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Michael P. Hlastala - One of the best experts on this subject based on the ideXlab platform.
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Pulmonary gas exchange improves in the prone position with Abdominal Distension.
American journal of respiratory and critical care medicine, 1998Co-Authors: M. Mure, Robb W. Glenny, Karen B. Domino, Michael P. HlastalaAbstract:Arterial blood oxygenation in patients with adult respiratory distress syndrome is often improved in the prone position. Critically ill patients often have Abdominal Distension and whether similar improvements in gas exchange occur with the prone position is not known. We therefore studied the effect of posture on gas exchange in eight ketamine-anesthetized pigs with Abdominal Distension. A rubber balloon, placed in the Abdominal cavity, was filled with water to increase intra-Abdominal pressure. The animals were mechanically ventilated with FIO2 = 0.4, and PaCO2 was kept constant. Gas exchange was measured in the supine and prone positions, with and without Abdominal Distension, in random order, using the multiple inert gas elimination technique (MIGET). When the abdomen was normal, the prone position increased PaO2 by 16 +/- 21 mm Hg (p < 0.05), accompanied by a small, but statistically insignificant, decrease in AaPO2 (p = 0.08) and no change in ventilation/perfusion (V A/Q) heterogeneity measured by MIGET. In the presence of Abdominal Distension, the prone position increased Pa O2 by 26 +/- 18 mm Hg (p < 0.01) and decreased AaPO2 (p < 0.05) and V A/Q heterogeneity as measured by the log standard deviation of the perfusion distribution (p < 0.01) and the arterial-alveolar difference area (p < 0.05). In addition, intragastric pressure was lower in the prone position (p < 0.01). We conclude that in anesthetized, mechanically ventilated pigs, the prone position improves pulmonary gas exchange to a greater degree in the presence of Abdominal Distension than when the abdomen is normal.
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pulmonary gas exchange improves in the prone position with Abdominal Distension
American Journal of Respiratory and Critical Care Medicine, 1998Co-Authors: M. Mure, Robb W. Glenny, Karen B. Domino, Michael P. HlastalaAbstract:Arterial blood oxygenation in patients with adult respiratory distress syndrome is often improved in the prone position. Critically ill patients often have Abdominal Distension and whether similar improvements in gas exchange occur with the prone position is not known. We therefore studied the effect of posture on gas exchange in eight ketamine-anesthetized pigs with Abdominal Distension. A rubber balloon, placed in the Abdominal cavity, was filled with water to increase intra-Abdominal pressure. The animals were mechanically ventilated with Fi O2 = 0.4, and PaCO2 was kept constant. Gas exchange was measured in the supine and prone positions, with and without Abdominal Distension, in random order, using the multiple inert gas elimination technique (MIGET). When the abdomen was normal, the prone position increased PaO2 by 16 ± 21 mm Hg (p < 0.05), accompanied by a small, but statistically insignificant, decrease in aaPo 2 (p = 0.08) and no change in ventilation/perfusion (V˙ a/Q˙) heterogeneity measured by...
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Pulmonary gas exchange in pigs improves in the prone position with Abdominal Distension
Critical Care, 1998Co-Authors: M. Mure, Robb W. Glenny, Karen B. Domino, Michael P. HlastalaAbstract:Partial pressure of oxygen (PaO2) in arterial blood tend to be higher in the prone compared to supine position. Whether similar improvements in gas exchange occur in the presence of Abdominal Distension is not clear. We studied the effect of position on gas exchange in eight ketamine anesthetized, mechanically ventilated pigs with Abdominal Distension. A intraAbdominal rubber balloon, was used to increase intraAbdominal pressure. Gas exchange was measured in the supine and prone positions, with and without Abdominal Distension, in random order using the multiple inert gas elimination technique. In presence of normal abdomen, only PaO2 increased (P < 0.05). In contrast, in the prone position with Abdominal Distension, the PaO2 (P < 0.01) increased and AaPO2 (P < 0.05) and AA/ heterogeneity, indicated by log SD (P < 0.01) and [(a-A)D] area (P < 0.05) were decreased in the prone compared to the supine position. We conclude that the prone position increases PaO2 by improving gas exchange in pigs with Abdominal Distension.
T Fiore - One of the best experts on this subject based on the ideXlab platform.
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impairment of lung and chest wall mechanics in patients with acute respiratory distress syndrome role of Abdominal Distension
American Journal of Respiratory and Critical Care Medicine, 1997Co-Authors: Marco V Ranieri, N Brienza, Sergio Santostasi, Filomena Puntillo, Luciana Mascia, Nicola Vitale, R Giuliani, Vincenzo Memeo, F Bruno, T FioreAbstract:Recent data have suggested that the elastic properties of the chest wall (CW) may be compromised in patients with ARDS because of Abdominal Distension (4). We partitioned CW and lung (L) mechanics, assessed the role of Abdominal Distension, and verified whether the underlying disease responsible for ARDS affects the impairment of respiratory mechanics. Volume-pressure (V-P) curves (interrupter technique) were assessed in nine patients with surgical ARDS and nine patients with medical ARDS. Relative to nine patients undergoing heart surgery, V-P curves of the respiratory system (rs) and L of patients with surgical or medical ARDS showed a rightward displacement. V-P curves of the CW and the L showed an upward concavity in patients with medical ARDS and a downward concavity in patients with surgical ARDS. Although the CW and the abdomen (abd) V-P curves in patients with medical ARDS were similar to those obtained in patients undergoing heart surgery, they showed a rightward shift and a downward flattening i...
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Impairment of lung and chest wall mechanics in patients with acute respiratory distress syndrome: role of Abdominal Distension.
American journal of respiratory and critical care medicine, 1997Co-Authors: V M Ranieri, N Brienza, Sergio Santostasi, Filomena Puntillo, Luciana Mascia, Nicola Vitale, R Giuliani, Vincenzo Memeo, F Bruno, T FioreAbstract:Recent data have suggested that the elastic properties of the chest wall (CW) may be compromised in patients with ARDS because of Abdominal Distension (4). We partitioned CW and lung (L) mechanics, assessed the role of Abdominal Distension, and verified whether the underlying disease responsible for ARDS affects the impairment of respiratory mechanics. Volume-pressure (V-P) curves (interrupter technique) were assessed in nine patients with surgical ARDS and nine patients with medical ARDS. Relative to nine patients undergoing heart surgery, V-P curves of the respiratory system (rs) and L of patients with surgical or medical ARDS showed a rightward displacement. V-P curves of the CW and the L showed an upward concavity in patients with medical ARDS and a downward concavity in patients with surgical ARDS. Although the CW and the abdomen (abd) V-P curves in patients with medical ARDS were similar to those obtained in patients undergoing heart surgery, they showed a rightward shift and a downward flattening in patients with surgical ARDS. In five of these patients, a reduction in static end-inspiratory pressure of the abd (69+/-4%), rs (30+/-3%), CW (41+/-2%), and L (27+/-3%) was observed after Abdominal decompression for acute bleeding. Abdominal decompression therefore caused an upward and leftward shift of the V-P curves of the respiratory system, chest wall, lung, and abdomen. In conclusion we showed that impairment of the elastic properties of the respiratory system may vary with the underlying disease responsible for ARDS. The flattening of the V-P curve at high pressures observed in some patients with ARDS may be due to an increase in chest wall elastance related to Abdominal Distension. These observations have implications for the assessment and ventilatory management of patients with ARDS.
Abelardo Margolles - One of the best experts on this subject based on the ideXlab platform.
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Abdominal Distension after eating lettuce the role of intestinal gas evaluated in vitro and by Abdominal ct imaging
Neurogastroenterology and Motility, 2019Co-Authors: Elizabeth Barba, Emanuel Burri, Anna Accarino, Eva Monclus, Isabel Navazo, Borja Sanchez, Francisco Guarner, Abelardo MargollesAbstract:Background: Some patients complain that eating lettuce, gives them gas and Abdominal distention. Our aim was to determine to what extent the patients' assertion is sustained by evidence. Methods: An in vitro study measured the amount of gas produced during the process of fermentation by a preparation of human colonic microbiota (n = 3) of predigested lettuce, as compared to beans, a high gas-releasing substrate, to meat, a low gas-releasing substrate, and to a nutrient-free negative control. A clinical study in patients complaining of Abdominal distention after eating lettuce (n = 12) measured the amount of intestinal gas and the morphometric configuration of the Abdominal cavity in Abdominal CT scans during an episode of lettuce-induced Distension as compared to basal conditions. Key Results: Gas production by microbiota fermentation of lettuce in vitro was similar to that of meat (P = .44), lower than that of beans (by 78 ± 15%; P < .001) and higher than with the nutrient-free control (by 25 ± 19%; P = .05). Patients complaining of Abdominal Distension after eating lettuce exhibited an increase in girth (35 ± 3 mm larger than basal; P < .001) without significant increase in colonic gas content (39 ± 4 mL increase; P = .071); Abdominal Distension was related to a descent of the diaphragm (by 7 ± 3 mm; P = .027) with redistribution of normal Abdominal contents. Conclusion and Inferences: Lettuce is a low gas-releasing substrate for microbiota fermentation and lettuce-induced Abdominal Distension is produced by an uncoordinated activity of the Abdominal walls. Correction of the somatic response might be more effective than the current dietary restriction strategy.
Fernando Azpiroz - One of the best experts on this subject based on the ideXlab platform.
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bloating and Abdominal Distension old misconceptions and current knowledge
The American Journal of Gastroenterology, 2017Co-Authors: Juanr Malagelada, Anna Accarino, Fernando AzpirozAbstract:Bloating, as a symptom and Abdominal Distension, as a sign, are both common functional-type complaints and challenging to manage effectively. Individual patients may weight differently the impact of bloating and Distension on their well-being. Complaints may range from chronic highly distressing pai
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abdominothoracic mechanisms of functional Abdominal Distension and correction by biofeedback
Gastroenterology, 2015Co-Authors: Elizabeth Barba, Emanuel Burri, Anna Accarino, Daniel Cisternas, Sergi Quiroga, Eva Monclus, Isabel Navazo, Juanr Malagelada, Fernando AzpirozAbstract:Background & Aims In patients with functional gut disorders, Abdominal Distension has been associated with descent of the diaphragm and protrusion of the anterior Abdominal wall. We investigated mechanisms of Abdominal Distension in these patients. Methods We performed a prospective study of 45 patients (42 women, 24–71 years old) with functional intestinal disorders (27 with irritable bowel syndrome with constipation, 15 with functional bloating, and 3 with irritable bowel syndrome with alternating bowel habits) and discrete episodes of visible Abdominal Distension. Subjects were assessed by abdominothoracic computed tomography (n = 39) and electromyography (EMG) of the abdominothoracic wall (n = 32) during basal conditions (without Abdominal Distension) and during episodes of severe Abdominal Distension. Fifteen patients received a median of 2 sessions (range, 1–3 sessions) of EMG-guided, respiratory-targeted biofeedback treatment; 11 received 1 control session before treatment. Results Episodes of Abdominal Distension were associated with diaphragm contraction (19% ± 3% increase in EMG score and 12 ± 2 mm descent; P P P P P ≤ .009 vs pretreatment for all). Conclusions In patients with functional gut disorders, Abdominal Distension is a behavioral response that involves activity of the abdominothoracic wall. This Distension can be reduced with EMG-guided, respiratory-targeted biofeedback therapy.
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mechanisms of Abdominal Distension in severe intestinal dysmotility abdomino thoracic response to gut retention
Neurogastroenterology and Motility, 2013Co-Authors: Elizabeth Barba, Emanuel Burri, Anna Accarino, Sergi Quiroga, Isabel Navazo, E M Lahoya, Carolina Malagelada, J R Malagelada, Fernando AzpirozAbstract:BACKGROUND: We previously showed that Abdominal Distension in patients with functional gut disorders is due to a paradoxical diaphragmatic contraction without major increment in intraAbdominal volume. Our aim was to characterize the pattern of gas retention and the abdomino-thoracic mechanics associated with Abdominal Distension in patients with intestinal dysmotility. METHODS: In 15 patients with manometrically proven intestinal dysmotility, two Abdominal CT scans were performed: one during basal conditions and other during an episode of severe Abdominal Distension. In 15 gender- and age-matched healthy controls, a basal scan was performed. KEY RESULTS: In basal conditions, patients exhibited more Abdominal gas than healthy subjects, particularly in the small bowel, and the volume significantly increased during an episode of Distension. During episodes of Abdominal Distension, the increase in Abdominal content was associated with increased girth and antero-posterior Abdominal diameter, as well as a cephalic displacement of the diaphragm, which reduced the height of the lung. The consequent reduction in the air volume of the lung was attenuated by an increase in the antero-posterior diameter of the chest. CONCLUSIONS & INFERENCES: Abdominal Distension in patients with severe intestinal dysfunction is related to marked pooling of gut contents, particularly in the small bowel. This increase in content is accommodated within the Abdominal cavity by a global and coordinated abdomino-phreno-thoracic response, involving an accommodative ascent of the diaphragm and a compensatory expansion of the chest wall.
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abdomino phrenic dyssynergia in patients with Abdominal bloating and Distension
The American Journal of Gastroenterology, 2011Co-Authors: Albert Villoria, Emanuel Burri, Daniel Cisternas, Fernando Azpiroz, Alfredo Soldevilla, Juanr MalageladaAbstract:OBJECTIVES: The abdomen normally accommodates intra-Abdominal volume increments. Patients complaining of Abdominal Distension exhibit abnormal accommodation of colonic gas loads (defective contraction and excessive protrusion of the anterior wall). However, Abdominal imaging demonstrated diaphragmatic descent during spontaneous episodes of bloating in patients with functional gut disorders. We aimed to establish the role of the diaphragm in Abdominal Distension. METHODS: In 20 patients complaining of Abdominal bloating and 15 healthy subjects, we increased the volume of the Abdominal cavity with a colonic gas load, while measuring Abdominal girth and electromyographic activity of the anterior Abdominal muscles and of the diaphragm. RESULTS: In healthy subjects, the colonic gas load increased girth, relaxed the diaphragm, and increased anterior wall tone. With the same gas load, patients developed significantly more Abdominal Distension; this was associated with paradoxical contraction of the diaphragm and relaxation of the internal oblique muscle. CONCLUSIONS: In this experimental provocation model, abnormal accommodation of the diaphragm is involved in Abdominal Distension.
Elizabeth Barba - One of the best experts on this subject based on the ideXlab platform.
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Abdominal Distension after eating lettuce the role of intestinal gas evaluated in vitro and by Abdominal ct imaging
Neurogastroenterology and Motility, 2019Co-Authors: Elizabeth Barba, Emanuel Burri, Anna Accarino, Eva Monclus, Isabel Navazo, Borja Sanchez, Francisco Guarner, Abelardo MargollesAbstract:Background: Some patients complain that eating lettuce, gives them gas and Abdominal distention. Our aim was to determine to what extent the patients' assertion is sustained by evidence. Methods: An in vitro study measured the amount of gas produced during the process of fermentation by a preparation of human colonic microbiota (n = 3) of predigested lettuce, as compared to beans, a high gas-releasing substrate, to meat, a low gas-releasing substrate, and to a nutrient-free negative control. A clinical study in patients complaining of Abdominal distention after eating lettuce (n = 12) measured the amount of intestinal gas and the morphometric configuration of the Abdominal cavity in Abdominal CT scans during an episode of lettuce-induced Distension as compared to basal conditions. Key Results: Gas production by microbiota fermentation of lettuce in vitro was similar to that of meat (P = .44), lower than that of beans (by 78 ± 15%; P < .001) and higher than with the nutrient-free control (by 25 ± 19%; P = .05). Patients complaining of Abdominal Distension after eating lettuce exhibited an increase in girth (35 ± 3 mm larger than basal; P < .001) without significant increase in colonic gas content (39 ± 4 mL increase; P = .071); Abdominal Distension was related to a descent of the diaphragm (by 7 ± 3 mm; P = .027) with redistribution of normal Abdominal contents. Conclusion and Inferences: Lettuce is a low gas-releasing substrate for microbiota fermentation and lettuce-induced Abdominal Distension is produced by an uncoordinated activity of the Abdominal walls. Correction of the somatic response might be more effective than the current dietary restriction strategy.
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abdominothoracic mechanisms of functional Abdominal Distension and correction by biofeedback
Gastroenterology, 2015Co-Authors: Elizabeth Barba, Emanuel Burri, Anna Accarino, Daniel Cisternas, Sergi Quiroga, Eva Monclus, Isabel Navazo, Juanr Malagelada, Fernando AzpirozAbstract:Background & Aims In patients with functional gut disorders, Abdominal Distension has been associated with descent of the diaphragm and protrusion of the anterior Abdominal wall. We investigated mechanisms of Abdominal Distension in these patients. Methods We performed a prospective study of 45 patients (42 women, 24–71 years old) with functional intestinal disorders (27 with irritable bowel syndrome with constipation, 15 with functional bloating, and 3 with irritable bowel syndrome with alternating bowel habits) and discrete episodes of visible Abdominal Distension. Subjects were assessed by abdominothoracic computed tomography (n = 39) and electromyography (EMG) of the abdominothoracic wall (n = 32) during basal conditions (without Abdominal Distension) and during episodes of severe Abdominal Distension. Fifteen patients received a median of 2 sessions (range, 1–3 sessions) of EMG-guided, respiratory-targeted biofeedback treatment; 11 received 1 control session before treatment. Results Episodes of Abdominal Distension were associated with diaphragm contraction (19% ± 3% increase in EMG score and 12 ± 2 mm descent; P P P P P ≤ .009 vs pretreatment for all). Conclusions In patients with functional gut disorders, Abdominal Distension is a behavioral response that involves activity of the abdominothoracic wall. This Distension can be reduced with EMG-guided, respiratory-targeted biofeedback therapy.
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mechanisms of Abdominal Distension in severe intestinal dysmotility abdomino thoracic response to gut retention
Neurogastroenterology and Motility, 2013Co-Authors: Elizabeth Barba, Emanuel Burri, Anna Accarino, Sergi Quiroga, Isabel Navazo, E M Lahoya, Carolina Malagelada, J R Malagelada, Fernando AzpirozAbstract:BACKGROUND: We previously showed that Abdominal Distension in patients with functional gut disorders is due to a paradoxical diaphragmatic contraction without major increment in intraAbdominal volume. Our aim was to characterize the pattern of gas retention and the abdomino-thoracic mechanics associated with Abdominal Distension in patients with intestinal dysmotility. METHODS: In 15 patients with manometrically proven intestinal dysmotility, two Abdominal CT scans were performed: one during basal conditions and other during an episode of severe Abdominal Distension. In 15 gender- and age-matched healthy controls, a basal scan was performed. KEY RESULTS: In basal conditions, patients exhibited more Abdominal gas than healthy subjects, particularly in the small bowel, and the volume significantly increased during an episode of Distension. During episodes of Abdominal Distension, the increase in Abdominal content was associated with increased girth and antero-posterior Abdominal diameter, as well as a cephalic displacement of the diaphragm, which reduced the height of the lung. The consequent reduction in the air volume of the lung was attenuated by an increase in the antero-posterior diameter of the chest. CONCLUSIONS & INFERENCES: Abdominal Distension in patients with severe intestinal dysfunction is related to marked pooling of gut contents, particularly in the small bowel. This increase in content is accommodated within the Abdominal cavity by a global and coordinated abdomino-phreno-thoracic response, involving an accommodative ascent of the diaphragm and a compensatory expansion of the chest wall.
