| 1. |
- Adhikari, Tara Ballav, et al.
(författare)
-
Burden and risk factors of chronic respiratory diseases in Nepal, 1990-2019 : An analysis of the global burden of diseases study
- 2023
-
Ingår i: Health Science Reports. - : Wiley-Blackwell. - 2398-8835. ; 6:2
-
Tidskriftsartikel (refereegranskat)abstract
- Background and Aims: Chronic respiratory diseases (CRDs) substantially contribute to morbidity and mortality globally and in Nepal. However, there is a paucity of evidence on the trend and the burden of CRDs in Nepal. This study reports the trend of the burden and contribution of major risk factors to CRDs in Nepal from 1990 to 2019.Methods: This study is an observational study using publicly available data from Global Burden of Disease 2019 estimations for Nepal. The age-standardized and age-specific prevalence, incidence, mortality, disability-adjusted life years (DALYs), and risk factors for CRDs in Nepal were extracted to measure the burden and its trend. The data are presented as percentages or as rates per 100,000 population.Results: The age-standardized incidence rate of CRDs in Nepal in 2019 was 913.6 per 100,000 (95% uncertainty interval [UI]: 828.7-1000.1), which was an increase of 7.7% from 848.6 per 100,000 (95% UI: 780.2-918.2) in 1990. However, the age-standardized prevalence rate [4453/100,000 (4234.2-4671.8) in 1990; 4457.1/100,000 (4255.2-4666.8) in 2019] was almost stagnant. Most CRDs attributed to deaths and DALYs were due to chronic obstructive pulmonary disease.Conclusions: Air pollution and smoking are the main risk factors for DALYs due to CRDs in Nepal. This surging burden of the incidence rate of CRDs in Nepal calls for more effective actions to curb the risk factors and diseases.
|
|
| 2. |
- Adhikari, Tara Ballav, et al.
(författare)
-
Community-based intervention for prevention and management of chronic obstructive pulmonary disease in Nepal (COBIN-P trial) : study protocol for a cluster-randomized controlled trial
- 2021
-
Ingår i: Trials. - : BioMed Central (BMC). - 1745-6215. ; 22
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death worldwide and the commonest of non-communicable diseases (NCDs) in Nepal. Risk factors like indoor and outdoor air pollution, a high prevalence of smoking, and the lack of awareness of COPD make it a serious public health concern. However, no attempt has been made in Nepal to estimate its burden and address the disease at the community level.Method: This study aims to evaluate the effect of a community-based health educational intervention administered by Female Community Health Volunteers (FCHVs) on the prevention and management of COPD. An open-label, two-group, community-based, cluster-randomized controlled trial will be implemented in the semi-urban area of Pokhara Metropolitan city (former Lekhnath Municipality) located in the Kaski district of Nepal. The estimated sample size of the intervention will be 1143. The unit of randomization is the ward (administrative unit) of the study area. The follow-up survey will be conducted immediately after 12months of FCHVs-led interventions. The difference in the rate of decline of forced expiratory volume in 1s (FEV1) and FEV1/FVC (forced vital capacity) ratio are the primary outcomes and the change in the proportion of modifiable risk factors of COPD, health-related quality of life scores, and change in knowledge of COPD will be secondary outcomes.Discussion: This study will estimate the burden of COPD, the magnitude of risk factors and generate evidence to mobilize community health workers for COPD prevention and management at the community level in Nepal.Trial registrationClinicalTrials.gov NCT03797768. Registered on January 9, 2019.
|
|
| 3. |
- Adhikari, Tara Ballav, et al.
(författare)
-
Prevalence of Chronic Obstructive Pulmonary Disease and its Associated Factors in Nepal : Findings from a Community-based Household Survey
- 2020
-
Ingår i: The International Journal of Chronic Obstructive Pulmonary Disease. - : Informa UK Limited. - 1176-9106 .- 1178-2005. ; 15, s. 2319-2331
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Despite chronic obstructive pulmonary disease (COPD) being the commonest non-communicable disease in Nepal, there is limited research evidence estimating the spirometry-based burden of COPD. This study aims to estimate the prevalence of COPD and its correlates through a community-based survey in Pokhara Metropolitan City, a semiurban area of Western Nepal. Methods: A cross-sectional household survey was conducted among 1459 adults >= 40 years. COPD was defined according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria as a post-bronchodilator ratio of forced expiratory volume in 1st second (FEV1) to forced vital capacity (FVC) <0.70 with the presence of symptoms. COPD was also defined by the lower limit of normal (LLN) threshold - FEV1/FVC < LLN cut-off values with the presence of symptoms. Study participants were interviewed about sociodemographic and behavioural characteristics and respiratory symptoms. Descriptive statistics and logistic regression analysis were applied. Results: Spirometry reports were acceptable in 1438 participants. The mean age of the participants was 55 (+/- 10) years, and, 54% were female. The prevalence of GOLD-defined COPD was 8.5% (95% CI: 7.1-10.0) and based on the LLN threshold of 5.4% (95% CI: 4.2-6.6). The multivariate logistic regression showed that increasing age, low body mass index, illiterate, current or former smoker, and biomass fuel smoke increased the odds of COPD in both the definitions. Conclusion: COPD is highly prevalent at community level and often underdiagnosed. Strategies aiming at early diagnosis and treatment of COPD, especially for the elderly, illiterate, and reducing exposure to smoking and biomass fuel smoke and childhood lung infection could be effective.
|
|
| 4. |
- Almgren, Birgitta, 1958-
(författare)
-
Endotracheal Suction a Reopened Problem
- 2005
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- During mechanical ventilation, patients are connected to the ventilator by an endotracheal tube. The tube needs to be cleaned from mucus by suction, which can cause negative effects such as lung collapse, hypoxemia and desaturation. These can be avoided by preoxygenation, change of ventilator settings, use of closed suction systems and recruitment manoeuvres. The aim of the study was to investigate the effects of endotracheal suction during different ventilator settings and by different suction methods. A method to reverse side effects was investigated.In anaesthetized pigs, the effect of suction during volume and pressure-controlled ventilation was investigated, and the effect of different suction systems and catheter sizes were compared. Suction efficacy was investigated in a bench study. The effect of recruitment manoeuvre added after suction, i.e. post-suction recruitment manoeuvre was evaluated.Endotracheal suction causes lung volume loss leading to impaired gas exchange, an effect that is more severe in pressure-controlled ventilation than in volume-controlled ventilation. When 14 French suction catheters were used more side effects were found compared to 12 French catheters, but no difference was found between open and closed suction system in pressure-controlled ventilation. Open suction system was more effective to remove mucus compared to closed system. Post-suction recruitment manoeuvre restored the side effects after the first recruitment when it was applied directly after suction.In conclusion, open endotracheal suction causes impairment in gas exchange and lung mechanics, and more so in pressure-controlled than in volume-controlled mode. These changes can be minimized if smaller suction catheters are used. A post-suction recruitment manoeuvre applied directly after suction restores lung function. It is obvious that the recruitment manoeuvre should be added directly after suction, because if the manoeuvre is delayed and the lung is collapsed and left collapsed, it will be more difficult to recruit the lung.
|
|
| 5. |
- Almgren, Birgitta, et al.
(författare)
-
Post-suction recruitment manoeuvre restores lung function in healthy, anaesthetized pigs
- 2004
-
Ingår i: Anaesthesia and Intensive Care. - 0310-057X .- 1448-0271. ; 32:3, s. 339-345:32, s. 339-345
-
Tidskriftsartikel (refereegranskat)abstract
- Endotracheal suction can cause partial lung collapse and hypoxia and alter lung mechanics. We investigated the effects of adding a recruitment manoeuvre directly after endotracheal suction to restore lung volume in volume-controlled ventilation and pressure-controlled ventilation modes. Five anaesthetized pigs were investigated. The effects of endotracheal suction with or without a recruitment manoeuvre were compared in random order. In volume-controlled ventilation, compliance decreased after suction from 33 +/- 5 to 26 +/- 6 ml x cmH2O(-1) (P<0.05), and 30 minutes later it remained decreased at 25 +/- 6 ml x cmH2O(-1). Venous admixture increased after suction from 5 +/- 2 to 8 +/- 4% (P<0.05), but had recovered at 30 minutes. In pressure-controlled ventilation, compliance decreased after suction from 34 +/- 3 to 25 +/- 7 ml x cmH2O(-1) (P<0.05), and 30 minutes later it remained decreased at 25 +/- 7 ml x cmH2O(-1). Venous admixture increased after suction from 5 +/- 2 to 13 +/- 7% (P<0.05), and had not recovered after 30 minutes, 10 +/- 4%. When a recruitment manoeuvre was applied directly after suction, no negative side-effects were registered in volume-controlled ventilation or pressure-controlled ventilation. We conclude that the impairment of lung mechanics and gas exchange induced by endotracheal suction can be prevented by a simple post-suction recruitment manoeuvre. Further studies are needed to identify a suitable suction recruitment manoeuvre in patients with diseased lungs.
|
|
| 6. |
- Almgren, Birgitta, et al.
(författare)
-
Side effects of endotracheal suction in pressure and volume controlled ventilation
- 2004
-
Ingår i: Chest. - : Elsevier BV. - 0012-3692 .- 1931-3543. ; 125:3, s. 1077-1080
-
Tidskriftsartikel (refereegranskat)abstract
- STUDY OBJECTIVES:To investigate the effects of endotracheal suction in volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV) with an open suction system (OSS) or a closed suction system (CSS).DESIGN:Randomized comparison.SETTING:Animal research laboratory.PATIENTS:Twelve healthy anesthetized pigs.INTERVENTIONS:The effects of endotracheal suction during VCV and PCV with tidal volume (VT) of 14 mL/kg were compared. A 60-mm inner-diameter endotracheal tube was used. Ten-second suction was performed using OSS and CSS with 12F and 14F catheters connected to - 14 kPa vacuum.MEASUREMENTS AND RESULTS:Thirty minutes after suction in PCV, VT was still decreased by 27% (p < 0.001), compliance (Crs) by 28% (p < 0.001), and PaO(2) by 26% (p < 0.001); PaCO(2) was increased by 42% (p < 0.0001) and venous admixture by 158% (p = 0.003). Suction in VCV affected only Crs (decreased by 23%, p < 0.001) and plateau pressure (increased by 24%, p < 0.001). The initial impairment of gas exchange following suction in VCV was no longer statistically significant after 30 min.CONCLUSIONS:In conclusion, endotracheal suction causes lung collapse leading to impaired gas exchange, an effect that is more severe and persistent in PCV than in VCV.
|
|
| 7. |
|
|
| 8. |
- Ballav Adhikari, Tara, et al.
(författare)
-
Health-Related Quality of Life of People Living with COPD in a Semiurban Area of Western Nepal : A Community-Based Study
- 2021
-
Ingår i: COPD. - : Informa UK Limited. - 1541-2555 .- 1541-2563. ; 18:3, s. 349-356
-
Tidskriftsartikel (refereegranskat)abstract
- Chronic Obstructive Pulmonary Disease (COPD) is a major cause of morbidity and mortality in Nepal. It is a progressive lung disease and has a significant impact on the quality of life of patients. Health-related quality of life (HRQOL) reflects the health- and disease-related facets of quality of life. Limited studies have assessed the impact of COPD on HRQOL and associated factors in Nepal. This study is based on a cross-sectional household survey data from a semiurban area of Western Nepal. A validated Nepali version of St George's Respiratory Questionnaire (SGRQ) was used to measure the HRQOL. COPD was defined together with post-bronchodilator airflow obstruction and the presence of respiratory symptoms. Post-bronchodilator airflow obstruction was defined as Forced Expiratory Volume in 1st second (FEV1) to Forced Vital Capacity (FVC) ratio < 0.70. COPD was diagnosed in 122 participants, and their median (IQR) total score of HRQOL was 40 (26 - 69); the score of symptoms, activity, and impact area were 53 (37 - 74), 57 (36 - 86), and 26 (13 - 62), respectively. The overall HRQOL was significantly different in terms of age, occupational status, physical activity, and comorbidities. Disease severity and the presence of respiratory symptoms had a significant difference in HRQOL (p = 0.0001). Appropriate measures to improve conditions and addressing the associated factors like respiratory symptoms and enhancing physical activity are necessary and important.
|
|
| 9. |
- Björnsson, Eyþór, et al.
(författare)
-
Airway hyperresponsiveness, peak flow variability and inflammatory markers in non-asthmatic subjects with respiratory infections
- 2007
-
Ingår i: Clinical Respiratory Journal. - : Wiley. - 1752-6981. ; 1:1, s. 42-50
-
Tidskriftsartikel (refereegranskat)abstract
- Objective: The aim of this study was to characterise non-asthmatic subjects with asthma-like symptoms during a common cold, particularly in relation to airway hyperresponsiveness (AHR). Materials and Methods: Subjects with acute respiratory infections and a group of controls (n = 20 + 20), age 20-65 years, underwent bronchial provocations with methacholine, adenosine and cold air. All were non-smokers and had no history of asthma or heart disease. Those with infection had asthma-like symptoms (> , 2). Measurements of exhaled nitric oxide (eNO), serum levels of eosinophil cationic protein (ECP), eosinophil peroxidase, myeloperoxidase and human neutrophil lipocalin were made at each provocation. A 17-day symptom and peak flow diary was calculated. Results: No differences between the two groups were found, regarding responsiveness to methacholine, adenosine or cold air challenge, as well as the inflammatory markers measured. In the infected group, the mean (standard deviation) ECP was higher in those with AHR to methacholine or cold air [15.7 (6.5) and 11.4 (4.2) mg/L, respectively; P < , 0.05], furthermore, eNO was higher in the infected group [116 ( 54) and 88 ( 52) nL/min, respectively, P = 0.055]. The infected group had, at all times, more symptoms and higher peak flow, with a decrease in the symptoms (P = 0.02) and a tendency to change in peak flow variation (P = 0.06). Conclusion: AHR does not seem to be the main cause of asthma-like symptoms in adults with infectious wheezing. Peak flow variation and symptom prevalence during the post-infection period may imply airway pathology different from AHR.
|
|
| 10. |
- Blöndal, Viiu, et al.
(författare)
-
Allergic sensitisation and type-2 inflammation is associated with new-onset and persistent allergic disease
- 2023
-
Ingår i: Clinical and Translational Allergy. - : Wiley-Blackwell. - 2045-7022. ; 13:4
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Allergic disease is common. The aim of this study was to look at the change in asthma and rhinitis over time and to characterise factors contributing to remission and persistence of disease.Methods: This cohort study included 255 individuals with or without asthma and or rhinitis that participated in a population survey and a follow-up 10 years later. The participants were tested for allergic sensitisation, total IgE, multiplex allergen component analysis and type-2 inflammatory markers: exhaled nitric oxide (FENO), eosinophil cationic protein (ECP) and eosinophil-derived neurotoxin (EDN).Results: Of the 132 healthy individuals, 112 remained healthy, 16 developed rhinitis, 4 asthma and rhinitis over the 10 years. Out of 82 subjects with rhinitis, 26 went into remission, 53 remained unchanged and 3 developed asthma in addition to rhinitis. None of the 41 participants with asthma and rhinitis went into remission. Subjects with persistent rhinitis and asthma had higher levels of total IgE (odds ratio [OR] 95% confidence interval [CI]: 6.16 [3.05-12.5]) at baseline and after 10 years, and FENO and ECP at baseline (OR per log unit increase, 95% CI 5.21 [1.20-22.7] and 6.32 [1.52-26.4], respectively), compared with those that remained healthy. Subjects with persistent rhinitis were more likely to be sensitised to grass pollen and had higher total IgE levels than those that went into remission. Individuals with persistent asthma were more likely to be sensitised to tree pollen and furry animals than those with only persistent rhinitis (OR 95% CI: 3.50 [1.29-9.49] and 6.73 [2.00-22.6], respectively).Conclusion: IgE sensitisation and total IgE levels are associated with the persistence of rhinitis and asthma. Participants with persistent allergic disease had higher levels of allergen sensitisation and type 2 inflammation markers at baseline than those who remained healthy.
|
|
| 11. |
- Blöndal, Viiu, et al.
(författare)
-
Study of atopic multimorbidity in subjects with rhinitis using multiplex allergen component analysis
- 2020
-
Ingår i: Clinical and Translational Allergy. - : BMC. - 2045-7022. ; 10:1
-
Tidskriftsartikel (refereegranskat)abstract
- Background Rhinitis is a common problem within the population. Many subjects with rhinitis also have atopic multimorbidity, such as asthma and eczema. The purpose of this investigation was to compare subjects with only rhinitis to those that have rhinitis, asthma and/or eczema in relation to immunoglobulin E (IgE) sensitization, inflammatory markers, family history, lung function and body mass index (BMI). Methods A total of 216 adult subjects with rhinitis from the European Community Respiratory Health Survey II were investigated with multiplex component allergen analysis (103 allergen components), total IgE, C-reactive protein, eosinophilic cationic protein, fractional exhaled nitric oxide and spirometry. Rhinitis, eczema, asthma and parental allergy were questionnaire-assessed. Results Of the 216 participants with rhinitis, 89 also had asthma and/or eczema. Participants with rhinitis that also had asthma or eczema were more likely to be IgE-sensitized (3.44, odds ratio, OR: 95% CI 1.62-7.30, adjusted for sex, age, mother's allergy, total IgE and forced expiratory volume (FEV1)). The number of IgE-positive components was independently associated with atopic multimorbidity (1.11, OR: 95% Cl 1.01-1.21) adjusted for sex, age, mother's allergy, total IgE and FEV1. When analysing different types of sensitization, the strongest association with atopic multimorbidity was found in participants that were IgE-sensitized both to perennial and seasonal allergens (4.50, OR: 95% CI 1.61-12.5). Maternal allergy (2.75, OR: 95% CI 1.15-4.46), high total IgE (2.38, OR: 95% CI 1.21-4.67) and lower FEV1 (0.73, OR: 95% CI 0.58-0.93) were also independently associated with atopic multimorbidity, while no association was found with any of the other inflammatory markers. Conclusion IgE polysensitization, to perennial and seasonal allergens, and levels of total IgE seem to be the main determinants of atopic multimorbidity in subjects with rhinitis. This indicates that disease-modifying treatment that targets IgE sensitization may be of value when decreasing the risk of developing atopic multimorbidity.
|
|
| 12. |
- Cristescu, S. M., et al.
(författare)
-
Methods of NO detection in exhaled breath
- 2013
-
Ingår i: Journal of Breath Research. - : IOP Publishing. - 1752-7155 .- 1752-7163. ; 7:1, s. 017104-
-
Tidskriftsartikel (refereegranskat)abstract
- There is still an unexplored potential for exhaled nitric oxide (NO) in many clinical applications. This study presents an overview of the currently available methods for monitoring NO in exhaled breath and the use of the modelling of NO production and transport in the lung in clinical practice. Three technologies are described, namely chemiluminescence, electrochemical sensing and laser-based detection with their advantages and limitations. Comparisons are made in terms of sensitivity, time response, size, costs and suitability for clinical purposes. The importance of the flow rate for NO sampling is discussed from the perspective of the recent recommendations for standardized procedures for online and offline NO measurement. The measurement of NO at one flow rate, such as 50 ml s(-1), can neither determine the alveolar site/peripheral contribution nor quantify the difference in NO diffusion from the airways walls. The use of NO modelling (linear or non-linear approach) can solve this problem and provide useful information about the source of NO. This is of great value in diagnostic procedures of respiratory diseases and in treatment with anti-inflammatory drugs.
|
|
| 13. |
|
|
| 14. |
|
|
| 15. |
- Ellingsen, Jens, 1979-, et al.
(författare)
-
CRP, Fibrinogen, White Blood Cells, and Blood Cell Indices as Prognostic Biomarkers of Future COPD Exacerbation Frequency : The TIE Cohort Study
- 2024
-
Ingår i: Journal of Clinical Medicine. - : MDPI. - 2077-0383. ; 13:13
-
Tidskriftsartikel (refereegranskat)abstract
- Background/Objective: Systemic inflammation is common in chronic obstructive pulmonary disease (COPD), and evidence suggests that inflammatory biomarkers can predict acute exacerbations (AECOPDs). The aim of this study was to analyse whether C-reactive protein (CRP), fibrinogen, white blood cell count (WBC), or the blood cell indices PLR (platelet-to-lymphocyte ratio), SII (systemic immune inflammation index), SIRI (systemic inflammation response index), and AISI (aggregate index of systemic inflammation) can predict future AECOPDs.Methods: In the Tools Identifying Exacerbations (TIE) cohort study, participants with spirometry-confirmed COPD were recruited from primary and secondary care in three Swedish regions and assessed during a stable phase of COPD. AECOPD frequency during the three-year follow-up was reviewed in medical records. Associations were analysed via ordinal logistic regressions.Results: Of the 571 participants, 46% had >= 1 AECOPD during follow-up, and the mean +/- SD AECOPD frequency was 0.63 +/- 1.2/year. In unadjusted analyses, high levels of CRP (odds ratio 1.86, 95% CI 1.29-2.67), fibrinogen (2.09, 1.38-3.16), WBCs (2.18, 1.52-3.13), SII (1.52, 1.05-2.19), SIRI (1.76, 1.23-2.52), and AISI (1.99, 1.38-2.87) were associated with a higher AECOPD frequency. After adjustment for AECOPD history, age, sex, smoking, body mass index, COPD Assessment Test score, lung function, and inhaled corticosteroid use, associations remained for high levels of CRP (adjusted odds ratio of 1.64; 95% CI of 1.08-2.49), fibrinogen (1.55; 1.07-2.24), and WBC (1.65; 1.10-2.47).Conclusions: CRP, fibrinogen, and WBC, assessed during stable-phase COPD, enhanced AECOPD prediction, whereas PLR, SII, SIRI, and AISI did not.
|
|
| 16. |
|
|
| 17. |
- Ellingsen, Jens, et al.
(författare)
-
Neutrophil-to-lymphocyte ratio, blood eosinophils and COPD exacerbations: a cohort study
- 2021
-
Ingår i: ERJ Open Research. - : ERS Publications. - 2312-0541. ; 7:4
-
Tidskriftsartikel (refereegranskat)abstract
- Background Blood neutrophil-to-lymphocyte ratio (NLR) and blood eosinophils (B-Eos) are emerging biomarkers in COPD. This study examined whether they could predict acute exacerbations of COPD (AECOPDs), and determined their longitudinal stability.Methods In this closed cohort study, Swedish subjects with spirometry-verified COPD attended three yearly visits in a stable phase of the disease. Blood cell counts, spirometry and questionnaire-assessed AECOPD-history (worsening of COPD leading to an unscheduled visit and/or use of antibiotics and/or oral corticosteroids) were collected at each visit.Results Of 466 included subjects 57% were female. Baseline mean±sd forced expiratory volume in 1 s was 58±17% predicted. High NLR (≥3.0) was more common in subjects with previous AECOPDs than in those without (33.5% versus 20.4%, p=0.002). In two-level mixed-effects logistic regression models adjusted for confounders, NLR as a continuous variable (OR 1.20, 95% CI 1.04–1.38) and B-Eos ≥300 cells·µL−1 (OR 1.54, 95% CI 1.06–2.24) were associated with future AECOPDs. In 386 subjects with blood cell data available at all three visits, the intraclass correlation coefficient for NLR was 0.61 (95% CI 0.56–0.66) and for B-Eos 0.69 (95% CI 0.64–0.73). NLR was persistently ≥3.0 in 10.6% and B-Eos was persistently ≥300 cells·µL−1 in 15.3%.Conclusions Stable phase NLR and B-Eos were associated with future AECOPDs. NLR on its own is probably not useful to predict AECOPDs but might be included in a risk scoring index. A minority of subjects with COPD had persistently elevated stable-phase NLR or B-Eos, and the biomarkers showed fair longitudinal reliability.
|
|
| 18. |
|
|
| 19. |
|
|
| 20. |
|
|
| 21. |
|
|
| 22. |
|
|
| 23. |
- Grubb, Tamara L, et al.
(författare)
-
Physiologic responses and plasma endothelin-1 concentrations associated with abrupt cessation of nitric oxide inhalation in isoflurane-anesthetized horses
- 2008
-
Ingår i: American Journal of Veterinary Research. - : American Veterinary Medical Association (AVMA). - 0002-9645 .- 1943-5681. ; 69:3, s. 423-430
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To assess physiologic responses and plasma endothelin (ET)-1 concentrations associated with abrupt cessation of nitric oxide (NO) inhalation in isoflurane-anesthetized horses. ANIMALS: 6 healthy adult Standardbreds. PROCEDURES: Horses were anesthetized with isoflurane in oxygen and placed in dorsal recumbency. Nitric oxide was pulsed into the respiratory tract for 2.5 hours, and then administration was abruptly discontinued. Just prior to commencement and at cessation of NO administration, and at intervals during a 30-minute period following cessation of NO inhalation, several variables including PaO(2), mean pulmonary artery pressure, venous admixture or pulmonary shunt fraction (Qs/Qt), and plasma ET-1 concentration were recorded or calculated. RESULTS: After cessation of NO inhalation, PaO(2) decreased slowly but significantly (172.7 +/- 29.8 mm Hg to 84.6 +/- 10.9 mm Hg) and Qs/Qt increased slowly but significantly (25 +/- 2% to 40 +/- 3%) over a 30-minute period. Mean pulmonary artery pressure increased slightly (14.0 +/- 1.3 mm Hg to 16.8 +/- 1 mm Hg) over the same time period. No change in serum ET-1 concentration was detected, and other variables did not change or underwent minor changes. CONCLUSIONS AND CLINICAL RELEVANCE: The improvement in arterial oxygenation during pulsed inhalation of NO to healthy isoflurane-anesthetized horses decreased only gradually during a 30-minute period following cessation of NO inhalation, and serum ET-1 concentration was not affected. Because a rapid rebound response did not develop, inhalation of NO might be clinically useful in the treatment of hypoxemia in healthy isoflurane-anesthetized horses.
|
|
| 24. |
- Heinonen, Erkki, et al.
(författare)
-
Pulsed delivery of nitric oxide counteracts hypoxaemia in the anaesthetized horse
- 2001
-
Ingår i: Veterinary Anaesthesia and Analgesia. - : Elsevier BV. - 1467-2987 .- 1467-2995. ; 28:1, s. 3-11
-
Tidskriftsartikel (refereegranskat)abstract
- Objective To study the effect of the pulsed delivery of nitric oxide (NO) on pulmonary gas exchange in the anaesthetized horses.Design Prospective, controlled randomized.Animals Five healthy Standardbred trotters, three geldings and two mares.Methods The horses were anaesthetized with thiopentone and isoflurane and positioned in dorsal recumbency. Nitric oxide was added as a pulse to the inspired gas during the first half of each inspiration. In three horses the effect of NO on the ventilation–perfusion distribution was also investigated using the multiple inert gas elimination technique. Data were analysed with repeated measures ANOVA.Results During spontaneous breathing, arterial oxygen tension (PaO2) increased with NO inhalation, from 14 ± 2 to 29 ± 3 kPa (105 ± 15 to 218 ± 23 mm Hg) (p < 0.001). Arterial oxygen tension also increased, from 17 ± 3 to 31 ± 5 kPa (128 ± 23 to 233 ± 38 mm Hg) (p < 0.05) during intermittent positive pressure ventilation. The increase in PaO2 was mainly due to a reduced right to left vascular shunt, but ventilation and perfusion matching also improved. The beneficial effect of NO inhalation was lost within 5 minutes of its discontinuation.Conclusion Delivery of NO as a pulse during inspiration is an effective method for counteracting impaired gas exchange caused by anaesthesia in horses. Pulsation has to be continuous because of the transience of NO's therapeutic effect.Clinical relevance Horses with impaired pulmonary gas exchange during anaesthesia can be treated with pulsed NO inhalation.
|
|
| 25. |
|
|
