The Experts below are selected from a list of 96 Experts worldwide ranked by ideXlab platform
Burkhard Lachmann - One of the best experts on this subject based on the ideXlab platform.
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Open Lung Ventilation preserves the response to delayed surfactant treatment in surfactant deficient newborn piglets
Critical Care Medicine, 2006Co-Authors: Mariette B Van Veenendaal, Anton H Van Kaam, Jack J Haitsma, Rene Lutter, Burkhard LachmannAbstract:OBJECTIVE: Delayed surfactant treatment (>2 hrs after birth) is less effective than early treatment in conventionally ventilated preterm infants with respiratory distress syndrome. The objective of this study was to evaluate if this time-dependent efficacy of surfactant treatment is also present during Open Lung Ventilation. DESIGN: Prospective, randomized controlled animal study. SETTING: University-affiliated research laboratory. SUBJECTS: Thirty-eight newborn piglets. INTERVENTIONS: Following repeated whole-Lung lavage, animals were randomly allocated to conventional positive pressure Ventilation (PPVCON) using a positive end-expiratory pressure (PEEP) of 5 cm H2O and a tidal volume of 7 mL/kg or Open Lung positive pressure Ventilation (PPVOLV). During PPVOLV, collapsed alveoli were actively recruited and thereafter stabilized with sufficient PEEP. Within each Ventilation group, animals received surfactant (25 mg/kg) either after 2 hrs (PPVCON-2 and PPVOLV-2) or after 4 hrs (PPVCON-4 and PPVOLV-4) of Ventilation. A control group received surfactant immediately after Lung lavage. Following surfactant administration, all animals were conventionally ventilated for an additional 2 hrs. MEASUREMENTS AND MAIN RESULTS: Two hours after surfactant treatment, both oxygenation and Lung mechanics showed a clear deterioration in the PPVCON-4 group compared with PPVCON-2 and the control group. However, this deterioration of the surfactant response over time was not observed during PPVOLV. Analysis of the bronchoalveolar lavage fluid obtained at the end of the experiment showed that the protein concentration and the conversion of large to small aggregate surfactant was significantly higher in the PPVCON-4 group compared with the PPVCON-2 group while comparable in both PPVOLV groups. In addition, interleukin-8 and myeloperoxidase levels tended to be higher in the PPVCON-4 group compared with the PPVOLV-4 group. CONCLUSIONS: In contrast to conventional Ventilation, Open Lung Ventilation preserves the response to delayed surfactant treatment in surfactant-deficient newborn piglets. This sustained response is accompanied by an attenuation of secondary Lung injury.
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Open Lung Ventilation does not increase right ventricular outflow impedance an echo doppler study
Critical Care Medicine, 2006Co-Authors: Dinis Reis Miranda, Ard Struijs, Burkhard Lachmann, Ad J.j.c. Bogers, Lennart Klompe, J Van Bommel, Joris Mekel, Diederik GommersAbstract:Objective: Ventilation according to the Open Lung concept (OLC) consists of recruitment maneuvers, followed by low tidal volume and elevated positive end-expiratory pressure (PEEP). Elevated PEEP is associated with an increased right ventricular afterload. We investigated the effect of OLC Ventilation on right ventricular outflow impedance during inspiration and expiration in patients after cardiac surgery using transesophageal echo-Doppler. Design: A prospective, single-center, crossover, randomized, controlled clinical study. Setting: Cardiothoracic intensive care unit of a university hospital. Patients: Twenty-eight patients scheduled for elective cardiac surgery with cardiopulmonary bypass. Interventions: In the intensive care unit, each patient was ventilated for approximately 30 mins according to both OLC and conventional Ventilation. During OLC Ventilation, recruitment maneuvers were applied until PaO2/FIO2 was >375 torr (50 kPa); during conventional Ventilation no recruitment maneuvers were performed. Measurements and Main Results: Transesophageal echo-Doppler measurements were performed at end-inspiration and endexpiration in a steady-state condition, 20 mins after initiation of a Ventilation strategy. Mean acceleration of flow was determined in the long axis of the pulmonary artery in a transverse axis view. During OLC Ventilation, a total PEEP of 14 4c m H2O was applied vs. 5c m H2O during conventional Ventilation. Mean acceleration during expiration was comparable between groups. During inspiration, OLC Ventilation did not cause a decrease of mean acceleration compared with expiration, whereas this did occur during conventional Ventilation. Conclusions: Despite the use of elevated PEEP levels, Ventilation according to OLC does not change right ventricular outflow impedance during expiration and decreases right ventricular outflow impedance during inspiration. (Crit Care Med 2006; 34:2555‐2560)
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the effect of Open Lung Ventilation on right ventricular and left ventricular function in Lung lavaged pigs
Critical Care, 2006Co-Authors: Dinis Reis Miranda, Burkhard Lachmann, Ad J.j.c. Bogers, Jack J Haitsma, Lennart Klompe, Filippo Cademartiri, Alessandro Palumbo, Johanna J M Takkenberg, Diederik GommersAbstract:Introduction Ventilation according to the Open Lung concept (OLC) consists of recruitment maneuvers, followed by low tidal volume and high positive end-expiratory pressure, aiming at minimizing atelectasis. The minimization of atelectasis reduces the right ventricular (RV) afterload, but the increased intrathoracic pressures used by OLC Ventilation could increase the RV afterload. We hypothesize that when atelectasis is minimized by OLC Ventilation, cardiac function is not affected despite the higher mean airway pressure.
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Open Lung Ventilation improves functional residual capacity after extubation in cardiac surgery.
Critical Care Medicine, 2005Co-Authors: Dinis Reis Miranda, Ard Struijs, Peter M. Koetsier, Robert J. Van Thiel, Ronald M. Schepp, Wim C. J. Hop, Jan Klein, Burkhard Lachmann, Ad J.j.c. Bogers, Diederik GommersAbstract:Objective:After cardiac surgery, functional residual capacity (FRC) after extubation is reduced significantly. We hypothesized that Ventilation according to the Open Lung concept (OLC) attenuates FRC reduction after extubation.Design:A prospective, single-center, randomized, controlled clinical stud
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reducing atelectasis attenuates bacterial growth and translocation in experimental pneumonia
American Journal of Respiratory and Critical Care Medicine, 2004Co-Authors: Anton H Van Kaam, Jack J Haitsma, Anne De Jaegere, Joke H Kok, Robert Lachmann, Egbert Herting, Freek Van Iwaarden, Arnold L Noorduyn, Burkhard LachmannAbstract:Besides being one of the mechanisms responsible for ventilator-induced Lung injury, atelectasis also seems to aggravate the course of experimental pneumonia. In this study, we examined the effect of reducing the degree of atelectasis by natural modified surfactant and/or Open Lung Ventilation on bacterial growth and translocation in a piglet model of Group B streptococcal pneumonia. After creating surfactant deficiency by whole Lung lavage, intratracheal instillation of bacteria induced severe pneumonia with bacterial translocation into the blood stream, resulting in a mortality rate of almost 80%. Treatment with 300 mg/kg of exogenous surfactant before instillation of streptococci attenuated both bacterial growth and translocation and prevented clinical deterioration. This goal was also achieved by reversing atelectasis in lavaged animals via Open Lung Ventilation. Combining both exogenous surfactant and Open Lung Ventilation prevented bacterial translocation completely, comparable to Group B streptococci instillation into healthy animals. We conclude that exogenous surfactant and Open Lung Ventilation attenuate bacterial growth and translocation in experimental pneumonia and that this attenuation is at least in part mediated by a reduction in atelectasis. These findings suggest that minimizing alveolar collapse by exogenous surfactant and Open Lung Ventilation may reduce the risk of pneumonia and subsequent sepsis in ventilated patients.
Diederik Gommers - One of the best experts on this subject based on the ideXlab platform.
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Open Lung Ventilation does not increase right ventricular outflow impedance an echo doppler study
Critical Care Medicine, 2006Co-Authors: Dinis Reis Miranda, Ard Struijs, Burkhard Lachmann, Ad J.j.c. Bogers, Lennart Klompe, J Van Bommel, Joris Mekel, Diederik GommersAbstract:Objective: Ventilation according to the Open Lung concept (OLC) consists of recruitment maneuvers, followed by low tidal volume and elevated positive end-expiratory pressure (PEEP). Elevated PEEP is associated with an increased right ventricular afterload. We investigated the effect of OLC Ventilation on right ventricular outflow impedance during inspiration and expiration in patients after cardiac surgery using transesophageal echo-Doppler. Design: A prospective, single-center, crossover, randomized, controlled clinical study. Setting: Cardiothoracic intensive care unit of a university hospital. Patients: Twenty-eight patients scheduled for elective cardiac surgery with cardiopulmonary bypass. Interventions: In the intensive care unit, each patient was ventilated for approximately 30 mins according to both OLC and conventional Ventilation. During OLC Ventilation, recruitment maneuvers were applied until PaO2/FIO2 was >375 torr (50 kPa); during conventional Ventilation no recruitment maneuvers were performed. Measurements and Main Results: Transesophageal echo-Doppler measurements were performed at end-inspiration and endexpiration in a steady-state condition, 20 mins after initiation of a Ventilation strategy. Mean acceleration of flow was determined in the long axis of the pulmonary artery in a transverse axis view. During OLC Ventilation, a total PEEP of 14 4c m H2O was applied vs. 5c m H2O during conventional Ventilation. Mean acceleration during expiration was comparable between groups. During inspiration, OLC Ventilation did not cause a decrease of mean acceleration compared with expiration, whereas this did occur during conventional Ventilation. Conclusions: Despite the use of elevated PEEP levels, Ventilation according to OLC does not change right ventricular outflow impedance during expiration and decreases right ventricular outflow impedance during inspiration. (Crit Care Med 2006; 34:2555‐2560)
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the effect of Open Lung Ventilation on right ventricular and left ventricular function in Lung lavaged pigs
Critical Care, 2006Co-Authors: Dinis Reis Miranda, Burkhard Lachmann, Ad J.j.c. Bogers, Jack J Haitsma, Lennart Klompe, Filippo Cademartiri, Alessandro Palumbo, Johanna J M Takkenberg, Diederik GommersAbstract:Introduction Ventilation according to the Open Lung concept (OLC) consists of recruitment maneuvers, followed by low tidal volume and high positive end-expiratory pressure, aiming at minimizing atelectasis. The minimization of atelectasis reduces the right ventricular (RV) afterload, but the increased intrathoracic pressures used by OLC Ventilation could increase the RV afterload. We hypothesize that when atelectasis is minimized by OLC Ventilation, cardiac function is not affected despite the higher mean airway pressure.
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Open Lung Ventilation does not increase right ventricular afterload in cardiac surgery patients
Critical Care, 2006Co-Authors: Lennart Klompe, Ard Struijs, Ad J.j.c. Bogers, Reis D Miranda, J Van Bommel, J Meekel, Diederik GommersAbstract:Open Lung Ventilation (OLV) consists of recruitment maneuvers, followed by low tidal volume and elevated positive end-expiratory pressure (PEEP). Elevated PEEP is associated with an increased right ventricular (RV) afterload. We investigated the effect of OLV on RV afterload during inspiration and expiration in patients after cardiac surgery using Doppler echocardiography. In 28 patients scheduled for cardiac surgery, two Ventilation strategies were applied in a randomized cross-over design. During OLV, recruitment maneuvers were applied until PaO2/FiO2 > 375 Torr was achieved (reflecting an Open Lung) and were maintained by the use of sufficient levels of PEEP. The tidal volume was 4–6 ml/kg. During conventional mechanical Ventilation (CMV) the Ventilation was with a low tidal volume (6–8 ml/kg) with 5 cmH2O PEEP, without recruitment maneuvers. The acceleration time (Acmean) of the pulmonary artery was measured with transesophageal echocardiography in a long-axis view of the pulmonary artery during end-inspiration and end-expiration. The total PEEP in the OLV group was 14 ± 4 compared with 5 ± 1 cmH2O in the CMV group. During expiration, the Acmean of both Ventilation strategies was comparable. Inspiration caused a significant decrease of Acmean compared with expiration during CMV (Table (Table1).1). Surprisingly, this did not occur during OLV. Table 1 We conclude that despite the use of 'relatively' high PEEP, OLV with low tidal volume does not increase RV afterload during inspiration and expiration.
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Open Lung Ventilation improves functional residual capacity after extubation in cardiac surgery.
Critical Care Medicine, 2005Co-Authors: Dinis Reis Miranda, Ard Struijs, Peter M. Koetsier, Robert J. Van Thiel, Ronald M. Schepp, Wim C. J. Hop, Jan Klein, Burkhard Lachmann, Ad J.j.c. Bogers, Diederik GommersAbstract:Objective:After cardiac surgery, functional residual capacity (FRC) after extubation is reduced significantly. We hypothesized that Ventilation according to the Open Lung concept (OLC) attenuates FRC reduction after extubation.Design:A prospective, single-center, randomized, controlled clinical stud
Carol L Hodgson - One of the best experts on this subject based on the ideXlab platform.
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maximal recruitment Open Lung Ventilation in acute respiratory distress syndrome pharlap a phase ii multicenter randomized controlled clinical trial
American Journal of Respiratory and Critical Care Medicine, 2019Co-Authors: Carol L Hodgson, James D Cooper, Yaseen M Arabi, Victoria King, Andrew D Bersten, Shailesh Bihari, Kathy Brickell, Andrew Ross DaviesAbstract:Rationale: Open Lung Ventilation strategies have been recommended in patients with acute respiratory distress syndrome (ARDS).Objectives: To determine whether a maximal Lung recruitment strategy re...
Dinis Reis Miranda - One of the best experts on this subject based on the ideXlab platform.
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Open Lung Ventilation does not increase right ventricular outflow impedance an echo doppler study
Critical Care Medicine, 2006Co-Authors: Dinis Reis Miranda, Ard Struijs, Burkhard Lachmann, Ad J.j.c. Bogers, Lennart Klompe, J Van Bommel, Joris Mekel, Diederik GommersAbstract:Objective: Ventilation according to the Open Lung concept (OLC) consists of recruitment maneuvers, followed by low tidal volume and elevated positive end-expiratory pressure (PEEP). Elevated PEEP is associated with an increased right ventricular afterload. We investigated the effect of OLC Ventilation on right ventricular outflow impedance during inspiration and expiration in patients after cardiac surgery using transesophageal echo-Doppler. Design: A prospective, single-center, crossover, randomized, controlled clinical study. Setting: Cardiothoracic intensive care unit of a university hospital. Patients: Twenty-eight patients scheduled for elective cardiac surgery with cardiopulmonary bypass. Interventions: In the intensive care unit, each patient was ventilated for approximately 30 mins according to both OLC and conventional Ventilation. During OLC Ventilation, recruitment maneuvers were applied until PaO2/FIO2 was >375 torr (50 kPa); during conventional Ventilation no recruitment maneuvers were performed. Measurements and Main Results: Transesophageal echo-Doppler measurements were performed at end-inspiration and endexpiration in a steady-state condition, 20 mins after initiation of a Ventilation strategy. Mean acceleration of flow was determined in the long axis of the pulmonary artery in a transverse axis view. During OLC Ventilation, a total PEEP of 14 4c m H2O was applied vs. 5c m H2O during conventional Ventilation. Mean acceleration during expiration was comparable between groups. During inspiration, OLC Ventilation did not cause a decrease of mean acceleration compared with expiration, whereas this did occur during conventional Ventilation. Conclusions: Despite the use of elevated PEEP levels, Ventilation according to OLC does not change right ventricular outflow impedance during expiration and decreases right ventricular outflow impedance during inspiration. (Crit Care Med 2006; 34:2555‐2560)
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the effect of Open Lung Ventilation on right ventricular and left ventricular function in Lung lavaged pigs
Critical Care, 2006Co-Authors: Dinis Reis Miranda, Burkhard Lachmann, Ad J.j.c. Bogers, Jack J Haitsma, Lennart Klompe, Filippo Cademartiri, Alessandro Palumbo, Johanna J M Takkenberg, Diederik GommersAbstract:Introduction Ventilation according to the Open Lung concept (OLC) consists of recruitment maneuvers, followed by low tidal volume and high positive end-expiratory pressure, aiming at minimizing atelectasis. The minimization of atelectasis reduces the right ventricular (RV) afterload, but the increased intrathoracic pressures used by OLC Ventilation could increase the RV afterload. We hypothesize that when atelectasis is minimized by OLC Ventilation, cardiac function is not affected despite the higher mean airway pressure.
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Open Lung Ventilation improves functional residual capacity after extubation in cardiac surgery.
Critical Care Medicine, 2005Co-Authors: Dinis Reis Miranda, Ard Struijs, Peter M. Koetsier, Robert J. Van Thiel, Ronald M. Schepp, Wim C. J. Hop, Jan Klein, Burkhard Lachmann, Ad J.j.c. Bogers, Diederik GommersAbstract:Objective:After cardiac surgery, functional residual capacity (FRC) after extubation is reduced significantly. We hypothesized that Ventilation according to the Open Lung concept (OLC) attenuates FRC reduction after extubation.Design:A prospective, single-center, randomized, controlled clinical stud
Nader M Habashi - One of the best experts on this subject based on the ideXlab platform.
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other approaches to Open Lung Ventilation airway pressure release Ventilation
Critical Care Medicine, 2005Co-Authors: Nader M HabashiAbstract:Objective:To review the use of airway pressure release Ventilation (APRV) in the treatment of acute Lung injury/acute respiratory distress syndrome.Data Source:Published animal studies, human studies, and review articles of APRV.Data Summary:APRV has been successfully used in neonatal, pediatric, an
