Pressure-flow signatures of central-airway mucus plugging

Zamanian, Maryam; Marini, John J.

doi:10.1097/01.ccm.0000196216.49407.ee

Cited by 12 publications

(8 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This could be due to cumulative effects of the blending of cellular contents, mucus, and protein exudates. [8] Kuyper et al . investigated the characteristic of mucus plugging in fatal asthma patients and it was observed that cellular content was a mixture of migratory inflammatory cells and shed epithelial cells.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Bronchoscopy as a rescue therapy in patients with status asthmaticus: Two case reports and review of literature

et al. 2013

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

“…Despite positive reports of the benefits of bronchoscopy and lavage in severe asthmaticus, its use continues to be documented only in case reports[489] and some observational studies. [9] Therefore, concrete evidence supporting the effectiveness of this potentially beneficial therapy is still awaited.…”

Section: Discussionmentioning

confidence: 99%

Bronchoscopy as a rescue therapy in patients with status asthmaticus: Two case reports and review of literature

et al. 2013

View full text Add to dashboard Cite

show abstract

“…In this study, we could not use any methods to measure the volume of secretions removed from the airway or analysis of the mucus mass displacement. These techniques are considered to be more objective ways to assess the technique's effects; (6,30,33) this lack may have limited the assessment of the possible benefits from this technique. Considering that this study had a small sample size and only assessed shortterm outcomes, larger sample sizes and assessment of long-term clinical outcomes are required before our findings can be extrapolated.…”

Section: Discussionmentioning

confidence: 99%

Pico de fluxo expiratório e resistência do sistema respiratório de pacientes sob ventilação mecânica submetidos a duas formas de tosse manualmente assistida

Silva¹,

Fluhr²,

Bezerra³

et al. 2012

Rev. bras. ter. intensiva

View full text Add to dashboard Cite

show abstract

“…Sometimes this phenomenon is difficult to appreciate. 26 Mouthward migration of mucus is favored by ventilatory pattern; high tidal volume, (low) PEEP, extended inspiratory to expiratory time ratio and square wave gas flow profile appear to be beneficial for secretion elimination.…”

Section: Mechanical Interventionsmentioning

confidence: 96%

Key Questions in Ventilator Management of the Burn-Injured Patient (Second of Two Parts)

Dries

2009

Journal of Burn Care & Research

View full text Add to dashboard Cite

While tidal volume reduction and application of end expiratory pressure are being studied and refined in contemporary ventilation strategies, alternative modes of ventilation designed to better match respiratory demand are also in development. Some of these strategies relevant to the burn-injured patient are briefly reviewed along with propagation of lung injury and fluid management physiology in the ventilated patient. FLUID MANAGEMENTMany investigators have demonstrated that the combination of inhalation and burn injury increases fluid volume during acute resuscitation in comparison to patients with burn injury alone. 1,2 Endorf and Gamelli 3 in a recent retrospective report review the difficulty in fluid titration with this combination of injuries and suggest that the PaO 2 /FiO 2 ratio may better predict fluid requirements during patient resuscitation. Remarkably, bronchoscopic grade of injury did not correspond in an incremental manner to fluid administration though outcome was reflected in bronchoscopic findings. Patients with PaO 2 /FiO 2 ratio Ͻ350 may have experienced increased inflammation and were noted to have increased fluid administration in this review of 80 patients. Citing large animal work of Shimazu and other investigators, Endorf and Gamelli suggest that ventilation/perfusion changes after smoke inhalation corresponded with disturbances in ventilation rather than shunting or alteration of perfusion. 3,4 While the relative impact of ventilation as opposed to perfusion changes in the setting of burn injury requires further investigation, there is additional clinical and experimental data to consider which is pertinent to fluid management in pulmonary support with burn injury. Distribution of ventilation and the relationship of pattern of ventilation to propagation of injury will be discussed below.Plurad et al 5 from the Los Angles County Medical Center and the University of Southern California associated decreased post-injury respiratory dysfunction with restrictive transfusion practices, reduced airway pressure and decreased crystalloid administration. These investigators reviewed over 2300 patients in a multiyear review during which chest Abbreviated Injury Score and mean Injury Severity Score remained stable while the incidence of posttraumatic Adult Respiratory Distress Syndrome (ARDS) (diagnosed 48 hours or more after admission) decreased. Incidence of late posttraumatic ARDS was increased with rising crystalloid volumes used with larger volume of packed red blood cells administered and relative elevation in peak airway pressure. While much has been written about strategies to improve ventilator management, the physiologic effects of fluid administration and blood flow through the lung and the impact of fluid and pressure gradients in the lung on pulmonary function have received less attention, particularly in models of injury.The normal lung exhibits three classic perfusion zones depending on the relationship between alveolar pressure and pulmonary, arterial and venous pressure. This conc...

show abstract

Pressure-flow signatures of central-airway mucus plugging

Abstract: Four newly observed signs were recorded that may serve to identify occult central airway mucus plugging in the ventilated asthmatic patient.

Cited by 12 publications

References 16 publications

Bronchoscopy as a rescue therapy in patients with status asthmaticus: Two case reports and review of literature

Bronchoscopy as a rescue therapy in patients with status asthmaticus: Two case reports and review of literature

Pico de fluxo expiratório e resistência do sistema respiratório de pacientes sob ventilação mecânica submetidos a duas formas de tosse manualmente assistida

Key Questions in Ventilator Management of the Burn-Injured Patient (Second of Two Parts)

Contact Info

Product

Resources

About