| 1. |
- Franklin, Karl A., et al.
(author)
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Obstructive sleep apnea is a common disorder in the population : a review on the epidemiology of sleep apnea
- 2015
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In: Journal of Thoracic Disease. - 2072-1439 .- 2077-6624. ; 7:8, s. 1311-1322
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Research review (peer-reviewed)abstract
- The prevalence of obstructive sleep apnea (OSA) defined at an apnea-hypopnea index (AHI) >= 5 was a mean of 22% (range, 9-37%) in men and 17% (range, 4-50%) in women in eleven published epidemiological studies published between 1993 and 2013. OSA with excessive daytime sleepiness occurred in 6% (range, 3-18%) of men and in 4% (range, 1-17%) of women. The prevalence increased with time and OSA was reported in 37% of men and in 50% of women in studies from 2008 and 2013 respectively. OSA is more prevalent in men than in women and increases with age and obesity. Smoking and alcohol consumption are also suggested as risk factors, but the results are conflicting. Excessive daytime sleepiness is suggested as the most important symptom of OSA, but only a fraction of subjects with AHI >5 report daytime sleepiness and one study did not find any relationship between daytime sleepiness and sleep apnea in women. Stroke and hypertension and coronary artery disease are associated with sleep apnea. Cross-sectional studies indicate an association between OSA and diabetes mellitus. Patients younger than 70 years run an increased risk of early death if they suffer from OSA. It is concluded that OSA is highly prevalent in the population. It is related to age and obesity. Only a part of subjects with OSA in the population have symptoms of daytime sleepiness. The prevalence of OSA has increased in epidemiological studies over time. Differences and the increase in prevalence of sleep apnea are probably due to different diagnostic equipment, definitions, study design and characteristics of included subjects including effects of the obesity epidemic. Cardiovascular disease, especially stroke is related to OSA, and subjects under the age of 70 run an increased risk of early death if they suffer from OSA.
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| 2. |
- Koyi, Hirsh, et al.
(author)
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Biopsy testing in an inoperable, non-small cell lung cancer population : a retrospective, real-life study in Sweden
- 2015
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In: Journal of Thoracic Disease. - 2072-1439 .- 2077-6624. ; 7:12, s. 2226-2233
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Journal article (peer-reviewed)abstract
- Background: Correct diagnosis and staging are required for optimal treatment choice in lung cancer patients. This retrospective, patient medical records study investigated the clinical practice of lung cancer biopsy procedures and testing in Sweden. Methods: Consecutive patients with a recorded inoperable, malignant tumour of bronchus and lung were retrospectively identified at geographically widespread pulmonology clinics (NCT01139619). Data, including diagnostic sampling methodology [bronchoscopy, biopsy by pulmonologist and computed tomography (CT)-guided biopsy], were collected for patients diagnosed between 1 June 2009-31 May 2010, and analysed using descriptive statistics. A study-predefined algorithm, including six criteria on tumour localization and size, forced expiratory volume in one second (FEV1), blood saturation and risk of bleeding theoretically categorizing patient suitability for CT-guided biopsy, was used. Results: In total, 132 patients (mean age 68 years, 48% women, 61% adenocarcinoma, 86% current/former smokers, 96% performance status <= 2, mean FEV1 volume >= 2 L) were included. The majority were examined by > 1 diagnostic procedure (29% by CT-guided biopsy). Median overall time from first hospital contact to established diagnosis was 12.0 days (10.0 and 28.0 days for bronchoscopy and CT-guided biopsy, respectively). No major differences in lung function, age, performance status or predefined algorithm criteria were noted for patients examined by CT-guided biopsy versus bronchoscopy or biopsy. Complications were reported for 11 patients, including pneumothorax in six patients. Histopathology was used most frequently to diagnose and subtype (70%), although 66% of patients examined solely by bronchoscopy were diagnosed by cytology. For 26.5% of patients, epidermal growth factor receptor (EGFR) mutation testing was recorded. Conclusions: No limitations regarding patient suitability or methodological complications were noted in this real-life, observational study. The CT-guided biopsy is a relatively safe and well-established method, and may need to be utilized further to fulfil current and future demands for faster diagnosis and high quality tissue as new tumour markers and targeted therapies become available.
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| 3. |
- Lavdas, Eleftherios, et al.
(author)
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A method for limiting pitfalls in the production of enhancement kinetic curves in 3T dynamic magnetic resonance mammography
- 2012
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In: Journal of Thoracic Disease. - 2072-1439 .- 2077-6624. ; 4:4, s. 358-367
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Journal article (peer-reviewed)abstract
- Purpose: The aim of the present study is to investigate means for the reduction or even elimination of enhancement kinetic curve errors due to breast motion in order to avoid pitfalls and to increase the sensitivity and specificity of the method. Methods: 115 women underwent breast Magnetic Resonance Imaging (MRI). All patients were properly immobilized in a dedicated bilateral phased array coil. A magnetic resonance unit 3-Tesla (Signa, GE Healthcare) was used. The following sequences were applied: (I) axial T2-TSE, (II) axial STIR and (III) Vibrant axial T1-weighted fat saturation (six phases). Kinetic curves were derived semi-automatically using the software of the system and manually by positioning the regions of interest (ROI) from stable reference points in all the phases. Results: 376 abnormalities in 115 patients were investigated. In 81 (21.5%) cases, a change of the enhancement kinetic curve type was found when the two different methods were used. In cases of large fatty breasts, a change of the enhancement kinetic curve type in 13 lesions was found. In cases of small and dense breasts, only in 4 lesions the kinetic curve type changed, whereas in cases of small and fatty breasts, the kinetic curve type changed in 64 lesions (50 were observed in left breasts and 14 in right breasts). Conclusions: The derivation of enhancement kinetic curves should be performed by controlling and verifying that the ROIs lay at the same location of the lesion in all the phases of the dynamic study.
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| 4. |
- Agewall, S
(author)
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Morphine in acute heart failure
- 2017
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In: Journal of thoracic disease. - : AME Publishing Company. - 2072-1439 .- 2077-6624. ; 9:7, s. 1851-1854
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Journal article (other academic/artistic)
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| 16. |
- Burgy, Olivier, et al.
(author)
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New players in chronic lung disease identified at the European Respiratory Society International Congress in Paris 2018 : From microRNAs to extracellular vesicles
- 2018
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In: Journal of Thoracic Disease. - : AME Publishing Company. - 2072-1439 .- 2077-6624. ; 10, s. 2983-2987
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Journal article (peer-reviewed)abstract
- Since the first description of microRNAs (miRNAs) in 1993 (1) a large and growing number of studies has explored their roles across a variety of biomedical research disciplines, including lung biology. According to GENCODE (version 27) (2), 1881 of the >7,500 human small non-coding RNAs are miRNAs. These 20–25 nucleotide-long, regulatory RNAs are involved in the translational regulation of gene expression principally via binding to miRNA recognition elements largely in the 3' untranslated regions of target mRNAs. Upon binding they can induce mRNA degradation, deadenylation or inhibition of their translation, leading to decreased target gene expression (3). Originally described to play important roles in developmental biology, miRNAs have since been found to have significant roles in a multitude of biological processes. Expression levels of miRNAs vary greatly between cells and tissues, and aberrant levels of miRNA are associated with many diseases in humans. In fact, these non-coding RNA molecules are now recognized as major regulators in the development and progression of various chronic lung diseases, including cystic fibrosis (CF), idiopathic pulmonary fibrosis (IPF), chronic obstructive pulmonary disease (COPD) and asthma (4-9).
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| 22. |
- Hillerdal, Gunnar, et al.
(author)
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Intrabronchial stents in heterogenous emphysema : a highly selected material followed 5 years
- 2020
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In: Journal of Thoracic Disease. - : AME Publishing Company. - 2072-1439 .- 2077-6624. ; 12:7, s. 3524-3528
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Journal article (peer-reviewed)abstract
- Background: Endobronchial lung volume reduction (EBVR) with one-way valves introduced into the most diseased lobe of the lung is a non-invasive method to improve lung function in patients with severe heterogenous emphysema. The problem is to select the right patients for the procedure. Furthermore, the long-term effects have not been reported in most studies.Methods: EBVR was performed in 35 patients with severely handicapping emphysema and with one radiologically clearly enlarged (at least 125%) target lung lobe and clearly visible and complete interlobar fissures on CT. Most of the successful survivors have then been followed for five years.Results: Five (14%) were primary failures (defined as less than 15% increase of FEV1sec) and 10 (28%) were secondary failures (the valves were coughed up or removed for some reason). In the 21 successful 1 patients, the improvement of FEV1sec was in the mean 59%. Over the years, FEV1sec gradually decreased but was still higher 5 years later than initially. Of the successful group, 76% were still alive after 5 years, while only 50% were in the refused or failed groups.Conclusions: With careful selection of patients remarkably good results in lung function can be achieved, and these improvements will last for years though slowly decrease. In addition, the results indicate an improvement in survival with successful EBVR procedure.
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| 23. |
- Ibrahim, Abdulhakim, et al.
(author)
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Post-implantation syndrome after frozen elephant trunk is associated with the volume of new-onset aortic thrombus
- 2021
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In: Journal of Thoracic Disease. - : AME PUBL CO. - 2072-1439 .- 2077-6624. ; 13:7, s. 4311-4321
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Journal article (peer-reviewed)abstract
- Background: Post-implantation syndrome (PIS) is defined as non-infectious continuous fever and a concomitant rise in inflammatory markers shortly after endovascular aortic repair. PIS occurrence after hybrid procedures, such as the frozen elephant trunk (FET) technique, has not been adequately investigated. The current study aims to define the incidence of PIS after the FET and to identify possible risk factors associated with its occurrence. Methods: The clinical charts of 59 patients undergoing the FET between February 2015 and April 2020 were reviewed retrospectively. The occurrence of PIS was defined as the presence of fever (>38 degrees C lasting longer than one day during the hospitalisation) and leucocytosis (white blood cell count >12,000/mu L). Patients with concomitant conditions possibly leading to fever and/or leucocytosis were excluded. Beside demographic and procedure-related data, serum/plasma inflammatory markers were evaluated before surgery and daily up to seven days postoperatively. Computed tomography scans (CT) were examined to calculate the volume of pre-existent and new-onset mural thrombus after the FET. Results: Thirty-eight patients met the inclusion criteria. The study cohort was divided into two groups based on the occurrence of PIS (17 cases; 44.7%). Patients with PIS were significantly younger than those without PIS (53.5 +/- 8.9 vs. 62.5 +/- 9.6 years; P=0.005). Female patients were less likely to develop PIS (5.2% vs. 26.3%, P=0.018). Patients with PIS had a higher volume of new-onset thrombus in the postoperative CT (P<0.001). Patients treated for post-dissection aneurysm had, postoperatively, significantly more thrombus material developed in a false lumen (P=0.02). Among the PIS markers, CRP (C-reactive protein) levels on the third postoperative day were independently associated with the volume of new-onset thrombus (P=0.011). After multivariate analysis, the volume of new-onset thrombus (P=0.028) and age (P=0.036) remained the variable associated with a statistically significant increased incidence of PIS. Conclusions: PIS can occur after the frozen elephant trunk procedure. The volume of new-onset thrombus seems to be associated with an increased incidence of PIS. These findings need to be confirmed in larger patient cohorts.
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| 24. |
- Janson, Christer
(author)
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Treatment with inhaled corticosteroids in chronic obstructive pulmonary disease
- 2020
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In: Journal of Thoracic Disease. - : AME Publishing Company. - 2072-1439 .- 2077-6624. ; 12:4, s. 1561-1569
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Research review (peer-reviewed)abstract
- In chronic obstructive pulmonary disease ( COPD), treatment with inhaled corticosteroids (ICSs) in combination with long acting beta-2-agonists (LABA) or LABA/long-acting muscarinic antagonists (LAMA) is used in order to reduce exacerbations. Treatment with ICS is, however, associated with side effects such as oropharyngeal candidiasis, skin thinning or easy bruising and pneumonia. The aim of this review was to investigate when to use ICS in COPD and to compare the effectiveness and safety of different ICSs. Studies comparing the effect of ICS/LABA and LABA/LAMA on exacerbations have shown divergent results, whereas most studies comparing ICS/LABA/LAMA (triple therapy) with LABA/LAMA have reported fewer exacerbations with triple therapy. Several investigations have shown that the number of eosinophils in blood predicts whether a patient will benefit from treatment with ICS. There is also data indicating that ICS has a small but significant positive effect on lung function decline and decrease mortality. There are four observational studies showing a better effect on exacerbations with budesonide/formoterol than fluticasone propionate/salmeterol and three observational studies showing less risk of pneumonia with budesonide than fluticasone propionate. Studies comparing the effect and safety of other ICSs such as fluticasone furoate and beclomethasone are too few to draw firm conclusions from. In conclusion, ICS together with LABA or LABA/LAMA reduces the risk of exacerbations in COPD. The indication of using ICS in COPD is stronger if the patient has increased blood eosinophils levels. There are data indicating that the choice of ICS matters, with studies showing a better effect-safety profile with budesonide compared to fluticasone propionate whereas it is not possible to make benefit-risk comparisons between the other licensed ICSs.
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| 29. |
- Kristenson, Karolina, et al.
(author)
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VE/VCO2 slope threshold optimization for preoperative evaluation in lung cancer surgery: identifying true high- and low-risk groups
- 2024
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In: Journal of Thoracic Disease. - : AME PUBLISHING COMPANY. - 2072-1439 .- 2077-6624. ; 16:1, s. 123-132
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Journal article (peer-reviewed)abstract
- Background: Cardiopulmonary exercise testing (CPET) enables measurement of the slope of the increase in minute ventilation in relation to carbon dioxide elimination during exercise (the VE/VCO2 slope). Several studies have shown that the VE/VCO2 slope is a strong marker for postoperative complications and mortality. However, current thresholds for adverse outcomes are generated from historical data in heart failure patients.Methods: This was a retrospective analysis of 158 patients with lung cancer who underwent lobectomy or pneumonectomy during 2008–2020. The main outcome was major pulmonary complications (MPC) or death ≤30 days of cancer surgery. Patients were first categorized using two different single threshold approaches; the traditional threshold of 35 and the highest Youden value from the receiver operating curve (ROC) analysis. Secondly, patients were categorized into three risk groups using two thresholds. These two thresholds were determined in an ROC analysis, where the VE/VCO2 slope values generating either a 90% sensitivity (lower threshold) or a 90% specificity (upper threshold) for the main outcome were chosen. The frequency of complications was compared using Chi2. The overall model quality was evaluated by an area under the curve (AUC) analysis. Positive predictive values (PPVs) and negative predictive values (NPVs) are presented.Results: The two thresholds, <30 (90% sensitivity) and >41 (90% specificity), created three risk groups: low risk (VE/VCO2 slope <30, n=44, 28%); intermediate risk (VE/VCO2 slope 30–41, n=95, 60%) and high risk (VE/VCO2 slope >41, n=19, 12%). The frequency of complications differed between groups: 5%, 16% and 47% (P<0.001). Using two thresholds compared to one threshold increased the overall model quality (reaching AUC 0.70, 95% confidence interval: 0.59–0.81), and identified a high sensitivity threshold (VE/VCO2 slope <30) which generated a NPV of 95% but importantly, also a high specificity threshold (VE/VCO2 slope >41) with a PPV of 47%.Conclusions: Risk stratification based on three risk groups from the preoperative VE/VCO2 slope increased the model quality, was more discriminative and generated better PPV and NPV compared to traditional risk stratification into two risk groups.
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| 30. |
- Lewthwaite, Hayley, et al.
(author)
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Predicting the rate of oxygen consumption during the 3-minute constant-rate stair stepping and shuttle tests in people with chronic obstructive pulmonary disease
- 2020
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In: Journal of Thoracic Disease. - : AME Publishing Company. - 2072-1439 .- 2077-6624. ; 12:5, s. 2489-2498
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Journal article (peer-reviewed)abstract
- Background: The 3-minute constant-rate stair stepping (3-min CRSST) and constant-speed shuttle tests (3-min CSST) were developed to assess breathlessness in response to a standardized exercise stimulus. Estimating the rate of oxygen consumption (V'O2) during these tests would assist clinicians to relate the stepping/shuttle speeds that elicit breathlessness to daily physical activities with a similar metabolic demand. This study: (I) developed equations to estimate the V'O2 of these tests in people with chronic obstructive pulmonary disease (COPD); and (II) compared the newly developed and American College of Sports Medicine (ACSM) metabolic equations for estimating the V'O2 of these tests. Methods: This study was a retrospective analysis of people with COPD who completed a 3-min CRSST (n=98) or 3-min CSST (n=69). Multivariate linear regression estimated predictors (alpha <0.05) of V'O2 to construct COPD-specific metabolic equations. The mean squared error (MSE) of the COPD-specific and ACSM equations was calculated and compared. Bland-Altman analyses evaluated level of agreement between measured and predicted V'O2 using each equation; limits of agreement (LoA) and patterns of bias were compared. Results: Stepping rate/shuttle speed and body mass were identified as significant predictors of V'O2. The MSE of the COPD-specific equations was 0.05 L.min?1 for both tests. Mean difference between measured and predicted V'O2 was 0.00 L.min?1 (95% LoA ?0.46, 0.46) and 0.00 L.min?1 (95% LoA ?0.44, 0.44) for the 3-min CRSST and 3-min CSST, respectively. For the ACSM metabolic equations, the MSE was 0.10 L.min?1 and 0.18 L.min?1 for the 3-min CRSST and 3-min CSST, respectively. The ACSM metabolic equations underestimated V'O2 of the 3-min CRSST by ?0.18 L.min?1 (95% LoA ?0.68, 0.32), and overestimated V'O2 of the 3-min CSST by 0.35 L.min?1 (95% LoA ?0.14, 0.84). Conclusions: This study presents metabolic equations to predict V'O2 of the 3-min CRSST and 3-min CSST for people with COPD that are more accurate than the ACSM metabolic equations.
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| 33. |
- Lindow, Thomas, et al.
(author)
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Interatrial block and ischemic stroke
- 2018
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In: Journal of Thoracic Disease. - : AME Publishing Company. - 2072-1439 .- 2077-6624. ; 10:12, s. 7052-7054
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Journal article (peer-reviewed)abstract
- Cardiac embolism is a common cause of ischemic stroke. Atrial fibrillation (AF) can be detected in nearly 25% of all patients with stroke by sequentially combining different electrocardiographic methods (1). Advanced IAB (aIAB) has been described to predict occurrence of new onset and recurrent AF (2). We describe a case of a patient in whom detection of atypical aIAB motivated extended cardiac monitoring resulting in the diagnosis of paroxysmal AF and a subsequent decision on full oral anticoagulation strategy.
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| 38. |
- Peker, Yüksel, 1961, et al.
(author)
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Cardiovascular outcomes of continuous positive airway pressure therapy for obstructive sleep apnea
- 2018
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In: Journal of Thoracic Disease. - : AME Publishing Company. - 2072-1439 .- 2077-6624. ; 10:Supplement: 34
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Research review (peer-reviewed)abstract
- Obstructive sleep apnea is a common disorder with increased risk for cardiovascular morbidity and mortality. The first choice of treatment of obstructive sleep apnea is continuous positive airway pressure, which reduces excessive daytime sleepiness and improves quality of life in sleep clinic cohorts. Nevertheless, the majority of patients with cardiovascular disease and concomitant obstructive sleep apnea do not report daytime sleepiness, and adherence to treatment is insufficient particularly in this group. The current article aims to give an updated overview of the impact of continuous positive airway pressure therapy on cardiovascular outcomes mainly based on the observational studies and the recent randomized controlled trials.
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| 39. |
- Perrotta, Sossio, 1975, et al.
(author)
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Short- and long-term outcome after surgical aortic valve replacement in patients on dialysis.
- 2022
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In: Journal of thoracic disease. - : AME Publishing Company. - 2072-1439 .- 2077-6624. ; 14:2, s. 269-277
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Journal article (peer-reviewed)abstract
- There is no consensus on the choice of aortic valve prosthesis for patients with end-stage renal failure. We analyzed short- and long-term complications in dialysis patients who underwent aortic valve replacement (AVR) with either a biological (bAVR) or a mechanical (mAVR) prosthesis.All patients on dialysis who underwent bAVR or mAVR in Sweden from 1995 to 2017 (n=335) were included in a nationwide, population-based, observational, cohort study. Short and long-term complications were compared. Long-term mortality was compared with multivariable Cox regression analysis adjusted for age, sex, comorbidities, and a propensity score-matched model. Median follow-up was 2.8 (range, 0-16) years.Biological and mechanical valves were implanted in 253 (75.5%) and 82 (24.5%) patients, respectively. The bAVR patients were older and had more comorbidities. There was no significant difference in early complication rate. Thirty-day mortality was 9.1% in bAVR and 7.3% in mAVR patients (P=0.62). The multivariable Cox regression model did not show significant difference in mortality risk between bAVR and mAVR patients [adjusted hazard ratio (aHR) 1.33; 95% CI: 0.84-2.13; P=0.22]. The results were confirmed in the propensity-score matched model. The rate of aortic valve reoperations did not differ significantly between the bAVR and mAVR group.The short- and long-term complication rate is high, and the expected life expectancy limited, in dialysis patients undergoing AVR, without significant difference between biological and mechanical prostheses. The results suggest that biological valve prosthesis, avoiding systemic anticoagulation, is appropriate in most dialysis patients.
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| 40. |
- Polaczek, M., et al.
(author)
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Pulmonary veins variations with potential impact in thoracic surgery: a computed-tomography-based atlas
- 2020
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In: Journal of Thoracic Disease. - : AME Publishing Company. - 2072-1439 .- 2077-6624. ; 12:3
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Journal article (peer-reviewed)abstract
- Background: Pulmonary veins (PVs) are important during segmentectomy. Many case reports prove that they may be the source of bleeding during surgery, especially when anatomical variants are present. We decided to describe venous variations and prepare a computed tomography based atlas of our observations. Methods: The study was conducted using 135 chest computed tomography studies with intra venous iodine contrast injection. The study population contained 86 females and 49 males, mean age was 60. Thirteen people had atrial fibrillation. Images were analysed using radiological workstation. Results: The variations were divided into three categories: atypical topography of the PV, atypical venous outflow to the left atrium (LA), atypical venous vascularization of the lung bronchopulmonary segment. Retrobronchial course of the vein of the posterior segment of the right upper lobe was observed in 8.15%. The most common variant of atrial venous outflow was the direct outflow of the middle lobe vein, observed in 25.19% of cases and the long common trunk of left PVs in 11.11%. The split drainage from the middle lobe into the right superior pulmonary vein (RSPV) and the right inferior pulmonary vein (RIPV) was observed in 9.63% as the full drainage into the RIPV in 2.96%. Conclusions: Long common trunk of left PVs and numerous variants of venous vascularisation of the middle lobe are the variations that may pose potential problems during thoracic surgeries. The frequency is high enough to justify the routine assessment of pulmonary vessels with computed tomography before surgery.
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| 41. |
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| 42. |
- Sartipy, U
(author)
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Frailty-a strong risk marker in heart surgery?
- 2018
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In: Journal of thoracic disease. - : AME Publishing Company. - 2072-1439 .- 2077-6624. ; 10:Suppl 33, s. S4137-S4139
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Journal article (other academic/artistic)
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| 43. |
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| 45. |
- Suarez-Sipmann, Fernando, et al.
(author)
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PEEP titration guided by transpulmonary pressure : lessons from a negative trial
- 2019
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In: Journal of Thoracic Disease. - : AME Publishing Company. - 2072-1439 .- 2077-6624. ; 11, s. S1957-S1962
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Journal article (other academic/artistic)abstract
- Since the first description of the acute respiratory distress syndrome (ARDS) by the landmark paper of Ashbaugh et al. (1), the adequate use of positive end-expiratory pressure (PEEP) has been surrounded by a vivid controversy. This stems from the fact that its beneficial effects on oxygenation by re-aerating collapsed or flooded airspaces, may be counterbalanced by potential adverse effects on hemodynamics and on the risk of increasing lung tissue mechanical stress. The vast amount of clinical and experimental reports over the last five decades, adequately reflect this “PEEP paradox”: the simultaneous effects of PEEP on gas exchange, lung mechanics and hemodynamics can have competing beneficial or deleterious consequences even in similar clinical or experimental conditions. Thus, the effects of PEEP are complex and difficult to predict, more so in the heterogeneous ARDS lung, and depend not only on the selected level but also on how this level interacts and modifies the lung status. For instance, a high PEEP level may improve oxygenation but if it not associated to significant recruitment of collapsed lung regions can increase non-dependent lung overdistension.Although in clinical practice the changes in oxygenation remain the main driver for PEEP selection, the progressive awareness that mechanical ventilation can aggravate lung injury has shifted the interest to the potential lung-protective effects of PEEP, already recognized in early experimental studies (2). By preventing end-expiratory lung collapse and increasing end-expiratory lung volume, PEEP can counteract the two major mechanisms related to ventilation-induced lung injury (VILI) (3). On the one hand, it reduces or avoids the strain resulting from cyclic recruitment-derecruitment in boundary-regions of the mid-dependent regions, between collapsed and aerated lung. On the other hand, it promotes a more homogeneous distribution of ventilation by increasing the size of the functional lung thereby reducing the cyclic inflation stress of the non-dependent lung. Lung-protective ventilation (LPV) strategies aimed at reducing the mechanical stress on the lung, are the only therapeutic interventions that have improved ARDS outcome, and although the ultimate contribution of VILI to mortality is not known, it is important to emphasize that only a fifth of ARDS patients die with refractory hypoxemia (4). However, the definitive role of PEEP in lung protection has been difficult to establish in clinical studies (5). Dichotomous high-vs-low PEEP study designs, failure to confirm patient responsiveness to PEEP (6), and absence of proper PEEP individualization are among the reasons behind this lacking evidence.
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| 46. |
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| 47. |
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| 48. |
- Villar, Jesus, et al.
(author)
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Should the ART trial change our practice?
- 2017
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In: Journal of Thoracic Disease. - : AME Publishing Company. - 2072-1439 .- 2077-6624. ; 9:12, s. 4871-4877
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Journal article (other academic/artistic)
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| 49. |
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