in the literature. Methods. Pressure and flow velocity (hot-wire anemometry) were measured in different lung compartments: 1. In transalveolar chambers sealed to the perforated pleural surfaces of dried pig lungs; 2. In emphysema-simulating airbags sealed to the isolated bronchial trees of dried pig lungs; and 3. In transalveolar chambers sealed to the perforated pleural surfaces of freshly excised pig lungs. Results. 1. The pressure amplitudes change from one area to another and depending on the exciting frequency. 2. High-frequency oscillation is associated with an increase in pressure amplitude when the exciting frequency rises, whereas with conventional high-frequency jet ventilation the pressure amplitude is more likely to decrease with frequency. 3. During high-frequency jet ventilation the local pressure amplitude changes with the position of the tube in the trachea rather than with the exciting frequency. 4. When the volume of the measuring chamber is doubled the resulting pressure amplitude falls to half the control value. 5. The pressure amplitude and mean pressure measured in the transalveolar chamber vary more or less independently from the peak flow velocity. High-frequency ventilation is thus seen to be a frequency-dependant, inhomogeneous mode of ventilation that can essentially be homogenized by systematically changing the exciting frequency. The frequency-dependant response to different lung areas to excitation is likely to result from an intrabronchially-localized aerodynamic effect rather than the mechanical properties of the lung parenchyma.

  8. Dynamic and quasi-static lung mechanics system for gas-assisted and liquid-assisted ventilation.

    Alvarez, Francisco J; Gastiasoro, Elena; Rey-Santano, M Carmen; Gomez-Solaetxe, Miguel A; Publicover, Nelson G; Larrabe, Juan L


    Our aim was to develop a computerized system for real-time monitoring of lung mechanics measurements during both gas and liquid ventilation. System accuracy was demonstrated by calculating regression and percent error of the following parameters compared to standard device: airway pressure difference (Delta P(aw)), respiratory frequency (f(R) ), tidal volume (V(T)), minute ventilation (V'(E)), inspiratory and expiratory maximum flows (V'(ins,max), V'(exp,max)), dynamic lung compliance (C(L,dyn) ), resistance of the respiratory system calculated by method of Mead-Whittenberger (R(rs,MW)) and by equivalence to electrical circuits (R(rs,ele)), work of breathing (W(OB)), and overdistension. Outcome measures were evaluated as function of gas exchange, cardiovascular parameters, and lung mechanics including mean airway pressure (mP(aw)). Delata P(aw), V(T), V'(ins,max), V'(exp,max), and V'(E) measurements had correlation coefficients r = 1.00, and %error or = 0.98 and %error ventilated groups had increased mP(aw) and W(OB), with decreased V(T), V'(E), C(L,dyn), R(rs,MW), and R(rs,ele) compared to controls. After 1-h ventilation, both injured group had decreased V(T), V'(E) , and C(L,dyn), with increased mP(aw), R(rs,MW), R(rs,ele), and W(OB) . In lung-injured animals, liquid ventilation restored gas exchange, and cardiovascular and lung functions. Our lung mechanics system was able to closely monitor pulmonary function, including during transitions between gas and liquid phases.

  9. Measurement of ventilation- and perfusion-mediated cooling during laser ablation in ex vivo human lung tumors.

    Vietze, Andrea; Koch, Franziska; Laskowski, Ulrich; Linder, Albert; Hosten, Norbert


    Perfusion-mediated tissue cooling has often been described in the literature for thermal ablation therapies of liver tumors. The objective of this study was to investigate the cooling effects of both perfusion and ventilation during laser ablation of lung malignancies. An ex vivo lung model was used to maintain near physiological conditions for the specimens. Fourteen human lung lobes containing only primary lung tumors (non-small cell lung cancer) were used. Laser ablation was carried out using a Nd:YAG laser with a wavelength of 1064 nm and laser fibers with 30 mm diffusing tips. Continuous invasive temperature measurement in 10 mm distance from the laser fiber was performed. Laser power was increased at 2 W increments starting at 10 W up to a maximum power of 12-20 W until a temperature plateau around 60 °C was reached at one sensor. Ventilation and perfusion were discontinued for 6 min each to assess their effects on temperature development. The experiments lead to 25 usable temperature profiles. A significant temperature increase was observed for both discontinued ventilation and perfusion. In 6 min without perfusion, the temperature rose about 5.5 °C (mean value, Pcooling are significant influencing factors on temperature development during thermal ablation. They should be taken into account during the planning and preparation of minimally invasive lung tumor treatment in order to achieve complete ablation. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.


    The efficacy of inhaled pharmaceuticals depends, in part, on their site of respiratory deposition. Markedly nonuniform ventilation distribution may occur in persons with obstructive airways diseases and may affect particle deposition. We studied the relationship between regional ...

  11. Inhibitor of neuronal nitric oxide synthase improves gas exchange in ventilator-induced lung injury after pneumonectomy

    Suborov Evgeny V


    Full Text Available Abstract Background Mechanical ventilation with high tidal volumes may cause ventilator-induced lung injury (VILI and enhanced generation of nitric oxide (NO. We demonstrated in sheep that pneumonectomy followed by injurious ventilation promotes pulmonary edema. We wished both to test the hypothesis that neuronal NOS (nNOS, which is distributed in airway epithelial and neuronal tissues, could be involved in the pathogenesis of VILI and we also aimed at investigating the influence of an inhibitor of nNOS on the course of VILI after pneumonectomy. Methods Anesthetized sheep underwent right pneumonectomy, mechanical ventilation with tidal volumes (VT of 6 mL/kg and FiO2 0.5, and were subsequently randomized to a protectively ventilated group (PROTV; n = 8 keeping VT and FiO2 unchanged, respiratory rate (RR 25 inflations/min and PEEP 4 cm H2O for the following 8 hrs; an injuriously ventilated group with VT of 12 mL/kg, zero end-expiratory pressure, and FiO2 and RR unchanged (INJV; n = 8 and a group, which additionally received the inhibitor of nNOS, 7-nitroindazole (NI 1.0 mg/kg/h intravenously from 2 hours after the commencement of injurious ventilation (INJV + NI; n = 8. We assessed respiratory, hemodynamic and volumetric variables, including both the extravascular lung water index (EVLWI and the pulmonary vascular permeability index (PVPI. We measured plasma nitrite/nitrate (NOx levels and examined lung biopsies for lung injury score (LIS. Results Both the injuriously ventilated groups demonstrated a 2–3-fold rise in EVLWI and PVPI, with no significant effects of NI. In the INJV group, gas exchange deteriorated in parallel with emerging respiratory acidosis, but administration of NI antagonized the derangement of oxygenation and the respiratory acidosis significantly. NOx displayed no significant changes and NI exerted no significant effect on LIS in the INJV group. Conclusion Inhibition of nNOS improved gas exchange

  12. A novel technique of differential lung ventilation in the critical care setting

    Kuwagata Yasuyuki


    Full Text Available Abstract Background Differential lung ventilation (DLV is used to salvage ventilatory support in severe unilateral lung disease in the critical care setting. However, DLV with a double-lumen tube is associated with serious complications such as tube displacement during ventilatory management. Thus, long-term ventilatory management with this method may be associated with high risk of respiratory incidents in the critical care setting. Findings We devised a novel DLV technique using two single-lumen tubes and applied it to five patients, two with severe unilateral pneumonia and three with thoracic trauma, in a critical care setting. In this novel technique, we perform the usual tracheotomy and insert two single-lumen tubes under bronchoscopic guidance into the main bronchus of each lung. We tie the two single-lumen tubes together and suture them directly to the skin. The described technique was successfully performed in all five patients. Pulmonary oxygenation improved rapidly after DLV induction in all cases, and the three patients with thoracic trauma were managed by DLV without undergoing surgery. Tube displacement was not observed during DLV management. No airway complications occured in either the acute or late phase regardless of the length of DLV management (range 2-23 days. Conclusions This novel DLV technique appears to be efficacious and safe in the critical care setting.

  13. Ventilation-perfusion lung scanning and spiral computed tomography of the lungs: competing or complementary modalities?

    Robinson, P.J.A. [Clinical Radiology Department, St. James`s University Hospital, Leeds (United Kingdom)


    The recently developed technique of spiral computed tomographic angiography (CTA) is being used for the detection of pulmonary emboli (PE), and several studies have assessed its accuracy using pulmonary angiography as the gold standard. CTA shows a high level of accuracy in the detection of pulmonary emboli in segmental or larger central vessels. The specificity is high enough to eliminate the requirement for angiography if a positive CTA result is found. The main factor limiting the sensitivity of CTA is the frequency of peripheral emboli in the vessels outside the central chest field covered by CTA. The incidence of such peripheral emboli varies in different reports from 0% to 36%, and their significance remains arguable. Interpretative criteria for V./Q.- lung scintigraphy have been refined as a result of the lessons learned from the PIOPED study. Using these modified criteria, and taking into account the prior probability of PE based on the presence or absence of clinical risk factors, treatment decisions can be reasonably made in patients in the following categories: those with normal lung scans, those with high probability scans and high prior probability of PE, and those with low probability scans and low clinical suspicion. Patients with intermediate probability or indeterminate scans, and those in whom the scan results conflict with the clinical expectation, will need further tests. Ultrasound examination of the leg veins, if positive, will select a further subgroup of patients for active treatment. Patients with a negative or inconclusive ultrasound result, who previously have been candidates for pulmonary angiography, can now go on to CTA. The advantages in specificity which CTA offers will make it an important part of the diagnostic workup for selected patients, but in view of its increased cost and high radiation dose, the argument that CTA should completely replace lung scintigraphy is currently unsupportable. (orig.)

  14. [Anesthesiological systems "Polinarkon-Vita" with microprocessor for artificial lung ventilation apparatuses and monitoring].

    Trushin, A I; Uliakov, G I; Reĭderman, E N


    The anesthesiological systems Polinarkon-Vita for adults and children are described. These systems were developed at VNIIMP-VITA, Ltd. on the basis of basic model of the anesthesiological system Polinarkon-E-Vita. The following new important units of the fifth generation apparatuses for inhalation anesthesia (IA) are described: Anestezist-4 monocomponent evaporator for liquid anesthetics (enfluran and isofluran); Diana, Diana-Det, and Elan-NR apparatuses for mechanical lung ventilation (MLV); dosimeters of medical gases, etc. These systems implement monitoring of vitally important functions of patient and parameters of IN and MLV. The anesthesiological systems Polinarkon-Vita are recommended for medical practice and commercially available from VNIIMP-VITA, Ltd. as small lots.

  15. Comparing lung regions of interest in gamma scintigraphy for assessing inhaled therapeutic aerosol deposition.

    Biddiscombe, Martyn F; Meah, Sally N; Underwood, S Richard; Usmani, Omar S


    Two-dimensional gamma scintigraphy is an important technique used to evaluate the lung deposition from inhaled therapeutic aerosols. Images are divided into regions of interest and deposition indices are derived to quantify aerosol distribution within the intrapulmonary airways. In this article, we compared the different approaches that have been historically used between different laboratories for geometrically defining lung regions of interest. We evaluated the effect of these different approaches on the derived indices classically used to assess inhaled aerosol deposition in the lungs. Our primary intention was to assess the ability of different regional lung templates to discriminate between central and peripheral airway deposition patterns generated by inhaling aerosols of different particle sizes. We investigated six methods most commonly reported in the scientific literature to define lung regions of interest and assessed how different each of the derived regional lung indices were between the methods to quantify regional lung deposition. We used monodisperse albuterol aerosols of differing particle size (1.5, 3, and 6 μm) in five mild asthmatic subjects [forced expiratory volume in 1 sec (FEV(1)) 90% predicted] to test the different approaches of each laboratory. We observed the areas of geometry used to delineate central (C) and peripheral (P) lung regions of interest varied markedly between different laboratories. There was greater similarity between methods in values of penetration index (PI), defined as P/C aerosol counts normalized by P/C krypton ventilation counts, compared to nonnormalized C/P or P/C aerosol count-ratios. Normalizing the aerosol deposition P/C count-ratios by the ventilation P/C count-ratios, reduced the variability of the data. There was dependence of the regional lung deposition indices on the size of the P region of interest in that, as P increased, C/P count-ratios decreased and P/C count-ratios increased, whereas PI was less

  16. Noninvasive Measurement of Carbon Dioxide during One-Lung Ventilation with Low Tidal Volume for Two Hours: End-Tidal versus Transcutaneous Techniques.

    Hong Zhang

    Full Text Available There may be significant difference between measurement of end-tidal carbon dioxide partial pressure (PetCO2 and arterial carbon dioxide partial pressure (PaCO2 during one-lung ventilation with low tidal volume for thoracic surgeries. Transcutaneous carbon dioxide partial pressure (PtcCO2 monitoring can be used continuously to evaluate PaCO2 in a noninvasive fashion. In this study, we compared the accuracy between PetCO2 and PtcCO2 in predicting PaCO2 during prolonged one-lung ventilation with low tidal volume for thoracic surgeries.Eighteen adult patients who underwent thoracic surgeries with one-lung ventilation longer than two hours were included in this study. Their PetCO2, PtcCO2, and PaCO2 values were collected at five time points before and during one-lung ventilation. Agreement among measures was evaluated by Bland-Altman analysis.Ninety sample sets were obtained. The bias and precision when PtcCO2 and PaCO2 were compared were 4.1 ± 6.5 mmHg during two-lung ventilation and 2.9 ± 6.1 mmHg during one-lung ventilation. Those when PetCO2 and PaCO2 were compared were -11.8 ± 6.4 mmHg during two-lung ventilation and -11.8 ± 4.9 mmHg during one-lung ventilation. The differences between PtcCO2 and PaCO2 were significantly lower than those between PetCO2 and PaCO2 at all five time-points (p < 0.05.PtcCO2 monitoring was more accurate for predicting PaCO2 levels during prolonged one-lung ventilation with low tidal volume for patients undergoing thoracic surgeries.

  17. Nitric oxide increases dramatically in air exhaled from lung regions with occluded vessels.

    Fernández-Mondéjar, E; Hambraeus-Jonzon, K; Ronéus, A; Hedenstierna, G


    We observed dramatic changes in exhaled nitric oxide concentration (DeltaNOE) during wedge measurements, and hypothesised that occlusion and redistribution of pulmonary blood flow affects NOE. We inflated the balloon of the pulmonary artery catheter and measured NOE and central hemodynamics in closed chest anesthetised pigs (n = 11) ventilated with hyperoxic gas (fraction of inspired oxygen [FIO2] = 0.5), before and during lung injury, and in open chest anesthetised pigs (n = 17) before and during left lower lobar (LLL) hypoxia (FIO2 0.05), and during hyperoxic (FIO2 0.8) ventilation of the other lung regions (HL). In the closed chest pigs NOE increased from 2.0 (0.9) to 3.4 (2.0) p.p.b. (P 0.07). When the balloon was inflated in the right pulmonary artery in the open chest pigs, the perfusion of the HL decreased from 2.57 (0.58) to 2.34 (0.55) l min(-1) (P 0.07) during wedge. The correlation coefficient (R2) was 0.66 between changes in regional blood flow and DeltaNOE, and 0.37 between changes in MPaP and DeltaNOE. Nitric oxide concentration increases dramatically from lung regions with occluded vessels, whereas changes in MPaP have minor effects on NOE. This is an important fact to consider when comparing NOE within or between studies, and indicates a possible marker of diseases with occluded lung vessels.

  18. Deviation of tracheal pressure from airway opening pressure during high-frequency oscillatory ventilation in a porcine lung model.

    Johannes, Amélie; Zollhoefer, Bernd; Eujen, Ulrike; Kredel, Markus; Rauch, Stefan; Roewer, Norbert; Muellenbach, Ralf M


    Oxygenation during high-frequency oscillatory ventilation is secured by a high level of mean airway pressure. Our objective was to identify a pressure difference between the airway opening of the respiratory circuit and the trachea during application of different oscillatory frequencies. Six female Pietrain pigs (57.1 ± 3.6 kg) were first ventilated in a conventional mechanical ventilation mode. Subsequently, the animals were switched to high-frequency oscillatory ventilation by setting mean airway opening pressure 5 cmH(2)O above the one measured during controlled mechanical ventilation. Measurements at the airway opening and at tracheal levels were performed in healthy lungs and after induction of acute lung injury by surfactant depletion. During high-frequency oscillatory ventilation, the airway opening pressure was set at a constant level. The pressure amplitude was fixed at 90 cmH(2)O. Starting from an oscillatory frequency of 3 Hz, the frequency was increased in steps of 3 Hz to 15 Hz and then decreased accordingly. At each frequency, measurements were performed in the trachea through a side-lumen of the endotracheal tube and the airway opening pressure was recorded. The pressure difference was calculated. At every oscillatory frequency, a pressure loss towards the trachea could be shown. This pressure difference increased with higher oscillatory frequencies (3 Hz 2.2 ± 2.1 cmH(2)O vs. 15 Hz 7.5 ± 1.8 cmH(2)O). The results for healthy and injured lungs were similar. Tracheal pressures decreased with higher oscillatory frequencies. This may lead to pulmonary derecruitment. This has to be taken into consideration when increasing oscillatory frequencies and differentiated pressure settings are mandatory.

  19. Mild hypothermia attenuates changes in respiratory system mechanics and modifies cytokine concentration in bronchoalveolar lavage fluid during low lung volume ventilation.

    Dostál, P; Senkeřík, M; Pařízková, R; Bareš, D; Zivný, P; Zivná, H; Cerný, V


    Hypothermia was shown to attenuate ventilator-induced lung injury due to large tidal volumes. It is unclear if the protective effect of hypothermia is maintained under less injurious mechanical ventilation in animals without previous lung injury. Tracheostomized rats were randomly allocated to non-ventilated group (group C) or ventilated groups of normothermia (group N) and mild hypothermia (group H). After two hours of mechanical ventilation with inspiratory fraction of oxygen 1.0, respiratory rate 60 min(-1), tidal volume 10 ml x kg(-1), positive end-expiratory pressure (PEEP) 2 cm H2O or immediately after tracheostomy in non-ventilated animals inspiratory pressures were recorded, rats were sacrificed, pressure-volume (PV) curve of respiratory system constructed, bronchoalveolar lavage (BAL) fluid and aortic blood samples obtained. Group N animals exhibited a higher rise in peak inspiratory pressures in comparison to group H animals. Shift of the PV curve to right, higher total protein and interleukin-6 levels in BAL fluid were observed in normothermia animals in comparison with hypothermia animals and non-ventilated controls. Tumor necrosis factor-alpha was lower in the hypothermia group in comparison with normothermia and non-ventilated groups. Mild hypothermia attenuated changes in respiratory system mechanics and modified cytokine concentration in bronchoalveolar lavage fluid during low lung volume ventilation in animals without previous lung injury.

  20. Time Series of EIT Measurements and Images During Lung Ventilation Based on Principal Component Analysis

    范文茹; 王化祥; 杨程屹; 马世文


    The aim of this paper is to propose a useful method for exploring regional ventilation and perfusion in the chest and also separation of pulmonary and cardiac changes.The approach is based on estimating both electrical impedance tomography(EIT) measurements and reconstructed images by means of principal component analysis(PCA).In the experiments in vivo,43 cycles of heart-beat rhythm could be detected by PCA when the volunteer held breath;9 breathing cycles and 50 heart-beat cycles could be detected by PCA ...

  1. Intravenous Infusion of Dexmedetomidine Combined Isoflurane Inhalation Reduces Oxidative Stress and Potentiates Hypoxia Pulmonary Vasoconstriction during One-Lung Ventilation in Patients

    Rui Xia


    Full Text Available Inhalation anesthetic isoflurane inhibits hypoxia pulmonary vasoconstriction (HPV, while dexmedetomidine (Dex could reduce the dose of isoflurane inhalation and potentiate HPV, but the mechanism is unclear. Inhibition of reactive oxygen species (ROS production can favor HPV during one-lung ventilation (OLV. Similarly, nitric oxide (NO, an important endothelium-derived vasodilator in lung circulation, can decrease the regional pulmonary vascular resistance of ventilated lung and reduce intrapulmonary shunting. We hypothesized that Dex may augment HPV and improve oxygenation during OLV through inhibiting oxidative stress and increasing NO release. Patients undergoing OLV during elective thoracic surgery were randomly allocated to either isoflurane + saline (NISO, n=24 or isoflurane + dexmedetomidine (DISO, n=25 group. Anesthesia was maintained with intravenous remifentanil and inhalational isoflurane (1.0–2.0%, with concomitant infusion of dexmedetomidine 0.7 μgkg−1h−1 in DISO and saline 0.25 mL kg−1h−1 in NISO group. Hemodynamic variables or depth of anesthesia did not significantly differ between groups. Administration of Dex significantly reduced Qs/Qt and increased PaO2 after OLV, accompanied with reduced lipid peroxidation product malondialdehyde and higher levels of SOD activity as well as serum NO (all P<0.05 DISO versus NISO. In conclusion, reducing oxidative stress and increasing NO release during OLV may represent a mechanism whereby Dex potentiates HPV.

  2. The protective effect of dopamine on ventilator-induced lung injury via the inhibition of NLRP3 inflammasome.

    Yang, Xiaomei; Sun, Xiaotong; Chen, Hongli; Xi, Guangmin; Hou, Yonghao; Wu, Jianbo; Liu, Dejie; Wang, Huanliang; Hou, Yuedong; Yu, Jingui


    Dopamine (DA), a neurotransmitter, was previously shown to have anti-inflammatory effects. However, its role in ventilator-induced lung injury (VILI) has not been explicitly demonstrated. This study aimed to investigate the therapeutic efficacy and molecular mechanisms of dopamine in VILI. Rats were treated with dopamine during mechanical ventilation. Afterwards, the influence of dopamine on histological changes, pulmonary edema, the lung wet/dry (W/D) ratio, myeloperoxidase (MPO) activity, polymorphonuclear(PMN)counts, inflammatory cytokine levels, and NLRP3 inflammasome protein expression were examined. Our results showed that dopamine significantly attenuated lung tissue injury, the lung W/D ratio, MPO activity and neutrophil infiltration. Moreover, it inhibited inflammatory cytokine levels in the Bronchoalveolar lavage fluid (BAL). In addition, dopamine significantly inhibited ventilation-induced NLRP3 activation. Our experimental findings demonstrate that dopamine exerted protective effects in VILI by alleviating the inflammatory response through inhibition of NLRP3 signaling pathways. The present study indicated that dopamine could be a potential effective therapeutic strategy for the treatment of VILI. Copyright © 2017 Elsevier B.V. All rights reserved.

  3. Use of an Endobronchial Blocker and Selective Lung Ventilation to Aid Surgical Removal of a Lung Lobe Abscess in a Dog

    Carl Bradbrook


    Full Text Available This paper documents use of an endobronchial blocker (EBB to achieve selective lung ventilation (SLV for the purpose of lung lobectomy with thoracoscopy. A 3-year-old female neutered Labrador Retriever, body mass of 18.5 kg, was presented for exploratory thoracoscopy. Acepromazine and methadone were administered as premedication, and anaesthesia was induced with propofol and maintained with isoflurane in 100% oxygen and continuous infusions of fentanyl and lidocaine. Mechanical ventilation of the dog’s lungs was performed prior to placement of an Arndt EBB caudal to the right cranial bronchus to allow SLV. Successful SLV was achieved with this technique, allowing continued inflation of the right cranial lobe. A reduction in the arterial partial pressure of oxygen to fractional inspired oxygen ratio (PaO2 : FiO2 of 444 to 306 occurred after placement of the EBB, with no change in monitored cardiopulmonary variables. F-shunt increased from 17.4% to 23.7% with a reduction in oxygen content (CaO2 of 20.0 to 18.7 mg dL-1, remaining within the physiologic range. Due to lung adhesions to the diaphragm, conversion to thoracotomy was required for completion of the procedure. This technique is challenging to perform in the dog. Arterial blood gas analysis should be performed to allow adequate monitoring of ventilation.

  4. Markers of inflammation and oxidative stress in patients undergoing CABG with CPB with and without ventilation of the lungs: a pilot study.

    Deblier, Ivo; Sadowska, Anna M; Janssens, Annelies; Rodrigus, Inez; DeBacker, Wilfried A


    Cardiopulmonary bypass triggers systemic inflammation and systemic oxidative stress. Recent reports suggest that continuous ventilation during cardiopulmonary bypass (CPB) can affect the outcome of patients after cardiac surgery. We investigated the influence of lung ventilation on inflammatory and oxidative stress markers during coronary artery bypass graft (CABG) with CPB in 13 patients with (Group 2) or without (Group 1) ventilation of the lungs with small tidal volume (4 ml/kg). IL-10 and elastase in blood were elevated in both groups with a peak at the end of CPB (PCPB is not directly influenced by continuous ventilation of the lungs with small tidal volumes. The modulation of antioxidant defense systems by ventilation needs further investigation.

  5. Regional pulmonary inflammation in an endotoxemic ovine acute lung injury model.

    Fernandez-Bustamante, A; Easley, R B; Fuld, M; Mulreany, D; Chon, D; Lewis, J F; Simon, B A


    The regional distribution of inflammation during acute lung injury (ALI) is not well known. In an ovine ALI model we studied regional alveolar inflammation, surfactant composition, and CT-derived regional specific volume change (sVol) and specific compliance (sC). 18 ventilated adult sheep received IV lipopolysaccharide (LPS) until severe ALI was achieved. Blood and bronchoalveolar lavage (BAL) samples from apical and basal lung regions were obtained at baseline and injury time points, for analysis of cytokines (IL-6, IL-1β), BAL protein and surfactant composition. Whole lung CT images were obtained in 4 additional sheep. BAL protein and IL-1β were significantly higher in injured apical vs. basal regions. No significant regional surfactant composition changes were observed. Baseline sVol and sC were lower in apex vs. base; ALI enhanced this cranio-caudal difference, reaching statistical significance only for sC. This study suggests that apical lung regions show greater inflammation than basal ones during IV LPS-induced ALI which may relate to differences in regional mechanical events.

  6. Comparison between the Comfort and Hartwig sedation scales in pediatric patients undergoing mechanical lung ventilation

    Werther Brunow de Carvalho


    Full Text Available CONTEXT: A high number of hospitalized children do not receive adequate sedation due to inadequate evaluation and use of such agents. With the increase in knowledge of sedation and analgesia in recent years, concern has also risen, such that it is now not acceptable that incorrect evaluations of the state of children's pain and anxiety are made. OBJECTIVE: A comparison between the Comfort and Hartwig sedation scales in pediatric patients undergoing mechanical lung ventilation. DESIGN: Prospective cohort study. SETTING: A pediatric intensive care unit with three beds at an urban teaching hospital. PATIENTS: Thirty simultaneous and independent observations were conducted by specialists on 18 patients studied. DIAGNOSTIC TEST: Comfort and Hartwig scales were applied, after 3 minutes of observation. MAIN MEASUREMENTS: Agreement rate (kappa. RESULTS: On the Comfort scale, the averages for adequately sedated, insufficiently sedated, and over-sedated were 20.28 (SD 2.78, 27.5 (SD 0.70, and 15.1 (SD 1.10, respectively, whereas on the Hartwig scale, the averages for adequately sedated, insufficiently sedated, and over-sedated were 16.35 (SD 0.77, 20.85 (SD 1.57, and 13.0 (SD 0.89, respectively. The observed agreement rate was 63% (p = 0.006 and the expected agreement rate was 44% with a Kappa coefficient of 0.345238 (z = 2.49. CONCLUSIONS: In our study there was no statistically significant difference whether the more complex Comfort scale was applied (8 physiological and behavioral parameters or the less complex Hartwig scale (5 behavioral parameters was applied to assess the sedation of mechanically ventilated pediatric patients.

  7. Advances in Clinical Stratergies of Lung Protective Ventilation%肺保护性通气策略临床应用进展

    郑康; 郑亚安


    In patients with ALI/ARDS, mechanical ventilation with lung protective ventilation strategies results in decreased mortality and enhances the number of days without ventilator use. While guidelines now strongly advise using lung protective ventilation in ALI/ARDS patients, there are presently no widely agreed - upon guidelines for the use of ventilation with lung protective ventilation strategies in patients who with non - ALI/ARDS conditions. Literatures concerning animal and clinical studies on lung protective mechanical ventilation in patients with non - ALI/ARDS conditions were searched out, and aspects including post ventilation oxygenation indices, cytokine levels, and lung histology were reviewed. The inconsistent results from different trials, however, do not definitely support the use of lung protective mechanical ventilation. Nevertheless, more prospective studies are needed to establish the optimal ventilator management strategies for patients with non - ALI/ARDS conditions.%机械通气时采取肺保护性通气策略有利于急性肺损伤/急性呼吸窘迫综合征(ALI/ARDS)患者缩短机械通气时间,降低病死率,在临床中已广泛应用.但是对于非ALI/ARDS的患者是否也采取肺保护性通气策略意见并不一致.现综述近年来的研究情况,包括机械通气后氧合指标、细胞因子水平和肺组织结构等方面的变化.目前对于肺保护性通气策略是否有利于避免非ALI/ARDS患者肺损伤的发生,研究结果并不一致,尚无明确结论.

  8. Distribution of ventilation in American alligator Alligator mississippiensis

    Bickler, P.E.; Spragg, R.G.; Hartman, M.T.; White, F.N.


    The regional distribution of ventilation in the multicameral lung of spontaneously ventilating alligators (Alligator mississippiensis) was studied with TTXe scintigraphy. Frequent gamma camera images of TTXe washin and washout were obtained and processed to allow evaluation of regional ventilation. Washin of TTXe to equilibrium occurred in three to four breaths in anterior, central, and posterior compartments. Washin was most rapid in the posterior compartment and slowest in the anterior. The structure of the lungs and distribution of ventilation of inspired gas is consistent with the rapid radial spread of gas through a parallel arrangement of lung units surrounding the central intrapulmonary bronchus. Washout to equilibrium of TTXe from all compartments occurred within three to four breaths. This rapid washin and washout of gas to all parts of the lung stands in contrast to the lungs of turtles and snakes, in which the caudal air sacs are relatively poorly ventilated.

  9. Leakage of protein into lungs of preterm ventilated rabbits is correlated with activation of clotting, complement, and polymorphonuclear leukocytes in plasma

    Brus, F; vanOeveren, W; Heikamp, A; Okken, A; Oetomo, SB


    We investigated whether leakage of protein in lungs of pre term ventilated rabbits of 28- and 29-d gestational age is correlated with activation of clotting, complement, and polymorphonuclear leukocytes (PMN) in plasma. We found signs of systemic activation of clotting, complement, and PMN in ventil

  10. The effect of low level laser therapy on ventilator-induced lung injury in mice (Conference Presentation)

    Szabari, Margit V.; Miller, Alyssa J.; Hariri, Lida P.; Hamblin, Michael R.; Musch, Guido; Stroh, Helene; Suter, Melissa J.


    Although mechanical ventilation (MV) is necessary to support gas exchange in critically ill patients, it can contribute to the development of lung injury and multiple organ dysfunction. It is known that high tidal volume (Vt) MV can cause ventilator-induced lung injury (VILI) in healthy lungs and increase the mortality of patients with Acute Respiratory Distress Syndrome. Low level laser therapy (LLLT) has demonstrated to have anti-inflammatory effects. We investigated whether LLLT could alleviate inflammation from injurious MV in mice. Adult mice were assigned to 2 groups: VILI+LLLT group (3 h of injurious MV: Vt=25-30 ml/kg, respiratory rate (RR)=50/min, positive end-expiratory pressure (PEEP)=0 cmH20, followed by 3 h of protective MV: Vt=9 ml/kg, RR=140/min, PEEP=2 cmH20) and VILI+no LLLT group. LLLT was applied during the first 30 min of the MV (810 nm LED system, 5 J/cm2, 1 cm above the chest). Respiratory impedance was measured in vivo with forced oscillation technique and lung mechanics were calculated by fitting the constant phase model. At the end of the MV, bronchoalveolar lavage (BAL) was performed and inflammatory cells counted. Lungs were removed en-bloc and fixed for histological evaluation. We hypothesize that LLLT can reduce lung injury and inflammation from VILI. This therapy could be translated into clinical practice, where it can potentially improve outcomes in patients requiring mechanical ventilation in the operating room or in the intensive care units.

  11. Suspended animation inducer hydrogen sulfide is protective in an in vivo model of ventilator-induced lung injury

    Aslami, Hamid; Heinen, André; Roelofs, Joris J. T. H.; Zuurbier, Coert J.; Schultz, Marcus J.


    Purpose Acute lung injury is characterized by an exaggerated inflammatory response and a high metabolic demand. Mechanical ventilation can contribute to lung injury, resulting in ventilator-induced lung injury (VILI). A suspended-animation-like state induced by hydrogen sulfide (H2S) protects against hypoxia-induced organ injury. We hypothesized that suspended animation is protective in VILI by reducing metabolism and thereby CO2 production, allowing for a lower respiratory rate while maintaining adequate gas exchange. Alternatively, H2S may reduce inflammation in VILI. Methods In mechanically ventilated rats, VILI was created by application of 25 cmH2O positive inspiratory pressure (PIP) and zero positive end-expiratory pressure (PEEP). Controls were lung-protective mechanically ventilated (13 cmH2O PIP, 5 cmH2O PEEP). H2S donor NaHS was infused continuously; controls received saline. In separate control groups, hypothermia was induced to reproduce the H2S-induced fall in temperature. In VILI groups, respiratory rate was adjusted to maintain normo-pH. Results NaHS dose-dependently and reversibly reduced body temperature, heart rate, and exhaled amount of CO2. In VILI, NaHS reduced markers of pulmonary inflammation and improved oxygenation, an effect which was not observed after induction of deep hypothermia that paralleled the NaHS-induced fall in temperature. Both NaHS and hypothermia allowed for lower respiratory rates while maintaining gas exchange. Conclusions NaHS reversibly induced a hypometabolic state in anesthetized rats and protected from VILI by reducing pulmonary inflammation, an effect that was in part independent of body temperature. Electronic supplementary material The online version of this article (doi:10.1007/s00134-010-2022-2) contains supplementary material, which is available to authorized users. PMID:20721529

  12. 4DCT-based assessment of regional airflow distribution in healthy human lungs during tidal breathing

    Choi, Jiwoong; Jahani, Nariman; Choi, Sanghun; Hoffman, Eric; Lin, Ching-Long


    Nonlinear dynamics of regional airflow distribution in healthy human lungs are studied with four-dimensional computed tomography (4DCT) quantitative imaging of four subjects. During the scanning session, subjects continuously breathed with tidal volumes controlled by the dual piston system. For each subject, 10 instantaneous volumetric image data sets (5 inspiratory and 5 expiratory phases) were reconstructed. A mass-preserving image registration was then applied to pairs of these image data to construct a breathing lung model. Regional distributions of local flow rate fractions are computed from time-varying local air volumes. The 4DCT registration-based method provides the link between local and global air volumes of the lung, allowing derivation of time-varying regional flow rates during the tidal breathing for computational fluid dynamics analysis. The local flow rate fraction remains greater in the lower lobes than in the upper lobes, being qualitatively consistent with those derived from three static CT (3SCT) images (Yin et al. JCP 2013). However, unlike 3SCT, the 4DCT data exhibit lung hysteresis between inspiration and expiration, providing more sensitive measures of regional ventilation and lung mechanics. NIH Grants U01-HL114494, R01-HL094315 and S10-RR022421.

  13. Visualization of neonatal lung injury associated with mechanical ventilation using x-ray dark-field radiography

    Yaroshenko, Andre; Pritzke, Tina; Koschlig, Markus; Kamgari, Nona; Willer, Konstantin; Gromann, Lukas; Auweter, Sigrid; Hellbach, Katharina; Reiser, Maximilian; Eickelberg, Oliver; Pfeiffer, Franz; Hilgendorff, Anne


    Mechanical ventilation (MV) and supplementation of oxygen-enriched gas, often needed in postnatal resuscitation procedures, are known to be main risk factors for impaired pulmonary development in the preterm and term neonates. Unfortunately, current imaging modalities lack in sensitivity for the detection of early stage lung injury. The present study reports a new imaging approach for diagnosis and staging of early lung injury induced by MV and hyperoxia in neonatal mice. The imaging method is based on the Talbot-Lau x-ray grating interferometry that makes it possible to quantify the x-ray small-angle scattering on the air-tissue interfaces. This so-called dark-field signal revealed increasing loss of x-ray small-angle scattering when comparing images of neonatal mice undergoing hyperoxia and MV-O2 with animals kept at room air. The changes in the dark field correlated well with histologic findings and provided superior differentiation than conventional x-ray imaging and lung function testing. The results suggest that x-ray dark-field radiography is a sensitive tool for assessing structural changes in the developing lung. In the future, with further technical developments x-ray dark-field imaging could be an important tool for earlier diagnosis and sensitive monitoring of lung injury in neonates requiring postnatal oxygen or ventilator therapy.

  14. Changes in Stroke Volume Induced by Lung Recruitment Maneuver Predict Fluid Responsiveness in Mechanically Ventilated Patients in the Operating Room.

    Biais, Matthieu; Lanchon, Romain; Sesay, Musa; Le Gall, Lisa; Pereira, Bruno; Futier, Emmanuel; Nouette-Gaulain, Karine


    Lung recruitment maneuver induces a decrease in stroke volume, which is more pronounced in hypovolemic patients. The authors hypothesized that the magnitude of stroke volume reduction through lung recruitment maneuver could predict preload responsiveness. Twenty-eight mechanically ventilated patients with low tidal volume during general anesthesia were included. Heart rate, mean arterial pressure, stroke volume, and pulse pressure variations were recorded before lung recruitment maneuver (application of continuous positive airway pressure of 30 cm H2O for 30 s), during lung recruitment maneuver when stroke volume reached its minimal value, and before and after volume expansion (250 ml saline, 0.9%, infused during 10 min). Patients were considered as responders to fluid administration if stroke volume increased greater than or equal to 10%. Sixteen patients were responders. Lung recruitment maneuver induced a significant decrease in mean arterial pressure and stroke volume in both responders and nonresponders. Changes in stroke volume induced by lung recruitment maneuver were correlated with those induced by volume expansion (r = 0.56; P recruitment maneuver predicted fluid responsiveness with a sensitivity of 88% (95% CI, 62 to 98) and a specificity of 92% (95% CI, 62 to 99). Pulse pressure variations more than 6% before lung recruitment maneuver discriminated responders with a sensitivity of 69% (95% CI, 41 to 89) and a specificity of 75% (95% CI, 42 to 95). The area under receiver operating curves generated for changes in stroke volume induced by lung recruitment maneuver (0.96; 95% CI, 0.81 to 0.99) was significantly higher than that for pulse pressure variations (0.72; 95% CI, 0.52 to 0.88; P recruitment maneuver could predict preload responsiveness in mechanically ventilated patients in the operating room.

  15. Low-Flow Extracorporeal Carbon Dioxide Removal Using the Hemolung Respiratory Dialysis System(®) to Facilitate Lung-Protective Mechanical Ventilation in Acute Respiratory Distress Syndrome.

    Akkanti, Bindu; Rajagopal, Keshava; Patel, Kirti P; Aravind, Sangeeta; Nunez-Centanu, Emmanuel; Hussain, Rahat; Shabari, Farshad Raissi; Hofstetter, Wayne L; Vaporciyan, Ara A; Banjac, Igor S; Kar, Biswajit; Gregoric, Igor D; Loyalka, Pranav


    Extracorporeal carbon dioxide removal (ECCO2R) permits reductions in alveolar ventilation requirements that the lungs would otherwise have to provide. This concept was applied to a case of hypercapnia refractory to high-level invasive mechanical ventilator support. We present a case of an 18-year-old man who developed post-pneumonectomy acute respiratory distress syndrome (ARDS) after resection of a mediastinal germ cell tumor involving the left lung hilum. Hypercapnia and hypoxemia persisted despite ventilator support even at traumatic levels. ECCO2R using a miniaturized system was instituted and provided effective carbon dioxide elimination. This facilitated establishment of lung-protective ventilator settings and lung function recovery. Extracorporeal lung support increasingly is being applied to treat ARDS. However, conventional extracorporeal membrane oxygenation (ECMO) generally involves using large cannulae capable of carrying high flow rates. A subset of patients with ARDS has mixed hypercapnia and hypoxemia despite high-level ventilator support. In the absence of profound hypoxemia, ECCO2R may be used to reduce ventilator support requirements to lung-protective levels, while avoiding risks associated with conventional ECMO.

  16. The Comparison of the Effects of Sevoflurane Inhalation Anesthesia and Intravenous Propofol Anesthesia on Oxidative Stress in One Lung Ventilation

    Engin Erturk


    Full Text Available Background. The aim of this study is to compare the effects of sevoflurane and propofol on one lung ventilation (OLV induced ischemia-reperfusion injury (IRI by determining the blood gas, ischemia-modified albumin (IMA, and malonyldialdehyde (MDA. Material and Methods. Forty-four patients undergoing thoracic surgery with OLV were randomized in two groups (sevoflurane Group S, propofol Group P. Anesthesia was inducted with thiopental and was maintained with 1–2.5% of sevoflurane within the 40/60% of O2/N2O mixture in Group S. In Group P anesthesia was inducted with propofol and was maintained with infusion of propofol and remifentanil. Hemodynamic records and blood samples were obtained before anesthesia induction (t1, 1 min before two lung ventilation (t2, 30 min after two lung ventilation (t3, and postoperative sixth hours (t4. Results. Heart rate at t2 and t3 in Group P was significantly lower than that in Group S. While there were no significant differences in terms of pH and pCO2, pO2 at t2 and t3 in Group S was significantly lower than that in Group P. IMA levels at t4 in Group S were significantly lower than those in Group P. Conclusion. Sevoflurane may offer protection against IRI after OLV in thoracic surgery.

  17. Validation of measurements of ventilation-to-perfusion ratio inequality in the lung from expired gas

    Prisk, G. Kim; Guy, Harold J B.; West, John B.; Reed, James W.


    The analysis of the gas in a single expirate has long been used to estimate the degree of ventilation-perfusion (Va/Q) inequality in the lung. To further validate this estimate, we examined three measures of Va/Q inhomogeneity calculated from a single full exhalation in nine anesthetized mongrel dogs under control conditions and after exposure to aerosolized methacholine. These measurements were then compared with arterial blood gases and with measurements of Va/Q inhomogeneity obtained using the multiple inert gas elimination technique. The slope of the instantaneous respiratory exchange ratio (R slope) vs. expired volume was poorly correlated with independent measures, probably because of the curvilinear nature of the relationship due to continuing gas exchange. When R was converted to the intrabreath Va/Q (iV/Q), the best index was the slope of iV/Q vs. volume over phase III (iV/Q slope). This was strongly correlated with independent measures, especially those relating to inhomogeneity of perfusion. The correlations for iV/Q slope and R slope considerably improved when only the first half of phase III was considered. We conclude that a useful noninvasive measurement of Va/Q inhomogeneity can be derived from the intrabreath respiratory exchange ratio.

  18. Automatic extraction of PIOPED interpretations from ventilation/perfusion lung scan reports.

    Fiszman, M; Haug, P J; Frederick, P R


    Free-text documents are the main type of data produced by a radiology department in a hospital information system. While this type of data is readily accessible for clinical data review it can not be accessed by other applications to perform medical decision support, quality assurance, and outcome studies. In an attempt to solve this problem, natural language processing systems have been developed and tested against chest x-rays reports to extract relevant clinical information and make it accessible to other computer applications. We have used a natural language processing tool called SymText to extract relevant clinical information from a different type of radiology report, the Ventilation/Perfusion lung scan report. Results of this effort can be analyzed in terms of precision and recall. The overall precision was 0.88 and recall was 0.92. In addition, the natural language processing system functions differently in reports with and without an impression section. If this type of information can be successfully extracted from radiology reports, one can develop quality monitors for the diagnostic performance of the radiologist by correlating the impressions with gold standard data present in a hospital information system. Avoiding the manual effort previously necessary to create quality assurance data, can lead to a higher frequency of quality review in a radiology department.

  19. Combined effects of ventilation mode and positive end-expiratory pressure on mechanics, gas exchange and the epithelium in mice with acute lung injury.

    Thammanomai, Apiradee; Hamakawa, Hiroshi; Bartolák-Suki, Erzsébet; Suki, Béla


    The accepted protocol to ventilate patients with acute lung injury is to use low tidal volume (V(T)) in combination with recruitment maneuvers or positive end-expiratory pressure (PEEP). However, an important aspect of mechanical ventilation has not been considered: the combined effects of PEEP and ventilation modes on the integrity of the epithelium. Additionally, it is implicitly assumed that the best PEEP-V(T) combination also protects the epithelium. We aimed to investigate the effects of ventilation mode and PEEP on respiratory mechanics, peak airway pressures and gas exchange as well as on lung surfactant and epithelial cell integrity in mice with acute lung injury. HCl-injured mice were ventilated at PEEPs of 3 and 6 cmH(2)O with conventional ventilation (CV), CV with intermittent large breaths (CV(LB)) to promote recruitment, and a new mode, variable ventilation, optimized for mice (VV(N)). Mechanics and gas exchange were measured during ventilation and surfactant protein (SP)-B, proSP-B and E-cadherin levels were determined from lavage and lung homogenate. PEEP had a significant effect on mechanics, gas exchange and the epithelium. The higher PEEP reduced lung collapse and improved mechanics and gas exchange but it also down regulated surfactant release and production and increased epithelial cell injury. While CV(LB) was better than CV, VV(N) outperformed CV(LB) in recruitment, reduced epithelial injury and, via a dynamic mechanotransduction, it also triggered increased release and production of surfactant. For long-term outcome, selection of optimal PEEP and ventilation mode may be based on balancing lung physiology with epithelial injury.

  20. Lung-protective Ventilation in Patients with Brain Injury: A Multicenter Cross-sectional Study and Questionnaire Survey in China

    Xu-Ying Luo; Ying-Hong Hu; Xiang-Yuan Cao; Yan Kang; Li-Ping Liu; Shou-Hong Wang; Rong-Guo Yu


    Background:Over the years,the mechanical ventilation (MV) strategy has changed worldwide.The aim of the present study was to describe the ventilation practices,particularly lung-protective ventilation (LPV),among brain-injured patients in China.Methods:This study was a multicenter,1-day,cross-sectional study in 47 Intensive Care Units (ICUs) across China.Mechanically ventilated patients (18 years and older) with brain injury in a participating ICU during the time of the study,including traumatic brain injury,stroke,postoperation with intracranial tumor,hypoxic-ischemic encephalopathy,intracranial infection,and idiopathic epilepsy,were enrolled.Demographic data,primary diagnoses,indications for MV,MV modes and settings,and prognoses on the 60th day were collected.Multivariable logistic analysis was used to assess factors that might affect the use of LPV.Results:A total of 104 patients were enrolled in the present study,87 (83.7%) of whom were identified with severe brain injury based on a Glasgow Coma Scale <8 points.Synchronized intermittent mandatory ventilation (SIMV) was the most frequent ventilator mode,accounting for 46.2% of the entire cohort.The median tidal volume was set to 8.0 ml/kg (interquartile range [IQR],7.0-8.9 ml/kg) of the predicted body weight;50 (48.1%) patients received LPV.The median positive end-expiratory pressure (PEEP) was set to 5 cmH2O (IQR,5-6 cmH2O).No PEEP values were higher than 10 cmH2O.Compared with partially mandatory ventilation,supportive and spontaneous ventilation practices were associated with LPV.There were no significant differences in mortality and MV duration between patients subjected to LPV and those were not.Conclusions:Among brain-injured patients in China,SIMV was the most frequent ventilation mode.Nearly one-half of the brain-injured patients received LPV.Patients under supportive and spontaneous ventilation were more likely to receive LPV.

  1. Evaluation of the ventilation-perfusion ratio in lung diseases by simultaneous anterior and posterior image acquisition

    Nakata, Yasunobu; Narabayashi, Isamu; Sueyoshi, Kozo; Matsui, Ritsuo; Namba, Ryuichiro; Tabuchi, Kojiro (Osaka Medical Coll., Takatsuki (Japan))


    Ventilation and perfusion images were acquired during tidal breathing using [sup 81m]Kr gas and [sup 99m]Tc-MAA. Anterior and posterior functional images of V/Q and Q/V were simultaneously acquired in 34 subjects with various lung diseases and 6 healthy controls. Superimposed anterior and posterior images were constructed and histograms of the frequency distribution for ventilation, perfusion, and the V/Q ratio were displayed for both lungs as well as for the left and right lungs individually. Blood gas analysis and general lung function tests were also performed on the day before scintigraphy. A correlation between marked uneven distribution of V/Q and A-aDO[sub 2] was found. When the proportion of counts at V/Q<0.67 and/or V/Q>1.50 in the V/Q counts histogram was compared with A-aDO[sub 2], there was a significant positive correlation for anterior images (r=0.684, p<0.05), posterior images (r=0.654, p<0.05) and superimposed images (r=0.696, p<0.05). Superimposed images therefore showed the highest correlation. There was no correlation between the results of lung function testing and A-aDO[sub 2]. Coronal SPECT images were also obtained in 15 patients and compared with the superimposed anterior and posterior planar images. There was a good correlation (r=0.888, p<0.001) between both the imaging methods regarding the marked uneven distribution of V/Q. Simultaneous anterior and posterior planar image acquisition reduces the examining time, is simple, and is noninvasive. The present results also suggest that it is useful for quantitative evaluation of the ventilation-perfusion ratio. (author).

  2. Prone position prevents regional alveolar hyperinflation and mechanical stress and strain in mild experimental acute lung injury.

    Santana, Maria Cristina E; Garcia, Cristiane S N B; Xisto, Débora G; Nagato, Lilian K S; Lassance, Roberta M; Prota, Luiz Felipe M; Ornellas, Felipe M; Capelozzi, Vera L; Morales, Marcelo M; Zin, Walter A; Pelosi, Paolo; Rocco, Patricia R M


    Prone position may delay the development of ventilator-induced lung injury (VILI), but the mechanisms require better elucidation. In experimental mild acute lung injury (ALI), arterial oxygen partial pressure (Pa O2), lung mechanics and histology, inflammatory markers [interleukin (IL)-6 and IL-1 beta], and type III procollagen (PCIII) mRNA expressions were analysed in supine and prone position. Wistar rats were randomly divided into two groups. In controls, saline was intraperitoneally injected while ALI was induced by paraquat. After 24-h, the animals were mechanically ventilated for 1-h in supine or prone positions. In ALI, prone position led to a better blood flow/tissue ratio both in ventral and dorsal regions and was associated with a more homogeneous distribution of alveolar aeration/tissue ratio reducing lung static elastance and viscoelastic pressure, and increasing end-expiratory lung volume and Pa O2. PCIII expression was higher in the ventral than dorsal region in supine position, with no regional changes in inflammatory markers. In conclusion, prone position may protect the lungs against VILI, thus reducing pulmonary stress and strain.

  3. Time Series of EIT Measurements and Images During Lung Ventilation Based on Principal Component Analysis

    FAN Wenru; WANG Huaxiang; YANG Chengyi; MA Shiwen


    The aim of this paper is to propose a useful method for exploring regional ventilation and perfusion in the chest and also separation of pulmonary and cardiac changes.The approach is based on estimating both electrical impedance tomography(EIT)measurements and reconstructed images by means of principal component analysis(PCA).In the experiments in vivo,43 cycles of heart-beat rhythm could be detected by PCA when the volunteer held breath; 9 breathing cycles and 50 heart-beat cycles could be detected by PCA when the volunteer breathed normally.The results indicate that the rhythms of cardiac activity and respiratory process can be exploited and separated through analyzing the boundary measurements by PCA without image reconstruction.

  4. Effects of a 1:1 inspiratory to expiratory ratio on respiratory mechanics and oxygenation during one-lung ventilation in the lateral decubitus position.

    Kim, S H; Choi, Y S; Lee, J G; Park, I H; Oh, Y J


    Prolonged inspiratory to expiratory (I:E) ratio ventilation may have both positive and negative effects on respiratory mechanics and oxygenation during one-lung ventilation (OLV), but definitive information is currently lacking. We therefore compared the effects of volume-controlled ventilation with I:E ratios of 1:1 and 1:2 on respiratory mechanics and oxygenation during OLV. Fifty-six patients undergoing thoracoscopic lobectomy were randomly assigned volume-controlled ventilation with an I:E ratio of 1:1 (group 1:1, n=28) or 1:2 (group 1:2, n=28) during OLV. Arterial and central venous blood gas analyses and respiratory variables were recorded 15 minutes into two-lung ventilation, at 30 and 60 minutes during OLV, and 15 minutes after two-lung ventilation was re-initiated. Peak and plateau airway pressures in cmH2O [standard deviation] during OLV were significantly lower in group 1:1 than in group 1:2 (P ventilation with an I:E ratio of 1:1 reduced peak and plateau airway pressures improved dynamic compliance and efficiency of alveolar ventilation, but it did not improve arterial oxygenation in a substantial manner. Furthermore, the associated increase in mean airway pressure might have reduced cardiac output, resulting in a lower central venous oxygen saturation.

  5. Potentiality of early chest roentgen examination in ventilator treated newborn infants to predict future lung function and disease

    Mortensson, W. (St. Goeran' s Children' s Hospital, Stockholm (Sweden). Dept. of Diagnostic Radiology); Andreasson, B.; Lindroth, M.; Svenningsen, N. (Lund Univ. (Sweden). Dept. of Pediatrics); Jonson, B. (Lund Univ. (Sweden). Dept. of Clinical Physiology)


    The potentiality of early chest X-ray to predict the risk of lung function abnormalities was studied prospectively in 40 preterm ventilator treated infants in a 8-10-year follow-up investigation. According to the findings at chest X-ray 3 to 10 days after completed ventilator treatment the infants were divided into 3 groups considered to respresent increasing risk and severity of lung damage: (1) normal findings, (2) interstitial parenchymal abnormalities exclusively or (3) in combination with local or general hyperinflation. Lung function tests and chest X-ray were performed at the age of 8 to 10 years. A correlation was found between the findings at the early chest roentgen examination and the risk of abnormal lung function at the follow-up. Occurrence of focal or general hyperinflation or both were associated with a greater risk of airway obstruction. Infants with only interstitial abnormalities were, however, at a higher risk than those with normal chest examination to develop general hyperinflation and increased air way obstruction. (orig.).

  6. Changes in positive end-expiratory pressure alter the distribution of ventilation within the lung immediately after birth in newborn rabbits.

    Marcus J Kitchen

    Full Text Available Current recommendations suggest the use of positive end-expiratory pressures (PEEP to assist very preterm infants to develop a functional residual capacity (FRC and establish gas exchange at birth. However, maintaining a consistent PEEP is difficult and so the lungs are exposed to changing distending pressures after birth, which can affect respiratory function. Our aim was to determine how changing PEEP levels alters the distribution of ventilation within the lung. Preterm rabbit pups (28 days gestation were delivered and mechanically ventilated with one of three strategies, whereby PEEP was changed in sequence; 0-5-10-5-0 cmH2O, 5-10-0-5-0 cmH2O or 10-5-0-10-0 cmH2O. Phase contrast X-ray imaging was used to analyse the distribution of ventilation in the upper left (UL, upper right (UR, lower left (LL and lower right (LR quadrants of the lung. Initiating ventilation with 10PEEP resulted in a uniform increase in FRC throughout the lung whereas initiating ventilation with 5PEEP or 0PEEP preferentially aerated the UR than both lower quadrants (p<0.05. Consequently, the relative distribution of incoming VT was preferentially directed into the lower lobes at low PEEP, primarily due to the loss of FRC in those lobes. Following ventilation at 10PEEP, the distribution of air at end-inflation was uniform across all quadrants and remained so regardless of the PEEP level. Uniform distribution of ventilation can be achieved by initiating ventilation with a high PEEP. After the lungs have aerated, small and stepped reductions in PEEP result in more uniform changes in ventilation.

  7. Effect of protective ventilation on postoperative lung injury during one-lung ventilation%保护性通气策略对于开胸术后肺损伤的影响

    焦卫平; 李简; 刘桐林


    [Objective] To evaluate the efficacy of individual protective ventilation strategy on the postoperative lung injury during one-lung ventilation (OLV). [Methods] Thirty-two patients undergoing pulmonary resection were randomly divided into two groups. Traditional ventilation group (TG): tidal volume 8 ml/kg and peak inspiratory pressure (PIP) <30 cmH20. Protective ventilation group (PG): tidal volume 1/2VT (half-tidal-volume from preoperative pulmonary function test) and PIP<25 cmH20. The arterial blood samples were collected for blood gases analysis immediately 20 minutes after two-lung ventilation (TLV) in the supine position after anesthesia (T1) and the end of operation (T2). The values of PaO2, PaCO2, pH and the inspired oxygen fraction (FiO2) were recorded and the values of oxygenation index (OI) were calculated respectively. The venous blood samples were collected for measurement of plasma interleukin-6 (IL-6) level at two time points. [Results] In all the patients, a decrease in OI and increase in plasma IL-6 level occurred at the end of operation (P <0.05). There were no significant differences of changes between the TG and the PG (P>0.05). For the overweight patients (difference between body weight and predicted body weight higher 10 kg), the decreases in OI were larger in traditional ventilation strategy than those in protective ventilation strategy (P<0.05). [Conclusion] During OLV, the individual protective ventilation strategy moderates the postoperative lung injury for the overweight patients.%目的评价单肺通气(OLV)期间个体化保护性通气策略的应用对于开胸术后肺损伤的影响.方法32例限期进行肺切除手术的患者随机分为两组.常规通气组(TG):潮气量8 mL/kg,吸气峰压(PIP)小于30cmH2O;保护性通气组(PG):潮气量1/2VT(为患者术前肺功能潮气量测试值减半),PIP<25 cmH2O.在全麻平卧位双肺通气20min后(T1)和手术结束(T2)两个时间点收集动脉血做血气分

  8. A complete audit cycle to assess adherence to a lung protective ventilation strategy

    Emma Joynes


    Full Text Available There is clear evidence for the use of a protective ventilation protocol in patients with acute respiratory distress syndrome (ARDS. There is evidence to suggest that protective ventilation is beneficial in patients at risk of ARDS. A protective ventilation strategy was implemented on our intensive care unit in critical care patients who required mechanical ventilation for over 48 h, with and at risk for ARDS. A complete audit cycle was performed over 13 months to assess compliance with a safe ventilation protocol in intensive care. The ARDS network mechanical ventilation protocol was used as the standard for our protective ventilation strategy. This recommends ventilation with a tidal volume (Vt of 6 ml/kg of ideal body weight (IBW and plateau airway pressure of ≤30 cm H 2 O. The initial audit failed to meet this standard with Vt ′s of 9.5 ml/kg of IBW. Following the implementation of a ventilation strategy and an educational program, we demonstrate a significant improvement in practice with Vt ′s of 6.6 ml/kg of IBW in the re-audit. This highlights the importance of simple interventions and continuous education in maintaining high standards of care.

  9. Pulmonary embolism among patients with a nearly normal ventilation/perfusion lung scan.

    Henry, J W; Stein, P D; Gottschalk, A; Raskob, G E


    Among patients with nearly normal ventilation/perfusion (V/Q) lung scans in the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED), pulmonary embolism (PE) was diagnosed more frequently in those who underwent pulmonary angiography than in those in whom PE was diagnosed on the basis of an adverse outcome while receiving no anticoagulant therapy. This may suggest that an adverse outcome is not apparent in patients with PE of such mild severity that the V/Q scan is nearly normal. If this were the case, patients with mild PE might not require treatment. The purpose of this investigation was to evaluate patients in PIOPED with nearly normal-V/Q lung scans. The V/Q scans and clinical characteristics of those in whom PE was diagnosed or excluded by pulmonary angiography (angiography group) were compared with those in whom PE was diagnosed or excluded by the presence or absence of an adverse outcome while not receiving anticoagulant therapy (outcome group). If the characteristics were the same, it would suggest that some patients with mild PE do well without treatment. If the characteristics were different, it would indicate that there is no evidence from these data that mild PE need not be treated. Data from PIOPED were evaluated from patients with suspected acute PE who had V/Q scans interpreted as nearly normal. There were 75 patients in the angiography group and 90 patients in the outcome group. Patients with entirely normal V/Q scans were excluded. PE was more frequent in the angiography group than in the outcome group, 8 of 75 (11%) vs 0 of 90 (0%) (p < 0.01). In patients with nearly normal V/Q scans who were in the outcome group in comparison to the angiography group, the V/Q scan showed fewer mismatched segmental perfusion defects, a lower percentage of low-probability V/Q interpretations by one of the two V/Q readers (compared with very low or normal probability), and a generally lower clinical assessment. The observed lower frequency of PE in the

  10. Lung ventilation-perfusion scintigraphy in children on long-term parenteral nutrition

    Pifarre, Paloma; Roca, Isabel [Universitat Autonoma de Barcelona, Department of Nuclear Medicine, Hospital de la Vall d' Hebron, Barcelona (Spain); Irastorza, Inaki; Hill, Susan [Great Ormond Street Hospital, Department of Gastroenterology, London (United Kingdom); Simo, Marc [Instituto Universitario Dexeus, Department of Nuclear Medicine, Barcelona (Spain); Biassoni, Lorenzo; Gordon, Isky [Great Ormond Street Hospital, Department of Nuclear Medicine, London (United Kingdom)


    Pulmonary emboli (PE) are one of the major complications associated with total parenteral nutrition (TPN). Ventilation-perfusion scintigraphy (V/Q) remains the most used test for the diagnosis of PE and follow-up of patients on TPN. The aim of our study was to demonstrate the high prevalence of undiagnosed PE in children on TPN. The medical and imaging files of 64 patients on TPN who underwent V/Q examinations covering the period of 1986-2004 were reviewed. Children were aged between 3.18 months and 21.6 years. TPN was started at birth (range 0-15 years). All children had a normal chest radiograph and no symptoms at the time of the V/Q scan. A comparative analysis between the prevalence of PE and risk factors number of days per week with lipophilic content of the TPN, bowel inflammation and thrombophilic factors (protein C and S) was performed. Of the 64 patients, 25 (39%) had an abnormal V/Q scan. A total of 29 PE episodes were diagnosed in all patients. Two children had three episodes of PE. The median age at PE diagnosis was 4.6 years. In 17 patients (68%) diagnosis was achieved on the first V/Q scan performed. PE was bilateral in 56% and unilateral in 44%. PE was the main cause of 2 out 15 recorded deaths. All risk factors were associated with an increase in PE prevalence by statistical analysis. PE is underdiagnosed in children on long-term TPN. Lung V/Q scintigraphy is useful in the diagnosis of PE in children with a low pretest probability. (orig.)

  11. Positive end expiratory pressure during one-lung ventilation: Selecting ideal patients and ventilator settings with the aim of improving arterial oxygenation

    Hoftman Nir


    Full Text Available The efficacy of positive end-expiratory pressure (PEEP in treating intraoperative hypoxemia during one-lung ventilation (OLV remains in question given conflicting results of prior studies. This study aims to (1 evaluate the efficacy of PEEP during OLV, (2 assess the utility of preoperative predictors of response to PEEP, and (3 explore optimal intraoperative settings that would maximize the effects of PEEP on oxygenation. Forty-one thoracic surgery patients from a single tertiary care university center were prospectively enrolled in this observational study. After induction of general anesthesia, a double-lumen endotracheal tube was fiberoptically positioned and OLV initiated. Intraoperatively, PEEP = 5 and 10 cmH 2 O were sequentially applied to the ventilated lung during OLV. Arterial oxygenation, cardiovascular performance parameters, and proposed perioperative variables that could predict or enhance response to PEEP were analysed. T-test and c2 tests were utilized for continuous and categorical variables, respectively. Multivariate analyses were carried out using a classification tree model of binary recursive partitioning. PEEP improved arterial oxygenation by ≥20% in 29% of patients (n = 12 and failed to do so in 71% (n = 29; however, no cardiovascular impact was noted. Among the proposed clinical predictors, only intraoperative tidal volume per kilogram differed significantly between responders to PEEP and non-responders (mean 6.6 vs. 5.7 ml/kg, P = 0.013; no preoperative variable predicted response to PEEP. A multivariate analysis did not yield a clinically significant model for predicting PEEP responsiveness. PEEP improved oxygenation in a subset of patients; larger, although still protective tidal volumes favored a positive response to PEEP. No preoperative variables, however, could be identified as reliable predictors for PEEP responders.

  12. Pulmonary ventilation/perfusion scan

    V/Q scan; Ventilation/perfusion scan; Lung ventilation/perfusion scan ... A pulmonary ventilation/perfusion scan is actually two tests. They may be done separately or together. During the perfusion scan, a health care provider injects ...

  13. Effects of continuous tracheal gas insufflation during pressure limited ventilation on pulmonary surfactant in rabbits with acute lung injury

    ZHU Guang-fa; ZHANG Wei; ZONG Hua; LIANG Ying


    Background Pulmonary surfactant dysfunction may contribute to the development of ventilator induced lung injury (VILI). Tracheal gas insufflation (TGI) is a technique in which fresh gas is introduced into the trachea and augment ventilation by reducing the dead space of ventilatory system, reducing ventilatory pressures and tidal volume (VT) while maintaining constant partial arterial CO2 pressure (PaCO2). We hypothesised that TGI limited peak inspiratory pressure (PIP) and VT and would minimize conventional mechanical ventilation (CMV) induced pulmonary surfactant dysfunction and thereby attenuate VILI in rabbits with acute lung injury (ALI).Methods ALI was induced by intratracheal administration of lipopolysaccharide in anaesthetized, ventilated healthy adult rabbits randomly assigned to continuous TGI at 0.5 L/min (TGI group) or CMV group (n=8 for each group), and subsequently ventilated with limited PIP and VT to maintain PaCO2 within 35 to 45 mmHg for 4 hours. Physiological dead space to VT ratio (VD/VT), dynamic respiratory compliance (Cdyn) and partial arterial O2 pressure (PaO2) were monitored. After ventilation, lungs were analysed for total phospholipids (TPL), total proteins (TP), pulmonary surfactant small to large aggregates ratio (SA/LA) in bronchoalveolar lavage fluid (BALF) and for determination of alveolar volume density (Vv), myeloperoxidase and interleukin (IL)-8.Results TGI resulted in significant (P<0.05 or P<0.01) decrease in PIP [(22.4±1.8) cmH2O vs (29.5±1.1) cmH2O], VT [(6.9±1.3) ml/kg vs (9.8±1.11) ml/kg], VD/VT [(32±5)% vs (46±2)%], TP [(109±22) mg/kg vs (187±25) mg/kg], SA/LA (2.5±0.4 vs 5.4±0.7), myeloperoxidase [(6.2±0.5) U/g tissue vs (12.3±0.8) U/g tissue] and IL-8 [(987±106) ng/g tissue vs (24±3) mN/m] of BALF, and significant (P<0.05) increase in Cdyn [(0.47±0.02) ml ·cmH2O-1 ·kg-1 vs (0.31±0.02) ml ·cmH2O-1 ·kg-1], PaO2 [(175±24) mmHg vs (135±26) mmHg],TPL/TP (52±8 vs 33±11) and Vv (0.65±0.05 vs 0

  14. Strategy of lung protection in one lung ventilation%单肺通气中肺保护策略研究进展



    Objective To supply the theoretical reference to one lung ventilation (OLV) and to attenuate hypoxeraia during OLV and postoperative pulmonary complications. Methods With the keywords " one lung ventilation, hypoxemia, lung protection" , a computer based on the search of Pubmed was undertaken to recognize the articles about OLV published from January 2007 to May 2012, the language was limited to English. The materials were selected firstly and free full texts were searched. Inclusion criteria:①the basic and clinical study on OLV; ②the study of lung protection. Exclusion criteria; reviews and repetitive study; Over 200 articles about OLV were searched, in which 14 were fitted for the inclusion criteria. Results In the 14 articles, 12 were about the study of the management during OLV, and 2 were the hypoxemia study of OLV. These literatures were analyzed including ventilation mode, the setting of tidal volume and respiratory frequency, the application of PEEP and CPAP, fraction of inspired oxygen and fluid management in order to summarize the strategy of lung protection and the development of management during OLV. Conclusion With the further study of lung protection in one - lung ventilation ( OLV) , anesthesia management of OLV will be more and more effective and reasonable.%目的 通过对单肺通气中肺保护策略研究进展的分析,为临床工作提供理论指导,减少单肺通气术中低氧血症和术后肺部并发症的发生.方法 应用计算机在Pubmed上检索2007年1月~ 2012年5月有关单肺通气的文章,检索词为:one lung ventilation,hypoxemia,lungprotection,限定文章语言种类为English.对资料进行初审,并查找全文.纳入标准:①有关单肺通气的实验及临床研究;②有关肺保护的试验研究.排除标准:①综述文献;②重复研究.共收集到200多篇有关单肺通气方面的文献,纳入14篇.结果 纳入的14篇文章中有关单肺通气术中管理方面的文献12篇,有关单

  15. Regional diffusing capacity in normal lungs during a slow exhalation.

    MacIntyre, N R; Nadel, J A


    From an analysis of carbon monoxide uptake and xenon-133 distribution after two bolus inhalations of these gases, we calculated regional diffusing capacity in the upper and lower volume halves of the lungs during the middle 60% of an exhaled vital capacity in five seated normal subjects. We found that the regional diffusing capacity of the upper half of the lungs was 11.6 +/- 4.2 (mean +/- SD) ml.min-1.Torr-1 and that the regional diffusing capacity of the lower half of the lungs was 24.4 +/- 2.4 ml.min-1.Torr-1 after 25% of the vital capacity had been exhaled. These values remained relatively constant as lung volume decreased from 25 to 75% of the exhaled vital capacity. Diffusing capacity in the upper half of the lungs ranged from 9.4 to 12.4 ml.min-1.Torr-1 during exhalation, and in the lower half of the lungs from 21.0 to 28.6 ml.min-1.Torr-1 during exhalation. These results suggest that total lung diffusing capacity remains relatively constant over this midrange of lung volumes and that this occurs because the regional diffusing capacities in both the upper and lower halves of the lungs remain relatively constant.

  16. Assessment of mean transit time in the engrafted lung with 133Xe lung ventilation scintigraphy improves diagnosis of bronchiolitis obliterans syndrome in living-donor lobar lung transplant recipients.

    Shinya, Takayoshi; Sato, Shuhei; Kato, Katsuya; Gobara, Hideo; Akaki, Shiro; Date, Hiroshi; Kanazawa, Susumu


    Staging of bronchiolitis obliterans syndrome (BOS) following lung transplantation is based on declines in forced expiratory volume in 1 s (FEV(1)). The aim of this study was to evaluate the usefulness of (133)Xe ventilation scintigraphy in the early detection of BOS following living-donor lobar lung transplantation (LDLLT), to compare (133)Xe washout imaging with computed tomography (CT) findings for early detection of BOS following LDLLT, and to evaluate (133)Xe washout imaging by quantitative analyses. Subjects comprised 30 double-lung recipients and 1 single-lung recipient, who had undergone LDLLT at our institution and survived more than 1 year. Clinically diagnosed BOS developed in six recipients. Declines in graft function were evaluated using a combination of three methods, namely, dynamic spirometry, high-resolution CT (HRCT), and (133)Xe ventilation scintigraphy. Findings for all transplanted lungs were compared between CT and (133)Xe washout imaging. (133)Xe washout imaging was assessed using mean transit time (MTT) of bi-and unilateral lungs. Correlations between MTT of bilateral lungs and FEV(1)% were evaluated. Differences in MTT between BOS and non-BOS lungs, and between non-BOS and donor lungs were also evaluated on unilateral lungs. Appropriate cut-off values of MTT of unilateral lungs were set for the diagnosis of BOS. In all six BOS cases, prolonged-washout images of engrafted lungs revealed early-phase BOS with declines from baseline FEV(1), whereas only one BOS case could be detected using early CT findings of BO (bronchodilatation, decrease in number and size of pulmonary vessels, thickening of septal lines, and volume reduction). A significant correlation was identified between MTT and FEV(1)% (r = -0.346, P lungs was significantly longer in BOS lungs than in non-BOS lungs (P lungs for the diagnosis of BOS was set at 64.77 s. Our data show that (133)Xe washout imaging offers excellent potential for early detection of BOS compared with early CT

  17. Regional pulmonary perfusion following human heart-lung transplantation

    Lisbona, R.; Hakim, T.S.; Dean, G.W.; Langleben, D.; Guerraty, A.; Levy, R.D. (Royal Victoria Hospital, Montreal, Quebec (Canada))


    Ventilation and perfusion scans were obtained in six subjects who had undergone heart-lung transplantation with consequent denervation of the cardiopulmonary axis. Two of the subjects had developed obliterative bronchiolitis, which is believed to be a form of chronic rejection. Their pulmonary function tests demonstrated airflow obstruction and their scintigraphic studies were abnormal. In the remaining four subjects without obstructive airways disease, ventilation and planar perfusion scans were normal. Single photon emission computed tomography imaging of pulmonary perfusion in these patients revealed a layered distribution of blood flow indistinguishable from that of normal individuals. It is concluded that neurogenic mechanisms have little influence on the pattern of local pulmonary blood flow at rest.

  18. Role of Alveolar β2-Adrenergic Receptors on Lung Fluid Clearance and Exercise Ventilation in Healthy Humans

    Paolillo, Stefania; Pellegrino, Riccardo; Salvioni, Elisabetta; Contini, Mauro; Iorio, Annamaria; Bovis, Francesca; Antonelli, Andrea; Torchio, Roberto; Gulotta, Carlo; Locatelli, Alessandro; Agostoni, Piergiuseppe


    Background In experimental conditions alveolar fluid clearance is controlled by alveolar β2-adrenergic receptors. We hypothesized that if this occurs in humans, then non-selective β-blockers should reduce the membrane diffusing capacity (DM), an index of lung interstitial fluid homeostasis. Moreover, we wondered whether this effect is potentiated by saline solution infusion, an intervention expected to cause interstitial lung edema. Since fluid retention within the lungs might trigger excessive ventilation during exercise, we also hypothesized that after the β2-blockade ventilation increased in excess to CO2 output and this was further enhanced by interstitial edema. Methods and Results 22 healthy males took part in the study. On day 1, spirometry, lung diffusion for carbon monoxide (DLCO) including its subcomponents DM and capillary volume (VCap), and cardiopulmonary exercise test were performed. On day 2, these tests were repeated after rapid 25 ml/kg saline infusion. Then, in random order 11 subjects were assigned to oral treatment with Carvedilol (CARV) and 11 to Bisoprolol (BISOPR). When heart rate fell at least by 10 beats·min−1, the tests were repeated before (day 3) and after saline infusion (day 4). CARV but not BISOPR, decreased DM (−13±7%, p = 0.001) and increased VCap (+20±22%, p = 0.016) and VE/VCO2 slope (+12±8%, p<0.01). These changes further increased after saline: −18±13% for DM (p<0.01), +44±28% for VCap (p<0.001), and +20±10% for VE/VCO2 slope (p<0.001). Conclusions These findings support the hypothesis that in humans in vivo the β2-alveolar receptors contribute to control alveolar fluid clearance and that interstitial lung fluid may trigger exercise hyperventilation. PMID:23613962

  19. Humidification of Base Flow Gas during Adult High-Frequency Oscillatory Ventilation:An Experimental Study Using a Lung Model



    Full Text Available In adult high-frequency oscillatory ventilation (HFOV with an R100 artificial ventilator, exhaled gas from patientʼs lung may warm the temperature probe and thereby disturb the humidification of base flow (BF gas. We measured the humidity of BF gas during HFOV with frequencies of 6, 8 and 10Hz, maximum stroke volumes (SV of 285, 205, and 160ml at the respective frequencies, and, BFs of 20, 30, 40l/min using an original lung model. The R100 device was equipped with a heated humidifier, HummaxⅡ, consisting of a porous hollow fiber in circuit. A 50-cm length of circuit was added between temperature probe (located at 50cm proximal from Y-piece and the hollow fiber. The lung model was made of a plastic container and a circuit equipped with another HummaxⅡ. The lung model temperature was controlled at 37℃. The HummaxⅡ of the R100 was inactivated in study-1 and was set at 35℃ or 37℃ in study-2. The humidity was measured at the distal end of the added circuit in study-1 and at the proximal end in study-2. In study-1, humidity was detected at 6Hz (SV 285ml and BF 20l/min, indicating the direct reach of the exhaled gas from the lung model to the temperature probe. In study-2 the absolute humidity of the BF gas decreased by increasing SV and by increasing BF and it was low with setting of 35℃. In this study setting, increasing the SV induced significant reduction of humidification of the BF gas during HFOV with R100.

  20. High spatiotemporal resolution measurement of regional lung air volumes from 2D phase contrast x-ray images

    Leong, Andrew F. T.; Islam, M. Sirajul; Kitchen, Marcus J. [School of Physics, Monash University, Victoria 3800 (Australia); Fouras, Andreas [Division of Biological Engineering, Monash University, Victoria 3800 (Australia); Wallace, Megan J.; Hooper, Stuart B. [Ritchie Centre and Department of Obstetrics and Gynaecology, Monash Institute of Medical Research, Monash University, Victoria 3168 (Australia)


    Purpose: Described herein is a new technique for measuring regional lung air volumes from two-dimensional propagation-based phase contrast x-ray (PBI) images at very high spatial and temporal resolution. Phase contrast dramatically increases lung visibility and the outlined volumetric reconstruction technique quantifies dynamic changes in respiratory function. These methods can be used for assessing pulmonary disease and injury and for optimizing mechanical ventilation techniques for preterm infants using animal models. Methods: The volumetric reconstruction combines the algorithms of temporal subtraction and single image phase retrieval (SIPR) to isolate the image of the lungs from the thoracic cage in order to measure regional lung air volumes. The SIPR algorithm was used to recover the change in projected thickness of the lungs on a pixel-by-pixel basis (pixel dimensions {approx}16.2 {mu}m). The technique has been validated using numerical simulation and compared results of measuring regional lung air volumes with and without the use of temporal subtraction for removing the thoracic cage. To test this approach, a series of PBI images of newborn rabbit pups mechanically ventilated at different frequencies was employed. Results: Regional lung air volumes measured from PBI images of newborn rabbit pups showed on average an improvement of at least 20% in 16% of pixels within the lungs in comparison to that measured without the use of temporal subtraction. The majority of pixels that showed an improvement was found to be in regions occupied by bone. Applying the volumetric technique to sequences of PBI images of newborn rabbit pups, it is shown that lung aeration at birth can be highly heterogeneous. Conclusions: This paper presents an image segmentation technique based on temporal subtraction that has successfully been used to isolate the lungs from PBI chest images, allowing the change in lung air volume to be measured over regions as small as the pixel size. Using

  1. Review of criteria appropriate for a very low probability of pulmonary embolism on ventilation-perfusion lung scans: a position paper.

    Stein, P D; Gottschalk, A


    The "low-probability" interpretation of ventilation-perfusion lung scans has been characterized as misleading or even dangerous because of the high prevalence of pulmonary embolism associated with such an interpretation. Since the completion of the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) study, analyses of the PIOPED database have allowed identification of several abnormalities seen on ventilation-perfusion scans that have a positive predictive value (PPV) for pulmonary embolism of less than 10%. These include nonsegmental perfusion abnormalities (PPV = 8%), perfusion defects smaller than the corresponding areas of increased opacity at chest radiography (PPV = 8%), matched ventilation-perfusion abnormalities in two or three zones of a single lung (PPV = 3%), one to three small segmental perfusion defects (PPV = 1%), triple matched defects in the upper or middle lung zone (PPV = 4%), and the stripe sign (PPV = 7%). Use of these abnormalities as interpretative criteria constitutes "very low probability" interpretation and will reduce the number of low-probability interpretations of ventilation-perfusion lung scans, which may be considered nondiagnostic because of the unacceptably high rate of false-negative results. This will enhance the utility of the ventilation-perfusion lung scan for screening patients with suspected pulmonary embolism.

  2. Hydrogen Sulfide Prevents Formation of Reactive Oxygen Species through PI3K/Akt Signaling and Limits Ventilator-Induced Lung Injury

    Sashko Georgiev Spassov


    Full Text Available The development of ventilator-induced lung injury (VILI is still a major problem in mechanically ventilated patients. Low dose inhalation of hydrogen sulfide (H2S during mechanical ventilation has been proven to prevent lung damage by limiting inflammatory responses in rodent models. However, the capacity of H2S to affect oxidative processes in VILI and its underlying molecular signaling pathways remains elusive. In the present study we show that ventilation with moderate tidal volumes of 12 ml/kg for 6 h led to an excessive formation of reactive oxygen species (ROS in mice lungs which was prevented by supplemental inhalation of 80 parts per million of H2S. In addition, phosphorylation of the signaling protein Akt was induced by H2S. In contrast, inhibition of Akt by LY294002 during ventilation reestablished lung damage, neutrophil influx, and proinflammatory cytokine release despite the presence of H2S. Moreover, the ability of H2S to induce the antioxidant glutathione and to prevent ROS production was reversed in the presence of the Akt inhibitor. Here, we provide the first evidence that H2S-mediated Akt activation is a key step in protection against VILI, suggesting that Akt signaling limits not only inflammatory but also detrimental oxidative processes that promote the development of lung injury.

  3. A novel combination of the Arndt endobronchial blocker and the laryngeal mask airway ProSeal™ provides one-lung ventilation for thoracic surgery.

    Li, Qiong; Li, Peiying; Xu, Jianghui; Gu, Huahua; Ma, Qinyun; Pang, Liewen; Liang, Weimin


    In this study, the feasibility and performance of the combination of the Arndt endobronchial blocker and the laryngeal mask airway (LMA) ProSeal™ in airway establishment, ventilation, oxygenation and lung isolation was evaluated. Fifty-five patients undergoing general anesthesia for elective thoracic surgeries were randomly allocated to group Arndt (n=26) or group double-lumen tube (DLT; n=29). Data concerning post-operative airway morbidity, ease of insertion, hemodynamics, lung collapse, ventilators, oxygenation and ventilation were collected for analysis. Compared with group DLT, group Arndt showed a significantly attenuated hemodynamic response to intubation (blood pressure, 149±31 vs. 115±16 mmHg; heart rate, 86±15 vs. 68±15 bpm), less severe injuries to the bronchus (injury score, 1.4±0.2 vs. 0.4±0.1) and vocal cords (injury score, 1.3±0.2 vs. 0.6±0.1), and lower incidences of post-operative sore throat and hoarseness. Furthermore, the novel combination of the Arndt and the LMA ProSeal showed similar ease of airway establishment, comparable ventilation and oxygenation performance, and an analogous lung isolation effect to DLT. The novel combined use of the Arndt endobronchial blocker and the LMA ProSeal can serve as a promising alternative for thoracic procedures requiring one-lung ventilation. The less traumatic properties and equally ideal lung isolation are likely to promote its use in rapidly spreading minimally invasive thoracic surgeries.

  4. Hydrogen Sulfide Prevents Formation of Reactive Oxygen Species through PI3K/Akt Signaling and Limits Ventilator-Induced Lung Injury

    Spassov, Sashko Georgiev; Donus, Rosa; Ihle, Paul Mikael; Engelstaedter, Helen; Hoetzel, Alexander


    The development of ventilator-induced lung injury (VILI) is still a major problem in mechanically ventilated patients. Low dose inhalation of hydrogen sulfide (H2S) during mechanical ventilation has been proven to prevent lung damage by limiting inflammatory responses in rodent models. However, the capacity of H2S to affect oxidative processes in VILI and its underlying molecular signaling pathways remains elusive. In the present study we show that ventilation with moderate tidal volumes of 12 ml/kg for 6 h led to an excessive formation of reactive oxygen species (ROS) in mice lungs which was prevented by supplemental inhalation of 80 parts per million of H2S. In addition, phosphorylation of the signaling protein Akt was induced by H2S. In contrast, inhibition of Akt by LY294002 during ventilation reestablished lung damage, neutrophil influx, and proinflammatory cytokine release despite the presence of H2S. Moreover, the ability of H2S to induce the antioxidant glutathione and to prevent ROS production was reversed in the presence of the Akt inhibitor. Here, we provide the first evidence that H2S-mediated Akt activation is a key step in protection against VILI, suggesting that Akt signaling limits not only inflammatory but also detrimental oxidative processes that promote the development of lung injury. PMID:28250891

  5. Effect of oleic acid-induced acute lung injury and conventional mechanical ventilation on renal function in piglets

    LIU Ai-jun; LING Feng; LI Zhi-qiang; LI Xiao-feng; LIU Ying-long; DU Jie; HAN Ling


    Background Animal models that demonstrate changes of renal function in response to acute lung injury (ALl) and mechanical ventilation (MV) are few.The present study was performed to examine the effect of ALl induced by oleic acid (OA) in combination with conventional MV strategy on renal function in piglets.Methods Twelve Chinese mini-piglets were randomly divided into two groups:the OA group (n=6),animals were ventilated with a conventional MV strategy of 12 ml/kg and suffered an ALl induced by administration of OA,and the control group (n=6),animals were ventilated with a protective MV strategy of 6 ml/kg and received the same amount of sterile saline.Results Six hours after OA injection a severe lung injury and a mild-moderate degree of renal histopathological injury were seen,while no apparent histological abnormalities were observed in the control group.Although we observed an increase in the plasma concentrations of creatinine and urea after ALl,there was no significant difference compared with the control group.Plasma concentrations of neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C increased (5.6±1.3) and (7.4±1.5) times in the OA group compared to baseline values,and were significantly higher than the values in the control group.OA injection in combination with conventional MV strategy resulted in a dramatic aggravation of hemodynamic and blood gas exchange parameters,while these parameters remained stable during the experiment in the control group.The plasma expression of TNF-α and IL-6 in the OA group were significantly higher than that in the control group.Compared with high expression in the lung and renal tissue in the OA group,TNF-α and IL-6 were too low to be detected in the lung and renal tissue in the control group.Conclusions OA injection in combination with conventional MV strategy not only resulted in a severe lung injury but also an apparent renal injury.The potential mechanisms involved a cytokine response of TNF-α and

  6. Pseudomonas aeruginosa Ventilator-Associated Pneumonia Induces Lung Injury through TNF-α/c-Jun NH2-Terminal Kinase Pathways

    Hsu, Ching-Mei


    Ventilator-associated pneumonia (VAP) is a common nosocomial infection among intensive care unit (ICU) patients. Pseudomonas aeruginosa (PA) is the most common multidrug-resistant Gram-negative pathogen and VAP caused by PA carries a high rate of morbidity and mortality. This study examined the molecular mechanism of PA VAP-induced lung injury. C57BL/6 wild-type (WT) mice and JNK1 knockout (JNK1-/-) mice received mechanical ventilation (MV) for 3 h at 2 days after receiving nasal instillation of PA. The WT and JNK1-/- mice also received MV after the induction of lung injury by instillation of supernatants from PA-stimulated alveolar macrophages (AMs). AMs isolated from WT, IκB-kinase (IKK)βΔMye (IKKβ was selectively deleted in macrophages), and JNK1-/- mice were ex vivo stimulated with live PA and supernatants were collected for cytokine assay. Intranasal instillation of 106 PA enhanced MV-induced NF-κB DNA binding activity in the lungs and nitrite levels in BALF. MV after PA instillation significantly increased the expression of ICAM and VCAM in the lungs and TNF-α, IL-1β, and IL-6 levels in bronchoalveolar lavage fluid (BALF) of WT mice, but not in JNK1-/- mice. MV after supernatant instillation induced more total protein concentration in BALF and neutrophil sequestration in the lungs in WT mice than JNK1-/- mice and cytokine assay of supernatants indicated that TNF-α is a critical regulator of PA VAP-induced lung injury. Ex vivo PA stimulation induced TNF-α production by AMs from WT as well as JNK1-/- mice but not IKKβΔMye mice. In summary, PA colonization plays an important role in PA VAP-induced lung injury through the induction of JNK1-mediated inflammation. These results suggest that the pathogenesis mechanism of PA VAP involves production of TNF-α through activation of IKK/NF-κB pathways in AMs and JNK signaling pathway in the lungs. PMID:28060857

  7. Lung protective ventilation induces immunotolerance and nitric oxide metabolites in porcine experimental postoperative sepsis.

    Jesper Sperber

    Full Text Available Low tidal volume ventilation is beneficial in patients with severe pulmonary dysfunction and would, in theory, reduce postoperative complications if implemented during routine surgery. The study aimed to investigate whether low tidal volume ventilation and high positive end-expiratory pressure (PEEP in a large animal model of postoperative sepsis would attenuate the systemic inflammatory response and organ dysfunction. Thirty healthy pigs were randomized to three groups: Group Prot-7h, i.e. protective ventilation for 7 h, was ventilated with a tidal volume of 6 mL x kg(-1 for 7 h; group Prot-5h, i.e. protective ventilation for 5 h, was ventilated with a tidal volume of 10 mL x kg(-1 for 2 h, after which the group was ventilated with a tidal volume of 6 mL x kg(-1; and a control group that was ventilated with a tidal volume of 10 mL x kg(-1 for 7 h. In groups Prot-7h and Prot-5h PEEP was 5 cmH2O for 2 h and 10 cmH2O for 5 h. In the control group PEEP was 5 cmH2O for the entire experiment. After surgery for 2 h, postoperative sepsis was simulated with an endotoxin infusion for 5 h. Low tidal volume ventilation combined with higher PEEP led to lower levels of interleukin 6 and 10 in plasma, higher PaO2/FiO2, better preserved functional residual capacity and lower plasma troponin I as compared with animals ventilated with a medium high tidal volume and lower PEEP. The beneficial effects of protective ventilation were seen despite greater reductions in cardiac index and oxygen delivery index. In the immediate postoperative phase low VT ventilation with higher PEEP was associated with reduced ex vivo plasma capacity to produce TNF-α upon endotoxin stimulation and higher nitrite levels in urine. These findings might represent mechanistic explanations for the attenuation of systemic inflammation and inflammatory-induced organ dysfunction.

  8. Effects of dexmedetomidine on oxygenation during one-lung ventilation for thoracic surgery in adults

    Scott Kernan


    Full Text Available Study Objective : To evaluate the effects of dexmedetomidine on hypoxic pulmonary vasoconstriction (HPV and oxygenation during one-lung ventilation (OLV in adults undergoing thoracic surgery. Design : Prospective, randomized, double-blinded trial. Setting : Tertiary care, University-based hospital. Patients : Nineteen adult patients undergoing thoracic surgery requiring OLV. Interventions : During inhalational anesthesia with desflurane, patients were randomized to receive either dexmedetomidine (bolus dose of 0.3 μg/kg followed by an infusion of 0.3 μg/kg/hr or saline placebo. Measurements : Three arterial blood gas samples (ABG were obtained to evaluate the effects of dexmedetomidine on oxygenation. Secondary outcomes included differences in hemodynamic parameters (heart rate and mean arterial pressure, end-tidal desflurane concentration required to maintain the bispectral index (BIS at 40-60, supplemental fentanyl to maintain hemodynamic stability, and phenylephrine to keep the mean arterial pressure (MAP within 10% of baseline values. Main Results : Oxygenation during OLV did not change following the administration of dexmedetomidine (PaO2/FiO2 ratio of 188 ± 115 in dexmedetomidine patients versus 135 ± 70 mmHg in placebo patients. There were no differences in hemodynamic variables or depth of anaesthesia between the two groups. With the administration of dexmedetomidine, there was a decrease in the expired concentration of desflurane required to maintain the BIS at 40-60 when compared with the control group (4.5 ± 0.8% versus 5.1 ± 0.8%. In patients receiving dexmedetomidine, fentanyl requirements were decreased when compared to placebo (2.7 μg/kg/patient versus 3.1 μg/kg/patient. However, more patients receiving dexmedetomidine required phenylephrine to maintain hemodynamic stability (6 of 9 patients versus 3 of 10 patients and the total dose of phenylephrine was greater in patients receiving dexmedetomidine when compared with

  9. Mechanical ventilation-induced intrathoracic pressure distribution and heart-lung interactions

    Lansdorp, Benno; Hofhuizen, C.; van Lavieren, M.A.; van Swieten, H.; Lemson, J.; van Putten, Michel Johannes Antonius Maria; van der Hoeven, J.G.; Pickkers, P.


    OBJECTIVE: Mechanical ventilation causes cyclic changes in the heart's preload and afterload, thereby influencing the circulation. However, our understanding of the exact physiology of this cardiopulmonary interaction is limited. We aimed to thoroughly determine airway pressure distribution, how

  10. Mechanical ventilation-induced intrathoracic pressure distribution and heart-lung interactions*

    Lansdorp, B.; Hofhuizen, C.M.; Lavieren, M. van; Swieten, H.A. van; Lemson, J.; Putten, M.J.A.M. van; Hoeven, J.G. van der; Pickkers, P.


    OBJECTIVE: Mechanical ventilation causes cyclic changes in the heart's preload and afterload, thereby influencing the circulation. However, our understanding of the exact physiology of this cardiopulmonary interaction is limited. We aimed to thoroughly determine airway pressure distribution, how thi

  11. Control of lung ventilation following overwintering conditions in bullfrogs, Lithobates catesbeianus

    Santin, Joseph M; Hartzler, Lynn K


    ... that regulate and enable pulmonary ventilation. Therefore, we performed experiments to determine whether aspects of the respiratory control system of bullfrogs, Lithobates catesbeianus, are maintained or suppressed following minimal use of air...

  12. Mechanical ventilation in post perfusion lung%体外循环术后并发灌注肺的机械通气治疗

    李一粟; 马建珍; 张立莉; 秦斌; 王维新; 万世杰


    Objective To review the experience in mechanical ventilation in 6 post perfusion lung cases after open heart surgery under cardiopulmonary bypass.  Method  Traditional mechanical ventilation models were performed in 3 cases and lung protective mechanical ventilation models were used in the other 3 cases. Result The perioperative mortality was 33.3%(1/3) in the traditional mechanical ventilation group, and there was no death in the other group. Conclusion Lung protective mechanical ventilation models have advantages superior to that of traditional mechanical ventilation models, which have less ventilator-induced lung injury and is beneficial to post perfusion lung patients.%目的回顾性分析6例体外循环心内直视术后并发灌注肺的机械通气治疗经验。方法采用传统的机械通气模式3例,采用肺保护性机械通气方案3例。结果传统的机械通气组死亡1例,肺保护性机械通气组全部存活。结论肺保护性机械通气方案优于传统的机械通气模式,它能有效地防治呼吸机相关性肺损伤,提高灌注肺患者的成活率。

  13. Ventilation/perfusion SPECT in chronic obstructive pulmonary disease: an evaluation by reference to symptoms, spirometric lung function and emphysema, as assessed with HRCT

    Joegi, Jonas; Bajc, Marika [Lund University, Skaane University Hospital, Department of Clinical Physiology, Institution of Clinical Sciences, Lund (Sweden); Ekberg, Marie [Lund University, Skaane University Hospital, Department of Respiratory Medicine and Allergology, Institution of Clinical Sciences, Lund (Sweden); Jonson, Bjoern [Lund University, Department of Clinical Physiology, Institution of Clinical Sciences, Lund (Sweden); Bozovic, Gracijela [Lund University, Skaane University Hospital, Department of Radiology, Institution of Clinical Sciences, Lund (Sweden)


    Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation which is not fully reversible. Despite the heterogeneity of COPD, its diagnosis and staging is currently based solely on forced expiratory volume in 1 s (FEV{sub 1}). FEV{sub 1} does not explain the underlying pathophysiology of airflow limitation. The relationship between FEV{sub 1}, symptoms and emphysema extent is weak. Better diagnostic tools are needed to define COPD. Tomographic lung scintigraphy [ventilation/perfusion single photon emission tomography (V/P SPECT)] visualizes regional V and P. In COPD, relations between V/P SPECT, spirometry, high-resolution computed tomography (HRCT) and symptoms have been insufficiently studied. The aim of this study was to investigate how lung function imaging and obstructive disease grading undertaken using V/P SPECT correlate with symptoms, spirometric lung function and degree of emphysema assessed with HRCT in patients with COPD. Thirty patients with stable COPD were evaluated with the Medical Research Council dyspnoea questionnaire (MRC) and the clinical COPD questionnaire (CCQ). Spirometry was performed. The extent of emphysema was assessed using HRCT. V/P SPECT was used to assess V/P patterns, total reduction in lung function and degree of obstructive disease. The total reduction in lung function and degree of obstructive disease, assessed with V/P SPECT, significantly correlated with emphysema extent (r = 0.66-0.69, p < 0.0001) and spirometric lung function (r = 0.62-0.74, p < 0.0005). The correlation between emphysema extent and spirometric lung function was weaker. No correlation between MRC, CCQ and objective measurements was found. V/P SPECT is sensitive to early changes in COPD. V/P SPECT also has the possibility to identify comorbid disease. V/P SPECT findings show a significant correlation with emphysema extent and spirometric lung function. We therefore recommend that scintigraphic signs of COPD, whenever found, should be

  14. Diagnosis of pulmonary embolus using ventilation/perfusion lung scintigraphy: more than 0.5 segment of ventilation/perfusion mismatch is sufficient.

    Howarth, D M; Booker, J A; Voutnis, D D


    To determine the optimal diagnostic cut-off point using a simplified criterion for the detection of pulmonary embolus (PE) and to evaluate the criterion's utility and reporter reproducibility. Lung scintigraphy was carried out in 924 patients for the diagnosis of PE. This group consisted of 316 men and 608 women with median age of 63 years (range 18-94 years). Ventilation imaging was carried out with Tc-99m Technegas followed by perfusion imaging using 190 MBq Tc-99m macroaggregated albumin. Studies were classified using a 6-category probability criterion of incremental ventilation/perfusion (V/Q) mismatch: A, normal; B, low (minor matched V/Q defects or segmental matched V/Q defects without opacity on chest X-ray); C, low-moderate (a partial segment of V/Q mismatch); D, moderate (1 segment of mismatch); E, moderate-high (1-2 segments of V/Q mismatch) and F, high probability (=2 segments of V/Q mismatch). Clinical end-points at 3 and 6 months were death by PE or PE treated with anticoagulation therapy. Three-reporter reproducibility was determined by kappa statistic on a subgroup of patients (53/924). A total of 122 patients (13%) had a confirmed diagnosis of PE at 3 months and no additional cases were registered at 6 months. The lung scintigraphy probability classification showed: normal 152 (16%), low 620 (67%), low-moderate 20 (2%), moderate 28 (3%), moderate-high 24 (3%) and high 80 (9%). The respective sensitivities and specificities, where the diagnostic cut-offs were established at F, high; E, moderate-high; D, moderate and C, low-moderate probability, were F, 64 and 100%; E, 82 and 99%; D, 95 and 98% and C, 98 and 96%. The respective false-negative cases for F, E, D and C cut-offs were 44, 22, 7 and 3. Using the revised Prospective Investigation of Pulmonary Embolism Diagnosis reporting classification reporter agreement showed kappa values of 0.31-0.48. Using a simplified 2-category (>0.5 segment of V/Q mismatch positive, all others negative) criterion

  15. Arterial to end-tidal carbon dioxide difference in children undergoing mechanical ventilation of the lungs during general anaesthesia.

    Onodi, C; Bühler, P K; Thomas, J; Schmitz, A; Weiss, M


    Capnography (ETCO2 ) is routinely used as a non-invasive estimate of arterial carbon dioxide (PaCO2 ) levels in order to modify ventilatory settings, whereby it is assumed that there is a positive gap between PaCO2 and ETCO2 of approximately 0.5 kPa. However, negative values (ETCO2 > PaCO2 ) can be observed. We retrospectively analysed arterial to end-tidal carbon dioxide differences in 799 children undergoing general anaesthesia with mechanical ventilation of the lungs in order to elucidate predictors for a negative gap. A total of 2452 blood gas analysis readings with complete vital sign monitoring, anaesthesia gas analysis and spirometry data were analysed. Mean arterial to end-tidal carbon dioxide difference was -0.18 kPa (limits of 95% agreement -1.10 to 0.74) and 71.2% of samples demonstrated negative values. The intercept model revealed PaCO2 to be the strongest predictor for a negative PaCO2 -ETCO2 difference. A decrease in PaCO2 by 1 kPa resulted in a decrease in the PaCO2 -ETCO2 difference by 0.23 kPa. This study demonstrates that ETCO2 monitoring in children whose lungs are mechanically ventilated may paradoxically lead to overestimation of ETCO2 (ETCO2 > PaCO2 ) with a subsequent risk of unrecognised hypocarbia. © 2017 The Association of Anaesthetists of Great Britain and Ireland.

  16. Respiratory monitoring with electrical impedance tomography for lung protective ventilation and alveolar recruitment maneuver in a patient with a single lung transplant and early graft dysfunction.

    Romero, A; Alonso, B; Latorre, I; García, J


    A case is presented on a patient who underwent left single lung transplantation for emphysema type COPD. There was early graft dysfunction gradeiii during the immediate postoperative period, which required the implantation of an extracorporeal membrane oxygenator (ECMO). Respirator ventilatory parameters were adjusted to avoid lung distension, low tidal volume (Vc) (280ml), high respiratory rates (20rpm), and a positive pressure at end expiration (PEEP) level of 8cmH2O. On monitoring the pulmonary tidal volume distribution by bedside electrical impedance tomography (EIT), it was noted that most of the tidal volume was distributed in the native lung emphysema. An alveolar recruitment manoeuvre was performed, under control of the EIT, that enabled the current volume and distribution and the pressures required to ventilate the transplanted lung to be observed. Copyright © 2015 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  17. A Short Period of Ventilation without Perfusion Seems to Reduce Atelectasis without Harming the Lungs during Ex Vivo Lung Perfusion

    Sandra Lindstedt


    Full Text Available To evaluate the lung function of donors after circulatory deaths (DCDs, ex vivo lung perfusion (EVLP has been shown to be a valuable method. We present modified EVLP where lung atelectasis is removed, while the lung perfusion is temporarily shut down. Twelve pigs were randomized into two groups: modified EVLP and conventional EVLP. When the lungs had reached 37°C in the EVLP circuit, lung perfusion was temporarily shut down in the modified EVLP group, and positive end-expiratory pressure (PEEP was increased to 10 cm H2O for 10 minutes. In the conventional EVLP group, PEEP was increased to 10 cm H2O for 10 minutes with unchanged lung perfusion. In the modified EVLP group, the arterial oxygen partial pressure (PaO2 was 18.5 ± 7.0 kPa before and 64.5 ± 6.0 kPa after the maneuver (P<0.001. In the conventional EVLP group, the PaO2 was 16.8 ± 3.1 kPa and 46.8 ± 2.7 kPa after the maneuver (P<0.01; P<0.01. In the modified EVLP group, the pulmonary graft weight was unchanged, while in the conventional EVLP group, the pulmonary graft weight was significantly increased. Modified EVLP with normoventilation of the lungs without ongoing lung perfusion for 10 minutes may eliminate atelectasis almost completely without harming the lungs.

  18. High-Frequency Oscillatory Ventilation in Pediatric Acute Lung Injury: A Multicenter International Experience.

    Rettig, Jordan S; Smallwood, Craig D; Walsh, Brian K; Rimensberger, Peter C; Bachman, Thomas E; Bollen, Casper W; Duval, Els L; Gebistorf, Fabienne; Markhorst, Dick G; Tinnevelt, Marcel; Todd, Mark; Zurakowski, David; Arnold, John H


    We aim to describe current clinical practice, the past decade of experience and factors related to improved outcomes for pediatric patients receiving high-frequency oscillatory ventilation. We have also modeled predictive factors that could help stratify mortality risk and guide future high-frequency oscillatory ventilation practice. Multicenter retrospective, observational questionnaire study. Seven PICUs. Demographic, disease factor, and ventilatory and outcome data were collected, and 328 patients from 2009 to 2010 were included in this analysis. None. Patients were classified into six cohorts based on underlying diagnosis. We used univariate analysis to identify factors associated with mortality risk and multivariate logistic regression to identify independent predictors of mortality risk. An oxygenation index greater than 35 and immunocompromise exhibited the greatest predictive power (p highly dependent on primary underlying condition. A trend toward an increase in oscillator amplitude and frequency was observed when compared with historical data. Given the number of centers and subjects included in the database, these findings provide a robust description of current practice regarding the use of high-frequency oscillatory ventilation for pediatric hypoxic respiratory failure. Patients with severe hypoxic respiratory failure and immunocompromise had the highest mortality risk, and those with respiratory syncytial virus had the lowest. A means of identifying the risk of 30-day mortality for subjects can be obtained by identifying the underlying disease and oxygenation index on conventional ventilation preceding the initiation of high-frequency oscillatory ventilation.

  19. Evaluation of lung infiltration score to predict postural hypoxemia in ventilated acute respiratory distress syndrome patients and the lateralization of skin pressure sore.

    Tripathi, Mukesh; Pandey, Mamta; Nepal, Bharat; Rai, Hari; Bhattarai, Balkrishna


    Mechanical ventilation with positive end expiratory pressure (PEEP) is associated with unequal aeration of lungs in acute respiratory distress syndrome (ARDS) patients. Therefore, patients may develop asymmetric atelectasis and postural hypoxemia during lateral positioning. To validate proposed lung infiltration score (LIS) based on chest x-ray to predict postural hypoxemia and lateralization of skin sores in ARDS patients. University hospital ICU. Prospective, observational study of consecutive patients. Sixteen adult patients of both genders on mechanical ventilation with PEEP for 24 to pressure sore grading was noted within a week of ICU stay. Nonparametric Bland and Altman correlation analysis, ANOVA and Student t test. Arterial oxygenation (PaO2/FiO2 = 313 +/- 145.6) was significantly (P or =3 between two lungs. The LIS mapping on chest x-ray was useful to differentiate between asymmetric lung disease and postural hypoxemia in ICU patients, which predisposed patients to early skin sore changes on higher LIS side.

  20. Minimizing {sup 99m}Tc incorporation of the staff during lung ventilation studies; Verringerung der Inkorporation von {sup 99m}Technetium beim Personal waehrend Lungenventilationsuntersuchungen

    Petzold, J.; Fundke, R.; Petzold, L.; Sabri, O.; Seese, A. [Universitaetsklinikum Leipzig (Germany). Klinik und Poliklinik fuer Nuklearmedizin; Alborzi, H. [Universitaetsklinikum Dresden (Germany)


    The causes of incorporation of {sup 99m}Tc of the staff during nuclear medical lung ventilation studies are investigated with the aim of minimizing it. It is shown that the incorporation of medical staff can be considerably reduced from more than 500 kBq per lung study to less than 500 Bq by some simple modifications of the technical equipment and small changes in the examination procedure. (orig.)

  1. Manual Ventilation and Sustained Lung Inflation in an Experimental Model: Influence of Equipment Type and Operator's Training.

    Cristiane do Prado

    Full Text Available To compare the influence of devices for manual ventilation and individual experience on the applied respiratory mechanics and sustained lung inflation.A total of 114 instructors and non-instructors from the Neonatal Resuscitation Program of the Brazilian Society of Pediatrics participated in this study. Participants ventilated an intubated manikin. To evaluate respiratory mechanics and sustained lung inflation parameters, a direct comparison was made between the self-inflating bag and the T-shaped resuscitator (T-piece, followed by an analysis of the effectiveness of the equipment according to the participants' education and training.A difference between equipment types was observed for the tidal volume, with a median (interquartile range of 28.5 mL (12.6 for the self-inflating bag and 20.1 mL (8.4 for the T-piece in the instructor group and 31.6 mL (14 for the self-inflating bag and 22.3 mL (8.8 for the T-piece in the non-instructor group. Higher inspiratory time values were observed with the T-piece in both groups of professionals, with no significant difference between them. The operator's ability to maintain the target pressure over the 10 seconds of sustained lung inflation was evaluated using the area under the pressure-time curve and was 1.7-fold higher with the use of the T-piece. Inspiratory pressure and mean airway pressure applied during sustained lung inflation were greater with the self-inflating bag, as evaluated between the beginning and the end of the procedure.The T-piece resulted in lower tidal volume and higher inspiratory time values, irrespective of the operator's experience, and increased the ease of performing the sustained lung inflation maneuver, as demonstrated by the maintenance of target pressure for the desired period and a higher mean airway pressure than that obtained using the self-inflating bag.

  2. High-Frequency Oscillatory Ventilation in Pediatric Acute Lung Injury : A Multicenter International Experience

    Rettig, Jordan S; Smallwood, Craig D; Walsh, Brian K; Rimensberger, Peter C; Bachman, Thomas E; Bollen, Casper W.; Duval, Els L; Gebistorf, Fabienne; Markhorst, Dick G; Tinnevelt, Marcel; Todd, Mark; Zurakowski, David; Arnold, John H


    OBJECTIVE: We aim to describe current clinical practice, the past decade of experience and factors related to improved outcomes for pediatric patients receiving high-frequency oscillatory ventilation. We have also modeled predictive factors that could help stratify mortality risk and guide future hi

  3. High-Frequency Oscillatory Ventilation in Pediatric Acute Lung Injury : A Multicenter International Experience

    Rettig, Jordan S; Smallwood, Craig D; Walsh, Brian K; Rimensberger, Peter C; Bachman, Thomas E; Bollen, Casper W.|info:eu-repo/dai/nl/304813362; Duval, Els L; Gebistorf, Fabienne; Markhorst, Dick G; Tinnevelt, Marcel; Todd, Mark; Zurakowski, David; Arnold, John H


    OBJECTIVE: We aim to describe current clinical practice, the past decade of experience and factors related to improved outcomes for pediatric patients receiving high-frequency oscillatory ventilation. We have also modeled predictive factors that could help stratify mortality risk and guide future hi

  4. High-Frequency Oscillatory Ventilation in Pediatric Acute Lung Injury : A Multicenter International Experience

    Rettig, Jordan S; Smallwood, Craig D; Walsh, Brian K; Rimensberger, Peter C; Bachman, Thomas E; Bollen, Casper W.; Duval, Els L; Gebistorf, Fabienne; Markhorst, Dick G; Tinnevelt, Marcel; Todd, Mark; Zurakowski, David; Arnold, John H


    OBJECTIVE: We aim to describe current clinical practice, the past decade of experience and factors related to improved outcomes for pediatric patients receiving high-frequency oscillatory ventilation. We have also modeled predictive factors that could help stratify mortality risk and guide future

  5. Automated continuous quantitative measurement of proximal airways on dynamic ventilation CT: initial experience using an ex vivo porcine lung phantom

    Yamashiro T


    Full Text Available Tsuneo Yamashiro,1 Maho Tsubakimoto,1 Yukihiro Nagatani,2 Hiroshi Moriya,3 Kotaro Sakuma,3 Shinsuke Tsukagoshi,4 Hiroyasu Inokawa,5 Tatsuya Kimoto,5 Ryuichi Teramoto,6 Sadayuki Murayama1 1Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Nishihara, Okinawa; 2Department of Radiology, Shiga University of Medical Science, Otsu; 3Department of Radiology, Ohara General Hospital, Fukushima; 4CT Systems Division, 5Center for Medical Research and Development, Toshiba Medical Systems Corporation, Otawara; 6Corporate Manufacturing Engineering Center, Toshiba Corporation, Yokohama, Japan Background: The purpose of this study was to evaluate the feasibility of continuous quantitative measurement of the proximal airways, using dynamic ventilation computed tomography (CT and our research software. Methods: A porcine lung that was removed during meat processing was ventilated inside a chest phantom by a negative pressure cylinder (eight times per minute. This chest phantom with imitated respiratory movement was scanned by a 320-row area-detector CT scanner for approximately 9 seconds as dynamic ventilatory scanning. Obtained volume data were reconstructed every 0.35 seconds (total 8.4 seconds with 24 frames as three-dimensional images and stored in our research software. The software automatically traced a designated airway point in all frames and measured the cross-sectional luminal area and wall area percent (WA%. The cross-sectional luminal area and WA% of the trachea and right main bronchus (RMB were measured for this study. Two radiologists evaluated the traceability of all measurable airway points of the trachea and RMB using a three-point scale. Results: It was judged that the software satisfactorily traced airway points throughout the dynamic ventilation CT (mean score, 2.64 at the trachea and 2.84 at the RMB. From the maximum inspiratory frame to the maximum expiratory frame, the cross-sectional luminal area of

  6. Partial liquid ventilation for preventing death and morbidity in adults with acute lung injury and acute respiratory distress syndrome.

    Galvin, Imelda M; Steel, Andrew; Pinto, Ruxandra; Ferguson, Niall D; Davies, Mark W


    Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are syndromes of severe respiratory failure that are associated with substantial mortality and morbidity. Artifical ventilatory support is commonly required and may exacerbate lung injury. Partial liquid ventilation (PLV) has been proposed as a less injurious form of ventilatory support for these patients. Although PLV has been shown to improve gas exchange and to reduce inflammation in experimental models of ALI, a previous systematic review did not find any evidence to support or refute its use in humans with ALI and ARDS. The primary objective of this review was to assess whether PLV reduced mortality (at 28 d, at discharge from the intensive care unit (ICU), at discharge from hospital and at one, two and five years) in adults with ALI or ARDS when compared with conventional ventilatory support.Secondary objectives were to determine how PLV compared with conventional ventilation with regard to duration of invasive mechanical ventilation, duration of respiratory support, duration of oxygen therapy, length of ICU stay, length of hospital stay, incidence of infection, long-term cognitive impairment, long-term health related quality of life, long- term lung function, long-term morbidity costs and adverse events. The following adverse events were considered: hypoxia (arterial PO2 blood pressure < 90 mm Hg sustained for longer than two minutes or requiring treatment with fluids or vasoactive drugs), bradycardia (heart rate < 50 beats per minute sustained for longer than one minute or requiring therapeutic intervention) and cardiac arrest (absence of effective cardiac output). In this updated review, we searched the Cochrane Central Register of Controlled Trials (CENTRAL Issue 10, 2012, in The Cochrane Library; MEDLINE (Ovid SP, 1966 to November 2012); EMBASE (Ovid SP, 1980 to November 2012) and CINAHL (EBSCOhost,1982 to November 2012) for published studies. In our original review, we searched until

  7. Complications of mechanical ventilation

    Drašković Biljana


    Full Text Available Mechanical ventilation of the lungs, as an important therapeutic measure, cannot be avoided in critically ill patients. However, when machines take over some of vital functions there is always a risk of complications and accidents. Complications associated with mechanical ventilation can be divided into: 1 airway-associated complications; 2 complications in the response of patients to mechanical ventilation; and 3 complications related to the patient’s response to the device for mechanical ventilation. Complications of artificial airway may be related to intubation and extubation or the endotracheal tube. Complications of mechanical ventilation, which arise because of the patient’s response to mechanical ventilation, may primarily cause significant side effects to the lungs. During the last two decades it was concluded that mechanical ventilation can worsen or cause acute lung injury. Mechanical ventilation may increase the alveolar/capillary permeability by overdistension of the lungs (volutrauma, it can exacerbate lung damage due to the recruitment/derecruitment of collapsed alveoli (atelectrauma and may cause subtle damages due to the activation of inflammatory processes (biotrauma. Complications caused by mechanical ventilation, beside those involving the lungs, can also have significant effects on other organs and organic systems, and can be a significant factor contributing to the increase of morbidity and mortality in critically ill of mechanically ventilated patients. Complications are fortunately rare and do not occur in every patient, but due to their seriousness and severity they require extensive knowledge, experience and responsibility by health-care workers.

  8. [Effect of propofol-based combined anesthesia on the development of adaptive mechanisms to the prolonged one-lung artificial ventilation].

    Kurilova, O A; Vyzhigina, M A; Sandrikov, V A; Mizikov, V M; Kulagina, T Iu; Zhukova, S G; Parshin, V D


    The paper deals with the assessment of the adequacy and safety of multicomponent anesthesia based on propofol at lung surgery requiring one-lung ventilation (OLV) in patients with chronic respiratory diseases and with the evaluation of the effect of propofol on the development of adaptive mechanisms in various ventilation modalities in thoracic surgery. The pressor, resistive, and volume characteristics of pulmonary blood flow, systemic and intracardiac hemodynamics under artificial ventilation (AV) and OLV of a duration of up to 1.5 hours by a combination of pulmonal and transpulmonal thermodilution on a PiCCO plus device with a VOLEF attachment were compared. Multicomponent balanced anesthesia based on continuous graduated propofol infusion provides adequate protection of patients during thoracic operations, including those with concomitant respiratory abnormality.

  9. Leakage of protein into lungs of preterm ventilated rabbits is correlated with activation of clotting, complement, and polymorphonuclear leukocytes in plasma

    Brus, F; vanOeveren, W; Heikamp, A; Okken, A; Oetomo, SB

    We investigated whether leakage of protein in lungs of pre term ventilated rabbits of 28- and 29-d gestational age is correlated with activation of clotting, complement, and polymorphonuclear leukocytes (PMN) in plasma. We found signs of systemic activation of clotting, complement, and PMN in

  10. Efficiency, efficacy, and safety of EZ-blocker compared with left-sided double-lumen tube for one-lung ventilation

    Mourisse, J.M.; Liesveld, J.; Verhagen, A.F.T.M.; Rooij, G. van; Heide, S. van der; Schuurbiers, O.C.J.; Heijden, E. van der


    BACKGROUND: Double-lumen tubes (DLTs) or bronchial blockers are commonly used for one-lung ventilation. DLTs are sometimes difficult or even impossible to introduce, and the incidence of postoperative hoarseness and airway injuries is higher. Bronchial blockers are more difficult to position and nee

  11. MR imaging of lung ventilation with aerosolized Gadolinium-chelates; MR-Bildgebung der Lungenventilation mittels aerosolierter Gadolinium-Chelate

    Haage, P.; Karaagac, S.; Spuentrup, E.; Guenther, R.W. [RWTH Aachen (Germany). Klinik fuer Radiologische Diagnostik; Adam, G. [Universitaetsklinikum Hamburg-Eppendorf (Germany). Abt. fuer Diagnostische und Interventionelle Radiologie


    Purpose: To evaluate the feasibility of magnetic resonance assessment of human lung ventilation with aerosolized Gd-chelates in healthy volunteers. Materials and Methods: Five healthy adults (mean age 37 years) were studied with a 1.5 T unit. The volunteers were instructed to inhale the aerosol through an airtight facial mask for 10 minutes. The aerosol was generated with a jet-type small particle nebulizer with attached heater. Ventilation imaging was performed using a respiration-gated dynamic T{sub 1}-weighted turbo spin echo sequence (T{sub R}=199 ms, T{sub E}=8.5 ms, 12 signal averages, slice thickness 10 mm). Pulmonary signal intensity changes were calculated before and after nebulization. Results: The investigation was successfully carried out in all volunteers. An acute or delayed allergic reaction to the aerosolized contrast medium was not observed. In 4 of 5 experiments (80%), a homogeneous signal intensity increase was readily visualized with an average signal increase of 35% after 10 minutes; in one experiment, the aerosol distribution was slightly heterogeneous. (orig.) [German] Ziel: Bestimmung der Durchfuehrbarkeit einer kernspintomographischen Darstellung der Lungenventilation mittels aerosolierter Gd-Chelate bei gesunden Probanden. Methoden: 5 Probanden (Durchschnittsalter 37 Jahre) wurden in einem 1,5T System untersucht. Die Probanden atmeten spontan aerosoliertes Gd-DTPA ueber eine Atemmaske fuer eine Dauer von 10 Minuten. Das Kontrastmittel-Aerosol wurde ueber einen leistungsfaehigen druckluftbetriebenen Vernebler generiert. Die Illustration der Ventilation erfolgte mit einer atemgegateten dynamischen T{sub 1}-gewichteten Turbo-Spin-Echosequenz. Zur Quantitifizerung der Lungenventilation wurden die Signalintensitaeten im Lungengewebe vor und nach Verneblung berechnet. Ergebnisse: Alle Untersuchungen wurden komplikationslos durchgefuehrt und beendet. Eine akute oder verzoegerte Kontrastmittelreaktion wurde nicht beobachtet. In 4 von 5

  12. Positive Fluid Balance Is Associated with Higher Mortality and Prolonged Mechanical Ventilation in Pediatric Patients with Acute Lung Injury

    Heidi R. Flori


    Full Text Available Introduction. We analyzed a database of 320 pediatric patients with acute lung injury (ALI, to test the hypothesis that positive fluid balance is associated with worse clinical outcomes in children with ALI. Methods. This is a post-hoc analysis of previously collected data. Cumulative fluid balance was analyzed in ml per kilogram per day for the first 72 hours after ALI while in the PICU. The primary outcome was mortality; the secondary outcome was ventilator-free days. Results. Positive fluid balance (in increments of 10 mL/kg/24 h was associated with a significant increase in both mortality and prolonged duration of mechanical ventilation, independent of the presence of multiple organ system failure and the extent of oxygenation defect. These relationships remained unchanged when the subgroup of patients with septic shock (n=39 were excluded. Conclusions. Persistently positive fluid balance may be deleterious to pediatric patients with ALI. A confirmatory, prospective randomized controlled trial of fluid management in pediatric patients with ALI is warranted.

  13. Pulmonary rehabilitation coupled with negative pressure ventilation decreases decline in lung function, hospitalizations, and medical cost in COPD

    Huang, Hung-Yu; Chou, Pai-Chien; Joa, Wen-Ching; Chen, Li-Fei; Sheng, Te-Fang; Lin, Horng-Chyuan; Yang, Lan-Yan; Pan, Yu-Bin; Chung, Fu-Tsai; Wang, Chun-Hua; Kuo, Han-Pin


    Abstract Pulmonary rehabilitation (PR) brings benefits to patients with chronic obstructive pulmonary disease (COPD). Negative pressure ventilation (NPV) increases ventilation and decreases hyperinflation as well as breathing work in COPD. We evaluated the long-term effects of a hospital-based PR program coupled with NPV support in patients with COPD on clinical outcomes. One hundred twenty-nine patients with COPD were followed up for more than 5 years, with the NPV group (n = 63) receiving the support of NPV (20–30 cm H2O delivery pressure for 60 min) and unsupervised home exercise program of 20 to 30 min daily walk, while the control group (n = 6) only received unsupervised home exercise program. Pulmonary function tests and 6 min walk tests (6MWT) were performed every 3 to 6 months. Emergency room (ER) visits and hospitalization with medical costs were recorded. A significant time-by-group interaction in the yearly decline of forced expiratory volume in 1 s in the control group analyzed by mixed-model repeated-measure analysis was found (P = 0.048). The 6MWT distance of the NPV group was significantly increased during the first 4 years, with the interaction of time and group (P = 0.003), the time alone (P = 0.014), and the quadratic time (P lung function, exacerbations, and hospitalization rates, and improved walking distance and medical costs in patients with COPD during a 5-year observation PMID:27741132

  14. Lung perfusion and ventilation scintigraphy in pre- and postoperative diagnostics; Lungenperfusions- und Ventilationsszintigraphie in der prae- und postoperativen Diagnostik

    Sandrock, D.; Munz, D.L. [Klinik und Poliklinik fuer Nuklearmedizin, Universitaetsklinikum Charite, Medizinische Fakultaet der Humboldt-Univ. zu Berlin (Germany)


    Lung perfusion (Tc-99m labeled albumin particles) and ventilation (Xe-133 gas) are used prior to thoracic surgery in order to evaluate changes in perfusion and ventilation due to the underlying diseases. Furthermore, perfusion scintigraphy allows combined with spirometry the prediction of the postinterventional vital capacity and the forced expiratory volume in 1 s. The correlation coefficient for this procedure compared with values measured postoperatively are in the range of 0.8. The method allows the assessment of operability in terms of postinterventional function. (orig.) [Deutsch] Die Lungenperfusions- (mit Tc-99m-markierten Albuminpartikeln) und die Ventilationsszintigraphie (mit Xe-133 als Gas) werden vor thoraxchirugrischen Eingriffen zur Beurteilung der durch die Grund- oder weitere Erkrankungen bedingte Einschraenkungen von Perfusion und Belueftung eingesetzt. Die Perfusionsszintigraphie erlaubt in Kombination mit der Spirometrie ausserdem die Vorausberechnung der postoperativ zu erwartenden Vitalkapazitaet und des forcierten exspiratorischen Erstsekundenvolumens. Im Vergleich mit den postoperativ gemessenen Volumina liegen die Korrelationskoeffizienten um 0,8. Die Methode ermoeglicht daher eine Beurteilung der Operabilitaet bezueglich der postoperativen Lungenfunktion. (orig.)

  15. Tc-99m technegas scintigraphy to evaluate the lung ventilation in patients with oral corticosteroid-dependent bronchial asthma

    Fujita, Jiro; Okada, Hiroki; Momoi, Atsuko; Yamadori, Ichiro; Takahara, Jiro; Tanabe, Masatada [Kagawa Medical Univ., Miki (Japan); Takahashi, Kazue; Satoh, Katashi; Ohkawa, Motoomi


    Bronchial asthma is a clinical syndrome characterized by the reversibility of airway obstruction. Recently it has been suggested that remodeling of the airway causes irreversible airway obstruction which may be responsible for the patient's symptoms. With this background, the purpose of the present study was to assess patients with corticosteroid-dependent asthma by Tc-99m Technegas scintigraphy (Technegas) in both planar and SPECT images. Twelve patients (7 females and 5 males aged 36-72 years with a median age of 60 years: 4 smokers and 8 non-smokers) with oral corticosteroid-dependent asthma were enrolled in this study. Lung ventilation scanning with Technegas in both planar and SPECT images, high-resolution computed tomography, and pulmonary function tests were performed in all patients. The results of Technegas scanning were graded and correlations with other clinical parameters were evaluated. Significant abnormalities were detected by ventilation scintigraphy with Technegas in patients with corticosteroid-dependent bronchial asthma even during remission. Our data demonstrate that airflow obstruction took place in patients with corticosteroid-dependent asthma even during remission. Technegas scanning appears to be a useful radiopharmaceutical for demonstrating airflow obstruction in patients with bronchial asthma. (author)

  16. Ventilation-perfusion relationships in the lung during head-out water immersion

    Derion, Toniann; Guy, Harold J. B.; Tsukimoto, Koichi; Schaffartzik, Walter; Prediletto, Renato; Poole, David C.; Knight, Douglas R.; Wagner, Peter D.


    Mechanisms of altered pulmonary gas exchange during water immersion were studied in 12 normal males: 6 young (aged 20-29) and 6 older (aged 40-45). It is concluded that, in young subjects with closing volume (CV) less than expiratory reserve volume (ERV), gas exchange was enhanced during immersion, because normal ventilation-perfusion relations were preserved, and by mass balance, the ventilation/O2 uptake changes elevated arterial P(O2). In older males with CV greater than ERV and 52 percent of tidal volume below CV, immersion-induced airways closure during tidal breathing was associated with minimally increased shunt that did not significantly impair gas exchange. It is suggested that airways closure of this degree is of little importance to gas exchange.

  17. Ventilation-perfusion relationships in the lung during head-out water immersion

    Derion, Toniann; Guy, Harold J. B.; Tsukimoto, Koichi; Schaffartzik, Walter; Prediletto, Renato; Poole, David C.; Knight, Douglas R.; Wagner, Peter D.


    Mechanisms of altered pulmonary gas exchange during water immersion were studied in 12 normal males: 6 young (aged 20-29) and 6 older (aged 40-45). It is concluded that, in young subjects with closing volume (CV) less than expiratory reserve volume (ERV), gas exchange was enhanced during immersion, because normal ventilation-perfusion relations were preserved, and by mass balance, the ventilation/O2 uptake changes elevated arterial P(O2). In older males with CV greater than ERV and 52 percent of tidal volume below CV, immersion-induced airways closure during tidal breathing was associated with minimally increased shunt that did not significantly impair gas exchange. It is suggested that airways closure of this degree is of little importance to gas exchange.

  18. [Ventilation mechanics in the premature and the newborn. I. Statistical measurements of the isolated lungs].

    Wierich, W


    On 31 pairs of lungs from still borns and newborns of differing stages of maturation and age (23rd week of gestation up to the 24th week after birth) statical measurements including liquid fillings were performed. On account of the histo-mechanical tests as well as morphological and clinical data, the group could be divided into normal lungs and lungs with decreased surfactant activity. Between the 35th week of gestation and the 5th week after birth a marked increase in pulmonary maturation with unproportional changes of the histomechanical values could be demonstrated. In lungs with decreased surfactant activity the influence of life span upon the mechanical properties of pulmonary tissue could be shown. The high surface tension decreases, presumably on account of surfactant synthesis, while the values of tissue elasticity decrease as a result of overstretching.

  19. Utilization of noninvasive ventilation in acute care hospitals: a regional survey.

    Maheshwari, Vinay; Paioli, Daniela; Rothaar, Robert; Hill, Nicholas S


    Little information is available on the utilization of noninvasive positive-pressure ventilation (NPPV) in the United States. Accordingly, we performed a survey on the use of NPPV at acute care hospitals in a region of the United States to determine variations in utilization and between hospitals, the reasons for lower rates of utilization, and the techniques used for application. Using survey methodology, we developed a questionnaire consisting of 19 questions and distributed it by mail to directors of respiratory care at all 82 acute care hospitals in Massachusetts and Rhode Island. Nonresponders were contacted by phone to complete the survey. Responses were analyzed using standard statistics, including t tests and Mann-Whitney U tests where appropriate. We obtained responses from 71 of the 82 hospitals (88%). The overall utilization rate for NPPV was 20% of ventilator starts, but we found enormous variation in the estimated utilization rates among different hospitals, from none to > 50%. The top two reasons given for lower utilization rates were a lack of physician knowledge and inadequate equipment. In the 19 hospitals that provided detailed information, COPD and congestive heart failure constituted 82% of the diagnoses of patients receiving NPPV, but NPPV was still used in only 33% of patients with these diagnoses receiving any form of mechanical ventilation. The utilization rates for NPPV vary enormously among different acute care hospitals within the same region. The perceived reasons for lower utilization rates include lack of physician knowledge, insufficient respiratory therapist training, and inadequate equipment. Educational programs directed at individual institutions may be useful to enhance utilization rates.

  20. High-frequency percussive ventilation and initial biomarker levels of lung injury in patients with minor burns after smoke inhalation injury.

    Reper, P; Heijmans, W


    Several biological markers of lung injury are predictors of morbidity and mortality in patients with acute respiratory distress syndrome (ARDS). Some lung-protective ventilation strategies, such as low tidal volume, are associated with a significant decrease in plasma biomarker levels compared to the high tidal volume ventilation strategy. The primary objective of this study was to test whether the institution of high-frequency percussive ventilation (HFPV) to patients with respiratory distress after smoke inhalation injury influenced initial biomarker levels of lung injury (just before and after using percussive ventilation). A prospective observational cohort study was conducted in the intensive care unit of the Brussels Burn Center. Fifteen intubated, mechanically ventilated patients with minor burns and ARDS following smoke inhalation were enrolled in our study. Physiologic data and serum samples were collected before intubation and at four different time points within the first 48h after intubation to measure the concentration of interleukin (IL)-6, IL-8, and tumor necrosis factor-α (TNF alpha). The differences in biomarker levels before and after starting HFPV were analyzed using repeated measure analysis of variance and a paired t test with correction for multiple comparisons. Before starting HFPV under endotracheal intubation, all biological markers (IL-6, IL-8, and TNF alpha) were elevated in the spontaneously breathing patients with acute lung injury (ALI). After intubation and institution of a positive pressure ventilation with HFPV (tidal volume 5.6-6.6ml/kg per ideal body weight), none of the biological markers were increased significantly at either an early (3±2h) or a later point in time. However, the levels of IL-8 had decreased significantly after intubation at a later point in time. During the post-intubation period, the PaO2/FiO2 (partial pressure of arterial oxygen/fraction of the inspired oxygen) ratio increased significantly and the plateau

  1. Effect of dexmedetomidine on damage to non-ventilated lung in patients undergoing one-lung ventilation%右美托咪定对单肺通气患者非通气侧肺损伤的影响

    张伟; 张加强; 孟凡民; 张卫


    Objective To investigate the effect of dexmedetomidine on the damage to the nonventilated lung in the patients undergoing one-lung ventilation (OLV).Methods Forty patients of both sexes, aged 18-64 yr, with body mass index of 18-25 kg/m2, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, scheduled for elective radical surgery for lung cancer under general anesthesia, were randomly divided into either control group (group C) or dexmedetomidine group (group D) with 20 in each group.After induction of anesthesia, the patients were tracheally intubated and mechanically ventilated.After correct positioning was confirmed by fiberoptic bronchoscopy, dexmedetomidine was infused for 20 min as a dose of 0.5 μg/kg, followed by an infusion of 0.5 μg · kg-1 · h-1 until the moment of tumor resection.The equal volume of normal saline was given in group C.Immediately after the beginning of OLV, at 60 min of OLV, and immediately after the end of OLV, the specimens of normal lung tissues around the tumor were obtained for microscopic examination of pathologic changes which were scored, and for determination of the expression of hypoxia-inducible factor-1 alpha (HIF-1α) and heme oxygenase-1 (HO-1) by Western blot.Results Compared with group C, the pathological score was significantly decreased on the non-ventilated side immediately after the end of OLV, and the expression of HIF-1α and HO-1 in the lung tissues on the non-ventilated side was up-regulated in group D (P<0.05).Conclusion Dexmedetomidine can mitigate the damage to the non-ventilated lung in the patients undergoing OLV, and the mechanism is associated with up-regulated expression of HIF-1α and HO-1.%目的 探讨右美托咪定对单肺通气患者非通气侧肺损伤的影响.方法 择期全麻下行胸腔镜下肺癌根治术的患者40例,性别不限,年龄18 ~ 64岁,体重指数18~ 25 kg/m2,ASA分级Ⅱ或Ⅲ级,采用随机数字表法分为2组(n=20):对照组(C组)和右美托咪

  2. Susceptibility To High Altitude Pulmonary Edema Is Associated With A More Uniform Distribution Of Regional Specific Ventilation.

    Patz, Michael D; Sá, Rui Carlos; Darquenne, Chantal; Elliott, Ann R; Assadi, Amran K; Theilmann, Rebecca J; Dubowitz, David J; Swenson, Erik Richard; Prisk, Gordon Kim; Hopkins, Susan Roberta


    High altitude pulmonary edema (HAPE) is a potentially fatal condition affecting high altitude sojourners. The biggest predictor of HAPE development is a history of prior HAPE. Magnetic resonance imaging (MRI) shows HAPE-susceptible, with a history of HAPE, but not HAPE-resistant (a history of repeated ascents without illness) individuals develop greater heterogeneity of regional pulmonary perfusion breathing hypoxic gas (O2=12.5%), consistent with uneven hypoxic pulmonary vasoconstriction (HPV). Why HPV is uneven in HAPE-susceptibles is unknown, but may arise from regionally heterogeneous ventilation resulting in an uneven stimulus to HPV. We tested the hypothesis that ventilation is more heterogeneous in HAPE-susceptible subjects (n=6) compared to HAPE-resistant controls (n=7). MRI Specific Ventilation Imaging (SVI), was used to measure regional specific ventilation and the relative dispersion (SD/mean) of SVI used to quantify baseline heterogeneity. Ventilation heterogeneity from conductive and respiratory airways was measured in normoxia and hypoxia (O2=12.5%) using multiple breath washout and heterogeneity quantified from the indices Scond and Sacin, respectively. Contrary to our hypothesis, HAPE-susceptibles had significantly lower relative dispersion of specific ventilation than the HAPE-resistant controls (Susceptible=1.33±0.67, Resistant=2.36±0.98, p=0.05) and Sacin tended to be more uniform (Susceptible=0.085±0.009, Resistant=0.113±0.030, p=0.07). Scond was not significantly different between groups (Susceptible=0.019±0.007, Resistant=0.020±0.004, p=0.67). Sacin and Scond did not change significantly in hypoxia (p=0.56, 0.19, respectively). In conclusion, ventilation heterogeneity does not change with short-term hypoxia irrespective of HAPE susceptibility and lesser rather than greater ventilation heterogeneity is observed in HAPE-susceptible subjects. This suggests the basis for uneven HPV in HAPE involves vascular phenomena.

  3. 单肺通气相关性肺损伤机制及其防治策略的研究进展%Advancement of Research about Mechanisms and Prevention Strategies of One-lung Ventilation Associated Lung Injury

    程远大; 董硕


    急性肺损伤(ALI)是胸外科手术后潜在并发症,单肺通气是引起ALI的主要原因之一,其损伤机制主要与牵张性肺损伤、低氧血症及氧化应激有关.保护性通气策略减少了单肺通气过程的机械应力,术中患侧肺持续呼吸道正压通气联合健侧肺呼气末正压通气以及高频正压通气等模式改善了单肺通气过程中的低氧血症,提高了单肺通气中动脉氧合.一些新的麻醉方式和麻醉药物的应用也减少了单肺通气过程中ALI的程度.%Acute lung injury( ALI )is a potential postoperative complication in the thoracic surgery and one-lung ventilation is one of the most important reasons of acute lung injury, which is associated with the stretch-induced lung injury, hypoxia-induced lung injury and hypoxia/reoxygenation-induced lung injury. Protective ventilation strategy reduces the stretch-induced lung injury and the application of continuous positive airway pressure to dependent lung and positive end-expiratory pressure to the non-dependent lung can improve oxygenation and reduce hypoxemia. Some new anesthesia technologies and drugs also alleviate ALI during one-lung ventilation.

  4. Propagation prevention: a complementary mechanism for "lung protective" ventilation in acute respiratory distress syndrome.

    Marini, John J; Gattinoni, Luciano


    To describe the clinical implications of an often neglected mechanism through which localized acute lung injury may be propagated and intensified. Experimental and clinical evidence from the medical literature relevant to the airway propagation hypothesis and its consequences. The diffuse injury that characterizes acute respiratory distress syndrome is often considered a process that begins synchronously throughout the lung, mediated by inhaled or blood-borne noxious agents. Relatively little attention has been paid to possibility that inflammatory lung injury may also begin focally and propagate sequentially via the airway network, proceeding mouth-ward from distal to proximal. Were this true, modifications of ventilatory pattern and position aimed at geographic containment of the injury process could help prevent its generalization and limit disease severity. The purposes of this communication are to call attention to this seldom considered mechanism for extending lung injury that might further justify implementation of low tidal volume/high positive end-expiratory pressure ventilatory strategies for lung protection and to suggest additional therapeutic measures implied by this broadened conceptual paradigm.

  5. [Ketamine versus propofol during one-lung ventilation in thoracic surgery].

    Vyzhigina, O A; Kurilova, O A; Riabova, O S; Titov, V A; Zhukova, S G; Parshin, V D


    A comparative analysis of gas, the metabolic rate, pressor, resistive and volumetric characteristics of pulmonary blood flow, central and intracardiac hemodynamics in patients undergoing thoracic surgery was conducted. 2 methods of anesthesia maintenance: on the basis of ketamine - fentanyl - pipecuronium and propofol - fentanyl - pipecuronim were compared. Invasive monitoring system PiCCOplus for the behaviour of the transpulmonary thermodilution (TT) in combination with VoLEF for the pulmonary thermodilution (PT) the change of ventilation mode ALV - OLV - ALV was used. OLV lasted for more than 1.5 hours.

  6. Immunoadjuvant Therapy and Noninvasive Ventilation for Acute Respiratory Failure in Lung Tuberculosis: A Case Study

    Flores-Franco, René Agustín; Olivas-Medina, Dahyr Alberto; Pacheco-Tena, Cesar Francisco; Duque-Rodríguez, Jorge


    Acute respiratory failure caused by pulmonary tuberculosis is a rare event but with a high mortality even while receiving mechanical ventilatory support. We report the case of a young man with severe pulmonary tuberculosis refractory to conventional therapy who successfully overcame the critical period of his condition using noninvasive ventilation and immunoadjuvant therapy that included three doses of etanercept 25 mg subcutaneously. We conclude that the use of etanercept along with antituberculosis treatment appears to be safe and effective in patients with pulmonary tuberculosis presenting with acute respiratory failure. PMID:26273486

  7. TU-F-17A-09: Four-Dimensional Cone Beam CT Ventilation Imaging Can Detect Interfraction Lung Function Variations for Locally Advanced Lung Cancer Patients

    Kipritidis, J; Keall, P [Radiation Physics Laboratory, University of Sydney, Sydney NSW 2006 Australia (Australia); Hugo, G; Weiss, E; Williamson, J [Department of Radiation Oncology, Virginia Commonwealth University, Richmond VA (United States)


    Purpose: Four-dimensional cone beam CT ventilation imaging (4D-CBCT VI) is a novel functional lung imaging modality requiring validation. We hypothesize that 4D-CBCT VI satisfies a necessary condition for validity: that intrafraction variations (e.g. due to poor 4D-CBCT image quality) are substantially different to interfraction variations (e.g. due to changes in underlying function). We perform the first comparison of intrafraction (pre/post fraction) and interfraction (week-to-week) 4D-CBCT VIs for locally advanced non small cell lung cancer (LA NSCLC) patients undergoing radiation therapy. Methods: A total of 215 4D-CBCT scans were acquired for 19 LA NSCLC patients over 4-6 weeks of radiation therapy, including 75 pairs of pre-/post-fraction scans on the same day. 4D-CBCT VIs were obtained by applying state-of-the-art, B-spline deformable image registration to obtain the Jacobian determinant of deformation between the end-exhale and end-inhale phases. All VIs were deformably registered to the corresponding first day scan, normalized between the 10th and 90th percentile values and cropped to the ipsilateral lung only. Intrafraction variations were assessed by computing the mean and standard deviation of voxel-wise differences between all same-day pairs of pre-/post-fraction VIs. Interfraction differences were computed between first-day VIs and treatment weeks 2, 4 and 6 for all 19 patients. We tested the hypothesis by comparing cumulative distribution functions (CDFs) of intrafraction and interfraction ventilation differences using two-sided Kolmogorov-Smirnov goodness-of-fit tests. Results: The (mean ± std. dev.) of intrafraction differences was (−0.007 ± 0.079). Interfraction differences for weeks 2, 4 and 6 were (−0.035 ± 0.103), (−0.006 ± 0.094) and (−0.019 ± 0.127) respectively. For week 2, the changes in CDFs for intrafraction and interfraction differences approached statistical significance (p=0.099). Conclusion: We have shown that 4D-CBCT VI

  8. Suppressing NF-κB and NKRF Pathways by Induced Pluripotent Stem Cell Therapy in Mice with Ventilator-Induced Lung Injury.

    Yung-Yang Liu

    Full Text Available High-tidal-volume mechanical ventilation used in patients with acute lung injury (ALI can induce the release of inflammatory cytokines, as macrophage inflammatory protein-2 (MIP-2, recruitment of neutrophils, and disruption of alveolar epithelial and endothelial barriers. Induced pluripotent stem cells (iPSCs have been shown to improve ALI in mice, but the mechanisms regulating the interactions between mechanical ventilation and iPSCs are not fully elucidated. Nuclear factor kappa B (NF-κB and NF-κB repressing factor (NKRF have been proposed to modulate the neutrophil activation involved in ALI. Thus, we hypothesized intravenous injection of iPSCs or iPSC-derived conditioned medium (iPSC-CM would decrease high-tidal-volume ventilation-induced neutrophil infiltration, oxidative stress, and MIP-2 production through NF-κB/NKRF pathways.Male C57BL/6 mice, aged between 6 and 8 weeks, weighing between 20 and 25 g, were exposed to high-tidal-volume (30 ml/kg mechanical ventilation with room air for 1 to 4 h after 5×10(7 cells/kg mouse iPSCs or iPSC-CM administration. Nonventilated mice were used as control groups.High-tidal-volume mechanical ventilation induced the increases of integration of iPSCs into the injured lungs of mice, microvascular permeability, neutrophil infiltration, malondialdehyde, MIP-2 production, and NF-κB and NKRF activation. Lung injury indices including inflammation, lung edema, ultrastructure pathologic changes and functional gas exchange impairment induced by mechanical ventilation were attenuated with administration of iPSCs or iPSC-CM, which was mimicked by pharmacological inhibition of NF-κB activity with SN50 or NKRF expression with NKRF short interfering RNA.Our data suggest that iPSC-based therapy attenuates high-tidal-volume mechanical ventilation-induced lung injury, at least partly, through inhibition of NF-κB/NKRF pathways. Notably, the conditioned medium of iPSCs revealed beneficial effects equal to those of iPSCs.

  9. Dependence of lung injury on inflation rate during low-volume ventilation in normal open-chest rabbits.

    D'Angelo, Edgardo; Pecchiari, Matteo; Saetta, Marina; Balestro, Elisabetta; Milic-Emili, Joseph


    Lung mechanics and morphometry were assessed in two groups of nine normal open-chest rabbits mechanically ventilated (MV) for 3-4 h at zero end-expiratory pressure (ZEEP) with physiological tidal volumes (Vt; 11 ml/kg) and high (group A) or low (group B) inflation flow (44 and 6.1 ml x kg(-1) x s(-1), respectively). Relative to initial MV on positive end-expiratory pressure (PEEP; 2.3 cmH(2)O), MV on ZEEP increased quasi-static elastance and airway and viscoelastic resistance more in group A (+251, +393, and +225%, respectively) than in group B (+180, +247, and +183%, respectively), with no change in viscoelastic time constant. After restoration of PEEP, quasi-static elastance and viscoelastic resistance returned to control, whereas airway resistance, still relative to initial values, remained elevated more in group A (+86%) than in group B (+33%). In contrast, prolonged high-flow MV on PEEP had no effect on lung mechanics of seven open-chest rabbits (group C). Gas exchange on PEEP was equally preserved in all groups, and the lung wet-to-dry ratios were normal. Relative to group C, both groups A and B had an increased percentage of abnormal alveolar-bronchiolar attachments and number of polymorphonuclear leukocytes in alveolar septa, the latter being significantly larger in group A than in group B. Thus prolonged MV on ZEEP with cyclic opening-closing of peripheral airways causes alveolar-bronchiolar uncoupling and parenchymal inflammation with concurrent, persistent increase in airway resistance, which are worsened by high-inflation flow.

  10. A retrospective exploration of patient-ventilator monitoring intensity, therapeutic intervention intensity, and compliance with lung protective guidelines in a cohort of patients with adult respiratory distress syndrome.

    Jones, Terry L


     The current approach to mechanical ventilation for adult respiratory distress syndrome (ARDS) and acute lung injury (ALI) involves maintaining key patient-ventilator parameters within established lung protective targets. Monitoring is part of the processes of nursing care believed to guide therapeutic intervention and facilitate compliance with these targets. Empirical relationships between monitoring, therapeutic intervention, and compliance with these practice guidelines have not been adequately explored.  A retrospective observational design was used to explore relationships between monitoring intensity, therapeutic intervention intensity, and compliance with a lung protective philosophy of mechanical ventilation in a cohort of patients with ARDS or ALI. Compliance with lung protective targets was measured as the proportion of time oxygen saturation, alveolar distending pressure, and tidal volume were maintained within recommended guidelines as evidenced by medical record documentation. Monitoring intensity and therapeutic intervention intensity were based on the frequency of recorded assessments and interventions in the medical record.  Monitoring intensity correlated positively with both severity of illness (r = 0.39) and with therapeutic intervention intensity (r = 0.30), and was inversely related to compliance with lung protective guidelines (CLPG) (r = -0.34). A regression model including monitoring intensity, severity of illness, risk for abdominal hypertension, and CLPG was statistically significant (p = 0.02) but explained little of the variance in compliance with lung protective parameters (R2 = 0.13).  Compliance with recommended lung protective parameters in the absence of standardized monitoring and intervention protocols is suboptimal. Preliminary evidence of positive relationships between monitoring and both severity of illness and therapeutic intervention was established. Control for nursing and physician practice variation is

  11. Acute lung injury in children : from viral infection and mechanical ventilation to inflammation and apoptosis

    Bern, R.A.


    Acute lung injury (ALI), ook bekend als acute respiratory distress syndrome (ARDS), is een uitgebreide ontstekingsreactie in beide longen door een longziekte of een aandoening elders in het lichaam. Kinderen lijken minder gevoelig voor de ziekte dan volwassenen, wellicht door de manier waarop de lon

  12. Quantification of lung injury using ventilation and perfusion distributions obtained from gamma scintigraphy.

    Brook, B S; Murphy, C M; Breen, D; Miles, A W; Tilley, D G; Wilson, A J


    This paper explores the potential of isotope V/Q lung scans to quantify lung disease. Areas of restricted perfusion in subjects with a pulmonary embolus (PE) were identified in 3D reconstructions of V/Q images achieved using anatomical data from the Visible Human Project. From these, the extent of lung damage was quantified. Significant differences in the values of both LogSD V and LogSD Q (p > 0.05) obtained from plots of V and Q against Log(V/Q) were found between normal subjects and subjects with a PE, but no correlation was found between either of these parameters and the degree of lung damage in subjects with a PE (p > 0.05). Whilst V/Q values were log normally distributed, the V/Q distributions from the subjects with a PE failed to show the bimodal distribution predicted from theoretical considerations and MIGET measurements previously reported. There was a statistically significant difference in the mean and standard deviation values of the V/Q distributions between normal subject and subjects with a PE (p 0.05). There was no correlation between the mean, median and standard deviation of the distributions from the subjects with a PE and the percentage of damage present (p > 0.05).

  13. Curcumin Attenuates Lung Oxidative Injury Induced by One Lung Ventilation in Rabbits%姜黄素减轻兔单肺通气导致的肺损伤

    李慧婷; 林文前; 谭红鹰; 操隆辉; 李靖; 曾维安


    [Objective] To investigate the effect of curcumin on lung injury induced by one-lung ventilation(OLV) in rabbits. [Methods]Twelve New Zealand white rabbits were randomly allocated into two groups; OLV group (group I ,n = 6) , and OLV+ curcumin group (group II ,re = 6). Rabbits in group I were given 1% sodium carboxymethylcellulose as placebo, while rabbits in group II were received curcumin 40 mg/kg which dissolved in 1% sodium carboxymethylcellulose via gastric tube for seven consecutive days before the operation. All rabbits in two groups were tracheostomized and inserted a ID 3.5 mm trachea tube into the right bronchus to establish one lung ventilation. The rabbits were mechanically ventilated using the volume-control mode (VT 12 ml/ kg, RR40 bpm, I : E = 1 '? 2 )after imitating the thoracic surgery. Firstly, they were received two-lung ventilation for 30 min, then one-lung ventilation for 3h, and finally return to two-lung ventilation for 30 min. Blood gases and airway pressure were monitored and the oxygenation (PaO2/FiO2) was calculated before and after the ventilation, respectively. At the end of ventilation, the rabbits were killed and two lungs tissue were sampled respectively for HE stain to assess lung injury degree and get lung damage score. Lungs were excised and bronchoalveolar lavage fluid (BALF) were collected for measurement of protein concentration and neutrophil counts. The contents of nitric oxide (NO), malondialdehyde (MDA), and superoxide dismutase (SOD) in the lung tissue were measured. [Results] The oxygenation of rabbits in group II was significantly higher(P < 0.05), and the right and left lung damage score, BALF protein concentration and neutrophil counts in group II were significantly lower (P < 0.05) , as compared with group I . The content of MDA and NO in both sides of lung tissue in group II were lower than those in group I (P < 0.05), the activity of SOD in group II was significantly higher than that in group I (P< 0.05). In each

  14. Partial liquid ventilation decreases tissue and serum tumor necrosis factor-α concentrations in acute lung injury model of immature piglet induced by oleic acid

    ZHU Yao-bin; FAN Xiang-ming; LI Xiao-feng; LI Zhi-qiang; WANG Qiang; SUN Li-zhong; LIU Ying-long


    Background Pediatric patients are susceptible to lung injury.Acute lung injury in children often results in high mortality.Partial liquid ventilation (PLV) has been shown to markedly improve oxygenation and reduce histologic evidence of injury in a number of lung injury models.This study was designed to examine the hypothesis that PLV would attenuate the production of local and systemic tumor necrosis factor (TNF)-α in an immature piglet model of acute lung injury induced by oleic acid (OA).Methods Twelve Chinese immature piglets were induced acute lung injury by OA.The animals were randomly assigned to two groups of six animals,(1) conventional mechanical ventilation (MV) group and (2) PLV with 10 ml/kg FC-77 group.Results Compared with MV group,the PLV group had better cardiopulmonary variables (P <0.05).These variables included heart rate,mean blood pressure,blood pH,partial pressure of arterial oxygen (PaO2),PaO2/inspired O2 fraction (FiO2) and partial pressure of arterial carbon dioxide (PaCO2).PLV reduced TNF-α levels both in plasma and tissue compared with MV group (P <0.05).Conclusion PLV provides protective effects against TNF-a response in OA-induced acute lung injury in immature piglets.

  15. Evaluation of cardiac output from a tidally ventilated homogeneous lung model.

    Benallal, Habib; Beck, Kenneth C; Johnson, Bruce D; Busso, Thierry


    We used the direct Fick measurements to validate a method for estimating cardiac output by iteratively fitting VCO(2) at the mouth to lung model values. This model was run using a series of 50, 30 and 10 breaths to test sensitivity to number of breaths used for fitting. The lung was treated as a catenary two-compartment lung model consisting of a dead space compartment connected with a single alveolar space compartment, perfused with constant pulmonary blood flow. The implemented mathematical modeling described variations in O(2) and CO(2) compartmental fractions and alveolar volume. This model also included pulmonary capillary gas exchange. Experimental data were collected from measurements performed on six healthy subjects at rest and during 20, 40, 60 and 85-90% of peak V(O)(2). The correlation between the two methods was highest and the average agreement between the methods was best using 50 breaths R = 095; P model) = 1.1Q(Fick) - 2.3). The mean difference and lower to upper limits of agreement between measured and estimated data were 0.7 l/min (-2.7 to 4.1 l/min) for cardiac output; -0.9 ml/100 ml (-1.3 to -0.5 ml/100 ml) for arterial O(2) content; -0.8 ml/100 ml (-3.8 to 2.2 ml/100 ml) for mixed venous O(2) content and -0.1 ml/100 ml (-2.9 to 2.7 ml/100 ml) for arteriovenous difference O(2) content. The cardiac output estimated by the lung model was in good agreement with the direct Fick measurements in young healthy subjects.

  16. Tomography assessment of lung hyper inflation areas within cats in a pressure controlled ventilation staggered; Avaliacao tomografica das areas de de hiperinsuflacao pulmonar em gatos submetidos a ventilacao controlada a pressao escalonada

    Martins, Alessandro Rodrigues de Carvalho, E-mail: [Universidade de Sao Paulo (FM/USP), SP (Brazil). Faculdade de Medicina. Programa de Anestesiologia; Fantoni, Denise Tabacchi; Ambrosio, Aline Magalhaes [Universidade de Sao Paulo (FMVZ/USP), SP (Brazil). Faculdade de Medicina Veterinaria e Zootecnia; Santos, Jaqueline Franca dos; Villamizar, Lenin Arturo [Universidade de Sao Paulo (FMVZ/USP), SP (Brazil). Faculdade de Medicina Veterinaria e Zootecnia. Programa de Cirurgia; Pinto, Ana Carolina Brandao de Campos Fonseca [Universidade de Sao Paulo (USP), SP (Brazil). Faculdade de Medicina Veterinaria e Zootecnia. Disciplina de Diagnostico por Imagem; Martins, Thiago do Amaral [UFAPE Vet Intenziv, Itapecerica da Serra, SP (Brazil); Malbouisson, Luis Marcelo Sa [Universidade de Sao Paulo (HC/USP), SP (Brazil). Faculdade de Medicina. UTI Anestesiologica


    Mechanical ventilation is essential for oxygen supply during anesthesia. Some strategies are related to lung injury associated with mechanical ventilation. 10 cats, 4±1 kg, 1-6 years old, induced and maintained with propofol (6mg/kg, 0,5mg/kg/min) placed in supine position, subjected to pressure controlled ventilation (PCV) in oxygen at 40% with 5cmH{sub 2}O peak pressure in 'ZEEP' for 20 minutes, rising in 2cmH{sub 2}O installments peak pressure every five minutes until it reached 15cmH{sub 2}O. Moments P5, P7, P9, P11, P13, P15. Respiratory rate and inspiratory time were held on 15 movements per minute and 1 second regardless their EtCO{sub 2}. Muscle relaxation achieved by rocuronium bollus (1mg/kg/IV). Immediately, at each increase on pressure was performed a 4 seconds' inspiratory pause to allow the five millimeters CT slice of diaphragmatic region followed by hemogasometric and cardiorespiratory variables collected. P5 had the smallest hyperinflated area (3,24±4,02) Compared to other moments. P5 blood gases showed acidaemia (7,257±0,08) for mild respiratory acidosis (45±9.2) with good oxygenation (178±40.8mmHg) compared to other times which obtained reduction of CO{sub 2} and an increased pH. As the increase in peak pressure was observed increased distension of the lung parenchyma, a fact related to possible risk of lung injury in prolonged periods. 5cmH{sub 2}O pressure was demonstrated to be less harmful due to its lower hyper inflated areas that other moments, even with a low pH and high CO{sub 2}, being corrected by increasing respiratory rate.

  17. Comparison of exogenous surfactant therapy, mechanical ventilation with high end-expiratory pressure and partial liquid ventilation in a model of acute lung injury

    A. Hartog (Anneke); G.F. Vazquez de Anda; D.A.M.P.J. Gommers (Diederik); U. Kaisers; S.J.C. Verbrugge (Serge); R. Schnabel; B.F. Lachmann (Burkhard)


    textabstractWe have compared three treatment strategies, that aim to prevent repetitive alveolar collapse, for their effect on gas exchange, lung mechanics, lung injury, protein transfer into the alveoli and surfactant system, in a model of acute lung injury. In adult r

  18. Alterations of alveolar type II cells and intraalveolar surfactant after bronchoalveolar lavage and perfluorocarbon ventilation. An electron microscopical and stereological study in the rat lung

    Burkhardt Wolfram


    Full Text Available Abstract Background Repeated bronchoalveolar lavage (BAL has been used in animals to induce surfactant depletion and to study therapeutical interventions of subsequent respiratory insufficiency. Intratracheal administration of surface active agents such as perfluorocarbons (PFC can prevent the alveolar collapse in surfactant depleted lungs. However, it is not known how BAL or subsequent PFC administration affect the intracellular and intraalveolar surfactant pool. Methods Male wistar rats were surfactant depleted by BAL and treated for 1 hour by conventional mechanical ventilation (Lavaged-Gas, n = 5 or partial liquid ventilation with PF 5080 (Lavaged-PF5080, n = 5. For control, 10 healthy animals with gas (Healthy-Gas, n = 5 or PF5080 filled lungs (Healthy-PF5080, n = 5 were studied. A design-based stereological approach was used for quantification of lung parenchyma and the intracellular and intraalveolar surfactant pool at the light and electron microscopic level. Results Compared to Healthy-lungs, Lavaged-animals had more type II cells with lamellar bodies in the process of secretion and freshly secreted lamellar body-like surfactant forms in the alveoli. The fraction of alveolar epithelial surface area covered with surfactant and total intraalveolar surfactant content were significantly smaller in Lavaged-animals. Compared with Gas-filled lungs, both PF5080-groups had a significantly higher total lung volume, but no other differences. Conclusion After BAL-induced alveolar surfactant depletion the amount of intracellularly stored surfactant is about half as high as in healthy animals. In lavaged animals short time liquid ventilation with PF5080 did not alter intra- or extracellular surfactant content or subtype composition.

  19. Mitochondrial-targeted DNA repair enzyme 8-oxoguanine DNA glycosylase 1 protects against ventilator-induced lung injury in intact mice.

    Hashizume, Masahiro; Mouner, Marc; Chouteau, Joshua M; Gorodnya, Olena M; Ruchko, Mykhaylo V; Potter, Barry J; Wilson, Glenn L; Gillespie, Mark N; Parker, James C


    This study tested the hypothesis that oxidative mitochondrial-targeted DNA (mtDNA) damage triggered ventilator-induced lung injury (VILI). Control mice and mice infused with a fusion protein targeting the DNA repair enzyme, 8-oxoguanine-DNA glycosylase 1 (OGG1) to mitochondria were mechanically ventilated with a range of peak inflation pressures (PIP) for specified durations. In minimal VILI (1 h at 40 cmH(2)O PIP), lung total extravascular albumin space increased 2.8-fold even though neither lung wet/dry (W/D) weight ratios nor bronchoalveolar lavage (BAL) macrophage inflammatory protein (MIP)-2 or IL-6 failed to differ from nonventilated or low PIP controls. This increase in albumin space was attenuated by OGG1. Moderately severe VILI (2 h at 40 cmH(2)O PIP) produced a 25-fold increase in total extravascular albumin space, a 60% increase in W/D weight ratio and marked increases in BAL MIP-2 and IL-6, accompanied by oxidative mitochondrial DNA damage, as well as decreases in the total tissue glutathione (GSH) and GSH/GSSH ratio compared with nonventilated lungs. All of these injury indices were attenuated in OGG1-treated mice. At the highest level of VILI (2 h at 50 cmH(2)O PIP), OGG1 failed to protect against massive lung edema and BAL cytokines or against depletion of the tissue GSH pool. Interestingly, whereas untreated mice died before completing the 2-h protocol, OGG1-treated mice lived for the duration of observation. Thus mitochondrially targeted OGG1 prevented VILI over a range of ventilation times and pressures and enhanced survival in the most severely injured group. These findings support the concept that oxidative mtDNA damage caused by high PIP triggers induction of acute lung inflammation and injury.

  20. Fisiopatologia e manejo clínico da ventilação seletiva Physiopathology and clinical management of one-lung ventilation

    Halina Cidrini Ferreira


    Full Text Available A ventilação seletiva consiste em ventilar um pulmão mecanicamente enquanto o outro é ocluído ou exposto ao ar ambiente. Essa técnica permite visualizar as estruturas intratorácicas e, assim, fornecer excelentes condições cirúrgicas. Todo o volume corrente é administrado apenas para um único pulmão. Entretanto, este procedimento está associado à redução da pressão parcial arterial de oxigênio, principalmente em pacientes com comprometimento pulmonar prévio, por diminuição na superfície da área de troca gasosa e perda da auto-regulação pulmonar normal. Sendo assim, a manutenção da oxigenação e a eliminação de gás carbônico adequadas representam o maior desafio durante o manejo da ventilação seletiva. Preconiza-se que o pulmão dependente seja ventilado com um volume corrente similar àquele utilizado para ventilar ambos os pulmões na ventilação mecânica convencional, além de altas frações inspiradas de oxigênio. Entretanto, vários outros métodos vêm sendo propostos a fim de minimizar a hipoxemia durante a ventilação seletiva: conferir o correto posicionamento do tubo de duplo-lúmen, uso de pressão positiva ao final da expiração, pressão contínua nas vias aéreas, uso de óxido nítrico, ventilação de alta freqüência e recrutamento alveolar. O manejo da ventilação seletiva continua sendo um desafio à prática clínica.During one-lung ventilation, the nonventilated lung is excluded from the ventilation, with all tidal volume directed into the ventilated lung. This technique facilitates viewing of intrathoracic structures, thereby providing optimal surgical conditions. However, this procedure has been associated with reduced arterial oxygen tension, principally in patients with a previous history of lung disease, since it reduces the surface area available for gas exchange and causes a loss of normal autonomic respiratory regulation. Therefore, maintaining sufficient oxygenation and

  1. Evaluation of residual functional lung volume on Tc-99m DTPA aerosol ventilation and Tc-99m MAA perfusion scintigraphy in primary ciliary dyskinesia (Kartagener syndrome).

    Chen, Yu-Wen; Chang, Chin-Chuan; Lai, Yung-Chuang; Lu, Chia-Ying; Dai, Zen-Kong


    Kartagener syndrome is diagnosed as sinusitis, bronchitis (bronchiectasis), and situs inversus by the clinical features. It is a subclass of primary ciliary dyskinesia (PCD) disease. A 12-year-old girl who had frequent upper and lower airway infections since birth, which was confirmed as Kartagener syndrome by HRCT imaging. We present the residual functional lung volume and mucociliary clearance findings seen on Tc-99m DTPA aerosol ventilation and Tc-99m MAA perfusion scintigraphy.

  2. Liquid Ventilation

    Peter N Cox


    Full Text Available There has been a recent explosion of interest in the use of liquid ventilation. Over time humans have lost the physiological attributes necessary for respiration in water. However, perfluorocarbons have high solubilities for oxygen and carbon dioxide, as well as a low surface tension. These characteristics allow them to be used as a medium to assist gas exchange and recruit atelectatic-dependent lung zones in respiratory distress syndrome. Current trials may prove perfluorocarbon to be a useful adjunct in lung protective strategies in respiratory distress syndrome.

  3. [Evaluation of preoperative non-invasive ventilation in thoracic surgery for lung cancer: the preOVNI study GFPC 12-01].

    Paleiron, N; André, M; Grassin, F; Chouaïd, C; Venissac, N; Margery, J; Couturaud, F; Noël-Savina, E; Tromeur, C; Vinsonneau, U; Vedrine, L; Leroyer, C; Nowak, E; Berard, H; Thomas, P; Brouchet, L; Bagan, P; Fournel, P; Mottier, D; Robinet, G


    Surgical resection is the best treatment for stage I and II non-small cell lung cancer. Despite an improvement in the perioperative management of cancer patients and specialization of surgical teams, morbidity and mortality remains significant. Non-invasive ventilation (NIV) is an effective therapeutic option in hypercapnic respiratory failure. It also improves functional and gasometric parameters when undertaken before surgery. The objective of the preOVNI study is to demonstrate that preoperative non-invasive ventilation for 7 days, at home, reduces the postoperative respiratory and cardiovascular complications of lung resection surgery, in a high-risk population. A prospective, randomized, controlled open-labelled multicentric French study, under the supervision of the Groupe Français de Pneumocancérologie (GFPC), comparing 7 days of preoperative non-invasive ventilation with standard treatment. Inclusion criteria are: patients suitable for lobectomy or segmentectomy for primary bronchial carcinoma and presenting with obstructive or restrictive lung disease, obesity or chronic cardiac insufficiency. The primary criterion is a composite one, including all respiratory and cardiac complications. The number of patients is 150 in each treatment arm, 300 in total. We think that preoperative NIV will be able to reduce the rate of postoperative complications. If this objective is achieved, the management of these patients could be changed. Copyright © 2012 SPLF. Published by Elsevier Masson SAS. All rights reserved.

  4. [Intermittent forced ventilation of the lungs with series "PO" IVL apparatus].

    Khorokhordin, N E; Leonov, G N; Vasil'ev, A V; Kotras, R L; Prokof'eva, E N


    The authors suppose that the intermittent ventilation (IMV) may be provided by the connection of an additional respiratory appliance made on the basis of a standard narcosis attachment of "Polynarcon" type with a respirator "PO" and the patient. A specific feature of this modified respiratory appliance is the bellows which fulfiles the function of a reserved capacity for a breath and a damper when in the smoothed out (hung up) state. The intubation tube is fastened to the T-joint adapter of the narcosis attachment (the scheme is shown), the hose being detached from the expiration valve and connected with the respirator T-joint adapter (to the place of the intubation tube). On the termination of the forced breath the patient can (if he has enough force to open the expiration valve) fulfill a self-dependent breath from the additional respiration appliance (the expiration is fulfilled into the respirator as during the forced breath). A method of realization of IMV in the "PO" type respirators which have been produced in lots by the "Krasnogvardeets" firm since 2000-2002 is described.

  5. Reference values for lung function tests: II. Maximal respiratory pressures and voluntary ventilation

    J.A. Neder


    Full Text Available The strength of the respiratory muscles can be evaluated from static measurements (maximal inspiratory and expiratory pressures, MIP and MEP or inferred from dynamic maneuvers (maximal voluntary ventilation, MVV. Although these data could be suitable for a number of clinical and research applications, no previous studies have provided reference values for such tests using a healthy, randomly selected sample of the adult Brazilian population. With this main purpose, we prospectively evaluated 100 non-smoking subjects (50 males and 50 females, 20 to 80 years old, selected from more than 8,000 individuals. Gender-specific linear prediction equations for MIP, MEP and MVV were developed by multiple regression analysis: age and, secondarily, anthropometric measurements explained up to 56% of the variability of the dependent variables. The most cited previous studies using either Caucasian or non-Caucasian samples systematically underestimated the observed values of MIP (P<0.05. Interestingly, the self-reported level of regular physical activity and maximum aerobic power correlates strongly with both respiratory and peripheral muscular strength (knee extensor peak torque (P<0.01. Our results, therefore, provide a new frame of reference to evaluate the normalcy of some useful indexes of respiratory muscle strength in Brazilian males and females aged 20 to 80.

  6. Novel method for conscious airway resistance and ventilation estimation in neonatal rodents using plethysmography and a mechanical lung.

    Zhang, Boyang; McDonald, Fiona B; Cummings, Kevin J; Frappell, Peter B; Wilson, Richard J A


    In unrestrained whole body plethysmography, tidal volume is commonly determined using the barometric method, which assumes that temperature and humidity changes (the 'barometric component') are solely responsible for breathing-related chamber pressure fluctuations. However, in small animals chamber pressure is also influenced by a 'mechanical component' dependent on airway resistance and airflow. We devised a novel 'mechanical lung' capable of simulating neonatal mouse breathing in the absence of temperature or humidity changes. Using this device, we confirm that the chamber pressure fluctuations produced by breathing of neonatal mice are dominated by the mechanical component, precluding direct quantitative assessment of tidal volume. Recognizing the importance of airway resistance to the chamber pressure signal and the ability of our device to simulate neonatal breathing at different frequencies and tidal volumes, we invented a novel in vivo, non-invasive method for conscious airway resistance and ventilation estimation (CARVE) in neonatal rodents. This technique will allow evaluation of developmental, pathological and pharmaceutical effects on airway resistance.

  7. 胸科手术的单肺通气策略%Strategy of one-lung ventilation for thoracic surgery

    闫丽娟; 李文志


    Background One-lung ventilation(OLV) can provide optimum surgical operating conditions and isolate the lungs to protect them during anesthesia for thoracic surgery.Unfortunately,OLV is a way of ventilation under the non-physiological condition.During the OLV,it often leads to ventilator-induced lung injury(VILI) as a result of barotraumas,oxygen toxicity,and so on.Objective Investigate the preferable strategy of one-lung ventilation for thoracic surgery.Content An alveolar recruitment strategy(ARS) and the lung protective ventilation strategy using low-tidal volumes and the appropriate positive end-expiratory pressure (PEEP) would limit plateau and peak inspiratory pressures (Pplat and Ppeak) to 25 cmH2O (1 cmH2O=0.098 kPa) and 35 cmH2O,respectively.FiO2 should be limited,too.According to the arterial blood gas analysis,respiration rate can be adjusted properly.Trend For the non-operated lung,it can avoid alveolar over-inflation and cyclic recruitment-derecruitment during the OLV.High FiO2 would aggravate oxidative stress,so it is wise to limit FiO2 during OLV.Also,hypercapnia is well tolerated in the short term.Individualized management of patients would create fewer admissions to the intensive care unit and a shorter hospital stay,and improve survival rates and quality of life of them.%背景 在胸科手术的麻醉中进行单肺通气(one-lung ventilation,OLV),不但可以为手术提供良好的术野,而且可以隔离并保护肺脏.但是,这是一种非生理状态下的通气方式,OLV期间的气压伤和氧毒性等因素常导致机械通气相关性肺损伤(ventilator-induced lung injury,VILI). 目的 探讨适合胸科手术的OLV策略. 内容 在OLV期间,采用肺泡复苏策略(alveolar recruitment strategy,ARS)和“小潮气量+呼气末正压通气(positive end-expiratory pressure,PEEP)”的保护性通气策略,使吸气平台压(plateau pressure,Pplat)<25 cmH2O(1 cmH2O=0.098 kPa)和气道峰压(peak inspiratory pressure,Ppeak)<35 cmH2

  8. The role of ventilation mode using a laryngeal mask airway during gynecological laparoscopy on lung mechanics, hemodynamic response and blood gas analysis.

    Jarahzadeh, Mohammad Hossein; Halvaei, Iman; Rahimi-Bashar, Farshid; Behdad, Shekoufeh; Abbasizadeh Nasrabady, Rouhollah; Yasaei, Elahe


    There are two methods for ventilation in gynecological laparoscopy: volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV). To compare the lung mechanics, hemodynamic response and arterial blood gas analysis and gas exchange of two modes of VCV and PCV using laryngeal mask airway (LMA) at different time intervals. Sixty infertile women referred for diagnostic laparoscopy, based on ventilation mode, were randomly divided into two groups of VCV (tidal volume: 10 ml/kg) and PCV. In the PCV group, ventilation was initiated with a peak airway pressure (tidal volume: 10 ml/kg, upper limit: 35 cm H2O). In both groups, the arterial blood samples were taken in several time intervals (5, 10 and 15 min after LMA insertion) for blood gas evaluation. Also the lung mechanics parameters were continuously monitored and were recorded at different time intervals. There were no significant differences for patient's age, weight, height and BMI in two groups. The peak and plateau airway pressure were significantly higher in VCV group compared to PCV group 5 and 10 min after insertion of LMA. PaO2 was significantly higher after 10 and 15 min in VCV group compared to PCV group (p=0.005 and p=0.03, respectively). PaCO2 showed significant increase after 5 min in PCV group, but the differences were not significant after 10 and 15 min in two groups. The end tidal CO2 showed significant increase after 10 and 15 min in VCV compared to PCV group. Both VCV and PCV seem to be suitable for gynecological laparoscopy. However, airway pressures are significantly lower in PCV compared to VCV.

  9. Effects of noninvasive ventilation on treadmill 6-min walk distance and regional chest wall volumes in cystic fibrosis: randomized controlled trial.

    Lima, Cibelle Andrade; Andrade, Armèle de Fátima Dornelas de; Campos, Shirley Lima; Brandão, Daniella Cunha; Fregonezi, Guilherme; Mourato, Ianny Pereira; Aliverti, Andrea; Britto, Murilo Carlos Amorim de


    Dyspnea and exercise intolerance are the symptoms that most affect the quality of life of children and adolescents with respiratory disorders resulting from cystic fibrosis (CF). To evaluate the effect of noninvasive ventilation (NIV) on treadmill 6-min walk distance and regional chest wall volumes in cystic fibrosis patients. Crossover clinical trial, randomized, controlled and open with 13 children and adolescents with CF, aged 7-16 years, with pulmonary impairment (NTC01987271). The patients performed a treadmill walking test (TWT) during 6 min, with and without NIV on a BiLEVEL mode, an interval of 24-48 h between tests. Before and after each test, patients were assessed by spirometry and optoelectronic plethysmography. Walking distance in TWT with NIV was significantly higher that without ventilatory support (mean ± sd: 0.41 ± 0.08 vs. 0.39 ± 0.85 km, p = 0.039). TWT with NIV increase forced expiratory volume on 1 s (FEV1; p = 0.036), tidal volume (Vt; p = 0.005), minute ventilation (MV; p = 0.013), pulmonary rib cage volume (Vrcp; p = 0.011), and decrease the abdominal volume (Vab; p = 0.013) after test. There was a significant reduction in oxygen saturation (p = 0.018) and permanent increase in respiratory rate after 5 min (p = 0.021) after the end test without NIV. During the walking test on the treadmill, the NIV change thoracoabdominal kinematics and lung function in order to optimized ventilation and tissue oxygenation, with improvement of walk distance. Consequently, NIV is an effective tool to increase functional capacity in children and adolescents with cystic fibrosis. Copyright © 2014 Elsevier Ltd. All rights reserved.

  10. PPARγexpression in rat lung tissue after ventilator-induced lung injury%机械通气致大鼠肺损伤时肺组织PPARγ表达的变化

    王秀芹; 王凯国; 罗红敏; 李浩; 王宝胜; 王培民


    Objective To observe the changes of PPARγ expression in ventilator-induced lung injury rats and explore the role of PPARγ in the pathogenesis of ventilator-induced lung injury. Methods Sixty male Sprague-Dawley rats were randomly divided into 3 groups ( n=21 each ):group N received large tidal volume with mechanical ventilation ( Vt=12 mL/kg);group C received lower tidal volume with mechanical ventilation ( Vt=6 mL/kg);group R received room air without mechanical ventilation. Rats in every group were randomly divided into 3 subgroups respectively by 1,4 and 8 h. The samples of lung were collected at 1,4 and 8 h after ventilation. Lung pathological examina-tion, total protein and white blood cells in bronchoalveolar fluid and wet-to-dry weight were detected. The exoressions of PPARγmRNA were detected by RTPCR;PPARγ protein in lung tissues was detected by western bolt. Result After 4 and 8 h ventilation in group N,total pro-tein and WBC in bronchoalvelor fluid,W/D were markedly higher than those of group C and R (P 0. 05). Conclusion PPARγmRNA and protein expressions in the rats lung tissue of ventilator-induced lung injury were decreased and as-sociated with inflammation and damage of lung tissue.%目的:观察PPARγ在通气相关性肺损伤大鼠肺组织中的表达,探讨PPARγ在通气相关性肺损伤中的作用。方法清洁雄性SD大鼠,随机分为大潮气量( Tidal volume,VT)组,Vt=12 mL;小潮气量组,Vt=6 mL;自主呼吸组。每组又分为3个亚组:即通气1h、4h、8h组。于各时间段末放血处死动物,收集肺组织和肺灌洗液标本,测定肺灌洗液中蛋白总量、白细胞计数;测定肺组织湿/干重比( W/D);逆转录聚合酶链反应检测PPARγmRNA的表达;western blot检测PPARγ蛋白的变化。结果大潮气量组机械通气4 h、8 h后,与小潮气量组及自主呼吸组相比,肺灌洗液中白细胞计数、蛋白总量明显增加(P 0.05)。结论通气相关性肺损伤大鼠肺组织

  11. TH-E-BRF-02: 4D-CT Ventilation Image-Based IMRT Plans Are Dosimetrically Comparable to SPECT Ventilation Image-Based Plans

    Kida, S [UC Davis School of Medicine, Sacramento, CA (United States); University of Tokyo Hospital, Bunkyo, Tokyo (Japan); Bal, M [Philips Healthcare (Netherlands); Kabus, S [Philips Research, Hamburg (Germany); Loo, B [Stanford University, Stanford, CA (United States); Keall, P [University of Sydney, Camperdown (Australia); Yamamoto, T [UC Davis School of Medicine, Sacramento, CA (United States); Stanford University, Stanford, CA (United States)


    Purpose: An emerging lung ventilation imaging method based on 4D-CT can be used in radiotherapy to selectively avoid irradiating highly-functional lung regions, which may reduce pulmonary toxicity. Efforts to validate 4DCT ventilation imaging have been focused on comparison with other imaging modalities including SPECT and xenon CT. The purpose of this study was to compare 4D-CT ventilation image-based functional IMRT plans with SPECT ventilation image-based plans as reference. Methods: 4D-CT and SPECT ventilation scans were acquired for five thoracic cancer patients in an IRB-approved prospective clinical trial. The ventilation images were created by quantitative analysis of regional volume changes (a surrogate for ventilation) using deformable image registration of the 4D-CT images. A pair of 4D-CT ventilation and SPECT ventilation image-based IMRT plans was created for each patient. Regional ventilation information was incorporated into lung dose-volume objectives for IMRT optimization by assigning different weights on a voxel-by-voxel basis. The objectives and constraints of the other structures in the plan were kept identical. The differences in the dose-volume metrics have been evaluated and tested by a paired t-test. SPECT ventilation was used to calculate the lung functional dose-volume metrics (i.e., mean dose, V20 and effective dose) for both 4D-CT ventilation image-based and SPECT ventilation image-based plans. Results: Overall there were no statistically significant differences in any dose-volume metrics between the 4D-CT and SPECT ventilation imagebased plans. For example, the average functional mean lung dose of the 4D-CT plans was 26.1±9.15 (Gy), which was comparable to 25.2±8.60 (Gy) of the SPECT plans (p = 0.89). For other critical organs and PTV, nonsignificant differences were found as well. Conclusion: This study has demonstrated that 4D-CT ventilation image-based functional IMRT plans are dosimetrically comparable to SPECT ventilation image

  12. Mechanical ventilation of the premature neonate.

    Brown, Melissa K; DiBlasi, Robert M


    Although the trend in the neonatal intensive care unit is to use noninvasive ventilation whenever possible, invasive ventilation is still often necessary for supporting pre-term neonates with lung disease. Many different ventilation modes and ventilation strategies are available to assist with the optimization of mechanical ventilation and prevention of ventilator-induced lung injury. Patient-triggered ventilation is favored over machine-triggered forms of invasive ventilation for improving gas exchange and patient-ventilator interaction. However, no studies have shown that patient-triggered ventilation improves mortality or morbidity in premature neonates. A promising new form of patient-triggered ventilation, neurally adjusted ventilatory assist (NAVA), was recently FDA approved for invasive and noninvasive ventilation. Clinical trials are underway to evaluate outcomes in neonates who receive NAVA. New evidence suggests that volume-targeted ventilation modes (ie, volume control or pressure control with adaptive targeting) may provide better lung protection than traditional pressure control modes. Several volume-targeted modes that provide accurate tidal volume delivery in the face of a large endotracheal tube leak were recently introduced to the clinical setting. There is ongoing debate about whether neonates should be managed invasively with high-frequency ventilation or conventional ventilation at birth. The majority of clinical trials performed to date have compared high-frequency ventilation to pressure control modes. Future trials with premature neonates should compare high-frequency ventilation to conventional ventilation with volume-targeted modes. Over the last decade many new promising approaches to lung-protective ventilation have evolved. The key to protecting the neonatal lung during mechanical ventilation is optimizing lung volume and limiting excessive lung expansion, by applying appropriate PEEP and using shorter inspiratory time, smaller tidal

  13. Effect of closed endotracheal suction in high-frequency ventilated premature infants measured with electrical impedance tomography

    van Veenendaal, M.B.; Miedema, M.; de Jongh, F.H.C.; van der Lee, J.H.; Frerichs, I.; van Kaam, A.H.


    Objective: To determine the global and regional changes in lung volume during and after closed endotracheal tube (ETT) suction in high-frequency ventilated preterm infants with respiratory distress syndrome (RDS). Design: Prospective observational clinical study. Setting: Neonatal intensive care

  14. Iatrogenic pneumothorax related to mechanical ventilation


    Pneumothorax is a potentially lethal complication associated with mechanical ventilation. Most of the patients with pneumothorax from mechanical ventilation have underlying lung diseases; pneumothorax is rare in intubated patients with normal lungs. Tension pneumothorax is more common in ventilated patients with prompt recognition and treatment of pneumothorax being important to minimize morbidity and mortality. Underlying lung diseases are associated with ventilator-related pneumothorax with...

  15. Inhaled versus systemic corticosteroids for preventing chronic lung disease in ventilated very low birth weight preterm neonates.

    Shah, Sachin S; Ohlsson, Arne; Halliday, Henry L; Shah, Vibhuti S


    Chronic lung disease (CLD) remains an important cause of mortality and morbidity in preterm infants and inflammation plays an important role in its pathogenesis. The use of inhaled corticosteroids may modulate the inflammatory process without concomitant high systemic steroid concentrations and less risk of adverse effects. To determine the effect of inhaled versus systemic corticosteroids started within the first two weeks of life on preventing CLD in ventilated very low birth weight (VLBW) infants. Randomised and quasi-randomised trials were identified by searching The Cochrane Library, MEDLINE , EMBASE , CINAHL, reference lists of published trials and abstracts published in Pediatric Research or electronically on the Pediatric Academic Societies web site in June 2007.This search was updated in June 2011 and included additional searches of, and Web of Science. Randomised or quasi-randomised clinical trials comparing inhaled versus systemic corticosteroid therapy (regardless of the dose and duration of therapy) started in the first two weeks of life in VLBW infants receiving assisted ventilation. Outcomes including CLD at 28 days or 36 weeks postmenstrual age (PMA), mortality, the combined outcome of death or CLD at 28 days or 36 weeks PMA, other pulmonary outcomes and adverse effects were evaluated. All data were analysed using RevMan 5.1. Meta-analyses were performed using relative risk (RR), risk difference (RD), and mean difference (MD) with their 95% confidence intervals (CI). If RD was significant, the numbers needed to benefit (NNTB) or to harm (NNTH) were calculated. No new trials were identified in this update. Two trials qualified for inclusion in this review. The incidence of CLD at 36 weeks PMA was increased (of borderline statistical significance) in the inhaled steroid group [RR 1.45 (95% CI 0.99 to 2.11); RD 0.11 (95% CI 0.00 to 0.21), p = 0.05, one trial, n = 278]. The incidence of CLD at 36 weeks PMA among

  16. Ventilator and viral induced inflammation

    Hennus, M.P.


    This thesis expands current knowledge on ventilator induced lung injury and provides insights on the immunological effects of mechanical ventilation during viral respiratory infections. The experimental studies in the first part of this thesis improve our understanding of how mechanical ventilation

  17. Lung function and incidence of chronic obstructive pulmonary disease after improved cooking fuels and kitchen ventilation: a 9-year prospective cohort study.

    Yumin Zhou


    Full Text Available BACKGROUND: Biomass smoke is associated with the risk of chronic obstructive pulmonary disease (COPD, but few studies have elaborated approaches to reduce the risk of COPD from biomass burning. The purpose of this study was to determine whether improved cooking fuels and ventilation have effects on pulmonary function and the incidence of COPD. METHODS AND FINDINGS: A 9-y prospective cohort study was conducted among 996 eligible participants aged at least 40 y from November 1, 2002, through November 30, 2011, in 12 villages in southern China. Interventions were implemented starting in 2002 to improve kitchen ventilation (by providing support and instruction for improving biomass stoves or installing exhaust fans and to promote the use of clean fuels (i.e., biogas instead of biomass for cooking (by providing support and instruction for installing household biogas digesters; questionnaire interviews and spirometry tests were performed in 2005, 2008, and 2011. That the interventions improved air quality was confirmed via measurements of indoor air pollutants (i.e., SO₂, CO, CO₂, NO₂, and particulate matter with an aerodynamic diameter of 10 µm or less in a randomly selected subset of the participants' homes. Annual declines in lung function and COPD incidence were compared between those who took up one, both, or neither of the interventions. Use of clean fuels and improved ventilation were associated with a reduced decline in forced expiratory volume in 1 s (FEV₁: decline in FEV₁ was reduced by 12 ml/y (95% CI, 4 to 20 ml/y and 13 ml/y (95% CI, 4 to 23 ml/y in those who used clean fuels and improved ventilation, respectively, compared to those who took up neither intervention, after adjustment for confounders. The combined improvements of use of clean fuels and improved ventilation had the greatest favorable effects on the decline in FEV₁, with a slowing of 16 ml/y (95% CI, 9 to 23 ml/y. The longer the duration of improved fuel use and

  18. Effect of surfactant and partial liquid ventilation treatment on gas exchange and lung mechanics in immature lambs: influence of gestational age.

    Carmen Rey-Santano

    Full Text Available OBJECTIVES: Surfactant (SF and partial liquid ventilation (PLV improve gas exchange and lung mechanics in neonatal RDS. However, variations in the effects of SF and PLV with degree of lung immaturity have not been thoroughly explored. SETTING: Experimental Neonatal Respiratory Physiology Research Unit, Cruces University Hospital. DESIGN: Prospective, randomized study using sealed envelopes. SUBJECTS: 36 preterm lambs were exposed (at 125 or 133-days of gestational age by laparotomy and intubated. Catheters were placed in the jugular vein and carotid artery. INTERVENTIONS: All the lambs were assigned to one of three subgroups given: 20 mL/Kg perfluorocarbon and managed with partial liquid ventilation (PLV, surfactant (Curosurf®, 200 mg/kg or (3 no pulmonary treatment (Controls for 3 h. MEASUREMENTS AND MAIN RESULTS: Cardiovascular parameters, blood gases and pulmonary mechanics were measured. In 125-day gestation lambs, SF treatment partially improved gas exchange and lung mechanics, while PLV produced significant rapid improvements in these parameters. In 133-day lambs, treatments with SF or PLV achieved similarly good responses. Neither surfactant nor PLV significantly affected the cardiovascular parameters. CONCLUSION: SF therapy response was more effective in the older gestational age group whereas the effectiveness of PLV therapy was not gestational age dependent.

  19. Decreased respiratory system compliance on the sixth day of mechanical ventilation is a predictor of death in patients with established acute lung injury

    Matthay Michael A


    Full Text Available Abstract Background Multiple studies have identified single variables or composite scores that help risk stratify patients at the time of acute lung injury (ALI diagnosis. However, few studies have addressed the important question of how changes in pulmonary physiologic variables might predict mortality in patients during the subacute or chronic phases of ALI. We studied pulmonary physiologic variables, including respiratory system compliance, P/F ratio and oxygenation index, in a cohort of patients with ALI who survived more than 6 days of mechanical ventilation to see if changes in these variables were predictive of death and whether they are informative about the pathophysiology of subacute ALI. Methods Ninety-three patients with ALI who were mechanically ventilated for more than 6 days were enrolled in this prospective cohort study. Patients were enrolled at two medical centers in the US, a county hospital and a large academic center. Bivariate analyses were used to identify pulmonary physiologic predictors of death during the first 6 days of mechanical ventilation. Predictors on day 1, day 6 and the changes between day 1 and day 6 were compared in a multivariate logistic regression model. Results The overall mortality was 35%. In multivariate analysis, the PaO2/FiO2 (OR 2.09, p th day of acute lung injury. In addition, a decrease in respiratory system compliance between days 1 and days 6 (OR 2.14, p Conclusions A low respiratory system compliance on day 6 or a decrease in the respiratory system compliance between the 1st and 6th day of mechanical ventilation were associated with increased mortality in multivariate analysis of this cohort of patients with ALI. We suggest that decreased respiratory system compliance may identify a subset of patients who have persistent pulmonary edema, atelectasis or the fibroproliferative sequelae of ALI and thus are less likely to survive their hospitalization.

  20. Early Open-Lung Ventilation Improves Clinical Outcomes in Patients with Left Cardiac Dysfunction Undergoing Off-Pump Coronary Artery Bypass: a Randomized Controlled Trial

    Bolzan, Douglas W.; Gomes, Walter José; Rocco, Isadora S.; Viceconte, Marcela; Nasrala, Mara L. S.; Pauletti, Hayanne O.; Moreira, Rita Simone L.; Hossne Jr, Nelson A.; Arena, Ross; Guizilini, Solange


    Objective To compare pulmonary function, functional capacity and clinical outcomes amongst three groups of patients with left ventricular dysfunction following off-pump coronary artery bypass, namely: 1) conventional mechanical ventilation (CMV); 2) late open lung strategy (L-OLS); and 3) early open lung strategy (E-OLS). Methods Sixty-one patients were randomized into 3 groups: 1) CMV (n=21); 2) L-OLS (n=20) initiated after intensive care unit arrival; and 3) E-OLS (n=20) initiated after intubation. Spirometry was performed at bedside on preoperative and postoperative days (PODs) 1, 3, and 5. Partial pressure of arterial oxygen (PaO2) and pulmonary shunt fraction were evaluated preoperatively and on POD1. The 6-minute walk test was applied on the day before the operation and on POD5. Results Both the open lung groups demonstrated higher forced vital capacity and forced expiratory volume in 1 second on PODs 1, 3 and 5 when compared to the CMV group (P<0.05). The 6-minute walk test distance was more preserved, shunt fraction was lower, and PaO2 was higher in both open-lung groups (P<0.05). Open-lung groups had shorter intubation time and hospital stay and also fewer respiratory events (P<0.05). Key measures were significantly more favorable in the E-OLS group compared to the L-OLS group. Conclusion Both OLSs (L-OLS and E-OLS) were able to promote higher preservation of pulmonary function, greater recovery of functional capacity and better clinical outcomes following off-pump coronary artery bypass when compared to conventional mechanical ventilation. However, in this group of patients with reduced left ventricular function, initiation of the OLS intra-operatively was found to be more beneficial and optimal when compared to OLS initiation after intensive care unit arrival. PMID:27982344

  1. Intraoperative mechanical ventilation for the pediatric patient.

    Kneyber, Martin C J


    Invasive mechanical ventilation is required when children undergo general anesthesia for any procedure. It is remarkable that one of the most practiced interventions such as pediatric mechanical ventilation is hardly supported by any scientific evidence but rather based on personal experience and data from adults, especially as ventilation itself is increasingly recognized as a harmful intervention that causes ventilator-induced lung injury. The use of low tidal volume and higher levels of positive end-expiratory pressure became an integral part of lung-protective ventilation following the outcomes of clinical trials in critically ill adults. This approach has been readily adopted in pediatric ventilation. However, a clear association between tidal volume and mortality has not been ascertained in pediatrics. In fact, experimental studies have suggested that young children might be less susceptible to ventilator-induced lung injury. As such, no recommendations on optimal lung-protective ventilation strategy in children with or without lung injury can be made.

  2. 机械通气致肺水肿损伤机制的研究进展%Progress on mechanism of lung edema induced by mechanical ventilation

    王慎会; 王月兰; 刘洋; 商丽梅; 宋秀梅


    Background Mechanisms of lung injury induced by mechanical ventilation are multiple.Biological damage is a key cause in ventilator induced lung injury (VILI).One of the lethal factor in the development of lung injury induced by mechanical ventilation is the vulnerant pulmonary edema,and usually ends on systemic inflammatory response syndrome and multiple organ failure.Objective To explore the mechanism of pulmonary edema and its interventions.Content This article reviews the latest research on the mechanism of VILI caused by biological damage and mechanical damage in order to prevent the occurrence of pulmonary edema,and establish theoretical basis for pulmonary edema induced by VILI during clinical anesthesia and intensive care units stay.Trend As a special receptors of lung injury induced by mechanical ventilation,mechanical damage trigger the occurrence of pulmonary edema.The study reviewed the mechanisim of transient receptor potential (TRP) superfamily in early lung edema,which take an important role in the perioperative lung preservation.%背景 机械通气致肺损伤(ventilator induced lung injury,VILI)的机制研究众多,传统认为生物学损伤为主要机制,机械性损伤为触发因素.VILI的致死因素之一就是肺水肿的发生发展或以全身炎症反应综合征及多器官功能衰竭而终结. 目的 探讨肺水肿发生的机械损伤机制及其干预措施. 内容 现就生物学损伤及机械性损伤致VILI肺水肿的发生机制的最新研究作一综述,以期预防肺水肿的发生,为临床麻醉及重症监护过程中VILI致肺水肿的发生奠定理论基础. 趋向 机械性损伤触发肺水肿的发生,做为机械通气诱发肺损伤的特殊感受器,研究综述了机械力直接损伤、瞬时感受电位(transient receptor potential,TRP)超家族介导机械刺激诱发神经源性炎症反应(neurogenic inflammation,NI)在肺水肿的发生中所起的闸门作用,阻断早期肺损伤的诱发因素对

  3. 七氟醚对单肺通气时肺顺应性的影响%The Impact of Sevoflurane on Lung Compliance during oOne-lung Ventilation

    陈志峰; 高峰; 陈丹娜; 蔡杰衡


    目的:分析单肺通气时七氟醚在不同最低有效浓度(MAC)下对肺顺应性产生的不同影响。方法左侧开胸手术的39例患者,平均分成三组。三组患者在手术前的麻醉诱导均使用芬太尼、力月西、维库溴铵和依托咪酯,手术过程中的维持麻醉方法用七氟醚一组0.5MAC,二组1.0MAC,三组1.5MAC。手术过程中用双腔支气管控制右肺呼吸。在单肺通气0min、1min、3min、5min、15min时记录肺部的气道压、血氧饱和度、肺顺应性、呼气末二氧化碳浓度、平均动脉压。结果患者手术时的单肺通气导致肺的顺应性下降明显,其中第三组与第一组、第二组之间的差异均存在统计学意义(P<0.05)。结论单肺通气时,维持肺内七氟醚1.5MAC可以明显增强肺顺应性,而当七氟醚MAC<1.0时不会改善肺的顺应性。%Objective To research the different influence of sevoflurane under different minimum alveolar concentration (MAC) on lung compliance during single lung ventilation. Methods 39 patients with open chest surgery on left side, were divided into three groups on average. Patients of three groups received preoperative anesthesia induction using fentanyl, midazolam, succinylcholine and etomidate. And 1 group received 0.5 MAC sevoflurane, 2 group 1.0 MAC and 3 group 1.5 MAC to maintain anesthesia method in the process of operation. Double cavity bronchial was used to control right lung breathing during procedure. the lung airway pressure, oxygen saturation, lung compliance, expiratory end carbon dioxide concentration, mean arterial pressure were recorded at 0 min, 1 minute, 3 minutes, 5 minutes and 15 minutes of one-lung ventilation. Results Single lung ventilation of patients during the operation resulted in a decline in the compliance of the lung. Among them there was a statistical significance between the third group and the first and second group (P<0.05). Conclusion During one-lung

  4. Navigated Percutaneous Lung Ablation under High-Frequency Jet Ventilation of a Metastasis from a Wilms’ Tumour: A Paediatric Case Report

    Jacob Freedman


    Full Text Available This is a case report of microwave energy being used to ablate an inoperable metastasis of a Wilms’ tumour in a 6-year-old boy using state-of-the-art navigated computed tomography targeting and high-frequency jet ventilation to reduce organ displacement and the potential risk of procedure-related pneumothorax. After the ablation, the young boy had high-dose chemotherapy followed by an autologous stem cell transplantation with rapid reduction of three recurrent right-sided lung metastases.

  5. Noninvasive monitoring of PaCO2 during one-lung ventilation and minimal access surgery in adults: End-tidal versus transcutaneous techniques

    Cox, Paul; Tobias, Joseph D.


    Background: Previous studies have suggested that end-tidal CO2 (ET-CO2) may be inaccurate during one-lung ventilation (OLV). This study was performed to compare the accuracy of the noninvasive monitoring of PCO2 using transcutaneous CO2 (TC-CO2) with ET-CO2 in patients undergoing video-assisted thoracoscopic surgery (VATS) during OLV. Materials and Methods: In adult patients undergoing thoracoscopic surgical procedures, PCO2 was simultaneously measured with TC-CO2 and ET-CO2 devices and compa...

  6. Severe intraoperative hypercarbia undetected by continuous end-tidal CO2 monitoring in a chronic smoker undergoing one-lung ventilation

    Shagun Bhatia Shah


    Full Text Available One-lung ventilation is known to alter the physiology and result in a discrepancy between end-tidal CO2 (ETCO2 and arterial blood CO2partial pressure despite protective mechanisms like hypoxic pulmonary vasoconstriction. Shunts in an emphysematous patient, lateral positioning and capnothorax may aggravate the discrepancy. We present here an incredible discrepancy of 40 mmHg which led us to question the very utility of ETCO2monitoring in this subset of patients and consider alternative techniques.

  7. Delimitation of the lung region with distributed ultrasound transducers

    Cardona Cárdenas, Diego Armando; Furuie, Sérgio Shiguemi


    One technique used to infer and monitor patient's respiratory conditions is the electrical impedance tomography (EIT). This provides images with information about lung function. The EIT image contrast is dependent on the variation of electrical impedance, therefore, this image does not provide anatomical details in border regions of several organs. To contribute to a clinical solution, we propose a new method to delimit regions of interest such as the pulmonary region and to improve the reconstruction quality of the EIT. Using a Matlab Toolbox k-wave, the ultrasound propagation phenomenon in homogeneous medium without patient (Reference) and with thoracic models were simulated, separately via a set of several ultrasound transducers distributed around the chest. After pulse emission by a transducer (TR), all received signals were compared considering the two sets of signals. If the energy relation between parts of the signals does not exceed an empirical threshold (30% in this study), a partial mask is generated between the transmitter and the receptor. This process was repeated until all 128 transducers are considered as TR-emitters. The 128 transducers (150kHz) are uniformly distributed. The evaluation was made by visually comparing the resulting images with the respective simulated object. A simple approach was presented to delimit high contrast organs with ultrasound transducers distributed around the patient. This approach allows other lower contrast objects to become invisible by varying the threshold limit. The investigation, based on numerical simulations of ultrasonic propagation, has shown promising results in the delimitation of the pulmonary region.

  8. Goal-Directed Fluid Therapy Using Stroke Volume Variation Does Not Result in Pulmonary Fluid Overload in Thoracic Surgery Requiring One-Lung Ventilation

    Sebastian Haas


    Full Text Available Background. Goal-directed fluid therapy (GDT guided by functional parameters of preload, such as stroke volume variation (SVV, seems to optimize hemodynamics and possibly improves clinical outcome. However, this strategy is believed to be rather fluid aggressive, and, furthermore, during surgery requiring thoracotomy, the ability of SVV to predict volume responsiveness has raised some controversy. So far it is not known whether GDT is associated with pulmonary fluid overload and a deleterious reduction in pulmonary function in thoracic surgery requiring one-lung-ventilation (OLV. Therefore, we assessed the perioperative course of extravascular lung water index (EVLWI and paO2/FiO2-ratio during and after thoracic surgery requiring lateral thoracotomy and OLV to evaluate the hypothesis that fluid therapy guided by SVV results in pulmonary fluid overload. Methods. A total of 27 patients (group T were enrolled in this prospective study with 11 patients undergoing lung surgery (group L and 16 patients undergoing esophagectomy (group E. Goal-directed fluid management was guided by SVV (SVV 0.05 in EVLWI during the observation period (BL: 7.8 ± 2.5, 24postop: 8.1 ± 2.4 mL/kg. A subgroup analysis for group L and group E also did not reveal significant changes of EVLWI. The paO2/FiO2-ratio decreased significantly during the observation period (group L: BL: 462 ± 140, OLVterm15: 338 ± 112 mmHg; group E: BL: 389 ± 101, 24postop: 303 ± 74 mmHg but remained >300 mmHg except during OLV. Conclusions. SVV-guided fluid management in thoracic surgery requiring lateral thoracotomy and one-lung ventilation does not result in pulmonary fluid overload. Although oxygenation was reduced, pulmonary function remained within a clinically acceptable range.

  9. A hybrid multibreath wash-in wash-out lung function quantification scheme in human subjects using hyperpolarized (3) He MRI for simultaneous assessment of specific ventilation, alveolar oxygen tension, oxygen uptake, and air trapping.

    Hamedani, Hooman; Kadlecek, Stephen; Xin, Yi; Siddiqui, Sarmad; Gatens, Heather; Naji, Joseph; Ishii, Masaru; Cereda, Maurizio; Rossman, Milton; Rizi, Rahim


    To present a method for simultaneous acquisition of alveolar oxygen tension (PA O2 ), specific ventilation (SV), and apparent diffusion coefficient (ADC) of hyperpolarized (HP) gas in the human lung, allowing reinterpretation of the PA O2 and SV maps to produce a map of oxygen uptake (R). An imaging scheme was designed with a series of identical normoxic HP gas wash-in breaths to measure ADC, SV, PA O2 , and R in less than 2 min. Signal dynamics were fit to an iterative recursive model that regionally solved for these parameters. This measurement was successfully performed in 12 subjects classified in three healthy, smoker, and chronic obstructive pulmonary disease (COPD) cohorts. The overall whole lung ADC, SV, PA O2 , and R in healthy, smoker, and COPD subjects was 0.20 ± 0.03 cm(2) /s, 0.39 ± 0.06,113 ± 2 Torr, and 1.55 ± 0.35 Torr/s, respectively, in healthy subjects; 0.21 ± 0.03 cm(2) /s, 0.33 ± 0.06, 115.9 ± 4 Torr, and 0.97 ± 0.2 Torr/s, respectively, in smokers; and 0.25 ± 0.06 cm(2) /s, 0.23 ± 0.08, 114.8 ± 6.0Torr, and 0.94 ± 0.12 Torr/s, respectively, in subjects with COPD. Hetrogeneity of SV, PA O2 , and R were indicators of both smoking-related changes and disease, and the severity of the disease correlated with the degree of this heterogeneity. Subjects with symptoms showed reduced oxygen uptake and specific ventilation. High-resolution, nearly coregistered and quantitative measures of lung function and structure were obtained with less than 1 L of HP gas. This hybrid multibreath technique produced measures of lung function that revealed clear differences among the cohorts and subjects and were confirmed by correlations with global lung measurements. Magn Reson Med 78:611-624, 2017. © 2016 International Society for Magnetic Resonance in Medicine. © 2016 International Society for Magnetic Resonance in Medicine.

  10. The effect of airway pressure and oscillation amplitude on ventilation in pre-term infants

    Miedema, M.; de Jongh, Franciscus H.C.; Frerichs, I.; van Veenendaal, M.B.; van Kaam, A.H.


    We determined the effect of lung recruitment and oscillation amplitude on regional oscillation volume and functional residual capacity (FRC) in high-frequency oscillatory ventilation (HFOV) used in pre-term infants with respiratory distress syndrome (RDS). Changes in lung volume, oscillation volume

  11. Frequently Asked Questions about Ventilator-Associated Pneumonia

    ... Submit Button Frequently Asked Questions about Ventilator-associated Pneumonia Recommend on Facebook Tweet Share Compartir What is a Ventilator-associated Pneumonia (VAP)? Ventilator-associated pneumonia (VAP) is a lung ...

  12. Ground-temperature controlling effects of duct-ventilated railway embankment in permafrost regions

    NIU; Fujun; CHENG; Guodong


    Based on observed data from field-testing embankment of the Qinghai-Tibet Railway, ground-temperature controlling effect of duct-ventilated embankment is studied in this paper.The results show that ventilation ducts can effectively cool the soils surrounding the ducts of the embankment, and the heat budget of the ambient soils in a year shows as heat release. Temperature status of the permafrost below the embankment with ducts buried in the relatively high position is similar to that of the common embankment. The permafrost processes warming all along in the two freezing-thawing cycles when the embankment was constructed. However, the temperature of the frozen soils below the embankment, in which the ducts buried in the relatively low position, rises a little in the initial stage. After that, it cools down gradually. At the same time,ventilation ducts can effectively reduce the thermal disturbance caused by the filled soils. The frozen soils below the common embankment and that with high-posited ducts absorb heat all along in the initial two cycles. While the soils below the embankment with low-posited ducts begin to release heat in the second cycle. This phenomenon proves that the ventilation embankment with low-posited ducts shows efficient temperature-controlling effect. Such embankment can actively cool the subgrade soils and therefore keeps the roadbed thermally stable.

  13. Non-invasive ventilation used as an adjunct to airway clearance treatments improves lung function during an acute exacerbation of cystic fibrosis: a randomised trial

    Tiffany J Dwyer


    Full Text Available Question: During an acute exacerbation of cystic fibrosis, is non-invasive ventilation beneficial as an adjunct to the airway clearance regimen? Design: Randomised controlled trial with concealed allocation and intention-to-treat analysis. Participants: Forty adults with moderate to severe cystic fibrosis lung disease and who were admitted to hospital for an acute exacerbation. Intervention: Comprehensive inpatient care (control group compared to the same care with the addition of non-invasive ventilation during airway clearance treatments from Day 2 of admission until discharge (experimental group. Outcome measures: Lung function and subjective symptom severity were measured daily. Fatigue was measured at admission and discharge on the Schwartz Fatigue Scale from 7 (no fatigue to 63 (worst fatigue points. Quality of life and exercise capacity were also measured at admission and discharge. Length of admission and time to next hospital admission were recorded. Results: Analysed as the primary outcome, the experimental group had a greater rate of improvement in forced expiratory volume in 1 second (FEV1 than the control group, but this was not statistically significant (MD 0.13% predicted per day, 95% CI –0.03 to 0.28. However, the experimental group had a significantly higher FEV1 at discharge than the control group (MD 4.2% predicted, 95% CI 0.1 to 8.3. The experimental group reported significantly lower levels of fatigue on the Schwartz fatigue scale at discharge than the control group (MD 6 points, 95% CI 1 to 11. There was no significant difference between the experimental and control groups in subjective symptom severity, quality of life, exercise capacity, length of hospital admission or time to next hospital admission. Conclusion: Among people hospitalised for an acute exacerbation of cystic fibrosis, the use of non-invasive ventilation as an adjunct to the airway clearance regimen significantly improves FEV1 and fatigue. Trial

  14. Ventilation/perfusion lung scan to diagnose pulmonary embolism: new insights (for the year 2000); Scintigraphie de ventilation/perfusion dans l'embolie pulmonaire donnees pour l'an 2000

    Baillet, G.; Thomassin, M.; Planchon, C.A.; Foult, J.M. [Hopital Americain de Neuilly, 92 (France)


    We present the changes that have taken place since the results of 'Prospective Investigation of Pulmonary Embolism Diagnosis' (PIOPED) in the diagnostic approach of pulmonary embolism (PE). In 1990 PIOPED documented the value of ventilation/perfusion lung scanning, but pulmonary angiography was often unavoidable. PIOPED had some drawbacks. During the last decade, three significant improvements have appeared: new ventilation tracers such as Technegas and 81m krypton yield high quality and dependable images; PIOPED reading criteria have been revised and improved; the diagnostic approach has benefited from lower extremity ultrasonography and D-dimer assay. New strategic approaches have therefore been devised and have become accurate enough to avoid the use of pulmonary angiography in a vast majority of cases. In pulmonary scintigram reading, the presence of an abnormal chest X-ray or of an underlying cardiopulmonary disease deserves special attention. Helical CT is of limited value in presence of PE restricted to sub-segmental arteries. Already published multicenter trials seem to indicate a lesser diagnostic value than initially anticipated with this semi-invasive method. CT cannot yet be recommended as a first line screening test for PE. (authors)

  15. Measurement of respiratory mechanics in a mechanically ventilated infant lung simulator: effects of variations in the frequency response of the flow measurement system.

    Turner, M J; MacLeod, I M; Rothberg, A D


    The frequency responses of systems used to measure flow and pressure in ventilated infants may differ, and hence affect estimates of resistance and compliance. We estimated resistance and compliance in 16 ventilated mechanical lung models using linear regression while varying the frequency response of the flow measurement system. Lung models comprised combinations of four sections of tubing and four bottles filled with steel wool. The cut-off frequencies of a filter in the flow measurement system were chosen to yield time delays of 0, +/-3, +/-6, and +/-9 ms relative to the pressure signal. When the phase lags in the measurement systems were not equal at 10 Hz, a bias in resistance approximately (relative delay) x (elastance) ensued. The bias in the resistance estimate when resistance is 5 Pa ml-1 s and compliance is 2 ml kPa-1 is approximately 28% per ms of delay mismatch. Time-shifting the flow data to eliminate the phase discrepancy reduced the resistance bias by 85%. The residual resistance bias was assumed to be due to inappropriate amplitude response. Compliance measurements were affected by less than 8% and less than 2% after time correction of the flow data. Pressure and flow signals must be synchronized to within 1 ms at 10 Hz and the amplitude responses of the measurement systems must be adequate for reliable resistance measurement.

  16. Faster reduction in hyperinflation and improvement in lung ventilation inhomogeneity promoted by aclidinium compared to glycopyrronium in severe stable COPD patients. A randomized crossover study.

    Santus, Pierachille; Radovanovic, Dejan; Di Marco, Fabiano; Raccanelli, Rita; Valenti, Vincenzo; Centanni, Stefano


    Standard spyrometric assessment in chronic obstructive pulmonary disease (COPD) only evaluates bronchial obstruction. However, airflow limitation and hyperinflation are the main pathophysiological factors responsible for dyspnoea and reduced exercise tolerance in patients with COPD. This study evaluated the effects of aclidinium bromide 400 μg and glycopyrronium bromide 50 μg on these parameters. Patients with stable severe/very severe COPD were randomized in this double-blind, double-dummy, crossover, Phase IV study. Patients received single doses of each drug on separate days. Primary endpoints were changes in residual volume (RV) and intra-thoracic gas volume (ITGV), assessed by full-body plethysmography. Other endpoints included changes variations in lung ventilation inhomogeneity (Phase III slope of single-breath nitrogen washout test, SBN2), dyspnoea visual analogue scale, and pulmonary specific total airway resistances. Assessments were performed at baseline and 5, 15, 30, 60, and 180 min post-administration. Thirty-seven patients were randomized (31 male; mean age 71 years). Aclidinium and glycopyrronium significantly improved ITGV versus baseline at all-time points (p hyperinflation and dyspnoea in severe and very severe COPD patients. Aclidinium however promoted a faster reduction in RV and was the only able to reduce lung ventilation inhomogeneity. Trial Registration numbers available on NCT02181023.

  17. [Outcome of patients with suspected pulmonary thromboembolism and low probability ventilation/perfusion lung scan who receive no long-term anticoagulation].

    Calvo Romero, J M; Arévalo Lorido, J C; Carretero Gómez, J


    To know in our area the security of no long-term anticoagulation in patients with suspected pulmonary thromboembolism (PTE) and a low probability ventilation/perfusion (V/Q) lung scan. Retrospective review of a series of consecutive outpatients with suspected PTE and a low probability V/Q lung scan, according to the modified PIOPED criteria, who receive no long-term anticoagulation. Among 38 patients with a low probability V/Q lung scan, 31 (81.6%) did not receive long-term anticoagulation. The median age was 69.1 years (range 26-88 years), and 19 (61.3%) were female. The clinical probability of PTE was moderate in 27 patients (87.1%). Twenty-two patients (71%) had a venous lower extremities echography-doppler negative for deep vein thrombosis (DVT). The median follow-up was 6.3 months (range 3-12 months). There was one case (3.2%; 95% confidence interval, 0.1-16.7%) with demonstrated PTE and DVT, and there was no death. No long-term anticoagulation in outpatients with a moderate clinical probability of PTE, a low probability V/Q lung scan and a venous lower extremities echography-doppler negative for DVT may be secure in our area.

  18. SU-C-BRA-06: Developing Clinical and Quantitative Guidelines for a 4DCT-Ventilation Functional Avoidance Clinical Trial

    Vinogradskiy, Y; Waxweiler, T; Diot, Q; Kavanagh, B; Schubert, L; Miften, M [University of Colorado Denver, Aurora, CO (United States); Castillo, R [University of Texas Medical Branch of Galveston, Pearland, TX (United States); Guerrero, T; Castillo, E [Beaumont Health System, Royal Oak, MI (United States)


    Purpose: 4DCT-ventilation is an exciting new imaging modality that uses 4DCTs to calculate lung ventilation. Because 4DCTs are acquired as part of routine care, calculating 4DCT-ventilation allows for lung function evaluation without additional cost or inconvenience to the patient. Development of a clinical trial is underway at our institution to use 4DCT-ventilation for thoracic functional avoidance with the idea that preferential sparing of functional lung regions can decrease pulmonary toxicity. The purpose of our work was to develop the practical aspects of a 4DCT-ventilation functional avoidance clinical trial including: 1.assessing patient eligibility 2.developing trial inclusion criteria and 3.developing treatment planning and dose-function evaluation strategies. Methods: 96 stage III lung cancer patients from 2 institutions were retrospectively reviewed. 4DCT-ventilation maps were calculated using the patient’s 4DCTs, deformable image registrations, and a density-change-based algorithm. To assess patient eligibility and develop trial inclusion criteria we used an observer-based binary end point noting the presence or absence of a ventilation defect and developed an algorithm based on the percent ventilation in each lung third. Functional avoidance planning integrating 4DCT-ventilation was performed using rapid-arc and compared to the patient’s clinically used plan. Results: Investigator-determined clinical ventilation defects were present in 69% of patients. Our regional/lung-thirds ventilation algorithm identified that 59% of patients have lung functional profiles suitable for functional avoidance. Compared to the clinical plan, functional avoidance planning was able to reduce the mean dose to functional lung by 2 Gy while delivering comparable target coverage and cord/heart doses. Conclusions: 4DCT-ventilation functional avoidance clinical trials have great potential to reduce toxicity, and our data suggest that 59% of lung cancer patients have lung

  19. Which nurseries currently care for ventilated neonates in Illinois and Wisconsin? Implications for the next generation of perinatal regionalization.

    Meadow, William; Kim, Mijung; Mendez, David; Bell, Anthony; Gray, Cathy; Corpuz, Maria; Lantos, John


    We were interested in the extent to which advances in the availability of neonatalogy expertise have provided a centrifugal impetus to perinatal care. Specifically, we wondered where infants who were sick enough to require mechanical ventilation were currently being managed. We surveyed 116 of 140 hospitals in Illinois and Wisconsin that offered obstetric/newborn services in 1998-1999. The 23 Level I nurseries were consistently small, and offered virtually no "advanced" neonatal intensive care unit (NICU) technology. The 16 Level III NICUs were consistently large, offered advanced technology and personnel, and received sick infants from many hospitals in their regional network. The 77 Level II nurseries (two thirds of all hospitals with newborn services) were less consistently characterized. In general, Level II nurseries were a "spoke" (not a hub), and did not offer extracorporeal-membrane oxygenation (ECMO), nitric oxide (NO), or cardiovascular (CV) surgery. However, 19 (25%) of 77 Level II centers self-designated as "Level II+". These were significantly more likely to offer ventilators, percutaneous central venous catheters (PCVCs), total parenteral nutrition (TPN), and surgery. Fifty-three percent (18/34) of all nurseries offering mechanical ventilation self-designated as a Level II or II+, as opposed to Level III. Facile inferences about the appropriate role of Level II centers derived from decades-old data are probably unsupportable. It is time to acknowledge the distinction between the Level II nursery of the past and the newly evolving Level II+ NICUs.

  20. Protective effects of lung protective ventilation on lungs in patients undergoing radical resection for esophageal cancer%肺保护性通气对食管癌根治术病人的肺保护效应

    方向志; 张扬; 高巨


    目的 评价肺保护性通气对食管癌根治术病人的肺保护效应.方法 择期全麻下行食管癌根治术病人68例,性别不限,年龄40 ~ 64岁,ASA分级Ⅰ或Ⅱ级,体重指数17~40 kg/m2,采用随机数字表法分为2组(n=34):常规通气组(CV组)和保护性通气组(PV组).麻醉诱导后置入左侧双腔支气管导管,接麻醉机行机械通气.CV组双肺通气时VT10 ml/kg,单肺通气时VT7 ml/kg,吸呼比1∶2;PV组双肺通气时VT7 ml/kg,单肺通气时VT5 ml/kg,吸呼比1∶2,并给予PEEP 10 cmH2O,每45 min双肺行肺复张1次.分别于麻醉诱导前、术后第1天、第3天和第5天时行动脉血气分析,并记录临床改良肺部感染评分;分别于麻醉诱导前和术后第5天时行床旁肺功能检查,记录每分钟最大通气量占预计值的百分比(MVV%)、用力肺活量占预计值的百分比(FVC%)、第1秒用力呼气量占预计值的百分比(FEV1%),计算FEV1/FVC;记录术后5d内呼吸衰竭、肺不张、切口感染等的发生情况.结果 与CV组比较,PV组MVV%、FVC%、FEV1%和FEV1/FVC升高,术后各时点临床改良肺部感染评分降低,SaO2和PaO2升高(P<0.05),肺不张和切口感染的发生率差异无统计学意义(P>0.05).结论 肺保护性通气对食管癌根治术病人具有肺保护效应.%Objective To evaluate the protective effects of lung protective ventilation on the lungs in patients undergoing radical resection for esophageal cancer.Methods Sixty-eight patients of both sexes,aged 40-64 yr,of ASA physical status Ⅰ or Ⅱ,with body mass index 17-40 kg/m2,scheduled for elective radical resection for esophageal cancer,were randomly divided into conventional ventilation group (CV group,n =34) and protective ventilation group (PV group,n =34) using a random number table.Double lumen tube was inserted after induction of anesthesia,an anesthesia machine was connected,and the patients were mechanically ventilated.In group CV,VT was set at 10 ml

  1. 高频振荡通气在降低新生儿呼吸机相关性肺损伤中的作用%Effect of high frequency oscillatory ventilation in reducing the neonatal ventilator associated lung injury



    目的:探讨高频振荡通气在降低新生儿呼吸机相关性肺损伤中的作用。方法:2011年5月-2013年5月收治呼吸窘迫综合征需要高频振荡通气支持治疗的患者100例。结果:NPM 患儿的 Pose(30.5±3.4)cmH2O、MAP(14.9±3.4)cmH2O、Ti(0.75±0.1)s 均明显比 PM 组 Pose(26.7±1.7)cmH2O、MAP(11.9±2.0)cmH2O、Ti(0.45±0.1)s 高(P<0.05)。NPM组患者的PaCO2(40±10)mmHg明显比PM组(48±6)mmHg低,NPM组OI(19±13)明显对PM组(14±8)高(P<0.05)。NPM 组和 PM 组患儿的 VALI 发生率分别为32%和12%,NPM 组患儿的 VALI 发生率明显比 PM 组高(P<0.05)。结论:高频振荡通气在降低新生儿呼吸机相关性肺损伤中的作用良好。%Objective:To explore the effect of high frequency oscillatory ventilation in reducing the neonatal ventilator associated lung injury.Methods:100 cases of patients with respiratory distress syndrome from May 2011 to May 2013 were treated with high frequency oscillatory ventilation.Results:The Pose (30.5 ± 3.4)cmH2O,MAP (14.9 ± 3.4)cmH2O,Ti (0.75 ± 0.1)s of children in NPM group were significantly higher than the Pose (26.7±1.7)cmH2O,MAP (11.9±2.0)cmH2O,Ti (0.45±0.1)s in PM group(P<0.05).The PaCO2 (40±10)mmHg of patients in NPM group were obviously lower than that of the PM group(48±6)mmHg,the OI (19±13)of the NPM group was significantly higher than that of the PM group(14±8)(P<0.05).The VALI rates of the NPM group and PM group were 32% and 12% respectively,and the VALI incidence of children in the NPM group was obviously higher than that of the PM group(P<0.05).Conclusion:High frequency oscillatory ventilation had good effect in reducing the neonatal ventilator associated lung injury.

  2. Dead space reduction by Kolobow's endotracheal tube does not justify the waiving of volume monitoring in small, ventilated lungs.

    Proquitté, Hans; Wendel, Rena; Roehr, Charles C; Wauer, Roland R; Schmalisch, Gerd


    In ventilated preterm infants the flow sensor contributes significantly to the total apparatus dead space, which may impair gas exchange. The aim of the study was to quantify to which extent a dead space reduced Kolobow tube (KB) without flow sensor improves the gas exchange compared with a conventional ventilator circuit with flow sensor [Babylog 8000 (BL)]. In a cross-over trial in 14 tracheotomized, surfactant-depleted (saline lavage) and mechanically ventilated newborn piglets (age space of BL and KB including the endotracheal tube were 3.0 and 1.34 mL. Despite a 50 % apparatus dead space reduction with KB compared to BL statistically significant improvements were only observed for body weights monitoring.

  3. The Introduction and Update of One Lung Ventilation in Thoracic Anesthesia%胸外科手术麻醉肺隔离技术及其进展



    The thoracic surgeries usually use general anesthesia. Due to the effect of thoracotomy on respiratory and circulatory systems, and the requirement for surgical performance to make a clean and still operation field,the anesthetic technique-one lung ventilation( OLV )is usually applied. With the consistent improvement and widespread application of double lumen endobronchial tube and novel endobronchial block-ers, the technique of lung isolation tends to be more mature. During OLV , however, owing to the dismatching of ventilation perfusion ratio, hypoxemia is likely to occur, shown as the drop of SpO2 and increase of Pmax, especially in the cases of left lung OLV. Recently, much work has been done in the advancement of safety of this technique and on the prevention and treatment of hypoxemia.%胸科手术多采用全身麻醉.由于开胸对机体呼吸循环系统的影响,以及外科手术操作的需要,胸科手术多需要使用肺隔离技术(OLV).随着双腔支气管导管及多种新型支气管阻塞器的不断改进和应用,单肺通气技术日趋成熟.肺隔离期间,由于通气血流比值的失调,肺内分流难以避免,低氧血症容易发生,主要表现为动脉血氧饱和度降低,呼吸道压力升高,尤其以左肺单肺通气时明显.近年来,在如何提高OLV的安全性及预防和处理低氧血症方面,国内外学着做了大量的工作.

  4. Redistributed Regional Ventilation after the Administration of a Bronchodilator Demonstrated on Xenon-Inhaled Dual-Energy CT in a Patient with Asthma

    Goo, Hyun Woo; Yu, Jin Ho [Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of)


    We report here on the redistributed regional ventilation abnormalities after the administration of a bronchodilator and as seen on xenon-inhaled dual-energy CT in a patient with asthma. The improved ventilation seen in the right lower lobe and the decreased ventilation seen in the right middle lobe after the administration of a bronchodilator on xenon-inhaled dual-energy CT could explain a positive bronchodilator response on a pulmonary function test. These changes may reflect the heterogeneity of the airway responsiveness to a bronchodilator in patients with asthma.

  5. Mechanical ventilation in children.

    Kendirli, Tanil; Kavaz, Asli; Yalaki, Zahide; Oztürk Hişmi, Burcu; Derelli, Emel; Ince, Erdal


    Mechanical ventilation can be lifesaving, but > 50% of complications in conditions that require intensive care are related to ventilatory support, particularly if it is prolonged. We retrospectively evaluated the medical records of patients who had mechanical ventilation in the Pediatric Intensive Care Unit (PICU) during a follow-up period between January 2002-May 2005. Medical records of 407 patients were reviewed. Ninety-one patients (22.3%) were treated with mechanical ventilation. Ages of all patients were between 1-180 (median: 8) months. The mechanical ventilation time was 18.8 +/- 14.1 days. Indication of mechanical ventilation could be divided into four groups as respiratory failure (64.8%), cardiovascular failure (19.7%), central nervous system disease (9.8%) and safety airway (5.4%). Tracheostomy was performed in four patients. The complication ratio of mechanically ventilated children was 42.8%, and diversity of complications was as follows: 26.3% atelectasia, 17.5% ventilator-associated pneumonia, 13.1% pneumothorax, 5.4% bleeding, 4.3% tracheal edema, and 2.1% chronic lung disease. The mortality rate of mechanically ventilated patients was 58.3%, but the overall mortality rate in the PICU was 12.2%. In conclusion, there are few published epidemiological data on the follow-up results and mortality in infants and children who are mechanically ventilated.

  6. Ventilation distribution in rats: Part I - The effect of gas composition as measured with electrical impedance tomography

    Dunster Kimble R


    Full Text Available Abstract The measurement of ventilation distribution is currently performed using inhaled tracer gases for multiple breath inhalation studies or imaging techniques to quantify spatial gas distribution. Most tracer gases used for these studies have properties different from that of air. The effect of gas density on regional ventilation distribution has not been studied. This study aimed to measure the effect of gas density on regional ventilation distribution. Methods Ventilation distribution was measured in seven rats using electrical impedance tomography (EIT in supine, prone, left and right lateral positions while being mechanically ventilated with either air, heliox (30% oxygen, 70% helium or sulfur hexafluoride (20% SF6, 20% oxygen, 60% air. The effect of gas density on regional ventilation distribution was assessed. Results Gas density did not impact on regional ventilation distribution. The non-dependent lung was better ventilated in all four body positions. Gas density had no further impact on regional filling characteristics. The filling characteristics followed an anatomical pattern with the anterior and left lung showing a greater impedance change during the initial phase of the inspiration. Conclusion It was shown that gas density did not impact on convection dependent ventilation distribution in rats measured with EIT.

  7. Goal-directed fluid optimization based on stroke volume variation and cardiac index during one-lung ventilation in patients undergoing thoracoscopy lobectomy operations: a pilot study

    Jian Zhang


    Full Text Available OBJECTIVES: This pilot study was designed to utilize stroke volume variation and cardiac index to ensure fluid optimization during one-lung ventilation in patients undergoing thoracoscopic lobectomies. METHODS: Eighty patients undergoing thoracoscopic lobectomy were randomized into either a goal-directed therapy group or a control group. In the goal-directed therapy group, the stroke volume variation was controlled at 10%±1%, and the cardiac index was controlled at a minimum of 2.5 L.min-1.m-2. In the control group, the MAP was maintained at between 65 mm Hg and 90 mm Hg, heart rate was maintained at between 60 BPM and 100 BPM, and urinary output was greater than 0.5 mL/kg-1/h-1. The hemodynamic variables, arterial blood gas analyses, total administered fluid volume and side effects were recorded. RESULTS: The PaO2/FiO2-ratio before the end of one-lung ventilation in the goal-directed therapy group was significantly higher than that of the control group, but there were no differences between the goal-directed therapy group and the control group for the PaO2/FiO2-ratio or other arterial blood gas analysis indices prior to anesthesia. The extubation time was significantly earlier in the goal-directed therapy group, but there was no difference in the length of hospital stay. Patients in the control group had greater urine volumes, and they were given greater colloid and overall fluid volumes. Nausea and vomiting were significantly reduced in the goal-directed therapy group. CONCLUSION: The results of this study demonstrated that an optimization protocol, based on stroke volume variation and cardiac index obtained with a FloTrac/Vigileo device, increased the PaO2/FiO2-ratio and reduced the overall fluid volume, intubation time and postoperative complications (nausea and vomiting in thoracic surgery patients requiring one-lung ventilation.

  8. Monitoring of intratidal lung mechanics: a Graphical User Interface for a model-based decision support system for PEEP-titration in mechanical ventilation.

    Buehler, S; Lozano-Zahonero, S; Schumann, S; Guttmann, J


    In mechanical ventilation, a careful setting of the ventilation parameters in accordance with the current individual state of the lung is crucial to minimize ventilator induced lung injury. Positive end-expiratory pressure (PEEP) has to be set to prevent collapse of the alveoli, however at the same time overdistension should be avoided. Classic approaches of analyzing static respiratory system mechanics fail in particular if lung injury already prevails. A new approach of analyzing dynamic respiratory system mechanics to set PEEP uses the intratidal, volume-dependent compliance which is believed to stay relatively constant during one breath only if neither atelectasis nor overdistension occurs. To test the success of this dynamic approach systematically at bedside or in an animal study, automation of the computing steps is necessary. A decision support system for optimizing PEEP in form of a Graphical User Interface (GUI) was targeted. Respiratory system mechanics were analyzed using the gliding SLICE method. The resulting shapes of the intratidal compliance-volume curve were classified into one of six categories, each associated with a PEEP-suggestion. The GUI should include a graphical representation of the results as well as a quality check to judge the reliability of the suggestion. The implementation of a user-friendly GUI was successfully realized. The agreement between modelled and measured pressure data [expressed as root-mean-square (RMS)] tested during the implementation phase with real respiratory data from two patient studies was below 0.2 mbar for data taken in volume controlled mode and below 0.4 mbar for data taken in pressure controlled mode except for two cases with RMS < 0.6 mbar. Visual inspections showed, that good and medium quality data could be reliably identified. The new GUI allows visualization of intratidal compliance-volume curves on a breath-by-breath basis. The automatic categorisation of curve shape into one of six shape

  9. Effect of one-lung ventilation with pressure-controlled ventilation or volume-controlled ventilation on intrinsic PEEP in patients undergoing esophagus surgery%食管癌术中定压和定容单肺通气对内源性PEEP的影响



    目的 比较食管癌术中定压(PCV)和定容(VCV)单肺通气(OLV)对内源性呼气末正压(PEEPi)的影响.方法 食管癌根治手术患者40例,随机均分为两组,采用全凭静脉麻醉,插入双腔气管导管.手术进胸前先行双肺VCV,潮气量(VT) 10 ml/kg,通气频率(f)12次/分;进胸后行OLV:A组采用PCV,压力限定设为双肺通气时的气道峰压(Ppeak),f为12次/分;B组采用VCV,VT为8 ml/kg,f为12次/分.记录Ppeak、气道平均压(Pmean)、分钟通气量(MV)、肺动态顺应性(Cdyn)和PEEPi.结果 与B组比较,A组Ppeak、MV和Pmean降低,而Cdyn升高,PEEPi发生率低(P<0.01).结论 食管癌手术采用PCV模式行OLV可降低Ppeak,改善Cdyn,减少PEEPi,利于肺保护.%Objective To investigate the effect of one-lung ventilation (OLV) with pressure-controlled ventilation(PCV) or volume-controlled ventilation (VCV) on intrinsic positive end-expired pressure(PEEPi) in patients undergoing esophagus surgery. Methods Fourty patients undergoing radical esophagus surgery under intravenous anesthesia were randomly and equally divided into two groups, who were intubated with double lumen bronchial tube and given two-lung VCV with a tidal volume(VT) of 10 ml/kg and frequency(f) of 12 breaths per minute before chest openning. After chest was opened, OLV in group A was performed in PCV mode with the same peak airway pressure (Ppeak) as that during two-lung VCV, which in group B in VCV mode with a Vt of 8 ml/kg and f of 12 breaths per minute. The Ppeak,mean airway pressure(Pmean),minute volume(MV),dynamic lung compliance(Cdyn) and PEEPi were recorded during OLV. Results Compared to group B,Ppeak,MV and Pmean were lower,the incidence and extent of PEEPi decreased,while Cdyn increased in group A (P<0. 01). Conclusion Compared to VCV, OLV in PCV mode can decrease Ppeak, improve Cdyn and attenuate PEEPi, which benefits lung protection in the patients undergoing esophagus surgery under OLV.

  10. TU-G-BRA-01: Assessing Radiation-Induced Reductions in Regional Lung Perfusion Following Stereotactic Radiotherapy for Lung Cancer

    McGurk, R; Green, R; Lawrence, M [NC Cancer Hospital, Chapel Hill, NC (United States); Schreiber, E; Das, S; Zagar, T; Marks, L [UNC School of Medicine, Chapel Hill, NC (United States); Sheikh, A; McCartney, W; Rivera, P [University of North Carolina at Chapel Hill, Chapel Hill, NC (United States)


    Purpose: The dose-dependent nature of radiation therapy (RT)-induced lung injury following hypo-fractionated stereotactic RT is unclear. We herein report preliminary results of a prospective study assessing the magnitude of RT-induced reductions in regional lung perfusion following hypo-fractionated stereotactic RT. Methods: Four patients undergoing hypo-fractionated stereotactic lung RT (SBRT: 12 Gy x 4 fractions or 10 Gy x 5 fractions) had a pre-treatment SPECT (single-photon emission computed tomography) perfusion scan providing a 3D map of regional lung perfusion. Scans were repeated 3–6 months post-treatment. Pre- and post SPECT scans were registered to the planning CT scan (and hence the 3D dose data). Changes in regional perfusion (counts per cc on the pre-post scans) were computed in regions of the lung exposed to different doses of radiation (in 5 Gy intervals), thus defining a dose-response function. SPECT scans were internally normalized to the regions receiving <5 Gy. Results: At 3 months post-RT, the changes in perfusion are highly variable. At 6 months, there is a consistent dose-dependent reduction in regional perfusion. The average percent decline in regional perfusion was 10% at 15–20 Gy, 20% at 20–25 Gy, and 30% at 25–30 Gy representing a relatively linear dose response with an approximate 2% reduction per Gray for doses in excess of 10 Gy. There was a subtle increase in perfusion in the lung receiving <10 Gy. Conclusion: Hypo-fractionated stereotactic RT appears to cause a dose-dependent reduction in regional lung perfusion. There appears to be a threshold effect with no apparent perfusion loss at doses <10 Gy, though this might be in part due to the normalization technique used. Additional data is needed from a larger number of patients to better assess this issue. This sort of data can be used to assist optimizing RT treatment plans that minimize the risk of lung injury. Partly supported by the NIH (CA69579) and the Lance Armstrong

  11. The temperature change in an endotracheal tube during high frequency ventilation using an artificial neonatal lung model with Babylog® 8000 plus.

    Nagaya, Ken; Tsuchida, Etsushi; Nohara, Fumikatsu; Okamoto, Toshio; Azuma, Hiroshi


    There is little available data on airway humidity during high-frequency ventilation (HFV). The purpose of this study is to evaluate the temperature drop in an endotracheal tube (ETT) during HFV. We examined the airway temperature in a neonatal HFV system using Babylog® 8000 plus. We measured the temperature change of inspired gases in the ETT under various oscillatory frequencies and oscillatory volumes with a fixed base flow. The temperatures in the ETT during HFV were compared with the temperatures during conventional intermittent positive pressure ventilation (IPPV). As the oscillatory frequency was increased and the oscillatory volume (VThf) decreased, the difference in temperature between the Y piece and the inlet of an artificial lung in the ETT (ETT outside of body) increased. However, as the oscillatory frequency increased, there was no difference in the ETT temperature under constant oscillatory volume. In contrast, as the oscillatory volume was decreased, the difference in temperature in the ETT was greater under constant oscillatory frequency. Moreover, the temperature drop in the ETT with HFV was lower than that in the IPPV temperature with a similar respiratory volume. The temperature change in the ETT was not dependent on the oscillatory frequency when the oscillatory volume was fixed; however, the temperature was dependent on the oscillatory volume when the oscillatory frequency was fixed. © 2013 Wiley Periodicals, Inc.

  12. Pulmonary lymphangioleiomyomatosis: Analysis of disease manifestation by region-based quantification of lung parenchyma

    Theilig, D., E-mail: [Charité, Universitätsmedizin Berlin, Department of Radiology, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin (Germany); Doellinger, F. [Charité, Universitätsmedizin Berlin, Department of Radiology, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin (Germany); Kuhnigk, J.M. [Fraunhofer MEVIS, Universitaetsallee 29, 28359 Bremen (Germany); Temmesfeld-Wollbrueck, B.; Huebner, R.H. [Charité, Department of Pneumology, Augustenburger Platz 1, 13353 Berlin (Germany); Schreiter, N.; Poellinger, A. [Charité, Universitätsmedizin Berlin, Department of Radiology, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin (Germany)


    Highlights: •The distribution of cystic lesions in LAM was evaluated with quantitative CT. •There were more cystic lesions in the central lung compared to peripheral areas. •Cystic changes were more frequent in apical two thirds compared to lower third. •Results might help to obviate the need for biopsy in more cases. -- Abstract: Purpose: Lymphangioleiomyomatosis (LAM) is characterized by proliferation of smooth muscle tissue that causes bronchial obstruction and secondary cystic destruction of lung parenchyma. The aim of this study was to evaluate the typical distribution of cystic defects in LAM with quantitative volumetric chest computed tomography (CT). Materials and methods: CT examinations of 20 patients with confirmed LAM were evaluated with region-based quantification of lung parenchyma. Additionally, 10 consecutive patients were identified who had recently undergone CT imaging of the lung at our institution, in which no pathologies of the lung were found, to serve as a control group. Each lung was divided into three regions (upper, middle and lower thirds) with identical number of slices. In addition, we defined a “peel” and “core” of the lung comprising the 2 cm subpleural space and the remaining inner lung area. Computerized detection of lung volume and relative emphysema was performed with the PULMO 3D software (v3.42, Fraunhofer MEVIS, Bremen, Germany). This software package enables the quantification of emphysematous lung parenchyma by calculating the pixel index, which is defined as the ratio of lung voxels with a density <−950 HU to the total number of voxels in the lung. Results: Cystic changes accounted for 0.1–39.1% of the total lung volume in patients with LAM. Disease manifestation in the central lung was significantly higher than in peripheral areas (peel median: 15.1%, core median: 20.5%; p = 0.001). Lower thirds of lung parenchyma showed significantly less cystic changes than upper and middle lung areas combined (lower

  13. Smoking and Lung Cancer: A Geo-Regional Perspective

    Zahraa Rahal; Shaza El Nemr; Ansam Sinjab; Hassan Chami; Arafat Tfayli; Humam Kadara


    Lung cancer is the leading cause of cancer-related deaths worldwide. Non-small cell lung cancer (NSCLC) represents the most frequently diagnosed subtype of this morbid malignancy. NSCLC is causally linked to tobacco consumption with more than 500 million smokers worldwide at high risk for this fatal malignancy. We are currently lagging in our knowledge of the early molecular (e.g., genomic) effects of smoking in NSCLC pathogenesis that would constitute ideal markers for early detection. This ...

  14. Regional differences in prediction models of lung function in Germany

    Schäper Christoph


    Full Text Available Abstract Background Little is known about the influencing potential of specific characteristics on lung function in different populations. The aim of this analysis was to determine whether lung function determinants differ between subpopulations within Germany and whether prediction equations developed for one subpopulation are also adequate for another subpopulation. Methods Within three studies (KORA C, SHIP-I, ECRHS-I in different areas of Germany 4059 adults performed lung function tests. The available data consisted of forced expiratory volume in one second, forced vital capacity and peak expiratory flow rate. For each study multivariate regression models were developed to predict lung function and Bland-Altman plots were established to evaluate the agreement between predicted and measured values. Results The final regression equations for FEV1 and FVC showed adjusted r-square values between 0.65 and 0.75, and for PEF they were between 0.46 and 0.61. In all studies gender, age, height and pack-years were significant determinants, each with a similar effect size. Regarding other predictors there were some, although not statistically significant, differences between the studies. Bland-Altman plots indicated that the regression models for each individual study adequately predict medium (i.e. normal but not extremely high or low lung function values in the whole study population. Conclusions Simple models with gender, age and height explain a substantial part of lung function variance whereas further determinants add less than 5% to the total explained r-squared, at least for FEV1 and FVC. Thus, for different adult subpopulations of Germany one simple model for each lung function measures is still sufficient.

  15. Increased risk of incorporation for the staff with lung ventilation examination and simple measures of radiation protection; Erhoehtes Inkorporationsrisiko fuer das Personal bei Lungenventilationsuntersuchungen und einfache Strahlenschutzmassnahmen

    Petzold, J.; Sabri, O. [Universitaetsklinikum Leipzig (Germany); Alborzi, H. [LfULG Dresden (Germany); Lorenz, J. [SMUL Dresden (Germany); Schoenmuth, T. [VKTA Rossendorf (Germany)


    The nuclear medical investigation of the ventilation of the lung is a procedure, that is accompanied by a considerable and traceable risk of incorporation of [99m]Tc carbon particles for the staff. Despite of a very careful approach by physicians, technologists and physicists these particles reach the compartment air during the course of the examination. Thereby, they are partly adsorbed on the workwear, but also end up in the lung of the personnel. After such an investigation and after measurements of the personnel in a whole body counter, absolute amounts of incorporated radioactivities of [99m]Tc of 500 to 800 kBq may be determined. Although having taken of the workwear and having washed and sometimes showered carefully the residual (incorporated) activity can barely not be reduced below 500kBq. Thus, incorporations of [99m]Tc carbon particles obviously can not be impeded completely during this particular nuclear medical examination. Therefore, this trial, that is supported and co-funded by the local authority responsible for control and approval according to the German Radiation Protection Ordinance, aims in locating and tracing the sources of the described incorporation in detail and in pinpointing (orig.)

  16. 七氟烷对单肺通气肺损伤的保护作用及其机制%The protective effect of sevoflurane on lung injury induced by one-lung ventilation and its mechanism

    金晶星; 李元海; 陈珂; 钟薇薇


    To evaluate the effect of sevoflurane on lung injury induced by one-lung ventilation and its mechanism. Methods 61 patients undergoing lung cancer surgery under one-lung ventiliation were evaluated in this study. The patients were randomly divided into two groups: control group ( group I , n = 29 ), sevoflurane group( II group,n = 32 ). Two groups were induced by the same way. Anesthesia was maintained with 1% ~3% sevoflurane or propofol TCI in two groups. Serum IL-8,TNF-a,oxygenation index levels,the expression of aquaporin l( AQP1 ) AQP4 and pathological features of the lung tissue were measured at intubation( Tl ), one-lung ventilation 90 min ( T2 ),two lung ventilation 30 min( T3 ). Results Compared with Tl ,the plasma of IL-8^TNF-a was increased obviously in both groups at T2, T3( P < 0. 05 ); Compared with Tl, the oxygenation index was declined dramatically at T2,T3( P < 0. 05 );The expression of AQP1 and APQ4 in lung tissue in two groups had no obvious difference; Compared with Tl ,the expression of AQP1 and APQ4 at T2 reduced dramatically in group I ( P <0. 05 ). Conclusion Sevoflurane can exert a protective effect on the lung injury result from one-lung ventilation, and its mechanism may be related to reducing the level of IL-8 and TNF-α in blood plasma and up-regulating the expression of AQP1 and AQP4 in lung tissue.%目的 探讨七氟烷对单肺通气肺损伤的保护作用及其可能机制.方法 择期行肺癌根治术患者61例,ASA Ⅱ~Ⅲ级,随机分为两组:对照组(Ⅰ组,n=29),七氟烷组(Ⅱ组,n=32);两组采用相同的麻醉诱导方式,气管插管后,I组用全凭静脉维持麻醉,Ⅱ组用七氟烷全程吸入维持麻醉.所有患者分别于插管即刻(T1)、单肺通气90 min(T2)、术毕双肺通气30 min(T3),3个时间点分别测定血浆中白介素8(IL-8)、肿瘤坏死因子-α(TNF-α)含量、动脉血气及测定肺组织水通道蛋白1(AQP1)、水通道蛋白4(AQP4)表达,观察肺组织病理改变.结果 与T1

  17. Effect of Electroacupuncture of"Zusanli"(ST 36) on Inflammatory Rseponse and Lung Injury of One Lung Ventilation in Rabbits%电针足三里穴对兔单肺通气所致炎性反应及肺损伤的影响

    任秋生; 陈雪琴; 王均炉; 包峰峰; 蒋柳明


    目的:观察电针足三里对兔单肺通气炎性介质反应水平及肺损伤程度的影响.方法:健康成年新西兰兔39只,随机分为电针非穴位组(EN组)、电针穴位组(EP组)和对照组(C组),每组13只.麻醉后右肺实施单肺通气3h.EN、EP两组于单肺通气开始时实施电针刺激,EN组取双侧足三里穴旁1 cm 处,EP组取双侧足三里穴处,双肺通气前、单肺通气前及单肺通气后测血液中性粒细胞水平.实验结束处死,测定肺组织TNF-α、IL-6 、IL-8 、IL-10 含量,观察肺组织病理形态学.结果:EP 组单肺通气后氧合指数高于EN 组及C 组(P <0.05),血液中性粒细胞明显低于EN 组及C 组(P <0.05),肺组织TNF-α、IL-6 、IL-8 亦明显降低(P<0.05),而IL-10 明显增高(P <0.05); 肺间质及肺泡水肿和岀血较少,仅见少量中性粒细胞浸润(P<0.05).结论:电针足三里可以通过调节炎性反应来减轻单肺通气引起的肺损伤.%Objective To observe the effects of electroacupuncture of "Zusanli"(ST 36) on inflammatory response and lung injury of one lung ventilation in rabbits. Methods Thirty-nine healthy New Zealand rabbits were randomized into three groups (n=13): electroacupuncture at no point group (EN), electroacupuncture at Zu-sanli points (EP)and control group (C ). Single right lung ventilation was performed following with anesthesia for 3 h. Electroacupuncture were administered in group EN and group EP when one lung ventilation began. Electroacupuncture was stimulated at somewhere 1 cm nearby Zusanli in group EN, at Zusanli points in group EP . Neutrophilic granulocytes in blood were counted before two lung ventilation, before one lung ventilation, and after one lung ventilation. Animal were executed at the end, and the TNF-a、IL-6、IL-8、IL-10 levels in the lung tissues determined, with observation of the pathomorphology of the lung. Results Compared with other groups, oxygenation index of group EP was higher after one lung

  18. Hyperpolarized {sup 3}helium magnetic resonance ventilation imaging of the lung in cystic fibrosis: comparison with high resolution CT and spirometry

    McMahon, Colm J.; Dodd, Jonathan D.; Skehan, Stephen J.; Masterson, James B. [St. Vincent' s University Hospital, Department of Radiology, Dublin (Ireland); Hill, Catherine; Woodhouse, Neil; Wild, Jim M.; Fichele, Stan [Royal Hallamshire Hospital, The Unit of Academic Radiology, University of Sheffield, Sheffield (United Kingdom); Gallagher, Charles G. [St. Vincent' s University Hospital, Department of National Referral Centre for Adult Cystic Fibrosis, Dublin (Ireland); Beek, Edwin J.R. van [Royal Hallamshire Hospital, The Unit of Academic Radiology, University of Sheffield, Sheffield (United Kingdom); University of Iowa, Department of Radiology, Carver College of Medicine, Iowa City, IA (United States)


    The purpose of this study was to compare hyperpolarized {sup 3}helium magnetic resonance imaging ({sup 3}He MRI) of the lungs in adults with cystic fibrosis (CF) with high-resolution computed tomography (HRCT) and spirometry. Eight patients with stable CF prospectively underwent {sup 3}He MRI, HRCT, and spirometry within 1 week. Three-dimensional (3D) gradient-echo sequence was used during an 18-s breath-hold following inhalation of hyperpolarized {sup 3}He. Each lung was divided into six zones; {sup 3}He MRI was scored as percentage ventilation per lung zone. HRCT was scored using a modified Bhalla scoring system. Univariate (Spearman rank) and multivariate correlations were performed between {sup 3}He MRI, HRCT, and spirometry. Results are expressed as mean{+-}SD (range). Spirometry is expressed as percent predicted. There were four men and four women, mean age=31.9{+-}9 (20-46). Mean forced expiratory volume in 1 s (FEV){sub 1}=52%{+-}29 (27-93). Mean {sup 3}He MRI score=74%{+-}25 (55-100). Mean HRCT score=48.8{+-}24 (13.5-83). The correlation between {sup 3}He MRI and HRCT was strong (R={+-}0.89, p<0.001). Bronchiectasis was the only independent predictor of {sup 3}He MRI; {sup 3}He MRI correlated better with FEV{sub 1} and forced vital capacity (FVC) (R=0.86 and 0.93, p<0.01, respectively) than HRCT (R={+-}0.72 and {+-}0.81, p<0.05, respectively). This study showed that {sup 3}He MRI correlates strongly with structural HRCT abnormalities and is a stronger correlate of spirometry than HRCT in CF. (orig.)

  19. Assessment of Ventilation Distribution during Laparoscopic Bariatric Surgery: An Electrical Impedance Tomography Study

    Michal Stankiewicz-Rudnicki


    Full Text Available Introduction. The aim of the study was to assess changes of regional ventilation distribution at the level of the 3rd intercostal space in the lungs of morbidly obese patients as a result of general anaesthesia and laparoscopic surgery as well as the relation of these changes to lung mechanics. We also wanted to determine if positive end-expiratory pressure of 10 cm H2O prevents the expected atelectasis in the morbidly obese patients during general anaesthesia. Materials and Methods. 49 patients completed the examination and were randomized to 2 groups: ventilated without positive end-expiratory pressure (PEEP 0 and with PEEP of 10 cm H2O (PEEP 10 preceded by a recruitment maneuver with peak inspiratory pressure of 40 cm H2O. Impedance Ratio (IR was utilized to examine ventilation distribution changes as a result of anaesthesia, pneumoperitoneum, and change of body position. We also analyzed intraoperative respiratory mechanics and pulse oximetry values. Results. In both groups general anaesthesia caused a ventilation shift towards the nondependent lungs which was not further intensified after pneumoperitoneum. Reverse Trendelenburg position promoted homogeneous ventilation distribution. Respiratory system compliance was reduced after insufflation and improved after exsufflation of pneumoperitoneum. There were no statistically significant differences in ventilation distribution between the examined groups. Respiratory system compliance, plateau pressure, and pulse oximetry values were higher in PEEP 10. Conclusions. Changes of ventilation distribution in the obese do occur at cranial lung regions. During pneumoperitoneum alterations of ventilation distribution may not follow the direction of the changes of lung mechanics. In the obese patients PEEP level of 10 cm H2O preceded by a recruitment maneuver improves respiratory compliance and oxygenation but does not eliminate atelectasis induced by general anaesthesia.

  20. 老年患者施行不同通气模式对单肺通气氧合及气道压力的影响%Effect of different ventilation modes on one-lung ventilation, oxygenation and airway pressure in elderly patients

    刘扬; 代志刚; 姜红; 董希玮; 王胜


    目的 观察老年患者胸科手术时单肺通气期间不同通气模式对患者气道压力和氧合的影响.方法 需行单肺通气麻醉的老年手术病人120例,其中男性80例,女性40例,年龄60岁以上.将120名患者分为例组,施行全麻诱导双腔插管后行双肺通气,进胸后分别再进行不同通气模式的单肺通气,单肺通气开始后,其中容量控制通气模式(VCV)组(Ⅰ组)VT=10 ml/kg,f=10;压力控制通气模式(PCV)(Ⅱ组)压力设定为达10 ml/kg潮气量的压力值,f=10;VCV组(Ⅲ组)VT=7 ml/kg,f=14;PCV组(Ⅳ组)压力设定为达7 ml/kg潮气量的压力值,f=14;VCV+选择性通气肺呼气末正压组(PEEP)(Ⅴ组)VT=7 ml/kg,f=14,PEEP=5 cm H2O;PCV+PEEP组(Ⅵ组)压力设定为达7 ml/kg潮气量的压力值,f=14,PEEP=5 cm H2O.定时记录数据.结果 单肺通气30 min后、单肺通气60 min后,Ⅲ组和Ⅳ组相比氧合具有显著统计学差异(P<0.05),Ⅲ组和Ⅴ组相比氧合具有显著统计学差异(P<0.05),Ⅳ组和Ⅵ组相比氧合具有显著统计学差异(P<0.05).结论 为了改善单肺通气时出现的低氧血症和确保患者在手术中的安全,需要合理选择通气模式,达到提高单肺通气效果的目的,使单肺通气技术得到广泛的推广.%Objective To observe the effect of different ventilation modes on one - lung ventilation, oxygenation and airway pressure during thoracic surgery in elderly patients. Methods One hundred and twenty elderly patients including 80 males and 40 females with age above 60 yr old had been received one - lung ventilation after anesthesia induction, and they were divided into 6 groups to receive double - lumen endobron-chial intubation anesthesia, then one - lung ventilation with different ventilation modes was carried out after it enters into chest, and the data were recorded at fixed time points. Results After 30 min and 60 min of one - lung ventilation, there was significant difference in oxygenation between group III and

  1. Correlation between lung scintigraphy and long-term outcome in survivors of congenital diaphragmatic hernia.

    Okuyama, Hiroomi; Kubota, Akio; Kawahara, Hisayoshi; Oue, Takaharu; Kitayama, Yasuhiro; Yagi, Makoto


    Lung scintigraphy has been used to evaluate the degree of pulmonary hypoplasia in infants with congenital diaphragmatic hernia (CDH). However, the relationship between lung scintigraphy and long-term outcome of CDH remains unclear. The aim of this study is to determine whether lung scintigraphy correlates with long-term pulmonary morbidity and nutritional status in survivors of CDH. Consecutive 31 survivors of CDH were enrolled in this study. The initial scan was performed at 1-2 months when the patients were ready for discharge and the follow-up scan was performed following an approximately 1-year interval. The regional ventilation and perfusion were evaluated using (133)Xe-inhalation and intravenous (99m)Tc-MAA injection, respectively. The ventilation and perfusion of the ipsilateral lung was expressed as a percentage of that of the contralateral lung. Physical growth at 1 and 2 years, and pulmonary morbidity were reviewed from medical records. The ventilation and perfusion of the ipsilateral lung at the follow-up scan increased significantly from those at the initial scan. Ten patients had pulmonary morbidity. The ventilation and perfusion of the ipsilateral lung was significantly lower in the patients with pulmonary morbidity compared to the patients without pulmonary morbidity. The initial ventilation and perfusion of the ipsilateral lung were strongly correlated with body weight at 1 and 2 years (ventilation: R = 0.503, P lung scintigraphy is useful to predict long-term pulmonary morbidity and poor nutritional status in survivors of CDH.

  2. Spatiotemporal Aeration and Lung Injury Patterns Are Influenced by the First Inflation Strategy at Birth.

    Tingay, David G; Rajapaksa, Anushi; Zonneveld, C Elroy; Black, Don; Perkins, Elizabeth J; Adler, Andy; Grychtol, Bartłomiej; Lavizzari, Anna; Frerichs, Inéz; Zahra, Valerie A; Davis, Peter G


    Ineffective aeration during the first inflations at birth creates regional aeration and ventilation defects, initiating injurious pathways. This study aimed to compare a sustained first inflation at birth or dynamic end-expiratory supported recruitment during tidal inflations against ventilation without intentional recruitment on gas exchange, lung mechanics, spatiotemporal regional aeration and tidal ventilation, and regional lung injury in preterm lambs. Lambs (127 ± 2 d gestation), instrumented at birth, were ventilated for 60 minutes from birth with either lung-protective positive pressure ventilation (control) or as per control after either an initial 30 seconds of 40 cm H2O sustained inflation (SI) or an initial stepwise end-expiratory pressure recruitment maneuver during tidal inflations (duration 180 s; open lung ventilation [OLV]). At study completion, molecular markers of lung injury were analyzed. The initial use of an OLV maneuver, but not SI, at birth resulted in improved lung compliance, oxygenation, end-expiratory lung volume, and reduced ventilatory needs compared with control, persisting throughout the study. These changes were due to more uniform inter- and intrasubject gravity-dependent spatiotemporal patterns of aeration (measured using electrical impedance tomography). Spatial distribution of tidal ventilation was more stable after either recruitment maneuver. All strategies caused regional lung injury patterns that mirrored associated regional volume states. Irrespective of strategy, spatiotemporal volume loss was consistently associated with up-regulation of early growth response-1 expression. Our results show that mechanical and molecular consequences of lung aeration at birth are not simply related to rapidity of fluid clearance; they are also related to spatiotemporal pressure-volume interactions within the lung during inflation and deflation.

  3. Inhalation therapy in mechanical ventilation

    Maccari, Juçara Gasparetto; Teixeira, Cassiano; Gazzana, Marcelo Basso; Savi, Augusto; Dexheimer-Neto, Felippe Leopoldo; Knorst, Marli Maria


    Patients with obstructive lung disease often require ventilatory support via invasive or noninvasive mechanical ventilation, depending on the severity of the exacerbation. The use of inhaled bronchodilators can significantly reduce airway resistance, contributing to the improvement of respiratory mechanics and patient-ventilator synchrony. Although various studies have been published on this topic, little is known about the effectiveness of the bronchodilators routinely prescribed for patients on mechanical ventilation or about the deposition of those drugs throughout the lungs. The inhaled bronchodilators most commonly used in ICUs are beta adrenergic agonists and anticholinergics. Various factors might influence the effect of bronchodilators, including ventilation mode, position of the spacer in the circuit, tube size, formulation, drug dose, severity of the disease, and patient-ventilator synchrony. Knowledge of the pharmacological properties of bronchodilators and the appropriate techniques for their administration is fundamental to optimizing the treatment of these patients. PMID:26578139

  4. 乌司他丁预先给药对单肺通气患者肺损伤的影响%Effects of ulinastatin pretreatment on the lung injury during one-lung ventilation

    严六狮; 袁伟; 王伟; 周荣胜


    Objective To investigate the effect of ulinastatin pretreat-ment on lung injury caused by one - lung ventilation. Methods Sixty patients scheduled for resection of carcinoma at the lower part of esopha-gus , were randomly assigned to 2 groups (n = 30): group C = control group; group U = ulinastain group. Each patient in group U received the total dose of 5000 U ? kg"1 ulinastain. Half of the dose diluted in normal saline to 50 mL was injected into vein slowly while the venous was cannu-lated for fluid replacement after the patients entered the operation room. The residual half dose was solved in normal saline and administered by intravenous drip in lh. The patients in group C received normal saline at the same volume with in group U. Blood samples were taken from internal jugular vein at the following time points: before induction of anesthesia (Tl) , immediately into one - lung ventilation ( T2 ) , 30 min into one -lung ventilation (T3) , 30 min after two - lung ventilation (T4) , the end of operation ( T5 ). The serum concentrations of interleukin - 6 (IL -6) , tumor necrosis factor - α ( TNF - α) , alveolar surfactant protein A ( SP - A) , malondialdehyde ( MDA) and 8 - iso - prostaglandin (8 - iso - PGF2a) were measured. Results For each group sertim concentra-tions of IL - 6 and TNF - a increased at T3 , T4, T5 compared with at T, (P 0. 05) , compare the two groups,the serum concentrations of IL -6, SP - A,MDA, 8 - iso - PGF2a at T3 ,T4 ,T5 were lower in group U than those in group C. Conclusion Ulinastatin pretreatment could reduce lung injury caused by the one - lung ventilation.%目的 评价乌司他丁预先给药对单肺通气患者肺损伤的影响.方法 择期行食道下段癌切除术患者60例,随机分为对照组(C组)和乌司他丁组(U组),每组30人.U组按5000 U·kg-1计算乌司他丁用量,半量于入室后缓慢静脉注射,半量持续1h静脉点滴.C组以等量生理盐水代替.于麻醉诱导前(T1),单肺通气即刻(T2),

  5. Open lung策略在新生儿呼吸窘迫综合征机械通气治疗中的应用%Application of open lung strategy in mechanical ventilation treatment of neonatal respiratory distress syndrom

    葛荣领; 张建华


    Objective To investigate the effects of open lung strategy in mechanical ventilation treatment of moderate to severe neonatal respiratory distress syndrom (NRDS).Methods Fifty - six cases of neonates with NRDS were randomized into open lung ventilation group ( group Ⅰ ) and routine ventilation group (group Ⅱ ),each group of 28 patients.In addition to general treatment,both groups were treated with PC + SIMV ventilation model,lung recruitment maneuver in group Ⅰ and traditional ventilation in group Ⅱ.The arterial blood gas results were compared between the two groups before ventilation and 6,12,24,48 hours after ventilation,the complications and the curative effect were compared between two groups.Results The results of PaO2,SaO2,PaO2/FiO2 after ventilation increased remarkably,compared with those before ventilation in two groups.The results of PaO2,SaO2,PaO2/FiO2 of group Ⅰ after ventilation increased more significantly than group Ⅱ after ventilation in same time point( P <0.05) ; the incidences of VIPI decreased remarkably in group Ⅰ than that in group Ⅱ,the incidences of VIH/PVL in two groups were no significant change( P > 0.05 ),the curative effect of group Ⅰ was increased more obviously than group Ⅱ( P < 0.05 ).Conclusions Open lung ventilation can improve the oxygenation remarkably,decrease the incidences of VIPI and increase the curative effect of NRDS.%目的 探讨Open lung策略在中重度新生儿呼吸窘迫综合征(NRDS)机械通气治疗中的作用.方法 将56例患儿随机分为策略通气组(Ⅰ组)和常规通气组(Ⅱ组),每组28例,除一般治疗外,均行PC+ SIMV通气模式,Ⅰ组实施开放肺通气操作,Ⅱ组进行常规机械通气.比较两组通气前及通气后6、12、24、48 h血气变化情况,并对并发症、疗效进行比较.结果 两组通气后较通气前动脉氧分压( PaO2)、动脉血氧饱和度(SaO2)、氧合指数[ PaO2/吸入氧浓度(FiO2)]都有显著改善,但

  6. Effects of drugs during anesthesia with one lung ventilation on pulmonary shunt fraction%单肺通气期间麻醉期用药对肺内分流的影响

    纪凡层; 牟爱珍


    Background Hypoxemia is one of the most common complications during one lung ventilation(OLV).Hypoxemia pulmonary vasoconstriction (HPV) is a reflex contraction of vascular smooth muscle in the pulmonary circulation in response to low regional partial pressure of oxygen.It can decrease pulmonary shunt fraction (Qs/Qt) and improve oxygenation.Objective To discuss the effects of drugs during anesthesia with OLV on Qs/Qt.Content Many drugs during anesthesia have an effect on HPV, Qs/Qt and oxygenation.Trend Drugs during anesthesia with OLV can inhibit or enhance the response of HPV, increase or decrease the Qs/Qt.We should avoid of drugs that inhibit the response of HPV and increase Qs/Qt.It can help patients to avoid of hypoxia.%背景 低氧血症是单肺通气(one lung ventilation,OLV)期间最常见的并发症.缺氧性肺血管收缩(hypoxic pulmonary vasoconstriction,HPV)是肺血管对局部低氧分压的反射性收缩,可以减少肺内分流(pulmonary shunt fraction,Qs/Qt)、维持动脉血氧分压(partial pressure of arterial oxygen,PaO2)、防止低氧血症的发生.目的 探讨OLV期间麻醉期用药对Qs/Qt的影响,指导临床应用.内容 综述OLV期间麻醉期用药对机体HPV、Qs/Qt和PaO2的影响.趋向 OLV期间麻醉期用药可以对HPV产生抑制或增强作用,从而影响Qs/Qt和PaO2.临床上要避免使用抑制HPV作用、增加Qs/Qt的药物,防止患者出现低氧血症.

  7. 4D-Imaging of the lung: reproducibility of lesion size and displacement on helical CT, MRI, and cone beam CT in a ventilated ex vivo system.

    Biederer, Juergen; Dinkel, Julien; Remmert, Gregor; Jetter, Siri; Nill, Simeon; Moser, Torsten; Bendl, Rolf; Thierfelder, Carsten; Fabel, Michael; Oelfke, Uwe; Bock, Michael; Plathow, Christian; Bolte, Hendrik; Welzel, Thomas; Hoffmann, Beata; Hartmann, Günter; Schlegel, Wolfgang; Debus, Jürgen; Heller, Martin; Kauczor, Hans-Ulrich


    Four-dimensional (4D) imaging is a key to motion-adapted radiotherapy of lung tumors. We evaluated in a ventilated ex vivo system how size and displacement of artificial pulmonary nodules are reproduced with helical 4D-CT, 4D-MRI, and linac-integrated cone beam CT (CBCT). Four porcine lungs with 18 agarose nodules (mean diameters 1.3-1.9 cm), were ventilated inside a chest phantom at 8/min and subject to 4D-CT (collimation 24 x 1.2 mm, pitch 0.1, slice/increment 24 x 10(2)/1.5/0.8 mm, pitch 0.1, temporal resolution 0.5 s), 4D-MRI (echo-shared dynamic three-dimensional-flash; repetition/echo time 2.13/0.72 ms, voxel size 2.7 x 2.7 x 4.0 mm, temporal resolution 1.4 s) and linac-integrated 4D-CBCT (720 projections, 3-min rotation, temporal resolution approximately 1 s). Static CT without respiration served as control. Three observers recorded lesion size (RECIST-diameters x/y/z) and axial displacement. Interobserver- and interphase-variation coefficients (IO/IP VC) of measurements indicated reproducibility. Mean x/y/z lesion diameters in cm were equal on static and dynamic CT (1.88/1.87; 1.30/1.39; 1.71/1.73; p > 0.05), but appeared larger on MRI and CBCT (2.06/1.95 [p CT]; 1.47/1.28 [MRI vs. CT/CBCT p CT vs. CBCT p CT), 2.29-4.48% (4D-CT); 5.44-6.22% (MRI) and 4.86-6.97% (CBCT). Interphase-VC for lesion sizes ranged from 2.28% (4D-CT) to 10.0% (CBCT). Mean displacement in cm decreased from static CT (1.65) to 4D-CT (1.40), CBCT (1.23) and MRI (1.16). Lesion sizes are exactly reproduced with 4D-CT but overestimated on 4D-MRI and CBCT with a larger variability due to limited temporal and spatial resolution. All 4D-modalities underestimate lesion displacement.

  8. Analytical modelling of regional radiotherapy dose response of lung

    Lee, Sangkyu; Stroian, Gabriela; Kopek, Neil; AlBahhar, Mahmood; Seuntjens, Jan; El Naqa, Issam


    Knowledge of the dose-response of radiation-induced lung disease (RILD) is necessary for optimization of radiotherapy (RT) treatment plans involving thoracic cavity irradiation. This study models the time-dependent relationship between local radiation dose and post-treatment lung tissue damage measured by computed tomography (CT) imaging. Fifty-eight follow-up diagnostic CT scans from 21 non-small-cell lung cancer patients were examined. The extent of RILD was segmented on the follow-up CT images based on the increase of physical density relative to the pre-treatment CT image. The segmented RILD was locally correlated with dose distribution calculated by analytical anisotropic algorithm and the Monte Carlo method to generate the corresponding dose-response curves. The Lyman-Kutcher-Burman (LKB) model was fit to the dose-response curves at six post-RT time periods, and temporal change in the LKB parameters was recorded. In this study, we observed significant correlation between the probability of lung tissue damage and the local dose for 96% of the follow-up studies. Dose-injury correlation at the first three months after RT was significantly different from later follow-up periods in terms of steepness and threshold dose as estimated from the LKB model. Dependence of dose response on superior-inferior tumour position was also observed. The time-dependent analytical modelling of RILD might provide better understanding of the long-term behaviour of the disease and could potentially be applied to improve inverse treatment planning optimization.

  9. 低流量单肺通气对肺癌手术患者呼吸功能的影响%Effects of low flow anesthesia on respiratory function during one lung ventilation in patients with lung cancer surgery

    胡彦艳; 秦丹丹; 叶凤青; 黄中华; 李静; 黄爱兰


    Objective To investigate the effects of low flow anesthesia on respiratory function during one lung ventilation in patients with lung cancer surgery. Methods A total of 40 ASA I or II grade patients, scheduled for lung cancer surgery under one lung ventilation ( OLV) were randomly divided into two groups with 20 each: normal flow anesthesia group( Group A) and low flow anesthesia group( Group B). Before OLV, two groups received high oxygen flow of 4 L/min and inhaled 1 % enflurane for ten minutes, then the oxygen flow was decreased to 3 L/min in group A and 1 L/min in group B, and two groups received high flow fresh gas of 4 L/min per 60 minutes for 5 minutes during OLV. The inhalation of enflurane was stopped at 30 min before operation cease and then the oxygen flow was recovered to 4 L/min until operation cease. Peak airway pressure( Ppeak) , mean airway pressure( Pmean) , airway resistance( Raw) , lung compliance( Cdyn) , arterial oxygen pressure( PaO2) , carbon dioxide pressure( PaCO2 ) were recorded before OLV(T0) and at 10 min(T1 ) , 30 min(T2) , 60 min(T3) min after OLV, 30 min (T4) after two lung ventilation. Results Ppeak, Pmean, Raw were increased (all P <0. 01) and Cdyn, PaO2 were decreased from T1 to T3 when compared with T0 in two groups (all P <0. 01) , there was no significant difference in other parameters from T0 to T4 between the two groups. Conclusion Low flow anesthesia has little effect on respiratory function in patients with lung cancer surgery. Low flow anesthesia can be safely used for one-lung ventilation.%目的 观察低流量单肺通气对肺癌手术患者呼吸功能的影响.方法 40例需单肺通气的择期肺癌手术患者,ASA Ⅰ~Ⅱ级,随机分为常流量组(A组)和低流量组(B组),各20例.两组单肺通气前吸入高流量(4 L/min)的氧气和1%安氟醚,10 min后将A组氧气流量调为3L/min,B组调为1L/min,两组每60 min给予高流量(4 L/min)的新鲜气体吸入5 min,手术结束前30 min停止吸入

  10. Correlation between timing of tracheostomy and duration of mechanical ventilation in patients with potentially normal lungs admitted to intensive care unit

    Mehrdad Masoudifar


    Conclusion: Our study with mentioned sample size could not show any relationship between timing of tracheostomy and duration of mechanical ventilation in patients under mechanical ventilation with good pulmonary function in ICU.

  11. Utilization of noninvasive ventilation in acute care hospitals: a regional survey

    Maheshwari, Vinay; Paioli, Daniela; Rothaar, Robert; Hill, Nicholas S


    ...) in the United States. Accordingly, we performed a survey on the use of NPPV at acute care hospitals in a region of the United States to determine variations in utilization and between hospitals, the reasons for lower...

  12. Effects of thoracic epidural anesthesia on pulmonary venous admixture and oxygenation with isoflurane or propofol anesthesia during one lung ventilation

    Reda S. Abdelrahman


    Conclusions: The administration of thoracic epidural anesthesia, either combined with propofol or isoflurane, was not associated with a relevant impairment of oxygenation during OLV. Therefore Pre-emptive analgesia via an epidural thoracic catheter can be used safely as a standard in lung surgery, decreasing the anesthesia requirements when combined with GA, maximizing the benefits of each form of anesthesia and improving the outcome in patients with cardiopulmonary diseases, hence it was found that it has no effect on oxygenation during OLV, and it is associated with stable hemodynamics.

  13. 液体通气:体外循环肺损伤的保护措施%Liquid ventilation:preventive intervention against cardiopulmonary bypass4nduced lung injury

    王晟; 刘进


    Prevention or reduction of cardiopulmonary bypass-induced pulmonary injury has become critically important researching aspect of cardiovascular anesthesia.Artificial circulation,ischemia/reperfusion injury and pulmonary re-expansion after collapse are the key elements to induce pulmonary inflammatory reaction.Liquid ventilation using perfluorocarbon has been shown to improve oxygenation after acute lung injury.Liquid ventilation can effectively reduce neutrophil infiltration and reactive oxygen species production in the lungs,thus exerting protective effects against acute lung injury.%预防或者减轻心肺转流(cardiopulmonary bypass,CPB)心脏手术引起的肺损伤是心血管麻醉一个极为重要的研究领域.人工的循环、缺血/再灌注损伤以及肺塌陷后复张是造成肺部炎症反应的关键因素.急性肺损伤后应用全氟化碳进行液体通气已经被证实可以改善肺的氧合.在体外循环前、期间以及体外循环后进行液体通气(liquid ventilation,LV),可以有效地减少中性粒细胞的浸润,减少肺内活性氧族产物,从而产生肺保护作用.

  14. Multiscale CT-Based Computational Modeling of Alveolar Gas Exchange during Artificial Lung Ventilation, Cluster (Biot and Periodic (Cheyne-Stokes Breathings and Bronchial Asthma Attack

    Andrey Golov


    Full Text Available An airflow in the first four generations of the tracheobronchial tree was simulated by the 1D model of incompressible fluid flow through the network of the elastic tubes coupled with 0D models of lumped alveolar components, which aggregates parts of the alveolar volume and smaller airways, extended with convective transport model throughout the lung and alveolar components which were combined with the model of oxygen and carbon dioxide transport between the alveolar volume and the averaged blood compartment during pathological respiratory conditions. The novel features of this work are 1D reconstruction of the tracheobronchial tree structure on the basis of 3D segmentation of the computed tomography (CT data; 1D−0D coupling of the models of 1D bronchial tube and 0D alveolar components; and the alveolar gas exchange model. The results of our simulations include mechanical ventilation, breathing patterns of severely ill patients with the cluster (Biot and periodic (Cheyne-Stokes respirations and bronchial asthma attack. The suitability of the proposed mathematical model was validated. Carbon dioxide elimination efficiency was analyzed in all these cases. In the future, these results might be integrated into research and practical studies aimed to design cyberbiological systems for remote real-time monitoring, classification, prediction of breathing patterns and alveolar gas exchange for patients with breathing problems.

  15. Effects of mechanical ventilation on cell apoptosis in lung tissue of rat with acute lung injury%机械通气对急性肺损伤大鼠细胞凋亡的影响

    陈宁; 赵鹤龄; 程彤; 申丽旻; 张耀宗


    Objective To investigate the effects of different tidal volumes and positive end expiratory pressures on cell apoptosis in lung tissue of rats with acute lung injury.Methods Forty healthy male Sprague-Dawley rats were randomly(random number)divided into five groups,namely low tidal volume group(LV,VT 8 mL/kg),high tidal volume group(HV,VT 30 mL/kg),low tidal volume group with PEEP 2cmH2O(LV2P,VT 8 mL/kg,PEEP 2 cmH2O),low tidal volume group and PEEP 5cmH2O (LV5P,VT 8 mL/kg,PEEP 5 cmH2O)and low tidal volume group and PEEP 8 cmH2O(LV8P,VT 8 mL/kg,PEEP 8 cmH2O).After intravenous administration of oleic acid(OA,0.1 mL/kg),the rat model of acute lung injury was made.Mechanical ventilation was employed in rats of the experiment groups.Rats were sacrificed and their whole lungs were taken after mechanical ventilation for 2 hours.The transferase d-UTP end labeling assay(TUNEL)was used to define the extent and distribution of apoptotic cells in bronchus and lung tissues.The level of caspase-3 protein was determined by immunohistochemistry.Results The apoptotic cells on both alveolar septum and bronchial epithelium obviously increased with high level of caaspase-3 protein in HV group.The number of apoptotic cells obviously decreased with decrease in caspase-3 protein after PEEP ventilation.These changes were more significant in LV5P than those in other groups(P < 0.01).Conclusions The mechanical ventilation with low tidal volume and PEEP produces protective effects on lung from injury.The cell apoptosis plays an important role in the course of VILI.%目的 研究不同潮气量及不同呼气末正压(PEEP)水平对急性肺损伤(AU)大鼠支气管和肺组织细胞凋亡的影响,并初步探讨细胞凋亡在呼吸机相关性肺损伤(VILI)中的作用机制.方法 选用40只SD大鼠,制作ALI模型,随机(随机数字法)分为:(1)小潮气量组(LV组),潮气量8 mL/kg,不加PEEP;(2)大潮气量组,潮气量30 mL./kg,不加PEEP;(3)小潮气量+ 2PEEP组(LV2P

  16. Rapid ventilation of the Mexico City basin and regional fate of the urban plume

    B. de Foy


    Full Text Available Urban areas can be large emitters of air pollutants leading to negative health effects and environmental degradation. The rate of venting of these airsheds determines the pollutant loading for given emission levels, and also determines the regional impacts of the urban plume. Mexico City has approximately 20 million people living in a high altitude basin with air pollutant concentrations above the health limits most days of the year. A mesoscale meteorological model (MM5 and a particle trajectory model (FLEXPART are used to simulate air flow within the Mexico City basin and the fate of the urban plume during the MCMA-2003 field campaign. The simulated trajectories are validated against pilot balloon and radiosonde trajectories. The residence time of air within the basin and the impacted areas are identified by episode type. Three specific cases are analysed to identify the meteorological processes involved. For most days, residence times in the basin are less than 12 h with little carry-over from day to day and little recirculation of air back into the basin. Very efficient vertical mixing leads to a vertically diluted plume which, in April, is transported predominantly towards the Gulf of Mexico. Regional accumulation was found to take place for some days however, with urban emissions sometimes staying over Mexico for more than 6 days. Knowledge of the residence times, recirculation patterns and venting mechanisms will be useful in guiding policies for improving the air quality of the MCMA.

  17. Human versus Computer Controlled Selection of Ventilator Settings: An Evaluation of Adaptive Support Ventilation and Mid-Frequency Ventilation

    Eduardo Mireles-Cabodevila


    Full Text Available Background. There are modes of mechanical ventilation that can select ventilator settings with computer controlled algorithms (targeting schemes. Two examples are adaptive support ventilation (ASV and mid-frequency ventilation (MFV. We studied how different clinician-chosen ventilator settings are from these computer algorithms under different scenarios. Methods. A survey of critical care clinicians provided reference ventilator settings for a 70 kg paralyzed patient in five clinical/physiological scenarios. The survey-derived values for minute ventilation and minute alveolar ventilation were used as goals for ASV and MFV, respectively. A lung simulator programmed with each scenario’s respiratory system characteristics was ventilated using the clinician, ASV, and MFV settings. Results. Tidal volumes ranged from 6.1 to 8.3 mL/kg for the clinician, 6.7 to 11.9 mL/kg for ASV, and 3.5 to 9.9 mL/kg for MFV. Inspiratory pressures were lower for ASV and MFV. Clinician-selected tidal volumes were similar to the ASV settings for all scenarios except for asthma, in which the tidal volumes were larger for ASV and MFV. MFV delivered the same alveolar minute ventilation with higher end expiratory and lower end inspiratory volumes. Conclusions. There are differences and similarities among initial ventilator settings selected by humans and computers for various clinical scenarios. The ventilation outcomes are the result of the lung physiological characteristics and their interaction with the targeting scheme.

  18. Pharmacologic Interventions to Improve Splanchnic Oxygenation During Ventilation with Positive End-Expiratory Pressure

    Fournell, A.; Scheeren, T. W. L.; Picker, O.; Schwarte, L. A.; Wolf, M; Bucher, HU; Rudin, M; VanHuffel, S; Wolf, U; Bruley, DF; Harrison, DK


    Mechanical ventilation with positive end-expiratory pressure (PEEP) is an indispensable tool in the management of respiratory failure to preserve or improve lung function and systemic oxygenation. However, PEEP per se may also, as has been shown in experimental animals, impair regional microcirculat

  19. Ventilation/perfusion lung scintigraphy: what is still needed? A review considering technetium-99m-labeled macro-aggregates of albumin.

    Zöphel, Klaus; Bacher-Stier, Claudia; Pinkert, Jörg; Kropp, Joachim


    Lung perfusion scintigraphy (LPS) with technetium-99m-labeled macro-aggregates of albumin (Tc-99m-MAA) is well established in the diagnostic of pulmonary embolism (PE). In the last decade, it was shown that single-photon emission computer tomography (SPECT) acquisition of LPS overcame static scintigraphy. Furthermore, there are rare indications for LPS, such as preoperative quantification of regional lung function prior to lung resection or transplantation, optimization of lung cancer radiation therapy, quantification of right-left shunt, planning of intra-arterial chemotherapy, and several rare indications in pediatrics. Moreover, LPS with Tc-99m-MAA is a safe method with low radiation exposure. PE can also be diagnosed by spiral computer tomography (CT), ultrasound, magnetic resonance angiography, or pulmonary angiography (PA, former gold standard). The present review considers all these methods, especially spiral CT, and compares them with LPS with respect to sensitivity and specificity and gives an overview of established and newer publications. It shows that LPS with Tc-99m-MAA represents a diagnostic method of continuing value for PE. In comparison with spiral CT and/or PA, LPS is not to be defeated as mentioned also by the most actual Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) II reports. This applies in particular to chronic or recurring embolisms, whereas currently spiral CT may be of greater value for major or life-threatening embolisms. At present, LPS cannot be replaced by other methods in some applications, such as pediatrics or in the quantification of regional pulmonary function in a preoperative context or prior to radiation therapy. LPS still has a place in the diagnostics of PE and is irreplaceable in several rare indications as described earlier.

  20. Accuracy of FDG-PET to diagnose lung cancer in a region of endemic granulomatous disease.

    Deppen, Stephen; Putnam, Joe B; Andrade, Gabriela; Speroff, Theodore; Nesbitt, Jonathan C; Lambright, Eric S; Massion, Pierre P; Walker, Ron; Grogan, Eric L


    The 18 F-fluorodeoxyglucose-positron emission tomography (FDG-PET) is used to evaluate suspicious pulmonary lesions due to its diagnostic accuracy. The southeastern United States has a high prevalence of infectious granulomatous lung disease, and the accuracy of FDG-PET may be reduced in this population. We examined the diagnostic accuracy of FDG-PET in patients with known or suspected non-small cell lung cancer treated at our institution. A total of 279 patients, identified through our prospective database, underwent an operation for known or suspected lung cancer. Preoperative FDG-PET in 211 eligible patients was defined by standardized uptake value greater than 2.5 or by description ("moderate" or "intense") as avid. Sensitivity, specificity, positive and negative predictive values, likelihood ratios, and decision diagrams were calculated for FDG-PET in all patients and in patients with indeterminate nodules. In all eligible patients (n=211), sensitivity and specificity of FDG-PET were 92% and 40%, respectively. Positive and negative predictive values were 86% and 55%. Overall FDG-PET accuracy to diagnose lung cancer was 81%. Preoperative positive likelihood ratio for FDG-PET diagnosis of lung cancer in this population was 1.5 compared with previously published values of 7.1. In 113 indeterminate lesions, 65% had lung cancer and the sensitivity and specificity were 89% and 40%, respectively. Twenty-four benign nodules (60%) had false positive FDG-PET scans. Twenty-two of 43 benign nodules (51%) were granulomas. In a region with endemic granulomatous diseases, the specificity of FDG-PET for diagnosis of lung cancer was 40%. Clinical decisions and future clinical predictive models for lung cancer must accommodate regional variation of FDG-PET scan results. Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  1. Discovery and Evaluation of Polymorphisms in the and Promoter Regions for Risk of Korean Lung Cancer

    Jae Sook Sung


    Full Text Available AKT is a signal transduction protein that plays a central role in the tumorigenesis. There are 3 mammalian isoforms of this serine/threonine protein kinase-AKT1, AKT2, and AKT3-showing a broad tissue distribution. We first discovered 2 novel polymorphisms (AKT2 -9826 C/G and AKT3 -811 A/G, and we confirmed 6 known polymorphisms (AKT2 -9473 C/T, AKT2 -9151 C/T, AKT2 -9025 C/T, AKT2 -8618G/A, AKT3 -675 A/-, and AKT3 -244 C/T of the AKT2 and AKT3 promoter region in 24 blood samples of Korean lung cancer patients using direct sequencing. To evaluate the role of AKT2 and AKT3 polymorphisms in the risk of Korean lung cancer, genotypes of the AKT2 and AKT3 polymorphisms (AKT2 -9826 C/G, AKT2 -9473 C/T, AKT2 -9151 C/T, AKT2 -9025 C/T, AKT2 -8618G/A, and AKT3 -675 A/- were determined in 360 lung cancer patients and 360 normal controls. Statistical analyses revealed that the genotypes and haplotypes in the AKT2 and AKT3 promoter regions were not significantly associated with the risk of lung cancer in the Korean population. These results suggest that polymorphisms of the AKT2 and AKT3 promoter regions do not contribute to the genetic susceptibility to lung cancer in the Korean population.

  2. High Frequency Oscillatory Ventilation

    AC Bryan


    Full Text Available High frequency oscillatory (HFO ventilation using low tidal volume and peak airway pressures is extremely efficient at eliminating carbon dioxide and raising pH in the newborn infant with acute respiratory failure. Improvement in oxygenation requires a strategy of sustained or repetitive inflations to 25 to 30 cm H2O in order to place the lung on the deflation limb of the pressure-volume curve. This strategy has also been shown to decrease the amount of secondary lung injury in animal models. Experience of the use of HFO ventilation as a rescue therapy as well as several published controlled trials have shown improved outcomes and a decrease in the use of extracorporeal membrane oxygenation when it has been used in newborns.

  3. Ventilation effectiveness

    Mathisen, Hans Martin; Nielsen, Peter V; Moser, Alfred


    Improving the ventilation effectiveness allows the indoor air quality to be significantly enhanced without the need for higher air changes in the building, thereby avoiding the higher costs and energy consumption associated with increasing the ventilation rates. This Guidebook provides easy-to-understand descriptions of the indices used to mesure the performance of a ventilation system and which indices to use in different cases.

  4. [Nucleotide sequence of HLA-DQA1 promoter region (QAP) in a lung cancer patient].

    Qiu, C; Zhou, W; Song, C


    The HLA-DQA1 allele and nucleotide sequence of HLA-DQA1 promoter region (QAP) in a patient with IDDM complicated lung cancer have been identified by PCR/SSCP, PCR/SSCP and PCR/sequencing. The results showed that: (1) All of the lung cancer patient and his family members carried HLA-DQA1* 0301/0501 alleles. (2) a single base substitution G-->A at position -155 and deletion CAA at position -161 to -163 occurred in the patient. These results suggest that the mutation of HLA-DQA1 promoter region may modulate HLA-DQA1 gene expression by trans-acting factors binding to variant cis-acting elements and may be responsible for pathogenesis of lung cancer.

  5. Demand Controlled Ventilation and Classroom Ventilation

    Fisk, William J. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Mendell, Mark J. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Davies, Molly [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Eliseeva, Ekaterina [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Faulkner, David [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Hong, Tienzen [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Sullivan, Douglas P. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)


    This document summarizes a research effort on demand controlled ventilation and classroom ventilation. The research on demand controlled ventilation included field studies and building energy modeling.

  6. Displacement Ventilation

    Nielsen, Peter Vilhelm

    Displacement ventilation is an interesting new type of air distribution principle which should be considered in connection with design of comfort ventilation in both smal1 and large spaces. Research activities on displacement ventilation are large all over the world and new knowledge of design...... methods appears continuously. This book gives an easy introduction to the basis of displacement ventilation and the chapters are written in the order which is used in a design procedure. The main text is extended by five appendices which show some of the new research activities taking place at Aalborg...

  7. Vagal denervation inhibits the increase in pulmonary blood flow during partial lung aeration at birth.

    Lang, Justin A R; Pearson, James T; Binder-Heschl, Corinna; Wallace, Megan J; Siew, Melissa L; Kitchen, Marcus J; Te Pas, Arjan B; Lewis, Robert A; Polglase, Graeme R; Shirai, Mikiyasu; Hooper, Stuart B


    Lung aeration at birth significantly increases pulmonary blood flow, which is unrelated to increased oxygenation or other spatial relationships that match ventilation to perfusion. Using simultaneous X-ray imaging and angiography in near-term rabbits, we investigated the relative contributions of the vagus nerve and oxygenation to the increase in pulmonary blood flow at birth. Vagal denervation inhibited the global increase in pulmonary blood flow induced by partial lung aeration, although high inspired oxygen concentrations can partially mitigate this effect. The results of the present study indicate that a vagal reflex may mediate a rapid global increase in pulmonary blood flow in response to partial lung aeration. Air entry into the lungs at birth triggers major cardiovascular changes, including a large increase in pulmonary blood flow (PBF) that is not spatially related to regional lung aeration. To investigate the possible underlying role of a vagally-mediated stimulus, we used simultaneous phase-contrast X-ray imaging and angiography in near-term (30 days of gestation) vagotomized (n = 15) or sham-operated (n = 15) rabbit kittens. Rabbits were imaged before ventilation, when one lung was ventilated (unilateral) with 100% nitrogen (N2 ), air or 100% oxygen (O2 ), and after all kittens were switched to unilateral ventilation in air and then ventilation of both lungs using air. Compared to control kittens, vagotomized kittens had little or no increase in PBF in both lungs following unilateral ventilation when ventilation occurred with 100% N2 or with air. However, relative PBF did increase in vagotomized animals ventilated with 100% O2 , indicating the independent stimulatory effects of local oxygen concentration and autonomic innervation on the changes in PBF at birth. These findings demonstrate that vagal denervation inhibits the previously observed increase in PBF with partial lung aeration, although high inspired oxygen concentrations can partially

  8. The ability of the Vigileo-FloTrac system to measure cardiac output and track cardiac output changes during one-lung ventilation.

    Suehiro, Koichi; Tanaka, Katsuaki; Yamada, Tokuhiro; Matsuura, Tadashi; Mori, Takashi; Funao, Tomoharu; Nishikawa, Kiyonobu


    This study was aimed at comparing the cardiac output (CO) measured by the Vigileo™-FloTrac™ system with that estimated by the thermodilution pulmonary artery catheter (PAC) during one-lung ventilation (OLV) and determining the reliability of this system in tracking phenylephrine-induced CO changes during OLV. Sixteen patients scheduled for descending aorta replacement were enrolled. The study was performed 30 min after starting OLV under stable hemodynamic conditions. We recorded hemodynamic variables, CO measured by PAC thermodilution (ICO), CO measured by Vigileo™-FloTrac™ system (Version 3.02, Edwards Lifesciences, Irvine, CA, USA) (APCO), and systemic vascular resistance index (SVRI) before (T0) and after (T1) phenylephrine (100 μg) administration. We used Bland-Altman analysis to compare ICO and APCO. Polar plot and four-quadrant plot were used to assess the tracking ability of the Vigileo™-FloTrac™ system against ICO after administration of phenylephrine. Ninety hemodynamic interventions were performed. Bland-Altman analysis revealed that the mean bias between APCO and ICO was 0.05 L/min and the percentage error, 46.9 %. Four-quadrant plot analysis showed a concordance rate of 24.7 %, while polar plot analysis showed that the concordance rate was 13.3 %; the angular bias, -45.9°; radial limit of agreement, 85.3°. The bias between APCO and ICO was significantly correlated with the SVRI value (p < 0.001, r(2) = 0.822). The reliability of the Vigileo™-FloTrac™ system during OLV to estimate CO and track phenylephrine-induced CO changes was not acceptable.

  9. Can non-invasive positive pressure ventilation prevent endotracheal intubation in acute lung injury/acute respiratory distress syndrome? A meta-analysis.

    Luo, Jian; Wang, Mao-yun; Zhu, Hui; Liang, Bin-miao; Liu, Dan; Peng, Xia-ying; Wang, Rong-chun; Li, Chun-tao; He, Chen-yun; Liang, Zong-an


    The role of non-invasive positive pressure ventilation (NIPPV) in acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) is controversial. The aim of this study was to investigate whether NIPPV could prevent endotracheal intubation and decrease mortality rate in patients with ALI/ARDS. Randomized controlled trials (RCT) which reported endotracheal intubation and mortality rate in patients with ALI/ARDS treated by NIPPV were identified in Pubmed, Medline, Embase, Central Cochrane Controlled Trials Register, Chinese National Knowledge Infrastructure, reference lists and by manual searches. Fixed- and random-effects models were used to calculate pooled relative risks. This meta-analysis included six RCT involving 227 patients. The results showed that endotracheal intubation rate was lower in NIPPV (95% confidence interval (CI): 0.44-0.80, z = 3.44, P = 0.0006), but no significant difference was found either in intensive care unit (ICU) mortality (95% CI: 0.45-1.07, z = 1.65, P = 0.10) or in hospital mortality (95% CI: 0.17-1.58, z = 1.16, P = 0.25). Only two studies discussed the aetiology of ALI/ARDS as pulmonary or extra-pulmonary, and neither showed statistical heterogeneity (I(2)  = 0%, χ(2)  = 0.31, P = 0.58), nor a significant difference in endotracheal intubation rate (95% CI: 0.35-9.08, z = 0.69, P = 0.49). In conclusion, the early use of NIPPV can decrease the endotracheal intubation rate in patients with ALI/ARDS, but does not change the mortality of these patients.

  10. Prevalence of acute pulmonary embolism in central and subsegmental pulmonary arteries and relation to probability interpretation of ventilation/perfusion lung scans.

    Stein, P D; Henry, J W


    The purpose of this investigation is to determine the prevalence of acute pulmonary embolism (PE) limited to subsegmental pulmonary arteries. Contrast-enhanced helical (spiral) and electron-beam CT, in the hands of experienced radiologists who are skillful with this modality, are sensitive for the detection of acute PE in central pulmonary arteries, but have a low sensitivity for the detection of PE limited to subsegmental pulmonary arteries. The potential for CT to diagnose PE, therefore, is partially dependent on the prevalence of PE limited to subsegmental pulmonary arteries. Data are from the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED). The largest pulmonary arteries that showed PE, as interpreted by the PIOPED angiographic readers, were identified in 375 patients in PIOPED with angiographically diagnosed PE. Among all patients with PE, 6% (95% confidence interval [CI], 4 to 9%) had PE limited to subsegmental branches of the pulmonary artery. Patients with high-probability ventilation/ perfusion (V/Q) scans had PE limited to subsegmental branches in only 1% (95% CI, 0 to 4%). Among patients with low-probability V/Q lung scans, 17% (95% CI, 8 to 29%) had PE limited to the subsegmental branches. Patients with low-probability V/Q scans and no prior cardiopulmonary disease had PE limited to the subsegmental pulmonary arteries in 30% (95% CI, 13 to 53%), whereas patients with low-probability V/Q scans who had prior cardiopulmonary disease had PE limited to subsegmental pulmonary arteries in 8% (95% CI, 2 to 22%) (p PIOPED, the prevalence of PE limited to subsegmental pulmonary arteries is low, 6%. PE limited to subsegmental pulmonary arteries was most prevalent among patients with low-probability V/Q scans, particularly if they had no prior cardiopulmonary disease.

  11. Effects of Salbutamol on lung collapse during one-lung ventilation in patients with chronic obstructive pulmonary disease%沙丁胺醇对慢性阻塞性肺疾病患者单肺通气时肺萎陷的影响

    周其富; 蒋宗明; 王海勇


    AIM: To study the effects of Sal-butamol aerosol inhalation prior to anesthesia induction on lung collapse during one lung ventilation in patients with chronic obstructive pulmonary disease. METHODS: Fourty patients with concomitant chronic obstructive pulmonary disease , scheduled for lobectomy were randomly allocated into observation group(n = 20) and control group(n = 20) . Salbutamol aerosol 200 μg (two puffs) were administered according to instructions before oxygenation via mask in observation group, whereas in control group no aerosol was given before oxygenation via mask. Anesthesia induction was initiated after 30 minutes' oxygenation in both groups. Extent of lung collapse was evaluated by verbal scale in 10 minutes and 20 minutes after one lung ventilation. Blood gas analysis was assayed in baseline, before anesthesia induction, double lung ventilation and 30 minutes during one lung ventilation (every 10minutes was performed). RESULTS: There was statistical significance in lung collapse score between observation group and control group(P< 0.05), the former was superior to the latter. Compared with the control group, the value of PaCO2 in anesthesia induction, double lung ventilation, 10 minutes and 20 minutes after one lung ventilation were lower than that in observation group, however , the value of PaO2 were higher in respective time. CONCLUSION: Salbutamol aerosol inhalation can accelerate lung collapse in early stage of one lung ventilation and at the same time provide better surgical access condition in patients with chronic obstructive pulmonary disease.%目的:麻醉诱导前吸入硫酸沙丁胺醇气雾剂(万托林),观察其对慢性-阻塞性肺疾病(COPD)患者单肺通气期间的肺萎陷的影响.方法:合并慢性阻塞性肺疾病的拟行肺叶切除手术的患者40例,随机分成观察组和对照组各20例,观察组:患者给予万托林200 μg(2揿)后面罩吸氧;对照组:单纯面罩吸氧,30 min后开始麻

  12. Clinical Observation of Single lumen endotracheal tube used for children with single lung ventilation%单腔气管导管用于儿童单肺通气的临床应用观察

    汪俊; 汪幸; 韩芬; 夏迎静


    目的:通过观察单腔气管导管用于儿童单肺通气(OLV)的应用,探讨其在临床应用的安全性。方法:随机选取14例行胸科手术患儿,全麻诱导气管插管后,将单腔气管导管在纤维支气管镜(φ:2.8mm)引导下置入健侧主支气管,并经听诊后确定封堵效果。观察单肺通气前(T1),单肺通气5mim后(T2),单肺通气结束前(T3),单肺通气结束后(T4)的心率HR、血压BP、SpO2、动脉血气分析、气道压力(PAW)变化。结果:左侧单肺通气5例,右侧单肺通气9例,单肺通气时间40~210mim。全组病例PaO2:T2较T1明显下降(204±102.2),T3持续小幅下降(202.9±112.3);T4基本恢复至单肺通气前水平(393.6±88.3)。 PaCO2:T2上升(36±4.8),T3持续升高(39.6±5.2),T4降至术前水平(36±5.1);PAW:T2升高(22±2.9),T3维持较高水平(21.4±2.3),T4恢复术前水平(17.9±1.9)。全组病例pH值各时间点数据无明显变化。结论:单腔气管导管能够安全的用于儿童的单肺通气。%Objective:by observing the single lumen endotracheal tube application of one-lung ventilation (OLV) in children and its safety in clinical application. Methods:randomly selected 14 children with routine thoracic surgery, after endotracheal intubation of general anesthesia induction, the single lumen endotracheal tube in fiber broncho-scope (φ:2.8 mm) guided into the contralateral primary bronchus, and determine the effect after auscultation. One-lung ventilation (T1), before the observation after 5 mim one-lung ventilation (T2), before the end of single lung ventilation (T3), single lung ventilation (T4), heart rate after HR, blood pressure (BP), SpO2, arterial blood gas analysis, and airway pressure changes (PAW). One-lung ventilation in 5 cases,Results:the left the right side of the 9 cases of single lung ventilation, 40-210 mim one-lung ventilation time. Incidence

  13. Initial ventilator settings for critically ill patients.

    Kilickaya, Oguz; Gajic, Ognjen


    The lung-protective mechanical ventilation strategy has been standard practice for management of acute respiratory distress syndrome (ARDS) for more than a decade. Observational data, small randomized studies and two recent systematic reviews suggest that lung protective ventilation is both safe and potentially beneficial in patients who do not have ARDS at the onset of mechanical ventilation. Principles of lung-protective ventilation include: a) prevention of volutrauma (tidal volume 4 to 8 ml/kg predicted body weight with plateau pressurerespiratory rate 20 to 35 breaths per minute); and d) prevention of hyperoxia (titrate inspired oxygen concentration to peripheral oxygen saturation (SpO2) levels of 88 to 95%). Most patients tolerate lung protective mechanical ventilation well without the need for excessive sedation. Patients with a stiff chest wall may tolerate higher plateau pressure targets (approximately 35 cmH2O) while those with severe ARDS and ventilator asynchrony may require a short-term neuromuscular blockade. Given the difficulty in timely identification of patients with or at risk of ARDS and both the safety and potential benefit in patients without ARDS, lung-protective mechanical ventilation is recommended as an initial approach to mechanical ventilation in both perioperative and critical care settings.

  14. Pulmonary functional MRI:an animal model study of oxygen-enhanced ventilation combined with Gd-DTPA-enhanced perfusion

    杨健; 万明习; 郭佑民


    Background The assessment of regional pulmonary ventilation and perfusion is essential for the evaluation of a variety of lung disorders. Pulmonary ventilation MRI using inhaled oxygen as a contrast medium can be obtained with a clinical MR scanner, without additional equipment, and has been demonstrated to be a feasible means of assessing ventilation in animal models and some clinical patients. However, few studies have reported on MR ventilation-perfusion imaging. In this study, we evaluated the usefulness of oxygen-enhanced ventilation in combination with first-pass Gd-DTPA-enhanced perfusion MRI in a canine model of pulmonary embolism and airway obstruction.Methods Peripheral pulmonary embolisms were produced in eight dogs by intravenous injection of gelfoam strips at the pulmonary segmental arterial level, and airway obstructions were created in five of the dogs by inserting a self-designed balloon catheter into a secondary bronchus. Oxygen-enhanced MR ventilation images were produced by subtracting images from before and after inhalation of pure oxygen. Pulmonary perfusion MR images were acquired with a dynamic three-dimensional fast gradient-echo sequence. MR ventilation and perfusion images were read and contrasted with results from general examinations of pathological anatomy, ventilation-perfusion scintigraphy, and pulmonary angiography. Results Regions identified as having airway obstructions matched using both MR ventilation and perfusion imaging, but regions of pulmonary embolisms were mismatched. The area of airway obstruction defects was smaller using MR ventilation imagery than that using ventilation scintigraphy. Abnormal perfusion regions due to pulmonary embolisms were divided into defective regions and reduced regions based on the time course of signal intensity changes. In the diagnosis of pulmonary embolisms with the technique of ventilation and perfusion MRI, sensitivity and specificity were 75.0% and 98.1%, respectively, and the diagnostic

  15. Effects of APRV-BIPAP ventilation On lung recruitment/open maneuvers in piglets with acute lung injury%双相正压通气对急性肺损伤猪肺复张/开放的影响

    殷娜; 宋志芳; 谢伟; 吴增斌; 杨晓路; 葛晓莉; 王莹


    Objective To study the effects of APBV (airway pressure release ventilation) / BIPAP(bipha-sic positive airway pressure) on lung recmitment/open maneuvers in piglets with acute lung injury. Method The model of acute lung injury (ALI) was induced by E. coll. intraperitoneal injection in piglets. Based APRV/BI-PAP model, the different pressure combinations (Phigh/Plow) of RMs increased gradually, such as RMI(30/15),RM2(35/20), RM3(40/25), RM4(45/30),RM5(50/35), RM6(55/40), RM7(60/45) cmH2O. The effects of stepwise RMs were studied by computed tomography (CT) at iaspiratory phase. Meantime the oxygen index (PaO2/FiO2), hemodynamic parameter and mean pressure of airway (Pmean) were continuously observed. The piglets were killed when RiMs finished and pulmonary pathological examination were done routinely by optical microscope. Data was analyzed by self-contrast method, using SPSS 11.5 software package. Results were expressed as mean ± standard deviation (x±s). Multiple comparisons were made with One-way ANOVA. Pearson correlative analysis was used to describe the relativity of PaO2/FiO2 and the collapsed alveolar area. Changes were considered as statistically significant if P value was less than 0.05. Results Eight piglets with ALl model were successfully made and all of them showed different degree of alveolar collapse under chest CT scan. During RMs their PaO2/FiO2 increased obviously (P0.05);研究过程中未发生气胸、纵隔气肿等,但病理检查有肺泡过度膨胀和间隔断裂.结论 借助APRV-BIPAP模式逐步递增压力组合实施RMs,35/20 cmH2O是最佳压力组合,对血流动力学和气道压等影响小;一旦RMs获得疗效满意,设置30/15 cmH2O维持20 min,RMs疗效好.




    A combination of cytogenetic and molecular studies has implicated the p21 region of human chromosome 3 as the probable site of a gene the loss of which contributes to the development of small cell lung cancer. We report here the isolation of a gene from this region which is expressed in normal lung

  17. Ventilation Effectiveness

    Mundt, M.; Mathisen, H. M.; Moser, M.;

    Improving the ventilation effectiveness allows the indoor air quality to be significantly enhanced without the need for higher air changes in the building, thereby avoiding the higher costs and energy consumption associated with increasing the ventilation rates. This Guidebook provides easy...

  18. Effect of low tidal volume one lung ventilation plus positive end-expiratory pressure on inflammatory responses of pulmonary in patients with lung cancer operation%低潮气量单肺通气复合呼气末正压对肺癌手术患者肺部炎症反应的影响



    Objective To compare the effect of low tidal volume and normal tidal volume one lung ventilation plus positive end-expiratory pressure(PEEP) on inflammatory responses of pulmonary in patients with lung cancer operation.Methods Divided 40 patients with lung cancer operation into PEEP group(group L) and normal tidal volume one lung ventilation group(goup N), 20 cases in each group, tumor necrosis factor-α(TNF-α), Interleukin-6(IL-6), Interleukin-8(IL-8) and Interleukin-10(IL-10) were assessed with ELISA on the following time①two lung ventilation after anesthesia induction(T1); ②60 min after one lung ventilation (T2); ③90 min after one lung ventilation (T3); ④60 min after two lung ventilation(T4); ⑤1d after operation (T5). Results Compared to T1, TNF-α、IL-6、IL-8 and IL-10 were increased in other time point in both groups. The TNF-α、IL-6、IL -8 in group L were significant decreased than group N in T2, T3, T4, T5 time point(P<0.05). The IL-10 in group L were significant increased than group N in T2, T3, T4, T5 time point(P<0.05).Conclusion Low tidal volume one lung ventilation plus positive end-expiratory pressure can lessen pulmonary inflammatory response obviously than normal tidal volume and relieve the lung injury.%目的:对比低潮气量单肺通气复合呼气末正压(PEEP)与正常潮气量单肺通气对肺癌手术患者肺部炎症反应的影响。方法40例择期肺癌手术患者随机分为低潮气量单肺通气复合PEEP组(L组)和正常潮气量单肺通气组(N组),每组20例。两组患者分别在麻醉诱导后双肺通气时(T1)、单肺通气60 min时(T2)、单肺通气90 min时(T3)、术毕双肺通气60 min时(T4)、术后1 d(T5)采取外周静脉血,采用放射酶联免疫吸附法(ELISA)测量肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)及白细胞介素-10(IL-10)水平。结果与T1比较,两组各时点血浆TNF-α, IL-6, IL-8及IL-10水平均持续升高(P<0.05)

  19. Effect of high volume mechanical ventilation on radiation-induced lung toxicity in rats%机械通气对大鼠照射后肺组织及细胞凋亡的影响

    金胜; 陈军; 叶繁; 冯丹


    Objective To evaluate the effects of mechanical ventilation on radiation induced lung injuries of apoptosis,acute inflammation,and oxidative stress by establishing a rat mechanical ventilation model and animal model.Methods Totally 40 male Sprague-Dawley(SD) rats were randomly divided into 4 groups with 10 rats in each group:control,radiation alone,high tidal volume ventilation,and high tidal volume ventilation following by radiation.After treatment,the pathological changes in lung tissue were observed,NF-κB activity was detected by electrophoretic mobility shift assay (EMSA),the expression of NF-κB subunit P65 protein level in lung cell nucleus was detected by Western blot,and the apoptosis of lung cells was detected by terminal dexynucleotidyl transferase (TdT)-mediated dUTP nick end labeling (TUNEL) method.The wet to dry weight ratio (W/D) of lung,myeloperoxidase (MPO),malondialdehyde (MDA) and superoxide dismutase (SOD) were detected.In addition,the total protein and white blood cell number in lung lavage fluid were also measured.Results Compared to the control,the acute lung injury (ALI) score,W/D ratio,MPO activity,total protein level,white blood cell number,apoptosis index (AI),lung tissue MDA,NF-κB activity and P65 protein expression were increased significantly (q =0.000 32-0.004 81,P <0.05),while SOD values was decreased significantly (q =0.000 18-0.002 53,P <0.01),in other three groups.Compared with radiation and high tidal volume ventilation group,the above indexes were significantly higher (q =0.004 3-0.022 6,P < 0.05) but the SOD value was significantly lower (q =0.002 9-0.008 3,P < 0.05) than those in the high tidal volume ventilation plus radiation group.Conclusions High tidal volume ventilation delivered to the radiation group produced more transparent ventilator-induced lung injury (VILI) than the high tidal volume ventilation alone induced VILI including permeable pulmonary edema,acute inflammation,oxidative stress and apoptosis in

  20. Lung scintigraphy in differential diagnosis of peripheral lung cancer and community-acquired pneumonia

    Krivonogov, Nikolay G., E-mail: [Research Institute of Cardiology, Kievskaya Street 111a, Tomsk, 634012 (Russian Federation); Efimova, Nataliya Y., E-mail:; Zavadovsky, Konstantin W.; Lishmanov, Yuri B. [Research Institute of Cardiology, Kievskaya Street 111a, Tomsk, 634012 (Russian Federation); Tomsk Polytechnic University, Lenin Avenue 30, Tomsk, 634050 (Russian Federation)


    Ventilation/perfusion lung scintigraphy was performed in 39 patients with verified diagnosis of community-acquired pneumonia (CAP) and in 14 patients with peripheral lung cancer. Ventilation/perfusion ratio, apical-basal gradients of ventilation (U/L(V)) and lung perfusion (U/L(P)), and alveolar capillary permeability of radionuclide aerosol were determined based on scintigraphy data. The study demonstrated that main signs of CAP were increases in ventilation/perfusion ratio, perfusion and ventilation gradient on a side of the diseased lung, and two-side increase in alveolar capillary permeability rate for radionuclide aerosol. Unlike this, scintigraphic signs of peripheral lung cancer comprise an increase in ventilation/perfusion ratio over 1.0 on a side of the diseased lung with its simultaneous decrease on a contralateral side, normal values of perfusion and ventilation gradients of both lungs, and delayed alveolar capillary clearance in the diseased lung compared with the intact lung.

  1. Lung scintigraphy in differential diagnosis of peripheral lung cancer and community-acquired pneumonia

    Krivonogov, Nikolay G.; Efimova, Nataliya Y.; Zavadovsky, Konstantin W.; Lishmanov, Yuri B.


    Ventilation/perfusion lung scintigraphy was performed in 39 patients with verified diagnosis of community-acquired pneumonia (CAP) and in 14 patients with peripheral lung cancer. Ventilation/perfusion ratio, apical-basal gradients of ventilation (U/L(V)) and lung perfusion (U/L(P)), and alveolar capillary permeability of radionuclide aerosol were determined based on scintigraphy data. The study demonstrated that main signs of CAP were increases in ventilation/perfusion ratio, perfusion and ventilation gradient on a side of the diseased lung, and two-side increase in alveolar capillary permeability rate for radionuclide aerosol. Unlike this, scintigraphic signs of peripheral lung cancer comprise an increase in ventilation/perfusion ratio over 1.0 on a side of the diseased lung with its simultaneous decrease on a contralateral side, normal values of perfusion and ventilation gradients of both lungs, and delayed alveolar capillary clearance in the diseased lung compared with the intact lung.

  2. Trends in corrected lung cancer mortality rates in Brazil and regions

    Malta, Deborah Carvalho; de Abreu, Daisy Maria Xavier; de Moura, Lenildo; Lana, Gustavo C; Azevedo, Gulnar; França, Elisabeth


    ABSTRACT OBJECTIVE To describe the trend in