1,721,144 research outputs found
Acute lung injury in thoracic surgery.
No full textPURPOSE OF REVIEW:
This review will analyze the risk factors of acute lung injury (ALI) in patients undergoing thoracic surgery. Evidence for the occurrence of lung injury following mechanical ventilation and one-lung ventilation (OLV) and the strategies to avoid it will also be discussed.
RECENT FINDINGS:
Post-thoracotomy ALI has become one of the leading causes of operative death. The pathogenesis of ALI implicates a multiple-hit sequence of various triggering factors (e.g. preoperative conditions, surgery-induced inflammation, ventilator-induced injury, fluid overload, and transfusion). Conventional ventilation during OLV is performed with high tidal volumes equal to those being used in two-lung ventilation, high FiO(2), and without positive end-expiratory pressure. This practice was originally recommended to improve oxygenation and decrease shunt fraction during OLV. However, a number of recent studies using experimental models or human patients have shown low tidal volumes to be associated with a decrease in inflammatory mediators and a reduction in pulmonary postoperative complications. However, the application of such protective strategies could be harmful if not still properly used.
SUMMARY:
The goal of ventilation is to minimize lung trauma by avoiding overdistension and repetitive alveolar collapse, while providing adequate oxygenation. Protective ventilation is not simply synonymous of low tidal volume ventilation, but it also involves positive end-expiratory pressure, lower FiO(2), recruitment maneuvers, and lower ventilatory pressures
Ventilatory management of one-lung ventilation
No full textHypoxemia is considered to be the most important challenge during one-lung ventilation (OLV). Recent studies, however, have shown that one-lung ventilation can involve some lung damage and can therefore be per se a cause of hypoxemia. OLV can be associated to an injury: but the techniques used to improve oxygenation may also damage the lung. A new ventilator approach should be used and applied with regards to what is so far known in terms of "lung protection" also during OLV
NITRIC OXIDE IN THORACIC SURGERY
No full textInhalation of nitric oxide has been reported to alter pulmonary blood flow in animal and human studies. This effect is related to the relaxant action of nitric oxide on arterial vascular smooth muscle cells. When nitric oxide is administered by inhalation, this effect is limited to the pulmonary vasculature as it is rapidly inactivated by hemoglobin as soon as it enters the blood stream. The effect of inhaled nitric oxide is more pronounced in well ventilated areas of the lung, where it promotes redistribution of pulmonary blood flow to regions with high ventilation-perfusion ratio decreasing pulmonary hypertension and improving oxygenation. Nitric oxide has been used to treat pulmonary hypertension and hypoxemia that occurred in thoracic surgery during one lung ventilation, postpneumonectomy pulmonary edema and lung transplantation. Inhaled nitric oxide may be a useful tool in patients with a low PaO2/FiO2 ratio during one lung ventilation. Further powered studies are still required to define the dose and timing of inhaled nitric oxide in patients who do have ischemia-reperfusion injury after lung transplantation
Macroinvertebrate-Based Biomonitoring of Coastal Wetlands in Mediterranean Chile: Testing Potential Metrics Able to Detect Anthropogenic Impacts
Full text linkMicrodistribution of macroinvertebrates in a temporary pond in Central Italy
No full text3rd European Pond Conservation Network Workshop, Valençia 14-16 May 200
- …
