ORCID Profile
0000-0002-3960-6013
Current Organisation
Fiona Stanley Hospital
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Publisher: Springer Science and Business Media LLC
Date: 08-07-2011
DOI: 10.1007/S00134-011-2298-X
Abstract: To investigate if femoral venous pressure (FVP) measurement can be used as a surrogate measure for intra-abdominal pressure (IAP) via the bladder. This was a prospective, multicenter observational study. IAP and FVP were simultaneously measured in 149 patients. The effect of BMI on IAP was investigated. The incidences of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) were 58 and 7% respectively. The mean APACHE II score was 22 ± 10, SAPS 2 score 42 ± 20, and SOFA score 9 ± 4. The mean IAP was 11.2 ± 4.5 mmHg versus 12.7 ± 4.7 mmHg for FVP. The bias and precision for all measurements were -1.5 and 3.6 mmHg respectively with the lower and upper limits of agreement being -8.6 and 5.7. When IAP was above 20 mmHg, the bias between IAP and FVP was 0.7 with a precision of 2.0 mmHg (lower and upper limits of agreement -3 and 4.6 respectively). Excluding those with ACS, according to the receiver operating curve analysis FVP = 11.5 mmHg predicted IAH with a sensitivity and specificity of 84.8 and 67.0% (AUC of 0.83 (95% CI 0.81-0.86) with P < 0.001). FVP = 14.5 mmHg predicted IAP above 20 mmHg with a sensitivity of 91.3% and specificity of 68.1% (AUC 0.85 (95% CI 0.79-0.91), P < 0.001). Finally, at study entry, the mean IAP in patients with a BMI less then 30 kg/m(2) was 10.6 ± 4.0 mmHg versus 13.8 ± 3.8 mmHg in patients with a BMI ≥ 30 kg/m(2) (P < 0.001). FVP cannot be used as a surrogate measure of IAP unless IAP is above 20 mmHg.
Publisher: Wiley
Date: 14-02-2006
DOI: 10.1111/J.1365-2044.2005.04441.X
Abstract: Although obesity predisposes to postoperative pulmonary complications, data on the relationship between body mass index (BMI) and peri-operative respiratory performance are limited. We prospectively studied the impact of spinal anaesthesia, obesity and vaginal surgery on lung volumes measured by spirometry in 28 patients with BMI 30-40 kg.m(-2) and in 13 patients with BMI > or = 40 kg.m(-2). Vital capacity, forced vital capacity, forced expiratory volume in 1 s, mid-expiratory and peak expiratory flows were measured during the pre-operative visit (baseline), after effective spinal anaesthesia with premedication, and after the operation at 20 min, 1 h, 2 h, and 3 h (after mobilisation). Spinal anaesthesia and premedication were associated with a significant decrease in spirometric parameters. Spinal anaesthesia and premedication were associated with a significant decrease in spirometric parameters mean (SD) vital capacities were - 19% (6.4) in patients with BMI 30-40 kg.m(-2) and - 33% (9.0) in patients with BMI > 40 kg.m(-2). The decrease of lung volumes remained constant for 2 h, whereas 3 h after the operation and after mobilisation, spirometric parameters significantly improved in all patients. This study showed that both spinal anaesthesia and obesity significantly impaired peri-operative respiratory function.
Publisher: Elsevier BV
Date: 04-2022
Publisher: Wiley
Date: 16-03-2004
Publisher: Termedia Sp. z.o.o.
Date: 04-08-2014
Publisher: SAGE Publications
Date: 29-07-2021
DOI: 10.1177/0310057X211007861
Abstract: Front-line staff routinely exposed to aerosol-generating procedures are at a particularly high risk of transmission of severe acute respiratory syndrome coronavirus 2. We aimed to assess the adequacy of respiratory protection provided by available N95/P2 masks to staff routinely exposed to aerosol-generating procedures. We performed a prospective audit of fit-testing results. A convenience s le of staff from the Department of Anaesthesia and Pain Medicine, who opted to undergo qualitative and/or quantitative fit-testing of N95/P2 masks was included. Fit-testing was performed following standard guidelines including a fit-check. We recorded the type and size of mask, pass or failure and duration of fit-testing. Staff completed a short questionnaire on previous N95/P2 mask training regarding confidence and knowledge gained through fit-testing. The first fit-pass rate using routinely available N95/P2 masks at this institution was only 47%. Fit-pass rates increased by testing different types and sizes of masks. Confidence ‘that the available mask will provide adequate fit’ was higher after fit-testing compared with before fit-testing (median, interquartile range) five-point Likert-scale (4.0 (4.0–5.0) versus 3.0 (2.0–4.0) P .001). This audit highlights that without fit-testing over 50% of healthcare workers were using an N95/P2 mask that provided insufficient airborne protection. This high unnoticed prevalence of unfit masks among healthcare workers can create a potentially hazardous false sense of security. However, fit-testing of different masks not only improved airborne protection provided to healthcare workers but also increased their confidence around mask protection.
Publisher: Termedia Sp. z.o.o.
Date: 22-06-2017
Publisher: American Thoracic Society
Date: 03-2011
Publisher: Termedia Sp. z.o.o.
Date: 04-08-2014
Publisher: Wiley
Date: 18-04-2007
DOI: 10.1111/J.1365-2044.2007.05030.X
Abstract: Trendelenburg positioning, a head-down tilt, is routinely used in anaesthesia when inserting a central venous catheter to increase the calibre of the jugular or subclavian veins and to prevent an air embolism. We investigated the impact of Trendelenburg positioning on functional residual capacity and ventilation homogeneity as well as the potential reversibility of these changes by repositioning and/or a recruitment manoeuvre in children with congenital heart disease. Functional residual capacity and ventilation homogeneity were assessed in 20 anaesthetised children between the ages of 3 months and 8 years who required central venous catheterisation before undergoing cardiac surgery. Functional residual capacity was measured (1) in the supine position, (2) in the Trendelenburg position, (3) after repositioning supine and (4) after a recruitment manoeuvre to total lung capacity which was performed by manually elevating the airway pressure to 40 cmH(2)O for ten consecutive breaths. Adopting the Trendelenburg position led to a significant decrease in functional residual capacity (median [range]- 12 (6-21)%) and increase in lung clearance index (12 (2-19)%). Baseline values were not reached after repositioning supine in any patient until after a standardised recruitment manoeuvre was performed.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2007
DOI: 10.1213/01.ANE.0000261503.29619.9C
Abstract: High fractions of inspired oxygen (Fio2) result in resorption atelectasis shortly after their application. However, the impact of different levels of Fio2 and their interaction with positive end-expiratory pressure (PEEP) on functional residual capacity (FRC) and ventilation distribution is unknown in anesthetized children. We hypothesized that the use of a Fio2 of 1.0 results in a decrease of FRC and ventilation homogeneity compared with that of a Fio2 of 0.3, and that this decrease is prevented by PEEP of 6-cm H2O compared to a PEEP of 3-cm H2O. Forty-six children (3-6 yr) without cardiopulmonary disease were randomly allocated to receive PEEP of 6-cm H2O (PEEP 6 group) during the entire study period or PEEP of 3-cm H2O (PEEP 3 group). The order of the Fio2 (0.3 or 1.0) was also randomized. A defined recruitment maneuver was performed after tracheal intubation and 5 min later the first measurement. This procedure was then repeated with the second Fio2 level. FRC and lung clearance index (LCI) were calculated by a blinded observer. While FRC (mean +/- sd) was similar at both levels of Fio2 (0.3: 25.6 +/- 2.9 mL/kg vs 1.0: 25.6 +/- 2.8 mL/kg, P = 0.189) in the PEEP 6 group, FRC decreased in the PEEP 3 group (0.3: 24.9 +/- 3.8 vs 1.0: 21.7 +/- 4.1, P < 0.0001). Furthermore, with continuous PEEP of 6-cm H2O a similar LCI was observed at both levels of Fio2 (0.3: 6.45 +/- 0.4 vs 6.43 +/- 0.4, P = 0.668) while LCI increased at the higher Fio2 in the PEEP 3 group (0.3: 6.5 +/- 0.5 vs 1.0: 7.7 +/- 1.2, P < 0.0001). During the application of a very low PEEP of 3-cm H2O, FRC and ventilation distribution decreased significantly at an Fio2 of 1.0 compared with that at an Fio2 of 0.3. This decrease could be counterbalanced by the administration of PEEP of 6-cm H2O, indicating that a low level of PEEP is sufficient to maintain FRC and ventilation distribution regardless of the oxygen concentration.
Publisher: Wiley
Date: 19-07-2004
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2014
Publisher: Springer Science and Business Media LLC
Date: 04-10-2021
DOI: 10.1186/S40635-021-00416-5
Abstract: Intra-abdominal hypertension (IAH) is common in critically ill patients and is associated with increased morbidity and mortality. High positive end-expiratory pressures (PEEP) can reverse lung volume and oxygenation decline caused by IAH, but its impact on alveolar overdistension is less clear. We aimed to find a PEEP range that would be high enough to reduce atelectasis, while low enough to minimize alveolar overdistention in the presence of IAH and lung injury. Five anesthetized pigs received standardized anesthesia and mechanical ventilation. Peritoneal insufflation of air was used to generate intra-abdominal pressure of 27 cmH 2 O. Lung injury was created by intravenous oleic acid. PEEP levels of 5, 12, 17, 22, and 27 cmH 2 O were applied. We performed computed tomography and measured arterial oxygen levels, respiratory mechanics, and cardiac output 5 min after each new PEEP level. The proportion of overdistended, normally aerated, poorly aerated, and non-aerated atelectatic lung tissue was calculated based on Hounsfield units. PEEP decreased the proportion of poorly aerated and atelectatic lung, while increasing normally aerated lung. Overdistension increased with each incremental increase in applied PEEP. “Best PEEP” (respiratory mechanics or oxygenation) was higher than the “optimal CT inflation PEEP range” (difference between lower inflection points of atelectatic and overdistended lung) in healthy and injured lungs. Our findings in a large animal model suggest that titrating a PEEP to respiratory mechanics or oxygenation in the presence of IAH is associated with increased alveolar overdistension.
Publisher: Elsevier BV
Date: 02-2018
DOI: 10.1016/J.JCRC.2017.10.012
Abstract: Intra-abdominal hypertension (IAH) is associated with impaired respiratory function. Animal data suggest that positive end-expiratory pressure (PEEP) levels adjusted to intra-abdominal pressure (IAP) levels may counteract IAH-induced respiratory dysfunction. In this pilot study, our aim was to assess whether PEEP adjusted for IAP can be applied safely in patients with IAH. We included patients on mechanical ventilation and with IAH. Patients were excluded with severe cardiovascular dysfunction or severe hypoxemia or if the patient was in imminent danger of dying. Following a recruitment manoeuvre, the following PEEP levels were randomly applied: PEEP of 5cmH Fifteen patients were enrolled. Six (41%) patients did not tolerate PEEP=100% IAP due to hypoxemia, hypotension or endotracheal cuff leak. PaO PEEP=100% of IAP was not well-tolerated and only marginally improved oxygenation in ventilated patients with IAH.
Publisher: Elsevier BV
Date: 2016
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2014
Publisher: Springer Science and Business Media LLC
Date: 10-2022
Publisher: SAGE Publications
Date: 11-2016
DOI: 10.1177/0310057X1604400604
Abstract: Intra-abdominal hypertension (IAH) is highly prevalent in critically ill patients admitted to the intensive care unit and is associated with an increased morbidity and mortality. The present study investigated whether femoral venous pressure (EVP) can be used as a surrogate parameter for intra-abdominal pressure (IAP) measured via the bladder in IAH grade II (IAP mmHg) or grade III (IAP ≥20 mmHg). This was a single-centre prospective study carried out in a tertiary adult intensive care unit. IAP was measured via the bladder with a urinary catheter with simultaneous recording of the FVP via a femoral central line. If the IAP was mmHg external weight to a maximum of 10 kg was applied to the abdomen with subsequent measurements of IAP and FVP. Eleven patients were enrolled into the study. IAH (IAP mmHg) was identified in five patients (42%) and abdominal compartment syndrome (ACS, IAP mmHg with new onset organ failure) in two (18%) with all-cause study mortality of 18%. The mean Acute Physiology and Chronic Health Evaluation (APACHE) II score was 21 ± 5, Simplified Acute Physiology (SAPS 2) score 49 ± 8, and Sequential Organ Failure Assessment (SOFA) score 9 ± 3. At baseline the bias between IAP and FVP was 3.2 with a precision of 3.63 mmHg (limits of agreement [LA] −4.1, 10.4). At 5 kg and 10 kg, the bias was 2.5 with a precision of 3.92 mmHg (LA-5.4, 10.3) and 2.26 mmHg (LA-2.1, 7.0) respectively. A receiver operating characteristic analysis for FVP to predict IAH showed an area under the curve of 0.87 (95% confidence interval 0.74–0.94, P=0.0001). FVP cannot be recommended as a surrogate measure for IAP even at IAP values above 20 mmHg. However, an elevated FVP was a good predictor of IAH.
Publisher: Wiley
Date: 11-2007
DOI: 10.1111/J.1460-9592.2007.02335.X
Abstract: Ketamine is commonly used in children in the emergency setting and while undergoing diagnostic and therapeutic interventions because of its combination of hypnotic and analgesic properties. Although studies comparing various levels of ketamine anesthesia are lacking, previous work suggests that lung mechanics might only be minimally affected by ketamine. After approval from the Ethics Committee, anesthesia was induced with 2 mg.kg(-1) racemic ketamine followed by a continuous infusion of ketamine 2 mg.kg(-1) h(-1) (level I) in 26 children (2-6 years of age), and after 5 min, the first set of measurements was performed. Then, a second bolus of ketamine 2 mg.kg(-1) followed by ketamine 4 mg.kg(-1) h(-1) was administered (level II) and after 5 min, the second set of measurements was performed. Functional residual capacity (FRC) and lung clearance index (LCI) were calculated using a multibreath analysis by a blinded observer. Functional residual capacity and LCI did not change between the two levels (FRC 25.6 [4.3] ml.kg(-1) vs 25.5 [4.2] ml.kg(-1), P=0.769, LCI 10.5 [1.2] vs 10.3 [1.1], P=0.403). The minute ventilation was similar between the two levels of anesthesia. The University of Michigan Sedation Scale increased from 3 (3) to 4 (3-4) at the second level of ketamine anesthesia. A deeper level of anesthesia induced by ketamine does not affect FRC, ventilation distribution or minute ventilation suggesting that the depth of ketamine anesthesia has a minimal effect on pulmonary function.
Publisher: Springer Science and Business Media LLC
Date: 05-07-2012
DOI: 10.1186/2110-5820-2-S1-S11
Abstract: Intra-abdominal pressure (IAP) is most commonly measured via the bladder with the patient in the supine position. In the ICU, patients are nursed with the head of the bed elevated at 30° (HOB30) to reduce the risk of ventilator-associated pneumonia. This study investigated whether gastric pressure at HOB30 can be used as a surrogate measure of IAP via the bladder in the supine position. A prospective observational study was conducted in a single-centre intensive care unit. A total of 20 patients were included. IAP was recorded simultaneously via the bladder catheter (bladder pressure, IBP) and via nasogastric tube (gastric pressures, IGP) in the supine and HOB30 position. Each patient had three sets of IAP measurements performed at least 4 h apart. In the supine position, mean IBP was 12.3 ± 4.5 mmHg compared to IGP of 11.8 ± 4.7 mmHg. The bias between the two groups was 0.5 and precision of 3.7 (LA, -6.8 to 7.5 mmHg). At 30 degrees, mean IBP was 15.8 ± 4.9 mmHg compared to IGP of 13.1 ± 6.1 mmHg. The bias between both groups was 2.7 with a precision of 5.5 (LA, -8.0 to 13.5). Comparing IBP in the supine position with IGP at 30° showed a bias of -0.8 and precision of 5.6 (LA, -10.1 to 11.6 mmHg). IAP measured via a nasogastric tube was less influenced by changing the body position from supine to HOB30 than was bladder pressure.
Publisher: Elsevier BV
Date: 2005
DOI: 10.1093/BJA/AEH295
Abstract: Lung volumes in obese patients are reduced significantly in the postoperative period. As the effect of different analgesic regimes on perioperative spirometric tests in obese patients has not yet been studied, we investigated the effect of thoracic epidural analgesia and conventional opioid-based analgesia on perioperative lung volumes measured by spirometry. Eighty-four patients having midline laparotomy for gynaecological procedures successfully completed the study. Premedication, anaesthesia and analgesia were standardized. The patients were given a free choice between epidural analgesia (EDA) (n=42) or opioids (n=42) for postoperative analgesia. We performed spirometry to measure vital capacity (VC), forced vital capacity, peak expiratory flow, mid-expiratory flow and forced expiratory volume in 1 s at preoperative assessment, 30-60 min after premedication and 20 min, 1 h, 3 h and 6 h after extubation. Baseline values were all within the normal range. All perioperative spirometric values decreased significantly with increasing body mass index (BMI). The greatest reduction in VC occurred directly after extubation, but was less in the EDA group than in the opioid group: mean of -23(sd 8)% versus -30(12)% (P 30) the difference in VC was significantly more pronounced than in patients of normal weight (BMI<25): -45(10)% versus -33(4)% (P<0.001). Recovery of spirometric values was significantly quicker in patients receiving EDA, particularly in obese patients. We conclude that EDA should be considered in obese patients undergoing midline laparotomy to improve postoperative spirometry.
Publisher: Wiley
Date: 06-07-2006
DOI: 10.1111/J.1365-2044.2006.04720.X
Abstract: Caudal block results in a motor blockade that can reduce abdominal wall tension. This could interact with the balance between chest wall and lung recoil pressure and tension of the diaphragm, which determines the static resting volume of the lung. On this rationale, we hypothesised that caudal block causes an increase in functional residual capacity and ventilation distribution in anaesthetised children. Fifty-two healthy children (15-30 kg, 3-8 years of age) undergoing elective surgery with general anaesthesia and caudal block were studied and randomly allocated to two groups: caudal block or control. Following induction of anaesthesia, the first measurement was obtained in the supine position (baseline). All children were then turned to the left lateral position and patients in the caudal block group received a caudal block with bupivacaine. No intervention took place in the control group. After 15 min in the supine position, the second assessment was performed. Functional residual capacity and parameters of ventilation distribution were calculated by a blinded reviewer. Functional residual capacity was similar at baseline in both groups. In the caudal block group, the capacity increased significantly (p < 0.0001) following caudal block, while in the control group, it remained unchanged. In both groups, parameters of ventilation distribution were consistent with the changes in functional residual capacity. Caudal block resulted in a significant increase in functional residual capacity and improvement in ventilation homogeneity in comparison with the control group. This indicates that caudal block might have a beneficial effect on gas exchange in anaesthetised, spontaneously breathing preschool-aged children with healthy lungs.
Publisher: Wiley
Date: 06-05-2007
DOI: 10.1111/J.1460-9592.2007.02228.X
Abstract: The Jackson Rees breathing system is commonly used for bag and mask ventilation in preschool children, although the lack of a pressure release valve can increase the risk of gastric insufflation. Therefore, we investigated the impact of bag and mask ventilation with a Jackson Rees system on functional residual capacity (FRC) and ventilation homogeneity and evaluated the effect of the level of training of the anesthesiologist in charge. Functional residual capacity and ventilation homogeneity were measured in 74 children (1-6 years) undergoing general surgery and the level of training of the anesthesiologist was recorded. FRC was measured (i) after intubation and (ii) after gastric emptying. Sixty-four children were ventilated using a Jackson Rees system, whereas 10 children were ventilated using a circle system to compare these two breathing systems in the second phase of the protocol. Functional residual capacity and ventilation homogeneity increased in all patients following gastric emptying with the highest improvement (25%) being observed when nurse students were in charge of the ventilation with the Jackson Rees system. The lowest changes in FRC and ventilation homogeneity were observed when pediatric consultants were in charge, whereas ventilation by the pediatric nurse anesthetists led to significant gastric gas insufflation. However, the circle system was associated with significantly less gastric insufflation than the Jackson Rees system. The efficacy of bag and mask ventilation was highly dependent on the training of the anesthesiologist with consultants demonstrating significantly better skills than any of the other groups. As the circle system is associated with a much steeper learning curve than the Jackson Rees system, its use in daily routine practice may prevent ventilatory impairment induced by gastric insufflation.
Publisher: S. Karger AG
Date: 2018
DOI: 10.1159/000493196
Abstract: b i Background: /i /b Prolonged intermittent renal replacement therapy (PIRRT) eliminates many drugs, and without dosing data, for new antibiotics like ceftolozane/tazobactam, suboptimal concentrations and treatment failure are likely. b i Objectives: /i /b Herein, we describe the effect of PIRRT on the plasma pharmacokinetics of ceftolozane/tazobactam administered in a critically ill 55-year-old patient with a polymicrobial sternal wound osteomyelitis, including a multiresistant i Pseudomonas aeruginosa /i . b i Method: /i /b Blood s les were taken over 4 days where the patient received a 7.5-h PIRRT treatment. One- and 2-compartment models were tested for ceftolozane and tazobactam separately, and the log-likelihood ratio and goodness-of-fit plots were used to select the final model. b i Results: /i /b Two-compartment models were developed for ceftolozane and tazobactam separately and described significant differences in clearance of ceftolozane and tazobactam with and without PIRRT (8.273 vs. 0.393 and 8.020 vs. 0.767 L/h, respectively). b i Conclusions: /i /b A ceftolozane/tazobactam dose of 500 mg/250 mg appears to be sufficient to attain pharmacokinetic harmacodynamic targets during PIRRT while the manufacturer’s recommended dosing of 100 mg/50 mg every 8 h was sufficient during non-PIRRT periods.
Publisher: Wiley
Date: 08-04-2007
DOI: 10.1111/J.1460-9592.2007.02226.X
Abstract: While functional residual capacity (FRC) is reduced in children undergoing general anesthesia, the lateral position leads to an increase in FRC compared with the supine position. The impact of neuromuscular blockade remains unknown. We tested the hypothesis that neuromuscular blockade leads to a decrease in FRC and increase in lung clearance index (LCI) while the application of positive endexpiratory pressure (PEEP) of 6 cmH(2)O leads to a restoration in both parameters. After approval of the local Ethics Committee, we studied 18 preschool children (2-6 years) without cardiopulmonary disease, who were scheduled for elective surgery. Anesthesia was standardized using propofol and fentanyl. FRC and LCI were calculated by a blinded observer using a SF6 multibreath washout technique with an ultrasonic transit-time airflow meter (Exhalyzer D). Measurements were taken in the left lateral position (PEEP 3 cmH2O) after 1. intubation with a cuffed tracheal tube, 2. neuromuscular blockade with rocuronium, and 3. the additional application of PEEP (6 cmH2O). Functional residual capacity mean (sd) decreased from 31.6 (4.4) ml.kg(-1) to 27.6 (4.2) ml.kg(-1) (P<0.001) following neuromuscular blockade while the LCI increased from 6.54 (0.6) to 7.0 (0.6) (P<or=0.001). After the application of PEEP (6 cmH2O), FRC increased to 32.4 (5.0) ml.kg(-1) whereas the LCI decreased to 6.58 (0.5) showing no significant changes from baseline measurements. In the lateral position, neuromuscular blockade led to a significant decrease in FRC associated with a small increase in ventilation inhomogeneity. FRC and LCI were restored to baseline levels with the application of PEEP 3 cmH2O that is in addition to a background of PEEP 3 cmH2O giving a total of 6 cmH2O PEEP.
Publisher: Termedia Sp. z.o.o.
Date: 29-12-2015
Publisher: Springer Science and Business Media LLC
Date: 2012
DOI: 10.1186/CC11840
Publisher: American Association for the Advancement of Science (AAAS)
Date: 04-06-2021
Abstract: Autism-associated CHD8/CHD7/kismet deficiency in blood-brain barrier glia causes developmental hyperserotonemia and sleep defects.
Publisher: AMPCo
Date: 06-09-2020
DOI: 10.5694/MJA2.50764
Publisher: Springer Science and Business Media LLC
Date: 25-04-2019
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2012
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2006
DOI: 10.1213/01.ANE.0000184814.57285.5B
Abstract: Nasal septum surgery is frequently performed to establish a functional nasal airway. In these patients obstructive sleep apnea syndrome (OSAS) is frequently present. Although patients with OSAS are at increased risk for hypoxemia, the impact of postoperative nasal packing (PNP) on sleep-disordered breathing and oxygen desaturations in patients with OSAS is unknown. We consecutively investigated 40 patients undergoing endonasal surgery receiving PNP. Fifteen of these patients had previously diagnosed OSAS (Group 2) and 25 did not (Group 1). In the control group, 12 healthy patients underwent elective ear or neck surgery without PNP. During the preoperative and postoperative nights, we continuously measured oronasal flow, thoracoabdominal movements, and oxygen saturation. We calculated the apnea-hypopnea index (AHI) and the oxygen-desaturation index (ODI). Compared with the preoperative values, after the operation, neither AHI nor ODI changed in the control group. In contrast, in Group 1, AHI (from 11 [5-19] to 37 [22-49]) and ODI (from 4 [2-8] to 13 [6-21]) significantly increased (P < 0.05), whereas in Group 2, only AHI significantly increased (from 14 [10-21] to 39 [26-50]) ODI remained similar (13 [8-27] versus 11 [4-37]). Because ODI did not increase in patients with OSAS and PNP who received postoperative oxygen overnight, postoperative intensive care monitoring might not be necessary on a routine basis for all patients with PNP and OSAS.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2019
DOI: 10.1097/CCM.0000000000003623
Abstract: To identify the prevalence, risk factors, and outcomes of intra-abdominal hypertension in a mixed multicenter ICU population. Prospective observational study. Fifteen ICUs worldwide. Consecutive adult ICU patients with a bladder catheter. None. Four hundred ninety-one patients were included. Intra-abdominal pressure was measured a minimum of every 8 hours. Subjects with a mean intra-abdominal pressure equal to or greater than 12 mm Hg were defined as having intra-abdominal hypertension. Intra-abdominal hypertension was present in 34.0% of the patients on the day of ICU admission (159/467) and in 48.9% of the patients (240/491) during the observation period. The severity of intra-abdominal hypertension was as follows: grade I, 47.5% grade II, 36.6% grade III, 11.7% and grade IV, 4.2%. The severity of intra-abdominal hypertension during the first 2 weeks of the ICU stay was identified as an independent predictor of 28- and 90-day mortality, whereas the presence of intra-abdominal hypertension on the day of ICU admission did not predict mortality. Body mass index, Acute Physiology and Chronic Health Evaluation II score greater than or equal to 18, presence of abdominal distension, absence of bowel sounds, and positive end-expiratory pressure greater than or equal to 7 cm H 2 O were independently associated with the development of intra-abdominal hypertension at any time during the observation period. In subjects without intra-abdominal hypertension on day 1, body mass index combined with daily positive fluid balance and positive end-expiratory pressure greater than or equal to 7 cm H 2 O (as documented on the day before intra-abdominal hypertension occurred) were associated with the development of intra-abdominal hypertension during the first week in the ICU. In our mixed ICU patient cohort, intra-abdominal hypertension occurred in almost half of all subjects and was twice as prevalent in mechanically ventilated patients as in spontaneously breathing patients. Presence and severity of intra-abdominal hypertension during the observation period significantly and independently increased 28- and 90-day mortality. Five admission day variables were independently associated with the presence or development of intra-abdominal hypertension. Positive fluid balance was associated with the development of intra-abdominal hypertension after day 1.
Publisher: Springer Science and Business Media LLC
Date: 15-05-2013
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2011
Publisher: Research Square Platform LLC
Date: 23-04-2020
DOI: 10.21203/RS.3.RS-24022/V1
Abstract: Background Intra-abdominal hypertension (IAH) is common in critically ill patients and is associated with increased morbidity and mortality. High positive end-expiratory pressures (PEEP) can reverse lung volume and oxygenation decline caused by IAH in the setting of injured lungs. The impact of high PEEP levels on alveolar overdistension in IAH and lung injury is unknown. We aimed to define an optimal PEEP range during IAH and lung injury that would be high enough to reduce atelectasis formation while low enough to minimize alveolar overdistention. Methods Five anesthetized pigs received standardized anesthesia and mechanical ventilation. Peritoneal insufflation of air was used to generate intra-abdominal pressure of 27cmH 2 O (20 mmHg). Lung injury was created by intravenous oleic acid. PEEP levels of 5, 12, 17, 22, and 27cmH 2 O were applied. We performed computed tomography and measured arterial oxygen levels, respiratory mechanics, and cardiac output 5 min after each new PEEP level. The proportion of overdistended, normally aerated, poorly aerated, and non-aerated atelectatic lung tissue was calculated based on Hounsfield units. Results PEEP decreased poorly aerated and atelectatic lung whilst increasing normally aerated lung. Overdistension increased with each incremental increase in applied PEEP. Conclusions Our findings in a large animal model suggest that an optimal PEEP level which maximally recruits atelectatic lung without causing overdistension or hemodynamic compromise may not exist.
Publisher: Springer Science and Business Media LLC
Date: 2010
DOI: 10.1186/CC9095
Publisher: Elsevier BV
Date: 02-2004
DOI: 10.1093/BJA/AEH046
Abstract: Although obese patients are thought to be susceptible to postoperative pulmonary complications, there are only limited data on the relationship between obesity and lung volumes after surgery. We studied how surgery and obesity affect lung volumes measured by spirometry. We prospectively studied 161 patients having either breast surgery (Group A, n=80) or lower abdominal laparotomy (Group B, n=81). Premedication and general anaesthesia were standardized. Spirometry was measured with the patient supine, in a 30 degrees head-up position. We measured vital capacity (VC), forced vital capacity, peak expiratory flow and forced expiratory volume in 1 s at preoperative assessment (baseline), after premedication (before induction of anaesthesia) and 10-20 min, 1 h and 3 h after extubation. Baseline spirometric values were all within the normal range. All perioperative values decreased significantly with increasing body mass index (BMI). The greatest reduction of mean VC (expressed as percentage of baseline values) occurred after extubation, and was more marked after laparotomy than after breast surgery (23 (SD 14)% vs 20 (14)%). Considering patients according to BMI ( 30), VC decreased after surgery by 12 (7)%, 24 (8)% and 40 (10)%, respectively. VC recovered more rapidly in Group A. Postoperative reduction in spirometric volumes was related to BMI. Obesity had more effect on VC than the site of surgery.
Publisher: Springer Science and Business Media LLC
Date: 28-02-2017
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2017
Publisher: Wiley
Date: 26-07-2005
DOI: 10.1111/J.1399-6576.2005.00754.X
Abstract: There is limited data comparing the impact of spinal anaesthesia (SA) and general anaesthesia (GA) on perioperative lung function. Here we assessed the differences of these two anaesthetic techniques on perioperative lung volumes in normal-weight (BMI < 25) and overweight (BMI 25-30) patients using spirometry. We prospectively studied 84 consenting patients having operations in the vaginal region receiving either GA (n = 41) or SA (n = 43). Both groups (GA and SA) were further ided into two subgroups each (normal-weight vs. overweight). We measured vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), midexpiratory (MEF25-75) and peak expiratory flow rates (PEFR) at the preoperative assessment (baseline), after premedication, after effective SA, and 20 min, 1 h, 2 h and 3 h after the operation (last measurement after patient mobilization). Premedication was associated with a small but significant decrease in lung volumes in direct correlation with BMI (-5%). Spinal anaesthesia resulted in a significant reduction in lung volumes in overweight as opposed to normal-weight patients. Postoperatively, lung volumes were significantly more reduced following GA than SA as indicated by differences in mean VC (SD) of -12 (6)% vs. -6 (5)% 20 min after the end of the operation in the normal-weight and -18 (5)% vs. -10 (5)% in the overweight patients. There was a significant impact of BMI on postoperative respiratory function, which was significantly more important in the GA group than in the SA group, and recovery of lung volumes was more rapid in the normal-weight patients than in the overweight patients, particularly in the SA group. In gynaecological patients undergoing vaginal surgery, the impact of anaesthesia on postoperative lung function as assessed by spirometry was significantly less after SA than GA, particularly in overweight patients.
Publisher: Informa UK Limited
Date: 03-2010
DOI: 10.3109/01902140903214667
Abstract: Congenital heart disease with left-to-right shunt may lead to precapillary pulmonary hypertension (PREPHT) with potential lung function impairment. The authors investigated the effects of PREPHT on lung responsiveness in a rat model of PREPHT by creating and repairing an abdominal aortocaval shunt (ACS). Rats were studied 4 weeks after the induction of ACS, and 4 weeks after its surgical repair. Control rats underwent sham surgery. To assess bronchial hyperreactivity, airway resistance (Raw) was measured at baseline and after increasing doses of methacholine. Raw was estimated by model fitting of the mechanical impedance of the respiratory system generated by forced oscillation technique. Lung morphological changes were assessed by histology. The prolonged presence of the ACS led to only minor changes in the basal respiratory mechanics, whereas it induced marked bronchial hyperreactivity, the methacholine-induced elevations in Raw being 49% +/- 5% before and 232% +/- 32% (P <.001) after ACS. These alterations were not associated with any changes in lung histology and were completely reversible on closure of the shunt. These results suggest that the induction of chronic increases in pulmonary blood flow and pressure causes reversible bronchial hyperreactivity. This may be consequent to the altered mechanical interdependence between the pulmonary vasculature and the respiratory tract.
Publisher: Elsevier BV
Date: 06-2022
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2015
Publisher: Elsevier BV
Date: 09-2022
DOI: 10.1016/J.GIM.2022.06.001
Abstract: ZMYND8 encodes a multidomain protein that serves as a central interactive hub for coordinating critical roles in transcription regulation, chromatin remodeling, regulation of super-enhancers, DNA damage response and tumor suppression. We delineate a novel neurocognitive disorder caused by variants in the ZMYND8 gene. An international collaboration, exome sequencing, molecular modeling, yeast two-hybrid assays, analysis of available transcriptomic data and a knockdown Drosophila model were used to characterize the ZMYND8 variants. ZMYND8 variants were identified in 11 unrelated in iduals 10 occurred de novo and one suspected de novo 2 were truncating, 9 were missense, of which one was recurrent. The disorder is characterized by intellectual disability with variable cardiovascular, ophthalmologic and minor skeletal anomalies. Missense variants in the PWWP domain of ZMYND8 abolish the interaction with Drebrin and missense variants in the MYND domain disrupt the interaction with GATAD2A. ZMYND8 is broadly expressed across cell types in all brain regions and shows highest expression in the early stages of brain development. Neuronal knockdown of the DrosophilaZMYND8 ortholog results in decreased habituation learning, consistent with a role in cognitive function. We present genomic and functional evidence for disruption of ZMYND8 as a novel etiology of syndromic intellectual disability.
No related grants have been discovered for Adrian Regli.