Crit Care Med
Dipartimento dell'Emergenza e Trapianti d'Organo, Sezione di Chirurgia Veterinaria, Università degli Studi Aldo Moro, Bari, Italy.
Published: July 2012
Rationale: In the presence of increased chest wall elastance, the airway pressure does not reflect the lung-distending (transpulmonary) pressure.
Objective: To compare the physiological effects of a conventional open lung approach titrated for an end-inspiratory airway opening plateau pressure (30 cm H2O) with a transpulmonary open lung approach titrated for a elastance-derived end-inspiratory plateau transpulmonary pressure (26 cm H2O), in a pig model of acute respiratory distress syndrome (HCl inhalation) and reversible chest wall mechanical impairment (chest wall and abdomen restriction).
Methods: In eight pigs, physiological parameters and computed tomography were recorded under three conditions: 1) conventional open lung approach, normal chest wall; 2) conventional open lung approach, stiff chest wall; and 3) transpulmonary open lung approach, stiff chest wall.
Measurements And Main Results: As compared with the normal chest wall condition, at end-expiration non aerated lung tissue weight was increased by 116 ± 68 % during the conventional open lung approach and by 28 ± 41 % during the transpulmonary open lung approach (p < .01), whereas cardiac output was decreased by 27 ± 19 % and 22 ± 14 %, respectively (p = not significant).
Conclusion: In this model, the end-inspiratory transpulmonary open lung approach minimized the impact of chest wall stiffening on alveolar recruitment without causing hemodynamic impairment.
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http://dx.doi.org/10.1097/CCM.0b013e31824e1b65 | DOI Listing |
Ann Oncol
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ETOP IBCSG Partners Foundation, Coordinating Center, Bern, Switzerland. Electronic address:
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Division of Pulmonary, Allergy, and Care, Department of Medicine, University of Pennsylvania, Philadelphia.
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Department of Molecular Medicine and Surgery, Stockholm Aortic Research Group, STAR, Karolinska Institutet, Stockholm, Sweden.
Background: The longitudinal effects of educational interventions in people with abdominal aortic aneurysm are largely unexplored. This prospective study investigated whether the anxiety-lowering effect of an eHealth intervention observed at the 1-month follow-up is maintained 1 year after abdominal aortic aneurysm surgery.
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