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Sökning: WFRF:(Costa Eduardo L. V.) > High Positive End-E...

LIBRIS Formathandbok  (Information om MARC21)
FältnamnIndikatorerMetadata
00006008naa a2200553 4500
001oai:DiVA.org:uu-357751
003SwePub
008180822s2018 | |||||||||||000 ||eng|
0247 a https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-3577512 URI
0247 a https://doi.org/10.1164/rccm.201706-1244OC2 DOI
040 a (SwePub)uu
041 a engb eng
042 9 SwePub
072 7a ref2 swepub-contenttype
072 7a art2 swepub-publicationtype
1001 a Morais, Caio C. A.u Univ Sao Paulo, Fac Med, Hosp Clin, Div Pneumol,Inst Coracao Incor, Sao Paulo, Brazil4 aut
2451 0a High Positive End-Expiratory Pressure Renders Spontaneous Effort Noninjurious
264 1b AMER THORACIC SOC,c 2018
338 a print2 rdacarrier
520 a Rationale: In acute respiratory distress syndrome (ARDS), atelectatic solid-like lung tissue impairs transmission of negative swings in pleural pressure (Ppl) that result from diaphragmatic contraction. The localization of more negative Ppl proportionally increases dependent lung stretch by drawing gas either from other lung regions (e.g., nondependent lung [pendelluft]) or from the ventilator. Lowering the level of spontaneous effort and/or converting solid-like to fluid-like lung might render spontaneous effort noninjurious.Objectives: To determine whether spontaneous effort increases dependent lung injury, and whether such injury would be reduced by recruiting atelectatic solid-like lung with positive end-expiratory pressure (PEEP).Methods: Established models of severe ARDS (rabbit, pig) were used. Regional histology (rabbit), inflammation (positron emission tomography; pig), regional inspiratory Ppl (intrabronchial balloon manometry), and stretch (electrical impedance tomography; pig) were measured. Respiratory drive was evaluated in 11 patients with ARDS.Measurements and Main Results: Although injury during muscle paralysis was predominantly in nondependent and middle lung regions at low (vs. high) PEEP, strong inspiratory effort increased injury (indicated by positron emission tomography and histology) in dependent lung. Stronger effort (vs. muscle paralysis) caused local overstretch and greater tidal recruitment in dependent lung, where more negative Ppl was localized and greater stretch was generated. In contrast, high PEEP minimized lung injury by more uniformly distributing negative Ppl, and lowering the magnitude of spontaneous effort (i.e., deflection in esophageal pressure observed in rabbits, pigs, and patients).Conclusions: Strong effort increased dependent lung injury, where higher local lung stress and stretch was generated; effort-dependent lung injury was minimized by high PEEP in severe ARDS, which may offset need for paralysis.
650 7a MEDICIN OCH HÄLSOVETENSKAPx Klinisk medicinx Lungmedicin och allergi0 (SwePub)302192 hsv//swe
650 7a MEDICAL AND HEALTH SCIENCESx Clinical Medicinex Respiratory Medicine and Allergy0 (SwePub)302192 hsv//eng
650 7a MEDICIN OCH HÄLSOVETENSKAPx Klinisk medicinx Anestesi och intensivvård0 (SwePub)302012 hsv//swe
650 7a MEDICAL AND HEALTH SCIENCESx Clinical Medicinex Anesthesiology and Intensive Care0 (SwePub)302012 hsv//eng
653 a acute respiratory distress syndrome
653 a spontaneous breathing
653 a ventilator-induced lung injury
653 a PEEP
7001 a Koyama, Yukikou Osaka Univ Hosp, Intens Care Unit, Suita, Osaka, Japan4 aut
7001 a Yoshida, Takeshiu Osaka Univ Hosp, Intens Care Unit, Suita, Osaka, Japan;Univ Toronto, Hosp Sick Children, Dept Crit Care Med & Anesthesia, Translat Med, 686 Bay St, Toronto, ON M5G 0A4, Canada4 aut
7001 a Plens, Glauco M.u Univ Sao Paulo, Fac Med, Hosp Clin, Div Pneumol,Inst Coracao Incor, Sao Paulo, Brazil4 aut
7001 a Gomes, Susimeireu Univ Sao Paulo, Fac Med, Hosp Clin, Div Pneumol,Inst Coracao Incor, Sao Paulo, Brazil4 aut
7001 a Lima, Cristhiano A. S.u Univ Sao Paulo, Fac Med, Hosp Clin, Div Pneumol,Inst Coracao Incor, Sao Paulo, Brazil4 aut
7001 a Ramos, Ozires P. S.u Univ Sao Paulo, Fac Med, Hosp Clin, Div Pneumol,Inst Coracao Incor, Sao Paulo, Brazil4 aut
7001 a Pereira, Sergio M.u Univ Sao Paulo, Fac Med, Hosp Clin, Div Pneumol,Inst Coracao Incor, Sao Paulo, Brazil4 aut
7001 a Kawaguchi, Naomasau Osaka Univ, Sch Allied Hlth Sci, Dept Pathol, Grad Sch Med, Suita, Osaka, Japan4 aut
7001 a Yamamoto, Hirofumiu Osaka Univ, Sch Allied Hlth Sci, Dept Pathol, Grad Sch Med, Suita, Osaka, Japan4 aut
7001 a Uchiyama, Akinoriu Osaka Univ Hosp, Intens Care Unit, Suita, Osaka, Japan4 aut
7001 a Batista Borges, João,d 1966-u Uppsala universitet,Anestesiologi och intensivvård,Hedenstiernalaboratoriet4 aut0 (Swepub:uu)joaba230
7001 a Melo, Marcos F. Vidalu Harvard Univ, Massachusetts Gen Hosp, Dept Anesthesia Crit Care & Pain Med, Boston, MA USA4 aut
7001 a Tucci, Mauro R.u Univ Sao Paulo, Fac Med, Hosp Clin, Div Pneumol,Inst Coracao Incor, Sao Paulo, Brazil4 aut
7001 a Amato, Marcelo B. P.u Univ Sao Paulo, Fac Med, Hosp Clin, Div Pneumol,Inst Coracao Incor, Sao Paulo, Brazil4 aut
7001 a Kavanagh, Brian P.u Univ Toronto, Hosp Sick Children, Dept Crit Care Med & Anesthesia, Translat Med, 686 Bay St, Toronto, ON M5G 0A4, Canada4 aut
7001 a Costa, Eduardo L. V.u Univ Sao Paulo, Fac Med, Hosp Clin, Div Pneumol,Inst Coracao Incor, Sao Paulo, Brazil4 aut
7001 a Fujino, Yujiu Osaka Univ Hosp, Intens Care Unit, Suita, Osaka, Japan4 aut
7102 a Univ Sao Paulo, Fac Med, Hosp Clin, Div Pneumol,Inst Coracao Incor, Sao Paulo, Brazilb Osaka Univ Hosp, Intens Care Unit, Suita, Osaka, Japan4 org
7730 t American Journal of Respiratory and Critical Care Medicined : AMER THORACIC SOCg 197:10, s. 1285-1296q 197:10<1285-1296x 1073-449Xx 1535-4970
8564 8u https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-357751
8564 8u https://doi.org/10.1164/rccm.201706-1244OC

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