Neinvazivna ventilacija (NIV) je učinkovit način respiracijske potpore za dio bolesnika sa zatajenjem disanja. Pravovremenom primjenom NIV-a kod dijela bolesnika može se izbjeći invazivna ventilacija ...i njezini neželjeni učinci, čime se skraćuje vrijeme provedeno u Jedinici intenzivnog liječenja (JIL). U zadnjih dvadeset godina bilježi se učestalija primjena NIV-a, a povećava se i broj indikacija kod kojih se NIV pokazao kao metoda izbora. Tijekom pandemije COVID-19 NIV je postao vrlo popularan i kod bolesnika sa zatajenjem disanja u sklopu infekcije COVID-19 primjenjivan je diljem svijeta. Cilj rada je istaknuti nužnost respiracijskog nadzora za sigurnu primjenu NIV-a te upozoriti kliničare koji primjenjuju NIV u svakodnevnom radu na važnost uočavanja ubrzanog disanja i velikoga inspiracijskog napora kao kliničkih pokazatelja velikoga dišnoga rada. Neovisno o primarnom uzroku plućnoga
oštećenja, veliki dišni rad dodatno pogoršava zatajenje disanja putem „samoozljeđivanja“ pluća (engl. patient self inflicted lung injury, P-SILI). Istaknuti su pokazatelji respiracijskog nadzora koji neizravno ukazuju na opasnost od P-SILI, a to su: veliki volumeni udisaja (engl. tidal volume, VT), negativni pomaci na krivulji alveolarnoga tlaka (engl. alveolar pressure, Paw), povećane vrijednosti okluzijskog tlaka u dišnome putu (P0.1) te visoke vrijednosti
„driving“ tlaka. Smanjenje i kontroliranje velikoga dišnoga rada izazov je u svim situacijama u kojima bolesnik spontano diše, neovisno je li na neinvazivnoj ili invazivnoj potpori disanja. Temeljem do sada objavljenih spoznaja, kao i iz osobnih iskustava stečenih dugogodišnjom primjenom NIV-a u različitim kliničkim indikacijama, nastojali smo sažeti moguće načine kontrole povećanoga dišnog rada. Samo striktnim nadzorom respiracijskih pokazatelja, kontrolom povećanoga dišnog rada i poznavanjem NIV-a kao metode potpore disanja njegova primjena postaje sigurna, a eventualni neuspjeh NIV-a i potreba za prijelazom na invazivnu ventilaciju bit će na vrijeme prepoznata.
To compare T-tube and pressure support ventilation (PSV) as two methods of mechanical ventilation weaning of patients with chronic obstructive pulmonary disease (COPD) after failed extubation.
A ...prospective randomized trial carried out at the multidisciplinary intensive care unit (ICU) over 2 years included 136 patients with COPD who required mechanical ventilation longer than 24 hours. The patients who could be weaned from mechanical ventilation were randomized to either a T-tube or PSV 2-hour spontaneous breathing trial. The patients in whom 2-hour trial was successful were extubated and excluded from further research. Patients in whom 2-hour trial failed had mechanical ventilation reinstated and underwent the same weaning procedure after 24 hours in case they fulfilled the weaning criteria. The weaning outcome was assessed according to the following parameters: extubation success, mechanical ventilation duration, time spent in ICU, reintubation rate, and mortality rate.
Two-hour trial failed in 31 patients in T-tube and 32 patients in PSV group, of whom 17 and 23, respectively, were successfully extubated (P<0.001, chi(2)test). Mechanical ventilation lasted significantly longer in T-tube than in PSV group (187 hours vs 163 hours, respectively, P<0.001, Mann-Whitney test). Also, patients in T-tube group spent significantly more time in ICU than patients in PVS group (241 hours interquartile range 211-268 vs 210 hours 211-268, respectively, P<0.001, Mann-Whitney test). Reintubation was required in 8 and 6 patients in T-tube and PVS group, respectively, and death occurred in 4 and 2 patients, respectively, during ICU stay.
Patients with COPD who failed the 2-hour spontaneous breathing trial had more favorable outcome when PVS rather than T-tube method was used for weaning from mechanical ventilation.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The aim of this post hoc analysis of a large cohort study was to evaluate the association between night-time surgery and the occurrence of intraoperative adverse events (AEs) and postoperative ...pulmonary complications (PPCs).
LAS VEGAS (Local Assessment of Ventilatory Management During General Anesthesia for Surgery) was a prospective international 1-week study that enrolled adult patients undergoing surgical procedures with general anaesthesia and mechanical ventilation in 146 hospitals across 29 countries. Surgeries were defined as occurring during ‘daytime’ when induction of anaesthesia was between 8:00 AM and 7:59 PM, and as ‘night-time’ when induction was between 8:00 PM and 7:59 AM.
Of 9861 included patients, 555 (5.6%) underwent surgery during night-time. The proportion of patients who developed intraoperative AEs was higher during night-time surgery in unmatched (43.6% vs 34.1%; P<0.001) and propensity-matched analyses (43.7% vs 36.8%; P=0.029). PPCs also occurred more often in patients who underwent night-time surgery (14% vs 10%; P=0.004) in an unmatched cohort analysis, although not in a propensity-matched analysis (13.8% vs 11.8%; P=0.39). In a multivariable regression model, including patient characteristics and types of surgery and anaesthesia, night-time surgery was independently associated with a higher incidence of intraoperative AEs (odds ratio: 1.44; 95% confidence interval: 1.09–1.90; P=0.01), but not with a higher incidence of PPCs (odds ratio: 1.32; 95% confidence interval: 0.89–1.90; P=0.15).
Intraoperative adverse events and postoperative pulmonary complications occurred more often in patients undergoing night-time surgery. Imbalances in patients' clinical characteristics, types of surgery, and intraoperative management at night-time partially explained the higher incidence of postoperative pulmonary complications, but not the higher incidence of adverse events.
NCT01601223.
The emergence of non-native fungal pathogens is a growing threat to global health, biodiversity, conservation biology, food security and the global economy. Moreover, a thorough understanding of the ...spread and emergence of pathogens among invasive and native host populations, as well as genetic analysis of the structure of co-invasive host populations, is crucial in terms of conservation biology and management strategies. Here we combined extensive catchment sampling, molecular detection tools and genomic signatures to i) assess the prevalence of the rosette agent Sphaerothecum destruens in invasive and native fish populations in contrasting french regions, and ii) characterize the genetic diversity and population structure of its co-invasive and asymptomatic carrier Pseudorasbora parva. Although S. destruens was not detected in all the fish collected its presence in contrasting freshwater ecosystems suggests that the disease may already be widespread in France. Furthermore, our results show that the detection of S. destruens DNA in its asymptomatic carrier P. parva is still limited. Finally, we found that P. parva populations show a homogeneous genetic and geographical structuring, which raises the possibility of the occurrence of successive introduction events in France from their native and invasive range.
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•A wide distribution of the fish parasite Rosette Agent in French rivers•A homogeneous genetic structure of its asymptomatic carrier Topmouth Gudgeon•We suggest potential bridgehead effects during the co-invasion process.
BACKGROUNDThe Pringle maneuver portal triad obstruction(PTO) provides huge disturbances during ischemia and even more thereafter in reperfusion. Contrarily, a possible solution may be stable gastric ...pentadecapeptide BPC 157, with already documented beneficial effects in ischemia/reperfusion conditions. Recently, BPC 157, as a cytoprotective agent, successfully resolved vessel occlusions in rats (ischemic colitis; deep vein thrombosis, superior anterior pancreaticoduodenal vein; bile duct cirrhosis) through rapid collateral vessel recruitment to circumvent vessel occlusion. Thereby, medication BPC 157 regimens were administered as a single challenge before and during ischemia or, alternatively, at various time points during reperfusion. AIMTo introduce BPC 157 therapy against pringle maneuver-damage. METHODSIn deeply anesthetised rats, the portal triad was clamped up for 30 min. Rats then underwent reperfusion for either 15 min or 24 h. Medication (10 µg, 10 ng/kg) regimens, administered as a single challenge picked (a) ischemia, PTO period at 5 min before (ip) or at 5 or 30 min of ligation time (as a bath to PTO) or (b) reperfusion, post-PTO period at 1 or 15 min (bath during surgery) or 24 h (ip) reperfusion-time. We provided gross, microscopy, malondialdehyde, serum enzymes, electrocardiogram, portal, caval, and aortal pressure, thrombosis and venography assessments. RESULTSBPC 157 counteracts electrocardiogram disturbances (increased P wave amplitude, S1Q3T3 QRS pattern and tachycardia). Rapidly presented vascular pathway (portal vein-superior mesenteric vein-inferior mesenteric vein-rectal veins-left ileal vein-inferior caval vein) as the adequate shunting immediately affected disturbed haemodynamics. Portal hypertension and severe aortal hypotension during PTO, as well as portal and caval hypertension and mild aortal hypotension in reperfusion and refractory ascites formation were markedly attenuated (during PTO) or completely abrogated (reperfusion); thrombosis in portal vein tributaries and inferior caval vein or hepatic artery was counteracted during portal triad obstruction PTO. Also, counteraction included the whole vicious injurious circle i.e., lung pathology (severe capillary congestion), liver (dilated central veins and terminal portal venules), intestine (substantial capillary congestion, submucosal oedema, loss of villous architecture), splenomegaly, right heart (picked P wave values) regularly perpetuated in ischemia and progressed by reperfusion in Pringle rats. CONCLUSIONBPC 157 resolves pringle maneuver-damage in rats, both for ischemia and reperfusion.
We documented that the stable gastric pentadecapeptide BPC 157 antagonized local anaesthetic effect of lidocaine. BPC 157 (LD1 not achieved) was implemented as an anti‐ulcer peptide in inflammatory ...bowel disease trials and now in a multiple sclerosis trial (Curr Pharm Des. 2018;24(18):1990–2001). Stable gastric pentadecapeptide BPC 157 was previously shown as a cardioprotective compound in a model of arrhythmia induced by bupivacaine toxicity where it counteracts arrhythmias and prevents lethal outcome (Eur J Pharmacol. 2016 Dec 15;793:56–65) much like in other cardiotoxicity mainly related to potassium disturbances, both hyperkalemia and hypokalemia, in vivo and in vitro (HEK293 cells) (Curr Pharm Des. 2018;24(18):1990–2001). We used Wistar Albino male rats, underwent regional blocks with lidocaine (spinal intrathecal block (lidocaine 6 mg/kg, 0.1 ml/rat, 550 g b.w.) or axillary block (lidocaine 15 mg/kg, 0.3 ml/rat, 220 g b.w.). Rats received BPC 157 (10 μg, 10 ng, 10 pg/kg intraperitoneally or intragastrically) or an equivolume of saline (5 ml/kg), either immediately or at 10 min when local anesthesia was fully established. Consistently, while lidocaine application produced a prolong function failure, all BPC 157 regimens significantly shortened time to full function recovery, either given immediately after lidocaine application or later, in the conditions of full local anesthesia. In other experiments, using a hot plate (55°C for 3 minutes) when rat hind paws were infiltrated with 2% lidocaine (0.1 ml/paw), a subsequent infiltration with BPC 157 (10 μg, 10 ng, 10 pg/kg) results in the faster feet lifting and much less edema (Figure 1). Finally, ECG recording documented that the mentioned regimens of BPC 157 markedly counteracted the lidocaine‐induced arrhythmias as well. Therefore, it may be possible that pentadecapeptide BPC 157 acts as the missing antidote to local anesthethics, and potentially deleterious and even life threatening adverse effects of toxic doses of local anesthethics would be markedly attenuated or even abolished.
Support or Funding Information
This work was supported by the University of Zagreb scientific support fund grant number BM099.
This is from the Experimental Biology 2019 Meeting. There is no full text article associated with this published in The FASEB Journal.
Acute respiratory failure due to chronic obstructive pulmonary disease presents an increasing problem for both health and economics in the modern world. The goal of this study was to compare invasive ...and noninvasive mechani-cal ventilation for patients with COPD. A prospective, randomized trial was performed in a multidisciplinary intensive care unit. Of 614 patients requiring mechanical ventilation (MV) longer than 24h, after excluding those who didn't meet the inclusion criteria, 72 patients with COPD remained the research sample. The MV procedure was per-formed using standard methods, applying two MV methods: invasive MV and noninvasive MV. Patients were ran-domized into two groups for MV application using closed, non transparent envelopes. Comparison was made based on patient characteristics, objective parameters 1h, 4h, 24h, and 48h after admission and finally treatment outcome. In patients with COPD NIMV had statistically better outcome compared to IMV with MV duration NIMV:IMV 102:187h, p < 0.001, time spent in ICU 127:233h, p < 0.001. Need for intubation/reintubation 16 (42.1%):34 (100%)/4 (11.8%), p < 0.001, hospital pneumonia 2 (5.3%):18 (52.9%), p =0.001. Applying strict application protocols, and based on com-parison of objective parameters of pulmonary mechanics, biochemistry and finally treatment outcome, high advantage of NIMV method was confirmed.
In BMR we observed that, on the level of derived categories, representations of the Lie algebra of a semisimple algebraic group over a field of finite characteristic with a given (generalized) ...regular central character can be identified with coherent sheaves on the formal neighborhood of the corresponding (generalized) Springer fiber. In the present paper we treat singular central characters. The basic step is the Beilinson-Bernstein localization of modules with a fixed (generalized) central character λ as sheaves on the partial flag variety corresponding to the singularity of λ. These sheaves are modules over a sheaf of algebras which is a version of twisted crystalline differential operators. We discuss translation functors and intertwining functors. The latter generate an action of the affine braid group on the derived category of modules with a regular (generalized) central character, which intertwines different localization functors. We also describe the standard duality on Lie algebra modules in terms of D-modules and coherent sheaves.
It is uncertain whether the association of the intraoperative driving pressure (ΔP) with postoperative pulmonary complications (PPCs) depends on the surgical approach during abdominal surgery. Our ...primary objective was to determine and compare the association of time-weighted average ΔP (ΔP
) with PPCs. We also tested the association of ΔP
with intraoperative adverse events.
Posthoc retrospective propensity score-weighted cohort analysis of patients undergoing open or closed abdominal surgery in the 'Local ASsessment of Ventilatory management during General Anaesthesia for Surgery' (LAS VEGAS) study, that included patients in 146 hospitals across 29 countries. The primary endpoint was a composite of PPCs. The secondary endpoint was a composite of intraoperative adverse events.
The analysis included 1128 and 906 patients undergoing open or closed abdominal surgery, respectively. The PPC rate was 5%. ΔP was lower in open abdominal surgery patients, but ΔP
was not different between groups. The association of ΔP
with PPCs was significant in both groups and had a higher risk ratio in closed compared to open abdominal surgery patients (1.11 95%CI 1.10 to 1.20, P < 0.001 versus 1.05 95%CI 1.05 to 1.05, P < 0.001; risk difference 0.05 95%CI 0.04 to 0.06, P < 0.001). The association of ΔP
with intraoperative adverse events was also significant in both groups but had higher odds ratio in closed compared to open abdominal surgery patients (1.13 95%CI 1.12- to 1.14, P < 0.001 versus 1.07 95%CI 1.05 to 1.10, P < 0.001; risk difference 0.05 95%CI 0.030.07, P < 0.001).
ΔP is associated with PPC and intraoperative adverse events in abdominal surgery, both in open and closed abdominal surgery.
LAS VEGAS was registered at clinicaltrials.gov (trial identifier NCT01601223 ).
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