The Experts below are selected from a list of 144 Experts worldwide ranked by ideXlab platform
Sten Walther - One of the best experts on this subject based on the ideXlab platform.
-
inhaled and intravenous corticosteroids both attenuate chlorine gas induced lung injury in pigs
Acta Anaesthesiologica Scandinavica, 2005Co-Authors: Jianpu Wang, Calle Winskog, Erik Edston, Sten WaltherAbstract:Background: The accidental release of chlorine gas is a constant threat in urban areas. The purpose of this randomized, blinded, controlled experiment was to examine the effects of post-injury administration of inhaled or intravenous corticosteroid in chlorine gas-injured pigs followed for 23 h.Methods: Anaesthetized, ventilated pigs (n = 24) in the prone position were exposed to chlorine gas (400 parts per million in air) (1160 mg/m3) for 15 min, then randomly allocated to receive inhaled Budesonide (BUD) and intravenous placebo, intravenous betamethasone (BETA) and inhaled placebo or inhaled and intravenous placebo. Haemodynamics, gas exchange and lung mechanics were evaluated for 23 h after exposure to chlorine gas.Results: Airway and pulmonary artery pressures increased and arterial oxygenation fell sharply (from 13.5 ± 0.8 to 6.7 ± 0.9 kPa, P < 0.001) after chlorine gas exposure. These immediate changes were followed by a gradual improvement over 5–7 h to a stable level of dysfunction for the rest of the experiment in placebo animals. Arterial oxygen tension, pulmonary vascular resistance and airway pressure recovered faster and more completely in the Budesonide and betamethasone groups than in the placebo group (P < 0.01). Lung wet weight to dry weight ratios were greater in the placebo group than in the Budesonide and betamethasone groups (6.34 ± 0.59 vs. 5.56 ± 0.38 and 5.53 ± 0.54, respectively, P < 0.05). There was a trend towards lower histological injury scores compared with placebo in animals that received Budesonide (P = 0.05) or betamethasone (P = 0.07).Conclusion: Treatment of chlorine gas lung injury with Nebulized Budesonide or intravenous betamethasone had similar positive effects on recovery of lung function.
-
administration of aerosolized terbutaline and Budesonide reduces chlorine gas induced acute lung injury
Journal of Trauma-injury Infection and Critical Care, 2004Co-Authors: Jianpu Wang, Liming Zhang, Sten WaltherAbstract:One of the most threatening scenarios in disaster medicine is the accidental release of toxic gases with the exposure of many people. In this respect, chlorine gas remains a significant threat due to its abundant use and transport through densely populated areas in modem society. Access to a simple and effective method of treatment that could be started early would be of great value. The main purpose of this study was to test a series of hypotheses related to chlorine gas lung injury and its treatment.Anesthetized and mechanically ventilated pigs were exposed to chlorine gas (400 parts per million in air) using a closed system with a ventilator connected to gas cylinders. Plasma endothelin-1 (ET -1) and pro inflammatory cytokines were evaluated for 5 hours after injury while hemodynamics, gas exchange and lung mechanics were followed for 23 hours. Histopathology and lung water balance were assessed at the end of the experiment.Chlorine gas exposure induced a rise in circulating ET-1 and circulating cytokines (TNF-α, and IL-1s, IL-6). Pretreatment or treatment with tezosentan, a potent dual endothelin receptor antagonist, reduced the deterioration of pulmonary function induced by chlorine gas inhalation. Immediate prone positioning after chlorine gas injury not only inhibited deterioration of gas exchange but was also associated with improved pulmonary function and oxygen transport. Nebulized Budesonide given within 30 minutes after chlorine gas lung injury was effective in preventing further progression of lung dysfunction but the effect of treatment given beyond 60 minutes was less efficient. The positive effects on pulmonary function and lung water were similar whether corticosteroids were given by aerosol or intravenously. Combined treatment with Nebulized terbutaline and Budesonide was associated with better recovery of lung function than either drug alone.In conclusion, these studies outline the early pathophysiology of chlorine gas injury. They show that the endothelin system mediates the early pulmonary hypertensive and also to some extent the brochoconstrictive responses to inhaled chlorine gas. The work supports early administration of corticosteroids and s2-agonists for individuals that are exposure to chlorine gas. In addition, early prone positioning of patients with severe chlorine gas lung injury may be useful.
Athanasios G Kaditis - One of the best experts on this subject based on the ideXlab platform.
-
viral croup diagnosis and a treatment algorithm
Pediatric Pulmonology, 2014Co-Authors: Argyri Petrocheilou, Kalliopi Tanou, Efthimia Kalampouka, Georgia Malakasioti, Christos Giannios, Athanasios G KaditisAbstract:Summary Viral croup is a frequent disease in early childhood. Although it is usually self-limited, it may occasionally become life-threatening. Mild croup is characterized by the presence of stridor without intercostal retractions, whereas moderate-to-severe croup is accompanied by increased work of breathing. A single dose of orally administered dexamethasone (0.15–0.6 mg/kg) is the mainstay of treatment with addition of Nebulized epinephrine only in cases of moderate-to-severe croup. Nebulized Budesonide (2 mg) can be given alternatively to children who do not tolerate oral dexamethasone. Exposure to cold air or administration of cool mist are treatment interventions for viral croup that are not supported by published evidence, but breathing heliox can potentially reduce the work of breathing related to upper airway obstruction. In summary, corticosteroids may decrease the intensity of viral croup symptoms irrespective to their severity on presentation to the emergency department. Pediatr Pulmonol. 2014; 49:421–429. © 2013 Wiley Periodicals, Inc.
Jianpu Wang - One of the best experts on this subject based on the ideXlab platform.
-
inhaled and intravenous corticosteroids both attenuate chlorine gas induced lung injury in pigs
Acta Anaesthesiologica Scandinavica, 2005Co-Authors: Jianpu Wang, Calle Winskog, Erik Edston, Sten WaltherAbstract:Background: The accidental release of chlorine gas is a constant threat in urban areas. The purpose of this randomized, blinded, controlled experiment was to examine the effects of post-injury administration of inhaled or intravenous corticosteroid in chlorine gas-injured pigs followed for 23 h.Methods: Anaesthetized, ventilated pigs (n = 24) in the prone position were exposed to chlorine gas (400 parts per million in air) (1160 mg/m3) for 15 min, then randomly allocated to receive inhaled Budesonide (BUD) and intravenous placebo, intravenous betamethasone (BETA) and inhaled placebo or inhaled and intravenous placebo. Haemodynamics, gas exchange and lung mechanics were evaluated for 23 h after exposure to chlorine gas.Results: Airway and pulmonary artery pressures increased and arterial oxygenation fell sharply (from 13.5 ± 0.8 to 6.7 ± 0.9 kPa, P < 0.001) after chlorine gas exposure. These immediate changes were followed by a gradual improvement over 5–7 h to a stable level of dysfunction for the rest of the experiment in placebo animals. Arterial oxygen tension, pulmonary vascular resistance and airway pressure recovered faster and more completely in the Budesonide and betamethasone groups than in the placebo group (P < 0.01). Lung wet weight to dry weight ratios were greater in the placebo group than in the Budesonide and betamethasone groups (6.34 ± 0.59 vs. 5.56 ± 0.38 and 5.53 ± 0.54, respectively, P < 0.05). There was a trend towards lower histological injury scores compared with placebo in animals that received Budesonide (P = 0.05) or betamethasone (P = 0.07).Conclusion: Treatment of chlorine gas lung injury with Nebulized Budesonide or intravenous betamethasone had similar positive effects on recovery of lung function.
-
administration of aerosolized terbutaline and Budesonide reduces chlorine gas induced acute lung injury
Journal of Trauma-injury Infection and Critical Care, 2004Co-Authors: Jianpu Wang, Liming Zhang, Sten WaltherAbstract:One of the most threatening scenarios in disaster medicine is the accidental release of toxic gases with the exposure of many people. In this respect, chlorine gas remains a significant threat due to its abundant use and transport through densely populated areas in modem society. Access to a simple and effective method of treatment that could be started early would be of great value. The main purpose of this study was to test a series of hypotheses related to chlorine gas lung injury and its treatment.Anesthetized and mechanically ventilated pigs were exposed to chlorine gas (400 parts per million in air) using a closed system with a ventilator connected to gas cylinders. Plasma endothelin-1 (ET -1) and pro inflammatory cytokines were evaluated for 5 hours after injury while hemodynamics, gas exchange and lung mechanics were followed for 23 hours. Histopathology and lung water balance were assessed at the end of the experiment.Chlorine gas exposure induced a rise in circulating ET-1 and circulating cytokines (TNF-α, and IL-1s, IL-6). Pretreatment or treatment with tezosentan, a potent dual endothelin receptor antagonist, reduced the deterioration of pulmonary function induced by chlorine gas inhalation. Immediate prone positioning after chlorine gas injury not only inhibited deterioration of gas exchange but was also associated with improved pulmonary function and oxygen transport. Nebulized Budesonide given within 30 minutes after chlorine gas lung injury was effective in preventing further progression of lung dysfunction but the effect of treatment given beyond 60 minutes was less efficient. The positive effects on pulmonary function and lung water were similar whether corticosteroids were given by aerosol or intravenously. Combined treatment with Nebulized terbutaline and Budesonide was associated with better recovery of lung function than either drug alone.In conclusion, these studies outline the early pathophysiology of chlorine gas injury. They show that the endothelin system mediates the early pulmonary hypertensive and also to some extent the brochoconstrictive responses to inhaled chlorine gas. The work supports early administration of corticosteroids and s2-agonists for individuals that are exposure to chlorine gas. In addition, early prone positioning of patients with severe chlorine gas lung injury may be useful.
Peter C Rowe - One of the best experts on this subject based on the ideXlab platform.
-
Nebulized Budesonide and oral dexamethasone for treatment of croup a randomized controlled trial
JAMA, 1998Co-Authors: Terry P Klassen, Lise K Watters, William R Craig, David Moher, Martin H Osmond, Hans Pasterkamp, Terry Sutcliffe, Peter C RoweAbstract:Context.— The effectiveness of glucocorticoids for patients with croup is well established but it remains uncertain which glucocorticoid regimen is most effective. Objective.— To determine the effectiveness of 3 glucocorticoid regimens in patients with croup. Design.— Randomized controlled trial with parallel design. Setting.— Emergency departments of 2 Canadian pediatric tertiary care hospitals. Participants.— Children with a clinical syndrome consistent with croup, aged 3 months to 5 years, with a croup score of 2 or greater following at least 15 minutes of mist therapy. Interventions.— Oral dexamethasone, 0.6 mg/kg, and Nebulized placebo; oral
-
the efficacy of Nebulized Budesonide in dexamethasone treated outpatients with croup
Pediatrics, 1996Co-Authors: Terry P Klassen, Mark Feldman, Lise K Watters, Teresa Sutcliffe, Peter C RoweAbstract:Objective. To determine the added clinical benefit of Nebulized Budesonide in children with mild to moderate croup treated with 0.6 mg/kg oral dexamethasone. Design. Randomized, double-blind, placebo-controlled trial. Setting. Emergency department of a tertiary-care pediatric hospital with 47 000 visits per year. Participants. Children 3 months to 5 years of age with a syndrome consisting of hoarseness, inspiratory stridor, and barking cough and a croup score of 3 or greater after at least 15 minutes of mist therapy. Patients were excluded from the study if they had diagnoses of epiglottitis, chronic upper or lower airway disease (not including asthma), or severe croup or had received corticosteroids within the preceding 2 weeks. Intervention. All patients received 0.6 mg/kg oral dexamethasone and were randomly assigned to receive 4 mL (2 mg) of Budesonide solution (n = 25) or 4 mL of 0.9% saline solution (n = 25) by updraft nebulizer with a continuous flow of oxygen at 5 to 6 L/min. Main Outcome Measures. The primary outcome measure was the proportion of patients in each group who had clinically important changes (two points) in the croup score during the 4 hours after treatment. Results. Eighty-four percent (n = 21) of the patients who received Budesonide had clinically important responses, compared with 56% (n = 14) in the placebo group. The number of patients who would need to be treated with Nebulized Budesonide for one patient to have a clinically important response is four patients. Conclusions. Despite receiving simultaneous oral dexamethasone, pediatric outpatients with mild to moderate croup have added, clinically important improvement in respiratory symptoms after treatment with Budesonide.
-
Nebulized Budesonide for children with mild to moderate croup
The New England Journal of Medicine, 1994Co-Authors: Terry P Klassen, Mark Feldman, Lise K Watters, Teresa Sutcliffe, Peter C RoweAbstract:Background Although recent evidence has strongly supported the use of glucocorticoid therapy in children hospitalized with croup, the benefit of this therapy in children with less severe croup has not been documented. This randomized, double-blind trial compared a Nebulized glucocorticoid, Budesonide, with placebo in outpatients with mild-to-moderate croup. Methods Children three months to five years of age were eligible for the study if their croup scores fell in the mild-to-moderate range (scores of 2 to 7 out of a possible 17). The patients were randomly assigned to receive either 2 mg (4 ml) of Nebulized Budesonide (27 children) or 4 ml of Nebulized normal saline (27 children); they were then assessed hourly for up to four hours by investigators who were unaware of the assigned treatments. Results The median croup score at entry into the study was 4 in both groups. At the final study assessment, the median score was significantly lower in the Budesonide group than in the placebo group (1 vs. 3, P = 0....
Terry P Klassen - One of the best experts on this subject based on the ideXlab platform.
-
Nebulized Budesonide and oral dexamethasone for treatment of croup a randomized controlled trial
JAMA, 1998Co-Authors: Terry P Klassen, Lise K Watters, William R Craig, David Moher, Martin H Osmond, Hans Pasterkamp, Terry Sutcliffe, Peter C RoweAbstract:Context.— The effectiveness of glucocorticoids for patients with croup is well established but it remains uncertain which glucocorticoid regimen is most effective. Objective.— To determine the effectiveness of 3 glucocorticoid regimens in patients with croup. Design.— Randomized controlled trial with parallel design. Setting.— Emergency departments of 2 Canadian pediatric tertiary care hospitals. Participants.— Children with a clinical syndrome consistent with croup, aged 3 months to 5 years, with a croup score of 2 or greater following at least 15 minutes of mist therapy. Interventions.— Oral dexamethasone, 0.6 mg/kg, and Nebulized placebo; oral
-
the efficacy of Nebulized Budesonide in dexamethasone treated outpatients with croup
Pediatrics, 1996Co-Authors: Terry P Klassen, Mark Feldman, Lise K Watters, Teresa Sutcliffe, Peter C RoweAbstract:Objective. To determine the added clinical benefit of Nebulized Budesonide in children with mild to moderate croup treated with 0.6 mg/kg oral dexamethasone. Design. Randomized, double-blind, placebo-controlled trial. Setting. Emergency department of a tertiary-care pediatric hospital with 47 000 visits per year. Participants. Children 3 months to 5 years of age with a syndrome consisting of hoarseness, inspiratory stridor, and barking cough and a croup score of 3 or greater after at least 15 minutes of mist therapy. Patients were excluded from the study if they had diagnoses of epiglottitis, chronic upper or lower airway disease (not including asthma), or severe croup or had received corticosteroids within the preceding 2 weeks. Intervention. All patients received 0.6 mg/kg oral dexamethasone and were randomly assigned to receive 4 mL (2 mg) of Budesonide solution (n = 25) or 4 mL of 0.9% saline solution (n = 25) by updraft nebulizer with a continuous flow of oxygen at 5 to 6 L/min. Main Outcome Measures. The primary outcome measure was the proportion of patients in each group who had clinically important changes (two points) in the croup score during the 4 hours after treatment. Results. Eighty-four percent (n = 21) of the patients who received Budesonide had clinically important responses, compared with 56% (n = 14) in the placebo group. The number of patients who would need to be treated with Nebulized Budesonide for one patient to have a clinically important response is four patients. Conclusions. Despite receiving simultaneous oral dexamethasone, pediatric outpatients with mild to moderate croup have added, clinically important improvement in respiratory symptoms after treatment with Budesonide.
-
Nebulized Budesonide for children with mild to moderate croup
The New England Journal of Medicine, 1994Co-Authors: Terry P Klassen, Mark Feldman, Lise K Watters, Teresa Sutcliffe, Peter C RoweAbstract:Background Although recent evidence has strongly supported the use of glucocorticoid therapy in children hospitalized with croup, the benefit of this therapy in children with less severe croup has not been documented. This randomized, double-blind trial compared a Nebulized glucocorticoid, Budesonide, with placebo in outpatients with mild-to-moderate croup. Methods Children three months to five years of age were eligible for the study if their croup scores fell in the mild-to-moderate range (scores of 2 to 7 out of a possible 17). The patients were randomly assigned to receive either 2 mg (4 ml) of Nebulized Budesonide (27 children) or 4 ml of Nebulized normal saline (27 children); they were then assessed hourly for up to four hours by investigators who were unaware of the assigned treatments. Results The median croup score at entry into the study was 4 in both groups. At the final study assessment, the median score was significantly lower in the Budesonide group than in the placebo group (1 vs. 3, P = 0....
