Dissertations / Theses: 'Edema pulmonar'

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Pereira, Vânia Carina Ventura. "Edema pulmonar em gatos." Master's thesis, Universidade de Lisboa, Faculdade de Medicina Veterinária, 2019. http://hdl.handle.net/10400.5/19287.

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Dissertação de Mestrado Integrado em Medicina Veterinária
O edema pulmonar é uma emergência médica que resulta de um distúrbio hemodinâmico de um ou mais sistemas. Tem um desenvolvimento agudo ou progressivo, mas com descompensação rápida que necessita de uma resposta imediata do médico veterinário. Este trabalho resultou de um estudo retrospectivo de uma amostra de onze gatos diagnosticados com edema pulmonar no Hospital VetSet, em Palmela e no Hospital do Atlântico, em Mafra, tendo sido feita a análise dos processos clínicos, dos exames complementares de diagnóstico realizados (radiografias torácicas e ecocardiogramas). Os principais objetivos foram: identificar a causa de edema pulmonar mais frequente; os sinais mais comuns; os padrões radiográficos, a distribuição pulmonar e simetria do edema pulmonar apresentados; associar o vertebral heart size (VHS) com o tipo de edema pulmonar encontrado; avaliar a gravidade do edema pulmonar; identificar o tratamento médico mais utilizado e quantificar o tempo de internamento e a sua necessidade. As características pulmonares mais frequentemente encontradas no exame radiográfico foram: o padrão misto (brônquico-intersticial ou interstício-alveolar), a distribuição uniforme difusa, maioritariamente simétrica e com grandes alterações de edema pulmonar. As causas de edema pulmonar mais prevalentes neste estudo foram de origem cardíaca ou mista. Nestes verificou-se um aumento do VHS, enquanto nos restantes casos (causa não cardíaca) apresentavam VHS apresentava-se normal ou com um aumento discreto. Pelo estudo ecocardiográfico verificou-se que as afeções cardíacas mais encontradas foram a hipertrofia do ventrículo esquerdo e a dilatação atrial esquerda. Os sinais mais frequentes foram a dispneia, a taquipneia, a taquicardia, a presença de fervores e de sopro sistólico. Já o tratamento de primeira linha continua a ser o recurso a diuréticos da ansa, seguido dos inibidores da enzima de conversão da angiotensina (IECAs) em casos de causa cardiogénica ou mista e de medicação dirigida a afeções secundárias. Para alívio dos sinais respiratórios e de ansiedade recorreu-se à oxigenoterapia e sedação. O internamento, quando necessário, foi de curta duração e os animais eutanasiados foram-no pela afeção primária causadora do edema pulmonar e não por esta complicação. Apesar da amostra de animais do estudo ter sido pequena, os resultados obtidos foram concordantes com a literatura existente.
ABSTRACT - Pulmonary edema is a medical emergency that results from a hemodynamic disorder of one or more systems. It has an acute or progressive development, but with rapid decompensation that needs immediate response from the veterinarian. This study was the result of a retrospective study of a sample of eleven cats diagnosed with pulmonary edema at VetSet Hospital in Palmela and at Atlântico Hospital in Mafra. The clinical processes, the complementary diagnostic tests (chest X-rays and echocardiograms) were analyzed. The main objectives were: to identify the cause of the most frequent pulmonary edema; the most common signs; the radiographic patters, pulmonary distribution and symmetry of pulmonary edema presented; associate the vertebral heart size (VHS) with the type of pulmonary edema found; assess the severity of pulmonary edema; identify the most commonly used medical treatment and quantify the lenght of stay and its need. The pulmonary characteristis most frequently found on radiographic examination were: mixed pattern (bronchial-intersticial or intersticial-alveolar), diffuse uniform distribution, mostly symmetrical and with large changes in pulmonary edema. The most prevalente causes of pulmonary edema in this study were of cardiac or mixed origin. In these cases, there was an increase in VHS, while the remaining cases (noncardiac cause) had normal ou slightly increased VHS. The echocardiographic study showed that the most common cardiac pathologies were left ventricular hypertrophy and left atrial dilatation. The signs more frequent were dyspnea, tachypnea, tachycardia, the presence of fervors and systolic murmur. First-line treatment remains the use of loop diuretics followed by angiotensin converting enzyme inhibitors (IECAs) in cases of cardiogenic or mixed cause and medication directed to secondary pathologies. To relieve respiratory signs and anxiety, oxygen therapy and sedation were used. Hospitalization, when necessary, was short and euthanized animals were due to the primary pathology that caused pulmonary edema and not to this complication. Although the sample of animals in this study was small, the results obtained were consistente with the literature.
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Viveiros, Carla Sofia Santos. "Edema pulmonar cardiogénico em felinos." Master's thesis, Universidade de Évora, 2021. http://hdl.handle.net/10174/29809.

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O presente trabalho é composto por três partes. A primeira consiste num relatório de estágio que decorreu durante três meses no Hospital Veterinário do Atlântico; a segunda consiste numa revisão bibliográfica sobre o edema pulmonar cardiogénico em gatos; e a terceira consiste num estudo de caso sobre o mesmo tema. Foram realizados também três meses de estágio adicionais em âmbito da clínica ambulatória na área de cardiologia. No entanto, estes não serão contabilizados para efeitos de relatório de estágio. No decorrer do estágio curricular foram acompanhadas as áreas de medicina preventiva e clínica médica e cirúrgica. Também foi possível acompanhar inúmeras cirurgias e consultas de especialidade e a realização exames complementares na área de imagiologia e análises laboratoriais; Cardiogenic pulmonary edema in felines Abstract: The present report comprises three parts. The first details the caseload observed in a three-month traineeship at the Atlantic Veterinary Hospital. The second consists of a literature review on cardiogenic pulmonary edema in felines. The third part consists of a case study on the same subject. An additional traineeship was also performed, for three months, in an ambulatory cardiology clinic; however, it will not be included in the report above. During the traineeship at the Atlantic Veterinary Hospital, it was allowed to assist procedures in preventive medicine and medical and surgical clinic. It was also possible to help in numerous surgeries and specialties appointments, perform complementary exams and reinforce imagiological and laboratory diagnosis skills.

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Abra, Blanco Eleonora Elisia. "Edema pulmonar de ratos vagotomizados : provavel envolvimento da histamina." [s.n.], 1985. http://repositorio.unicamp.br/jspui/handle/REPOSIP/314644.

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Orientador : Rui Errerias Maciel
Dissertação (mestrado) - Universidade Estadual de Campinas, Instituto de Biologia
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Resumo: A vagotomia cervical bilateral seguida de exercício físico promove edema pulmonar agudo no rato dentro de minutos. A porcentagem de tecido seco pulmonar nos animais vagotomizados é menor que nos animais controles (CV) e nos vago-adrenalectomizados e seus controles (CVA). ¿Adrenalectomia bilateral imediatamente após a vagotomia previne este tipo de edema. ¿Nos pulmões dos ratos vagotomizados, o nível histamínico sofreu uma significante queda em relação ao seu controle (CV), enquanto que não se constatou o mesmo nos vago-adrenalectomizados em relação ao seu controle (CVA). ¿A concentração de histamina nos fígados dos vagotomizados e vago-adrenalectomizados não sofreu alteração significante em relação aos seus grupos controles, indicando que a alteração histamínica ocorreu a nível pulmonar, somente. ¿ Adepleção histamínica pulmonar nos ratos vagotomizados não se deveu à adrenalina liberada durante o exercício físico e ¿stress¿, uma vez que todos os animais dos outros grupos que também foram submetidos ao exercício, tiveram nível histamínico maior. ¿O exame histológico demonstrou nos pulmões dos ratos vagotomizados um desarranjo na configuração alveolar, e que os mastócitos se tornaram menos freqüentes nestes órgãos.-Concluímos, finalmente, que a lateração histamínica observada é um fator indicativo da sua participação no processo edematogênico pulmonar, conseqüente à vagotomia. ...Observação: O resumo, na íntegra, poderá ser visualizado no texto completo da tese digital
Abstract: Not informed.
Mestrado
Fisiologia
Mestre em Ciências Biológicas

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Caticha, Aurora Santana de. "Pleurisia e edema de pulmão induzidos por palications." [s.n.], 1990. http://repositorio.unicamp.br/jspui/handle/REPOSIP/313837.

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Orientador: Gilberto de Nucci
Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: A superfície das células endoteliais é recoberta por microdomínios constituídos de carga negativa. A presença de substâncias catiônicas, por exemplo policátions, em contato com a derme, peritôneo e pata de rato desencadeiam um processo inflamatório caracterizado pela infiltração de leucócitos e aumento da permeabilidade local. Neste trabalho avaliou-se o efeito de policátions (poli-L-arginina e poli-L-lisina) em duas superfícies de caracteristicas fisiológica e morfológica distintas: a pleura e o alvéolo. Para tal, empregou-se o modelo da pleurisia (pleura) e o modelo da instilação intratraqueal de policátions (alvéolo) em animais. Policátions foram agentes capazes de induzir pleurisia e edema de pulmão. A introdução intratraqueal desse agente, na mesma dose utilizada por via pleural apresentou alta mortalidade. A resposta inflamatória a esse composto depende do local de sua aplicação. A depleção de histamina e 5-HT nos animais reduziu e o volume de exsudato produzido nos animais submetidos à pleurisia, porém não reduziu a mortalidade nos animais que receberam policátions pela via intratraqueal. O antagonismo da carga dos policátions, através da utilização de agentes aniônicos (sulfato de heparina e de dermatam) reduziu drasticamente o volume de exsudato pleural e aboliu completamente o efeito letal desse agente quando realizada a instilação intratraqueal. Esses resultados sugerem que a superfície pleural e alveolar são dotadas de microdominios negativos, que podem ser neutralizados durante o processo inflamatório de acordo com essa teoria agentes aniônicos aferecem uma nova abordagem terapêutica no tratamento da inflamação
Abstract: The surface of endothelial cells is covered by negatively charged microdomains. The presence of cationic substances, for example polycations, in contact with rat skin, peritoneum and paw initiates an inflammatory process characterized by the infiltration of leukocytes and an increase in local permeability. In this work, the effect ofpolycations (poly-L-arginine and poly-L-lysine) was studied in two surfaces with distinct physiological and morphological characteristics: the pleura and the alveolus. For this purpose, a model of pleurisy and a model utilizing the intratracheal administration of polycations were used. Polycations were capable of inducing pleurisy and pulmonary edema. The intratracheal administration of these compounds, in the same dose used via the pleural route, resulted in a high mortality: The inflammatory response to these compounds depends on the site of application. Histamine and 5-HT depletion reduced the volume of exudate produced in animals subjected to pleurisy, but did not reduce the mortality in animals which received polycations intratracheally. Neutralization of the polycation charge, through the use of anionic compounds (heparin and dermatan sulfate) markedly reduced the volume of pleural exudate and completely abolished the lethal effect of polycations administered intratracheally. These results suggest that the pleural and alveolar surfaces possess negatively charged microdomains which may be neutralized during the inflammatory process. This hypothesis suggests that anionic compounds may offer a new therapeutic approach to the treatment of inflammation
Mestrado
Mestre em Farmacologia

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Iazzetti, Paulo Eduardo 1956. "Efeitos da hiperoxigenação hiperbarica no edema pulmonar neurogenico em ratos vagotonizados." [s.n.], 1989. http://repositorio.unicamp.br/jspui/handle/REPOSIP/314645.

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Orientador : Rui Errerias Maciel
Dissertação (mestrado) - Universidade Estadual de Campinas, Instituto de Biologia
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Resumo: Através da vagotomia cervical bilateral em ratos produziu-se um edema pulmonar neurogênico. Uma hora após a cirurgia, 33 animais foram colocados em.uma câmara hiperbárica experimental respirando 100% de oxigênio a 1,8 atmosferas absolutas por 325 minutos. Enquanto isto, 30 animais vagotomizados permaneceram respirando em condições ambientes normais como controles. Vinte e quatro horas após a vagotomia, os animais dos dois grupos foram sacrificados pa ra aferição de gaseometrias arteriais e massas pulmonares seca e úmida. Foram calculados os índices pulmonares seco e úmido, dividindo-se a massa do pulmão pela massa corporal de cada animal. Não houve diferença estatística notável entre a massa úmida (total) dos pulmões entre os grupos, entanto, o índice pulmonar seco foi 38% menor no grupo exposto a hiperóxia hiperbárica do que para os controles (p < 0,001). Demonstrando que esta exposição previa ao oxigênio retardou o desenvolvimento do edema pulmonar neste modelo, diminuindo o extravasamento de proteínas e células para os espaços intersticial e intralveolar
Abstract: Neurogenic pulmonary edema was induced in rats by bilateral cervical vagotomy. One hour after surgery 33 animals were placed in an experimental hyperbaric chamber and allowed to breathe oxigen at 1.8 absolute atmospheres for 325 minutes. Vagotomized controls, 30 animalss breathed atmospheric air. Twenty-four hours after vagotomys arterial blood samples were obtained and the lungs removed. Lungs were weighed wet and dry and lung indexes were calculated for each animal by dividing lung weight by total body weight. There was no statistical difference in total lung weight or water among groups. However, the dry lung index was about 38% lower in oxigen-treated animals than in controus (p < 0,001). There was no difference between hiperbaric oxygen-treated animals and non-vagotomized normal animals, but vagotomized air-breathing controls differed significantly from non-vagotomized (p <0,05). These results strongly suggest a slower formation of pulmonary edema in the hyperbaric oxygen-treated grou
Mestrado
Fisiologia
Mestre em Ciências Biológicas

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Rossari, José Roberto Freitas. "Fibrose pulmonar induzida por bleomicina intraqueal em ratos : uso do interferon-a-2b em um modelo experimental de síndrome da distrição respiratória aguda -SDRA-." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2004. http://hdl.handle.net/10183/4890.

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Zanette, Elvira Amélia de Oliveira 1953. "Near miss e morte materna em mulheres com distúrbios hipertensivos graves : estudo multicêntrico no Brasil = Near miss and maternal death in women with severe hypertensive disorders : multicenter study in Brazil." [s.n.], 2012. http://repositorio.unicamp.br/jspui/handle/REPOSIP/313602.

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Orientador: Mary Angela Parpinelli
Texto em português e inglês
Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: Introdução: Estima-se que os distúrbios hipertensivos (DH) na gravidez causem 50.000 mortes maternas (MM) a cada ano e que a imensa maioria ocorra em países de baixa ou média renda, além de aumentarem de 3 a 25 vezes o risco de complicações graves. Nas duas últimas décadas, tem sido crescente o interesse em estudar a morbidade materna grave (MMG)/near miss (NM) como método complementar às auditorias e inquéritos sobre MM. A investigação do NM é capaz de fornecer mais detalhes sobre fatores que contribuem para ambos, mortalidade e morbidade grave e uma referência para avaliação da qualidade do cuidado obstérico. Objetivo: identificar a prevalência e os fatores associados ao NM/MM em uma população de mulheres com DH graves (pré-eclâmpsia grave, eclâmpsia, hipertensão arterial grave e síndrome HELLP). Método: estudo multicêntrico, envolvendo 27 maternidades de referência, participantes da Rede Nacional de Vigilância da Morbidade Materna Grave, localizadas nas cinco regiões do Brasil. Realizou-se vigilância prospectiva com dados coletados após o desfecho final do caso de todas as mulheres admitidas por MMG e selecionados para o estudo os casos de MMG por DH grave, no período de junho de 2009 a julho de 2010. Os dados foram coletados em formulários específicos e digitados na plataforma OpenClinics®. Foram estudadas variáveis maternas sociodemográficas, obstétricas, clínicas, resultados perinatais e tipos de demora no cuidado obstétrico. Os casos foram classificados segundo os critérios da OMS em condição potencialmente ameaçadora da vida (CPAV) e NM/MM. Foi realizada análise bivariada pelo cálculo das razões de prevalência (RP) e seus respectivos intervalos de confiança (IC) de 95% ajustados pelo efeito conglomerado e análise múltipla por regressão de Poisson. O nível de significância adotado foi de 0,05%. Resultados: os DH graves foram a principal causa de MMG (6706/9555); a prevalência de NM foi 4,2 casos por 1000 (NV), a relação caso/fatalidade foi de 8,3 NM para 1 MM. A manifestação precoce da doença e a hemorragia pós-parto foram variáveis independentes associadas ao desfecho em NM/MM, além do edema agudo de pulmão, cardiopatia prévia e demoras no cuidado de segundo e terceiro tipos. Conclusão: o estudo do near miss identificou dentre as mulheres com DH graves situações independentemente associadas ao pior desfecho, e que pode ser modificado por intervenções no cuidado obstétrico direto a estas mulheres e no sistema de saúde. O estudo mostrou ainda a factibilidade de um sistema de vigilância hospitalar de MMG capaz de contribuir para a redução da MM
Abstract: Introduction: It has been estimated that hypertensive disorders (HD) in pregnancy may cause 50.000 maternal deaths (MD) annually and the large majority occurs in low-income or middle-income countries. Furthermore, these disorders increase the risk of severe complications by 3 to 25 times. In the last two decades, there has been increased interest in the study of severe maternal morbidity (SMM)/near miss (NM) as a supplementary method to audits and enquiries about MD. The investigation of NM is able to offer more details about factors that may contribute to both mortality and severe morbidity and may be used as a reference for evaluating quality of obstetric care. Objective: to identify the prevalence and factors associated with NM/MD in a female population suffering from severe HD (severe preeclampsia, eclampsia, severe arterial hypertension and HELLP syndrome). Method: A multicenter study, involving 27 referral maternity hospitals, participating in the National Surveillance Network for Severe Maternal Morbidity, located in five Brazilian regions. A prospective surveillance was performed with data collected after final case outcome in all women admitted to hospital for SMM and selected for the study of SMM cases due to severe HD, from June 2009 to July 2010. Data were collected in specific forms and entered into the OpenClinics® platform. Variables studied were maternal sociodemographic characteristics, obstetric and clinical history, perinatal results and types of delay in obtaining obstetric care. Cases were classified according to the WHO criteria: potentially life-threatening conditions (PLTC) and NM/MD. Bivariate analysis was performed by estimation of prevalence ratios (PR) and their respective 95% confidence intervals (CI) adjusted by the conglomerate effect and Poisson multiple regression analysis. The significance level adopted was 0.05%. Results: severe HD was the main cause of SMM (6706/9555); the prevalence of NM was 4.2 cases per 1000 (LB), the case/fatality rate was 8.3 NM to 1 MD and the MD index was 10.7%. Early manifestation of disease and postpartum hemorrhage were independent variables associated with outcome in NM/MD, in addition to acute pulmonary edema, previous heart disease and delays in receiving secondary and tertiary care. Conclusion: the near miss study identified severe conditions that were independently associated with a worse outcome among women with HD that could be modified by interventions in direct obstetric care of these women and in the healthcare system. The study also showed that a hospital surveillance system for SMM is feasible and can contribute to a reduction in MD
Mestrado
Saúde Materna e Perinatal
Mestra em Ciências da Saúde

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Orgaes, Flávio Augusto Flório Stillitano de [UNESP]. "Modelo experimental de infusão rápida de cristaloide em ratos. -." Universidade Estadual Paulista (UNESP), 2013. http://hdl.handle.net/11449/108575.

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Foi descrito um modelo experimental de estudo de infusão rápida de cristaloide em ratos, discutindo-se os resultados clínicos, laboratoriais e histológicos obtidos com a administração de diferentes volumes. Utilizou-se 56 ratos machos da linhagem Wistar com peso médio de 318 g (± 4), divididos aleatoriamente em sete grupos de oito animais. Os animais dos grupos 1 ao 6 receberam solução de Ringer com lactato por via intravenosa, de maneira rápida (25 ml/min), no volume correspondente a 50%, 100%, 150%, 200%, 250% e 300% da volemia (V), respectivamente, formando os grupos de estudo. Os ratos do grupo 0 foram operados da mesma forma, mas não receberam o cristaloide, constituindo o grupo controle (SHAM). A avaliação laboratorial do sangue e dos sinais clínicos foram realizados em dois tempos (antes e dez minutos após a infusão líquida). A avaliação gravimétrica do edema pulmonar (EP) foi feita com o pulmão esquerdo e a histológica com o pulmão direito, ambos extraídos após eutanásia. As variáveis que apresentavam dois tempos foram analisadas através da diferença entre os momentos, comparando com o grupo controle por uma análise de variância, seguido do teste de Dunnet. As análises do índice pulmonar (IP), seco-úmido (ISU), histologia e desfecho foram realizadas utilizando uma análise de variância (ANOVA). O nível de significância foi fixado em 5%. Os sinais clínicos apresentaram alteração significativa a partir da hidratação com volume correspondente a 2 vezes a V. A queda na taxa de hematócrito foi significativa nos 6 grupos de estudo, confirmando a eficácia do método na promoção de hemodiluição. Os exames laboratoriais de sangue apresentaram-se alterados a partir da infusão de volume igual à V. O EP foi bem caracterizado pelo método gravimétrico e histológico após infusão de líquido de 2,5 vezes a V. A parada respiratória foi observada a partir da hidratação ...
It was described an animal model study of crystalloid rapid infusion in rats, discussing the clinical, laboratorial and histological results acquired with the administration of various amounts. Fifty six male Wistar rats were used with a medium weight of 318 (± 4) grams, divided randomly in seven groups of eight animals. The rats of groups 1 to 6 received lactated Ringer´s solution intravenously, in a rapid way (25 ml/min), in the amount of 0.5, 1, 1.5, 2, 2.5 and 3 fold its blood volume (BV), respectively, composing the study groups. The rats of group 0 were submitted to surgery the same way, but did not receive the crystalloid, composing the control group (SHAM). The laboratorial evaluation of blood and the clinical signs were made in two times (before and ten minutes after the fluid infusion). The gravimetric assessment of pulmonary edema (PE) was made with the left lung and the histological assessment with the right lung, both extracted after euthanasia. The data with two distinct times were analyzed through the difference between the moments, comparing to the control group with an analysis of variance, followed by Dunnett´s test. The evaluation of the lung wet weight/body weight ratio (LW/BW), the lung wet/dry weight ratio (W/D), histology and upshot were performed by an analysis of variance (ANOVA). The findings were significant at the 0.05 level. The clinical signs significantly changed in the 2, 2.5 and 3 fold BV groups. The hematocrit reduction was significant in the six study groups, corroborating the method effectiveness to promote hemodilution. The laboratorial blood exams significantly changed from 1 fold BV group. The PE was clearly identified by the gravimetric and histological assessment in the 2.5 and 3 fold BV. The respiratory arrest was observed in the 1.5, 2, 2.5 and 3 fold BV groups. The volume of 3 fold BV was lethal to all animals of the group. This animal model was easily performed ...

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Orgaes, Flávio Augusto Flório Stillitano de. "Modelo experimental de infusão rápida de cristaloide em ratos. -." Botucatu, 2013. http://hdl.handle.net/11449/108575.

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Orientador: Fausto Viterbo
Banca: Paulo do Nascimento Junior
Banca: Luis Vicente Garcia
Resumo: Foi descrito um modelo experimental de estudo de infusão rápida de cristaloide em ratos, discutindo-se os resultados clínicos, laboratoriais e histológicos obtidos com a administração de diferentes volumes. Utilizou-se 56 ratos machos da linhagem Wistar com peso médio de 318 g (± 4), divididos aleatoriamente em sete grupos de oito animais. Os animais dos grupos 1 ao 6 receberam solução de Ringer com lactato por via intravenosa, de maneira rápida (25 ml/min), no volume correspondente a 50%, 100%, 150%, 200%, 250% e 300% da volemia (V), respectivamente, formando os grupos de estudo. Os ratos do grupo 0 foram operados da mesma forma, mas não receberam o cristaloide, constituindo o grupo controle (SHAM). A avaliação laboratorial do sangue e dos sinais clínicos foram realizados em dois tempos (antes e dez minutos após a infusão líquida). A avaliação gravimétrica do edema pulmonar (EP) foi feita com o pulmão esquerdo e a histológica com o pulmão direito, ambos extraídos após eutanásia. As variáveis que apresentavam dois tempos foram analisadas através da diferença entre os momentos, comparando com o grupo controle por uma análise de variância, seguido do teste de Dunnet. As análises do índice pulmonar (IP), seco-úmido (ISU), histologia e desfecho foram realizadas utilizando uma análise de variância (ANOVA). O nível de significância foi fixado em 5%. Os sinais clínicos apresentaram alteração significativa a partir da hidratação com volume correspondente a 2 vezes a V. A queda na taxa de hematócrito foi significativa nos 6 grupos de estudo, confirmando a eficácia do método na promoção de hemodiluição. Os exames laboratoriais de sangue apresentaram-se alterados a partir da infusão de volume igual à V. O EP foi bem caracterizado pelo método gravimétrico e histológico após infusão de líquido de 2,5 vezes a V. A parada respiratória foi observada a partir da hidratação ...
Abstract: It was described an animal model study of crystalloid rapid infusion in rats, discussing the clinical, laboratorial and histological results acquired with the administration of various amounts. Fifty six male Wistar rats were used with a medium weight of 318 (± 4) grams, divided randomly in seven groups of eight animals. The rats of groups 1 to 6 received lactated Ringer's solution intravenously, in a rapid way (25 ml/min), in the amount of 0.5, 1, 1.5, 2, 2.5 and 3 fold its blood volume (BV), respectively, composing the study groups. The rats of group 0 were submitted to surgery the same way, but did not receive the crystalloid, composing the control group (SHAM). The laboratorial evaluation of blood and the clinical signs were made in two times (before and ten minutes after the fluid infusion). The gravimetric assessment of pulmonary edema (PE) was made with the left lung and the histological assessment with the right lung, both extracted after euthanasia. The data with two distinct times were analyzed through the difference between the moments, comparing to the control group with an analysis of variance, followed by Dunnett's test. The evaluation of the lung wet weight/body weight ratio (LW/BW), the lung wet/dry weight ratio (W/D), histology and upshot were performed by an analysis of variance (ANOVA). The findings were significant at the 0.05 level. The clinical signs significantly changed in the 2, 2.5 and 3 fold BV groups. The hematocrit reduction was significant in the six study groups, corroborating the method effectiveness to promote hemodilution. The laboratorial blood exams significantly changed from 1 fold BV group. The PE was clearly identified by the gravimetric and histological assessment in the 2.5 and 3 fold BV. The respiratory arrest was observed in the 1.5, 2, 2.5 and 3 fold BV groups. The volume of 3 fold BV was lethal to all animals of the group. This animal model was easily performed ...
Mestre

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Rodrigues, Roseny dos Reis. "Avaliação da aeração e edema pulmonar por meio de tomografia computadorizada em pacientes submetidos a revascularização do miocárdio." Universidade de São Paulo, 2010. http://www.teses.usp.br/teses/disponiveis/5/5152/tde-21092010-100820/.

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Introdução: A disfunção respiratória é uma das complicações de maior prevalência no período pós-operatório de pacientes submetidos à cirurgia de revascularização do miocárdio (RM) com circulação extracorpórea (CEC), mesmo na ausência de doença pulmonar prévia1. Por meio de tomografia computadorizada, foram investigadas as alterações pulmonares pósoperatórias e o seu impacto na oxigenação. Métodos: vinte pacientes não hipoxêmicos em programação de cirurgia eletiva de revascularização do miocárdio com CEC foram estudados. Medidas hemodinâmicas, e amostras sanguíneas seriadas foram obtidas antes da cirurgia, após a intubação orotraqueal, após a CEC, na UTI, 12h, 24h e 48h após a cirurgia. Tomografias volumétricas pré e pós-operatórias foram adquiridas em condições de apneia após uma expiração espontânea. Os dados foram analisados usando teste de t Student; o comportamento temporal dos dados hemodinâmicos e outras variáveis fisiológicas foi analisado ao longo do tempo, usando análise de variância de uma via para repetidas medidas, seguido pelo teste de Student-Neumann-Keuls, quando necessário.Resultados: a relação PaO2/FiO2 diminuiu de forma significativa após a indução da anestesia, atingindo o seu nadir após a saída de CEC. Comparando-se com a TC pré-operatória, foi observada uma redução de 31% no volume de gás pulmonar (p<0,001), ao passo que foi observado um aumento do volume de tecido de 19% (p<0,001). A área não aerada dos pulmões aumentou de 253 97 g(p < 0.001), de 3 % a 27 %, após a cirurgia; e a área pobremente aerada pulmonar apresentou aumento de 72 68 g (p < 0.001), de 24 % to 27 %, enquanto a área normalmente aerada pulmonar reduziu de 147 119 g (p < 0.001), que representa 72 % to 46%. Não foram observadas correlações entre a relação PO2/FIO2 ou na fração de shunt nas primeiras 24 horas pós-operatórias Conclusões: A estrutura pulmonar está profundamente modificada após a cirurgia de RM com CEC. Associadas a outros fatores, essas alterações são responsáveis pela ocorrência de hipoxemia resultantes de atelectasias
Introduction: Hypoxemia is a frequent complication after coronary artery bypass graft (CABG) with cardiopulmonary bypass (CPB), usually attributed to atelectasis. Using computed tomography (CT), we investigated pulmonary alterations postoperatively and its impact on oxygenation. Methods: Twenty non-hypoxemic patients with normal cardiac function scheduled to CABG under CPB were studied. Hemodynamic measurements and blood samples were obtained before surgery, after intubation, after CPB, at ICU admission, 12h, 24h and 48h after surgery. Pre and postoperative volumetric thoracic CT scans were acquired in apnea conditions after a spontaneous expiration. Data was analyzed using paired Student t test and two-way repeated measures analysis of variance followed by SNK test when indicated. Results: PaO2/FiO2 ratio was significantly reduced after anesthesia induction, reaching its nadir after CPB and partially ameliorating 12h after surgery. Compared to preoperative CT, there was a postoperative 31 % reduction in pulmonary gas volume (p < 0.001) while tissue volume increased by 19 % (p < 0.001). Non-aerated lung increased by 253 97 g(p < 0.001), from 3 % to 27 %, after surgery and poorly-aerated lung by 72 68 g (p < 0.001), from 24 % to 27 % while normally-aerated lung was reduced by 147 119 g (p < 0.001), from 72 % to 46 %. No correlations were observed between PaO2/FiO2 ratio or shunt fraction at 24 h postoperatively and postoperative lung alterations. Conclusions: Lung structure is profoundly modified after CABG with CPB. Taken together, these multiple alterations occurring in the lungs are responsible for postoperative hypoxemia instead of atelectasis alone

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Guerrero, Noriega Anibal. "Edema agudo de pulmón cardiogénico en ancianos y muy ancianos : factores desencadenantes y su pronóstico al año." Bachelor's thesis, Universidad Nacional Mayor de San Marcos, 2004. https://hdl.handle.net/20.500.12672/1815.

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FUNDAMENTOS. En nuestro medio no conocemos los factores desencadenates de edema agudo de pulmón cardiogénico (EAPC)) y la tasa de mortalidad al año en pacientes ³70 años. METODOLOGIA. El presente trabajo es un estudio retrospectivo-descriptivo y longitudinal. Se incluyeron 35 casos de pacientes ³70 años con Diagnostico de Edema Agudo de Pulmón Cardiogénico, atendidos en la Unidad de Trauma Shock del Hospital Nacional Alberto Sabogal Sologuren entre el 1 de enero del 2001 y 31 de Junio del 2002 siendo seguidos por un año para conocer su mortalidad. Sus datos clínicos, y ecocardiográficos fueron obtenidos de sus historias clínicas.
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Wicpolt, Nathalia dos Santos. "Edema e enfisema pulmonar agudo de bovinos (EEPAB) no sul do Brasil: doença espontânea e reprodução experimental." Universidade do Estado de Santa Catarina, 2014. http://tede.udesc.br/handle/handle/915.

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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior
We describe the epidemiological, clinical signs and lesions of four outbreaks of acute pulmonary edema and emphysema in cattle (EEPAB) in the states of Santa Catarina and Paraná and its experimental reproduction of disease. Spontaneous disease occurred after transfer of mature cattle grazing and dry for another young and flourishing. All affected cattle were cows of the Dutch and Swiss brown races. The main clinical signs were dyspnea , labored abdominal breathing with the neck extended and mouth open and some had subcutaneous emphysema , besides the decrease in milk production and slow recovery or death . Necropsy findings were restricted to the lung which had dark red color, not collapsed, glossy and hipercriptante with marked interlobular emphysema. Histological lesions in the lung consisted mainly of alveolar and interlobular emphysema interspersed with areas of congestion and edema, hyaline degeneration of the wall of alveoli and infiltration of macrophages and eosinophils , moderate , diffuse . The experimental reproduction of the disease was performed in a beef with administration of 0.7 mg / kg / BW of L - Tryptophan orally in a single dose. The animal died on the seventh day of the experiment. The clinical signs and lesions were similar to those observed in naturally occurring disease
Descrevem-se os dados epidemiológicos, sinais clínicos e lesões de quatro surtos da doença do edema e enfisema pulmonar agudo de bovinos (EEPAB) nos estados de Santa Catarina e Paraná e sua reprodução experimental. A doença espontânea ocorreu após transferência de bovinos de pastagem madura e seca para outra jovem e viçosa. Todos os bovinos afetados eram vacas das raças holandês e pardo suíço. Os principais sinais clínicos foram dispnéia, respiração abdominal dificultosa com o pescoço estendido e boca aberta e alguns apresentavam enfisema subcutâneo, além de queda na produção de leite e morte ou recuperação lenta. Os achados de necropsia foram restritos ao pulmão o qual tinha coloração vermelho escuro, não colabado, de aspecto brilhante e hipercriptante com enfisema interlobular acentuado. As lesões histológicas no pulmão consistiam principalmente de enfisema alveolar e interlobular intercalado por áreas de congestão e edema, degeneração hialina da parede de alvéolos e infiltrado de macrófagos e eosinófilos, moderado, difuso. A reprodução experimental da doença foi realizada em um bovino, com administração de 0,7mg/kg/PV de L-Triptofano por via oral em dose única. O animal morreu no sétimo dia de experimento. Os sinais clínicos e lesões foram idênticos aos observados na doença espontânea

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Passarini, Juliana Nalin de Souza 1977. "Ventilação não invasiva (VNI) em emergência : preditores de sucesso ou insucesso em casos de insuficiência respiratória aguda decorrente oo edema agudo de pulmão (EAP) e exacerbação da doença pulmonar obstrutiva crônica (DPOC) = Noninvasive ventilation (NIV) in emergency : predictors of success or failure in cases of acute respiratory failure arising out of acute pulmonary edema (EAP) and exacerbation of chronic obstructive pulmonary disease (COPD)." [s.n.], 2012. http://repositorio.unicamp.br/jspui/handle/REPOSIP/309758.

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Orientadores: Ivete Alonso Bredda Saad, Lair Zambon
Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: O objetivo deste estudo foi analisar os casos de insuficiência respiratória aguda (IRpA) decorrente do Edema Agudo de Pulmão (EAP) e agudização da Doença Pulmonar Obstrutiva Crônica (DPOC) submetidos a ventilação mecânica não invasiva (VNI) a fim de identificar fatores associados ao sucesso ou insucesso do método em um serviço de urgência e emergência. Trata-se de um estudo descritivo e analítico prospectivo. Estabeleceu-se uma pressão expiratória entre 5 e 8 cmH2O, e pressão inspiratória entre 10 e 12 cmH2O, com suplementação de oxigênio para manter a saturação periférica de oxigênio (SpO2) superior a 90%. A variável desfecho considerada foi a intubação endotraqueal (IE). Foram incluídos 152 pacientes, o tempo de VNI foi de 10 horas para os pacientes com DPOC (n=60) e de 7,5 para os pacientes com EAP (n=92). Foi observada diferença estatisticamente significante nos pacientes que evoluíram para IE quanto menor SpO2 e pior escore de APACHE II (p<0,001). O uso de BiPAP mostrou 2,3 vezes mais chance de ocorrência de IE em comparação com os pacientes que usaram CPAP (p=0,032). Entre os pacientes com diagnóstico de EAP a chance de evolução para IE foi 63% menor. Dos 152 casos, 75,7% evoluíram com sucesso. As variáveis associadas a IE foram taquipneia, SpO2 abaixo de 80%, pacientes que receberam BiPAP, com maior valor de APACHE II, menor valor de escala de coma de Glasgow (ECG) e aqueles com diagnóstico de DPOC
Abstract: The objective of this study was to analyze the cases of acute respiratory failure (ARF) due to acute pulmonary edema and acute exacerbation of Chronic Obstructive Pulmonary Disease (COPD) undergoing noninvasive ventilation (NIV) to identify factors associated with success or failure of the method in an emergency department. This is a prospective descriptive and analytical study. It was established an expiratory pressure of 5 to 8 cmH2O, inspiratory pressure of 10 to 12 cmH2O and supplemental oxygen to maintain oxygen saturation (SpO2) above 90%. The outcome variable was considered endotracheal intubation (EI). The study included 152 patients NIV time was 10 hours for COPD patients (n = 60) and 7.5 hours to APE patients (n = 92). Statistically significant difference was observed in patients who developed EI for the lower SpO2 and worse APACHE II score (p <0.001). The use of BiPAP showed 2.3 times greater chance of occurrence of IE compared with patients who used CPAP (p = 0.032). Among patients diagnosed with EAP the chance of developing into IE was 63% lower. Of the 152 cases, 75.7% progressed successfully. Variables associated with IE were tachypnea, SpO2 below 80%, patients who received BiPAP, with the highest APACHE II, lower value of Glasgow coma scale (GCS) and those diagnosed with COPD
Mestrado
Fisiopatologia Cirúrgica
Mestre em Ciências

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Bragadeste, Ana Filipa dos Reis. "Clínica de animais de companhia." Master's thesis, Universidade de Évora, 2019. http://hdl.handle.net/10174/25896.

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Este relatório é apresentado para conclusão do mestrado integrado em medicina veterinária, descrevendo as atividades desenvolvidas, durante o estágio curricular no Hospital Veterinário da Arrábida. Encontra-se dividido em duas partes. Na primeira parte, é descrita a relação casuística das diferentes áreas clínicas acompanhadas. Na segunda parte, é apresentada uma revisão bibliográfica, sobre o stress respiratório em urgência e a síndrome de dificuldade respiratória aguda (ARDS – Acute Respiratory Distress Syndrome), em animais de companhia. O stress respiratório pode ser definido como o aumento do trabalho respiratório, associado a hipoxémia, sendo uma das condições mais frequentes em medicina de urgência. A ARDS é responsável pelo desenvolvimento de stress respiratório, em pacientes críticos. Como tal, é importante conhecer as características clínicas desta síndrome, de modo a identificá-la e, assim, aumentar a probabilidade de sobrevivência destes pacientes; Abstract: Small animal practice This report is presented for the conclusion of the integrated master's degree in veterinary medicine, describing the activities developed during the internship at the Hospital Veterinário da Arrábida. It consists of two parts. In the first part, it’s described a brief statistic of the clínical cases followed, during the period of internship. In the second part, is presented a literature review about respiratory distress, in the emergency room, and Acute Respiratory Distress Syndrome (ARDS). Respiratory distress, defined as increased respiratory effort associated with hypoxemia, is one of the most frequent conditions in emergency medicine. ARDS is responsible for the development of respiratory distress in critical ill patients. It is important to know the clinical characteristics of this syndrome in order to identify it and thus increase the probability of survival of these patients

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García, Alday Iker. "Estudio de la difusión pulmonar durante el ejercicio en condiciones extremas." Doctoral thesis, Universitat de Barcelona, 2020. http://hdl.handle.net/10803/672249.

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La siguiente tesis doctoral tiene como objetivo principal estudiar la respuesta de la difusión pulmonar en la barrera alveolocapilar durante diferentes condiciones extremas relacionados con el entrenamiento de natación y el ejercicio en altitud. De esta forma, se describirán los siguientes objetivos específicos: 1. Evaluar posibles cambios en la difusión pulmonar (DLCO y KCO) y otros parámetros respiratorios (VA, TLC, VCIN y RV) durante el entrenamiento (pre- vs. post-) en natación y natación artística, además de valorar su posible relevancia clínica. o Describir los parámetros de capacidad pulmonar y de difusión en deportistas acuáticos. 2. Valorar el impacto de una concentración de entrenamiento en altitud a 1.850 m en los parámetros de capacidad pulmonar y difusión de un grupo de nadadores de elite. o Evaluar posibles cambios en la difusión pulmonar después de una sesión de ciclismo a intensidad moderada a 3.000 m de hipoxia normobárica. 3. Comparar la respuesta de difusión pulmonar en un grupo de nadadores de elite vs. un grupo de sujetos sanos durante una exposición aguda a 4.000 m simulados de hipoxia hipobárica y después de un ejercicio de intensidad moderada a dicha altitud.
Lung diffusing capacity describes the alveolar-capillary diffusion in the lungs, which increase linearly in relation to cardiac output, and decrease in the presence of lung interstitial disease. This thesis aimed to study whether aquatic exercise (swimming and artistic swimming) provoke a decrease in lung diffusing capacity for carbon monoxide (DLCO) during training; and whether altitude training camp or exercise in a short-term exposure to high-altitude modify lung diffusing capacity in elite swimmers. The first article describes the initial justification of this research. In this report case, we describe the circumstance faced by a female elite swimmers who had repeated dyspnoea associated to the intensity of the swimming exercise. She experimented a post-exercise reduction in spirometric values and the presence of ultrasound lung comets (ULCs), suggesting a swimming-induced pulmonary oedema (SIPO). The report case conclude that the administration of an inhibitor of the carbonic anhydrase (Acetazolamide) solved this condition. The second and third article form two parts of the same research. We conducted a follow-up during 10 swimming training session in 21 elite junior swimmers evaluating the DLCO pre- and post-training. We show a slight decrease in lung diffusing capacity (−2.5%) after training, showing that swimmers experience subclinical decrease in lung diffusing capacity. Also, there were a large inter-individual variability in the response of DLCO to swim training along the follow-up including 6 subjects showing a considerable average decrease (−5.6–11.2%), suggesting that, doctors and coaches should pay attention to the individual changes in alveolar-capillary diffusing capacity among elite swimmers. The fourth article describes the changes in DLCO during an artistic swimming session in 11 artistic swimmers. After the first part of the training (apnoeic swimming) there were an increase in lung diffusing capacity (+9.2%) and later, after the second part (choreography and figures) there were a decrease in lung diffusing capacity regarding to basal condition (−4.0%). Therefore, it could be interesting to monitor carefully individual response to exercise since there occur decreases in DLCO up to 20% after training. The fifth article studies the possible modifications in lung diffusing capacity during a 14-day swimming altitude training camp at 1,850 m. There were no changes in DLCO after the training camp, but a decrease in alveolar volume (VA) and an increase in transfer coefficient of the lung for carbon monoxide (KCO) occur. In contrast to the results found at sea level in the second and third article, a swimming training session in moderate altitude did not change lung diffusing capacity acutely in elite swimmers, but a posterior cycling session at normobaric-simulated 3,000 m reduced DLCO significantly (−10%). The sixth article reports the lung diffusing response to 30-min moderate intensity interval exercise in a short-term exposure to high-altitude (4,000 m) in elite swimmers. There were no changes in DLCO although elite swimmers showed large decrease in SpO2 (72 ± 5 %) and a large increase in HR (139 ± 9 beats·min-1) at the end of the exercise. The seventh article evaluates whether there are changes in alveolar-capillary diffusion after different modalities of exercise, both at sea level (SL) and high-altitude (HA) in 11 healthy subjects. At SL, lung diffusing capacity largely increased after 30-s maximal exercise in a cycle ergometer, although the O2-dependence was small during anaerobic exercise. In contrast, DLCO did not change after 15-min moderate intensity continuous exercise at SL. Later, at HA, and similar to the previous study, an acute protocol of exercise at HA did not modify lung diffusing capacity in healthy subjects, suggesting that short-term exercise modalities at high-altitude are well covered by the functional properties of healthy individuals’ lungs. Lastly, the eighth article describes the pulmonary functional capabilities in elite swimmers, artistic swimmers and water polo players, showing higher lung volumes and diffusing capacity than the reference values by height and age. In this article, we discuss that swimming-based sports could be beneficial to improve the pulmonary function in many different segments of the population (from subjects with chronic pathologies to elite athletes) due to the physical properties of the water and physiological implications of the practice of swimming.

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Uchôa, Carlos Henrique Gomes. "Impacto da apneia obstrutiva do sono na recorrência do edema agudo dos pulmões cardiogênico." Universidade de São Paulo, 2016. http://www.teses.usp.br/teses/disponiveis/5/5131/tde-07032017-163952/.

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Introdução: O Edema Agudo dos Pulmões Cardiogênico (EAP) é uma condição clínica caracterizada por alta morbidade e mortalidade apesar dos avanços na terapia médica. Relatos de casos sugerem que a Apneia Obstrutiva do Sono (AOS) pode contribuir para desencadear episódios de EAP. No entanto, não existem estudos que avaliaram o impacto da AOS em pacientes com EAP. O objetivo desse estudo foi o de avaliar o impacto da AOS em eventos cardiovasculares após a recuperação de um evento confirmado de EAP. Métodos: No período de Janeiro de 2013 a Janeiro de 2015, recrutamos casos consecutivos de EAP nas Unidades de Emergências de três centros terciários de Cardiologia. Foram excluídos pacientes que não atenderam os critérios clínicos para EAP, pacientes que morreram antes de estudo do sono ou se recusaram a participar do protocolo. Após o tratamento de rotina para EAP e estabilização clínica (~30 dias), todos os pacientes com EAP confirmado foram convidados a realizar a monitorização portátil do sono. A AOS foi definida por um índice de apneia e hipopneia (IAH) >= 15 eventos/hora, excluindo-se casos com apneia predominantemente do tipo central. Realizamos o seguimento dos pacientes em busca de eventos cardiovasculares adotando critérios padronizados. O objetivo primário foi identificar a recorrência do EAP em pacientes com e sem AOS. Objetivos secundários incluíram incidência do infarto agudo do miocárdio (IAM), o óbito total e cardiovascular bem como identificar o período de ocorrência do EAP em pacientes com e sem AOS. Análise de regressão de Cox foi obtida para identificar preditores independentes de eventos. Um valor de p < 0,05 foi considerado estatisticamente significante. Resultados: Avaliamos inicialmente 255 pacientes adultos com suspeita clínica de EAP. Após as exclusões, foram estudados 104 pacientes com diagnóstico confirmado de EAP. A monitorização do sono ocorreu 31±7 dias após o episódio de EAP. A frequência da AOS nestes pacientes foi de 61% (64 pacientes). Destes, apenas 3 pacientes (3%) tinham conhecimento prévio da AOS e nenhum estava sobre tratamento específico para a AOS. Pacientes com e sem AOS não apresentaram diferenças de idade, sexo, índice de massa corpórea e fração de ejeção do ventrículo esquerdo. O seguimento médio foi de 12 ± 7meses. Trinta e um pacientes (30%) tiveram recorrência do EAP no seguimento. Em comparação com indivíduos sem AOS, os pacientes com AOS apresentaram maior recorrência do EAP (6 vs. 25 episódios, p=0,01) e maior incidência de IAM (0 vs. 15 episódios, p=0,0004). Todos os óbitos ocorreram no grupo com AOS (p=0,0001), sendo 17 óbitos totais, dos quais 13 por causas cardiovasculares. A AOS foi independentemente associada com maior recorrência de EAP (HR 3,3; IC 95% 1,2-8,8; p=0,01); incidência de IAM: (HR 2,3; IC 95% 1,1-9,5; p=0,002), óbito total (HR 6,5; 95% CI% 1,2-64,0; p=0,005) e óbito cardiovascular (HR 5,4; IC 95% 1,4-48,4; p=0,004). Entre os pacientes com AOS, aqueles que tiveram recorrência de EAP ou foram à óbito tiveram maior IAH e mais episódios de EAP cujo início dos sintomas ocorreram durante o sono. A análise de sobrevida livre de eventos após o estudo do sono mostrou que o grupo com AOS teve pior prognóstico para recorrência de EAP, incidência de IAM e óbitos totais e por causas cardiovasculares do que pacientes sem AOS. Conclusões: A AOS é muito comum, subdiagnosticada e independentemente associada com maior recorrência do EAP e morbimortalidades em pacientes que sobreviveram a um episódio prévio de EAP
Introduction: Acute cardiogenic pulmonary edema (ACPE) is a clinical condition characterized by high morbidity and mortality despite advancements in medical therapy. Case reports suggest that obstructive sleep apnea (OSA) may contribute to trigger ACPE episodes. However, no previous systematic study evaluated the impact of OSA on patients with ACPE. The aim of this study was to evaluate the impact of OSA on cardiovascular events after ACPE recovery. Methods: From January 2013 to January 2015, we recruited consecutive cases of ACPE from three Emergency Units Cardiology tertiary hospitals. We excluded patients who did not meet criteria for ACPE, died before sleep study or refused to participate in the protocol. After routine treatment for ACPE and clinical stabilization (~ 30 days), all patients with confirmed ACPE were invited to perform a portable sleep monitoring. OSA was defined by an apnea-hypopnea index (AHI) >= 15 events/hour. We excluded patients with predominantly central apnea. We carried out the follow-up searching for cardiovascular events by adopting standardized criteria. The main aim was ACPE recurrence. Secondary aims included incidence of acute myocardial infarction (AMI), total and cardiovascular deaths as well as differences in the period of occurrence of the ACPE in patients with and without OSA. Cox regression analysis was performed to identify independent predictors of events. A p value < 0.05 was considered statistically significant. Results: We initially evaluated 255 adult patients with clinical suspicion of ACPE. After exclusions, 104 patients were studied with a confirmed diagnosis of ACPE. The potable sleep monitoring occurred 31 ± 7 days following the ACPE episode. The frequency of OSA in these patients was 61% (64 patients). Of these, only 3 patients (3%) had prior knowledge of OSA diagnosis. None of them was on specific treatment. Patients with and without OSA showed no differences in age, sex, body mass index and left ventricular ejection fraction. The mean follow-up was 12 ± 7 months. Thirty one patients (30%) presented ACPE recurrence during the follow-up. Compared to individuals without OSA, patients with OSA had higher ACPE recurrence (6 vs. 25 episodes, p = 0.01), higher incidence of AMI (0 vs. 15 episodes, p=0.0004). All 17 deaths (13 from cardiovascular causes) occurred in the OSA group (p=0.0001). OSA was independently associated with higher ACPE recurrence (HR 3.3, 95% CI 1.2 to 8.8; p = 0.01); incidence of AMI (HR 2.3, 95% CI 1.1 to 9.5; p=0.02); total mortality (HR 6.5; 95% CI 1.2 to 164; p=0.005) and cardiovascular death (HR 5.4, 95% CI 1.4 to 48.4; p=0.004). Limiting our analysis to OSA patients, those who had ACPE recurrence or death had higher AHI and more ACPE episodes whose onset of symptoms occurred during sleep. Event-free survival analysis after the sleep study showed that OSA patients had a worse prognosis for ACPE recurrence, AMI incidence, total and cardiovascular mortality than patients without OSA. Conclusions: OSA is very common, underdiagnosed and independently associated with ACPE recurrence and morbimortality in patients with a previous ACPE episode

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Antonio, Ana Carolina Pecanha. "Avaliação dos aspectos ultrassonográficos pulmonares em pacientes submetidos a teste de respiração espontânea para desmame da ventilação mecânica." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2016. http://hdl.handle.net/10183/148836.

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Introdução: Descontinuação prematura ou tardia da ventilação mecânica invasiva (VM) associa-se a maior morbimortalidade. Redução da pressão intratorácica durante o teste de respiração espontânea (TRE) pode precipitar disfunção cardíaca através da elevação abrupta do retorno venoso e da pós-carga do ventrículo esquerdo. Da mesma maneira, alterações na demanda respiratória e cardíaca que ocorrem ao longo do TRE também podem manifestar-se à ultrassonografia pulmonar. O padrão B é um artefato sonográfico que se correlacionada com edema intersticial. Um ensaio clínico randomizando concluiu que a ultrassonografia pulmonar foi capaz de prever insuficiência ventilatória pós extubação através de variações na aeração pulmonar observadas durante o procedimento de desmame; contudo, a ferramenta não pôde rastrear pacientes antes da submissão ao TRE. O impacto do balanço hídrico (BH) e de sinais radiológicos de congestão pulmonar antes do TRE sobre os desfechos no desmame também precisam ser determinados. Métodos: Cinquenta e sete indivíduos elegíveis para o desmame ventilatório foram recrutados. Traqueostomizados foram excluídos. Realizou-se avaliação ultrassonográfica de seis zonas pulmonares imediatamente antes e ao final do TRE. Predominância B foi definida como qualquer perfil com padrão B presente bilateralmente em região torácica anterior. Os pacientes foram seguidos por até 48 horas depois da extubação. Após esse estudo piloto, foi conduzido um estudo observacional, prospectivo, multicêntrico em duas unidades de terapia intensiva (UTIs) clínico-cirúrgicas ao longo de dois anos. Os mesmos critérios de inclusão e de exclusão foram aplicados; contudo, a ultrassonografia foi realizada apenas antes do TRE. O desfecho primário foi falha no TRE, definido como incapacidade de tolerar o teste T durante 30 a 120 minutos e, nesse caso, o paciente não era extubado. Dados demográficos e fisiológicos, BH das 48 horas antecedendo o TRE (entrada de fluidos menos débitos durante 48 horas) e desfechos foram coletados. Em uma análise post hoc de 170 procedimentos de desmame, um radiologista aplicou um escore radiológico na interpretação de radiografias digitais de tórax realizadas previamente ao TRE – o exame mais recente disponível foi avaliado em termos de congestão pulmonar. Resultados: No estudo piloto, 38 indivíduos foram extubados com sucesso, 11 falharam no TRE e 8 necessitaram de reintubação em até 48 horas após a extubação. No início do teste T, padrão B ou consolidação já estava presente em porções inferiores e posteriores dos pulmões em mais da metade dos casos, e tais regiões mantiveram-se não aeradas até o final do teste. Perda de aeração pulmonar durante o TRE foi observada apenas no grupo que falhou no mesmo (p= 0,07). Esses pacientes também demonstraram maior predominância B ao final do teste (p= 0,019). Antes do procedimento de desmame, todavia, não foi possível discernir indivíduos que falhariam no TRE, tampouco aqueles que necessitariam de reintubação dentro de 48 horas. Posteriormente, de 2011 a 2013, 250 procedimentos de desmame foram avaliados. Falha no TRE ocorreu em 51 (20,4%). Cento e oitenta e nove pacientes (75,6%) foram extubados na primeira tentativa. Indivíduos que falharam no TRE eram mais jovens (mediana de 66 versus 75 anos, p= 0,03) e apresentaram maior duração de VM e maior prevalência de doença pulmonar obstrutiva crônica (DPOC) (19,6 versus 9,5%, p= 0,04). Predominância B mostrou-se um preditor muito fraco para falha no TRE, exibindo sensibilidade de 47%, especificidade de 64%, valor preditivo positivo de 25% e valor preditivo negativo de 82%. Não houve diferença estatisticamente significativa no BH das 48 horas antecedendo o TRE entre os grupos (falha no TRE: 1201,65 ± 2801,68 ml versus sucesso no TRE: 1324,39 ± 2915,95 ml). Entretanto, em pacientes portadores de DPOC, ocorreu associação estatisticamente significativa entre BH positivo nas 48 horas antes do TRE e falha no TRE (odds ratio= 1,77 [1,24 – 2.53], p= 0,04). O escore radiológico, obtido em 170 testes T, foi similar entre os pacientes com falha e sucesso no TRE (mediana de 3 [2 – 4] versus 3 [2 – 4]), p= 0, 15). Conclusão: Maior perda de aeração pulmonar observada à ultrassonografia durante o TRE pode sugerir disfunção cardiovascular e aumento na água extravascular, ambos induzidos pelo processo de desmame. BH, sinais radiológicos de congestão pulmonar ou padrão B documentado através de um protocolo ultrassonográfico simplificado não devem contraindicar o TRE em pacientes estáveis hemodinamicamente e adequadamente oxigenados, haja vista o fato de tais variáveis não terem predito maior probabilidade de falha de desmame em pacientes críticos clínico-cirúrgicos. Ainda assim, evitar BH positivo em pacientes com DPOC parece otimizar os desfechos do desmame.
Introduction: Both delayed and premature liberation from mechanical ventilation (MV) are associated with increased morbi-mortality. Inspiratory fall in intra-thoracic pressure during spontaneous breathing trial (SBT) may precipitate cardiac dysfunction through abrupt increase in venous return and in left ventricular afterload. Changes in respiratory and cardiac load occurring throughout SBT might manifest with dynamic changes in lung ultrasound (LUS). B-pattern is an artifact that correlates with interstitial edema. A randomized controlled trial concluded that bedside LUS could predict post extubation distress due to changes in lung aeration throughout weaning procedure; however, it could not screen patients before submission to SBT. The impact of fluid balance (FB) as well as of radiological signs of pulmonary congestion prior to SBT on weaning outcomes must also be determined. Methods: Fifty-seven subjects eligible for ventilation liberation were enrolled. Patients with tracheostomy were excluded. LUS assessment of six thoracic zones was performed immediately before and at the end of SBT. B-predominance was defined as any profile with anterior bilateral B-pattern. Patients were followed up to 48 hours after extubation. After this pilot report, we conducted a 2-year prospective, multicenter, observational study in two adult medical surgical intensive care units (ICUs). Same inclusion and exclusion criteria were applied; however, LUS was performed only immediately before SBT. The primary outcome was SBT failure, defined as inability to tolerate a T-piece trial during 30 to 120 minutes, in which case patients were not extubated. Demographic, physiologic, FB in the preceding 48 hours of SBT (fluid input minus output over the 48-hour period), and outcomes data were collected. As a post hoc analysis in 170 weaning procedures performed in one of the ICUs, an attending radiologist applied a radiological score on interpretation of digital chest x-rays performed before SBT - the most recent available exam was analyzed regarding degree of lung fluid content. Results: In the pilot study, 38 subjects were successfully extubated, 11 failed the SBT and 8 needed reintubation within 48 hours of extubation. At the beginning of T-piece trial, B-pattern or consolidation were already found at lower and posterior lung regions in more than half of the individuals and remained nonaerated at the end of the trial. Loss of lung aeration during SBT was observed only in SBT-failure group (p= 0.07). These subjects also exhibited higher B-predominance at the end of trial (p= 0.019). Prior to weaning procedure, however, we were not capable to discriminate individuals who would fail SBT, nor who would need reintubation within 48 hours. Afterwards, from 2011 to 2013, 250 weaning procedures were evaluated. SBT failure occurred in 51 (20.4%). One hundred eighty-nine patients (75.6%) were extubated at first attempt. Individuals who failed SBT were younger (median 66 versus 75 years, p= 0.03), had higher duration of MV (median 7 versus 4 days, p< 0.0001) and higher prevalence of chronic obstructive pulmonary disease (COPD) (19.6 versus 9.5%, p= 0.04). B-predominance was a very weak predictor for SBT failure, showing 47% sensitivity, 64% specificity, 25% positive predictive value, and 82% negative predictive value. There were no statistically significant differences in 48 hour-FB prior to SBT between groups (SBT failure: 1201.65 ± 2801.68 mL versus SBT success: 1324.39 ± 2915.95 mL). However, in COPD subgroup, we found significant association between positive FB in the 48 hours prior to SBT and SBT failure (odds ratio = 1.77 [1.24 – 2.53], p= 0.04). Radiological score, obtained in 170 T-piece trials, was similar between SBT failure and success subjects (median 3 [2 - 4] vs 3 [2 - 4], p= 0.15). Conclusion: Higher loss of lung aeration observed by LUS during SBT might suggest cardiovascular dysfunction and increases in extravascular lung water, both induced by weaning. Neither FB, nor radiological findings of pulmonary congestion, nor B-pattern detected by a simplified LUS protocol should preclude hemodynamically stable, sufficiently oxygenated patients from performing an SBT, since such variables did not predict greater probability of weaning failure in medical-surgical critically ill population. Notwithstanding, avoiding positive FB in COPD patients might improve weaning outcomes.

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Oliveira, Fagner Neves. "Toxicidade da peçonha de Tityus serrulatus procedente do Distrito Federal por meio da avaliação da DL50, efeitos da peçonha e edema pulmonar induzido." reponame:Repositório Institucional da UnB, 2011. http://repositorio.unb.br/handle/10482/8989.

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Dissertação (mestrado)-Universidade de Brasília, Faculdade de Ciências da Saúde, 2011
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O escorpião Tityus serrulatus, espécie endêmica do Brasil, é responsável pelos acidentes mais graves frequentemente registrados no país, particularmente na região Sudeste. A principal causa de morte por este agravo é o edema pulmonar agudo (EPA). A incidência desta espécie no DF tem aumentado, porém, não existem registros de escorpionismo grave nesta região. Diante disso, os objetivos do presente trabalho foram avaliar a toxicidade da peçonha de T. serrulatus do DF (TS-DF), por meio da avaliação da DL50 e das alterações induzidas pela peçonha em camundongos; avaliar a capacidade de indução de EPA em ratos por meio da relação entre a massa úmida do pulmão e a massa corpórea de ratos tratados e não tratados com peçonha; avaliar a permeabilidade vascular pulmonar (PVP), utilizando o protocolo de azul de Evans (AE); realizar análises histológicas do pulmão e do coração dos animais experimentados; e determinar as dosagens séricas de CK e CK-MB, além da contagem total de leucócitos no lavado bronco-aveolar (LBA) dos ratos. Todos esses ensaios foram também conduzidos com a peçonha de T. serrulatus de MG (TS-MG) para fins de comparação. A peçonha de TS-DF apresentou-se duas vezes menos tóxica a camundongos (51,6 ?g/kg) que a peçonha de TS-MG (26 ?g/kg). Foi verificado um aumento significativo na relação massa úmida dos pulmões / massa corpórea e um aumento na PVP nos ratos do grupo TS-MG (p> 0,001) em relação ao controle e ao TS-DF, sendo que, entre esses dois últimos grupos, essas diferenças não foram observadas (p <0,05). As análises histológicas mostraram EPA intra-alveolar multifocal apenas em animais do grupo TS-MG. Os tecidos cardíacos de todos os animais apresentaram-se normais. No entanto, as dosagens séricas de CK e CK-MB e a quantidade de leucócitos encontrados no LBA foram maiores apenas nos animais do grupo TS-MG (p>0.05). Os perfis cromatográficos obtidos para as peçonhas de T. serrulatus das duas populações estudadas foram qualitativamente semelhantes. Algumas diferenças quantitativas foram observadas e podem explicar as diferenças na toxicidade e nas atividades biológicas dessas peçonhas. Assim, a peçonha de TS-DF é duas vezes menos tóxica a camundongos que a peçonha de TS-MG e não é capaz de induzir EPA em ratos, ao contrário do que é observado para a peçonha de TS-MG. É possível que a peçonha de TS-DF possua uma menor quantidade de peptídeos que atuam em canais para Na+, que são considerados os principais responsáveis pela maioria dos sintomas apresentados no escorpionismo. Estes resultados corroboram com os sintomas descritos para o escorpionismo no DF causado por esta espécie de escorpião e confirmam a variação na peçonha das duas populações estudadas.

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Vital, Flavia Maria Ribeiro [UNIFESP]. "Efetividade e segurança da ventilação com pressão positiva não-invasiva no edema pulmonar cardiogênico: revisão sistemática e metanálise." Universidade Federal de São Paulo (UNIFESP), 2006. http://repositorio.unifesp.br/handle/11600/21515.

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Contexto: A ventilação com pressão positiva não-invasiva tem sido amplamente utilizada para aliviar os sinais e sintomas decorrentes de insuficiência respiratória por diversas causas. Sua utilização previne o colapso alveolar e auxilia na redistribuição do líquido extravasado nos alvéolos, melhorando assim a complacência pulmonar e diminuindo o trabalho respiratório. Objetivos: Determinar a efetividade e segurança do tratamento com ventilação com pressão positiva não-invasiva associado ao tratamento padrão comparado ao tratamento padrão no edema pulmonar cardiogênico. Fonte de dados: Foi realizada uma busca sensível em seis bases de dados eletrônicas em abril de 2005. Foi revisada a lista de referências bibliográficas de todos os estudos incluídos e realizado o contato com os autores, além de especialistas na área, fabricantes de equipamentos e com o Cochrane Heart Group. Não houve restrições a idiomas. Seleção dos estudos: Foram selecionados ensaios clínicos aleatórios e ensaios clínicos quase-aleatórios que incluíram pacientes adultos com edema pulmonar cardiogênico agudo ou crônico agudizado. Os principais desfechos avaliados foram: mortalidade hospitalar, freqüência de intubação endotraqueal, tempo de permanência na UTI, tempo de permanência hospitalar, incidência de infarto agudo do miocárdio, alteração nos gases do sangue arterial e no pH, bem como alteração nos sinais vitais. Extração dos dados: Dois autores selecionaram de forma independente os artigos que satisfizeram os critérios de inclusão, um terceiro autor analizou e resolveu as discordâncias. A qualidade dos estudos foi avaliada com ênfase na ocultação de alocação, na análise por intenção de tratar e nas perdas durante o acompanhamento. A extração dos dados foi realizada por meio de uma ficha padronizada. Resultados: Foram incluídos 21 estudos envolvendo 1071 participantes. O uso da ventilação com pressão positiva não-invasiva resultou numa significativa redução da mortalidade Risco relativo (RR) 0.64; 95% intervalo de confiança (IC) 0.47, 0.87], da freqüência de intubação endotraqueal (RR 0.53; 95%IC 0.35, 0.82) e do tempo de permanência na UTI [diferença média ponderada (DMP) -1.07 dias; 95%IC -1.60, -0.53], além de demonstrar uma melhora na freqüência respiratória (DMP -2.63 rpm; 95%IC -3.67, -1.59) e na freqüência cardíaca (DMP -4.63 bpm; 95%IC -9.11, -0.15) após uma hora de intervenção. Não houve diferença estatisticamente significante em relação à incidência de infarto agudo do miocárdio durante (RR 1.23; 95%IC 0.78, 1.93) ou após o uso da ventilação não-invasiva (RR 1.08;95%IC 0.11, 10.23), no tempo de permanência hospitalar, na pressão arterial e nas variáveis gasométricas. Conclusão: A ventilação com pressão positiva não-invasiva é uma intervenção efetiva e segura no tratamento de pacientes adultos com edema pulmonar cardiogênico.
Context: Noninvasive positive-pressure ventilation has been widely used to alleviate signs and symptoms of respiratory distress due to several causes. It prevents alveolar collapse and helps to redistribute intra-alveolar fluid, improving pulmonary compliance and reducing respiratory work. Objectives: To determine the effectiveness and safety of noninvasive positive pressure ventilation (CPAP and NPPV bi-level) compared with standard medical care for treatment of cardiogenic pulmonary edema. Data Sources: We performed a comprehensive search of 6 electronic databases in April of 2005. Additionally, we reviewed the bibliographies of all included studies and contacted your authors, experts, equipment manufacturers, and the Heart Group of Cochrane Collaboration. No language restrictions were applied. Study Selection: We selected blinded or unblinded randomized or quasi-randomized clinical trials evaluating adult patients with acute or acute-on-chronic cardiogenic pulmonary edema and reporting any: of hospital mortality, endotracheal intubation rate, hospital and intensive care unit length of stay, incidence of acute myocardial infarction, arterial blood gases and pH alteration and vital signs alteration. Data Extraction: Two authors independently selected articles meeting the inclusion criteria, assessed study quality with emphasis on allocation concealment, intention-to-treat analysis and loss to follow-up. Data extraction was undertaken through a standardized form. Results: We included 21 studies involving 1071 participants. Use of noninvasive ventilation led to significant reductions in hospital mortality [Relative Risk (RR) 0.64; 95% Confidence Interval (CI) 0.47, 0.87], endotracheal intubation rate (RR 0.53; 95%IC 0.35, 0.82) and intensive care unit length of stay [weighted mean difference (WMD) –1.07 days; 95%IC -1.60,-0.53]. We noted non significant differences in the incidence of acute myocardial infarction during (RR 1.23; 95%IC 0.78, 1.93) or after noninvasive ventilation (RR 1.08; 95%IC 0.11, 10.23), side-effects and in hospital length of stay. Further led to significant improvement in respiratory (WMD -2.63 rpm; 95%IC -3.67, -1.59) and cardiac rate (WMD -4.63 bpm; 95%IC -9.11, -0.15) after one hour intervention. Conclusion: Noninvasive positive pressure ventilation is an effective and safe intervention for the treatment of adult patients with cardiogenic pulmonary edema.
BV UNIFESP: Teses e dissertações

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Samano, Marcos Naoyuki. "Estudo dos efeitos da pneumonectomia esquerda sobre o pulmão remanescente de ratos: avaliação das alterações histológicas e funcionais agudas." Universidade de São Paulo, 2008. http://www.teses.usp.br/teses/disponiveis/5/5156/tde-29052008-095356/.

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INTRODUÇÃO: A pneumonectomia está associada à alta mortalidade e alto índice de complicações. Entre estas, o edema pulmonar pós-pneumonectomia é uma das mais graves, podendo chegar a 100% de mortalidade. Pouco se sabe acerca dos fatores etiológicos desta doença, bem como sua associação a um processo inflamatório ou estresse oxidativo. O objetivo deste estudo foi analisar os efeitos agudos da pneumonectomia esquerda sobre o pulmão remanescente de ratos quanto à avaliação funcional por gasometria e avaliação histológica por formação de edema, infiltrado inflamatório, estresse oxidativo e reatividade vascular. MÉTODOS: Trinta e um ratos Wistar foram submetidos ao estudo. Vinte e um foram submetidos à pneumonectomia esquerda, sendo sacrificados em 48 horas (11 animais) e 72 horas (10 animais). Como controle do tratamento, 10 ratos foram submetidos à operação sham, sendo 5 sacrificados em 48 horas e 5 em 72 horas. A avaliação funcional foi realizada por meio de coleta de sangue arterial, gasometria e análise da relação pO2/FiO2. A análise histológica consistiu da avaliação dos seguintes parâmetros: (1) grau de edema perivascular; (2) presença de infiltrado inflamatório obtido por meio da densidade de neutrófilos; (3) expressão tecidual imunoistoquímica da Óxido Nítrico Sintase (NOS) para a avaliação do estresse oxidativo e (4) do grau de reatividade vascular, medido por meio da relação luz parede (lumen/wall ratio). Na avaliação do estresse oxidativo, foram analisadas a isoformas induzida e endotelial da NOS (iNOS e eNOS). Além destes parâmetros, o edema pulmonar foi avaliado por meio do ganho de massa pulmonar proporcional, denominado de Índice Pulmonar (IP) e da relação do peso úmido e do peso seco (Razão U/S). A análise estatística foi realizada por meio do teste ANOVA. RESULTADOS: Não houve diferença entre os grupos quanto à relação pO2/FiO2. Quanto à análise histológica, houve diferença quanto ao edema perivascular, infiltrado inflamatório, imunoexpressão de iNOS e eNOS e reatividade vascular. Houve interação entre a pneumonectomia e o sacrifício mais tardio, com maior índice de edema perivascular neste grupo (p=0,0274). Houve menor densidade de neutrófilos nos animais submetidos à pneumonectomia tanto em 48 como 72 horas (p=0,0168). Não houve diferença na imunoexpressão tecidual de iNOS entre os animais submetidos à pneumonectomia e seus respectivos grupos controle, mas houve diminuição no grupos de 72 horas (p=0,0212). A análise imunoistoquímica da eNOS evidenciou maior expressão nos animais submetidos à pneumonectomia (p=0,0208). Quanto ao grau de reatividade vascular, houve menor razão L/P nos grupos sacrificados após 72 horas (p=0,0107), sugerindo maior vasoconstrição nestes grupos. Embora tenha havido maior ganho de massa pulmonar nos dois grupos de animais submetidos à pneumonectomia (p=0,0033), a Razão U/S não mostrou diferença entre os grupos. CONCLUSÕES: A pneumonectomia esquerda em ratos não causou alterações funcionais, mas causou alterações histológicas. Quanto a estas alterações, não foram de natureza inflamatória e nem relacionadas ao estresse oxidativo. Foram caracterizadas por edema perivascular e vasoconstrição, observados após 72 horas da operação.
INTRODUCTION: Pneumonectomy is associated with high mortality and complication rates. Of these complications, post-pneumonectomy pulmonary edema is one of the most severe with a mortality rate that can reach 100%. Little is known about the etiological factors involved in this process and its association with inflammatory process or oxidative stress. The objective of this study was to analyze the acute effects of left pneumonectomy on the remaining lung of rats based on functional assessment by blood gas analysis and on histological assessment by edema formation, inflammatory infiltrate, oxidative stress and vascular reactivity. METHODS: Thirty one Wistar rats were included in the study. Twenty one underwent left pneumonectomy and were sacrificed in 48 hours (11 animals) and 72 hours (10 animals). Ten rats underwent sham procedure for control and five were sacrificed in 48 hours and five in 72 hours. Functional assessment was conducted by arterial blood gas and pO2/FiO2 ratio analyses. Histological analysis consisted of the assessment of the following parameters: (1) degree of perivascular edema; (2) presence of inflammatory infiltrate suggested by neutrophil density; (3) immunohistochemical expression of Nitric Oxide Synthase (NOS) in tissues to assess oxidative stress and (4) the degree of vascular reactivity measured by lumen/wall ratio (L/W ratio). For the assessment of oxidative stress, induced and endothelial isoforms of NOS (iNOS and eNOS) were analyzed. In addition to these parameters, pulmonary edema was assessed by means of proportional pulmonary mass gain, called Pulmonary Ratio (PR) and of the wet/dry weight ratio (W/D Ratio). The statistical analysis was conducted using the ANOVA test. RESULTS: The histological analysis showed difference regarding perivascular edema, inflammatory infiltrate, immunoexpression of iNOS and eNOS and vascular reactivity. The rate of perivascular edema was higher in animals submitted to pneumonectomy and sacrificed after 72 hours (p=0.0274). Neutrophil density was lower in animals submitted to pneumonectomy for those sacrificed after 48 and 72 hours alike (p=0.0168). There was no difference in the immunoexpression of iNOS in tissues between animals submitted to pneumonectomy and control groups, but such immunoexpression was reduced in both 72-hour groups (p=0.0212). The immunohistochemical analysis of eNOS evidenced a higher expression in animals submitted to pneumonectomy (p=0.0208). As concerns the degree of vascular reactivity, there was a lower W/D ratio in the groups sacrificed after 72 hours (p=0.0107), suggesting greater vasoconstriction in these groups. There was no difference between the groups as to the pO2/FiO2 ratio. Although the two groups submitted to pneumonectomy had greater gain of mass (p=0.0033), there was no difference in the W/D ratio between the groups. CONCLUSIONS: Left pneumonectomy in rats did not cause functional alterations but caused histological alterations that were neither of inflammatory nature nor related to oxidative stress. The alterations included perivascular edema and vasoconstriction observed after 72 hours of the procedure.

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Leal, Filho Manoel Baldoino. "Contribuição ao estudo das alterações da medula espinhal em modelo experimental de lesão traumatica na fase aguda." [s.n.], 2004. http://repositorio.unicamp.br/jspui/handle/REPOSIP/310146.

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Orientadores: Antonio Guilherme Borges Neto, Konradin Metze
Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas
Made available in DSpace on 2018-08-04T01:18:13Z (GMT). No. of bitstreams: 1 LealFilho_ManoelBaldoino_D.pdf: 8399962 bytes, checksum: 28257f9a450586d75448f83538f8d1f3 (MD5) Previous issue date: 2004
Resumo: O autor apresenta uma experiência com 58 ratos Wistar adultos, que foram submetidos a trauma raquimedular torácico com o cateter balão de Fogarty (12-062-2F). Este experimento foi aprovado pela Comissão de Ética em Experimentação Animal (CEEA-IB-Unicamp). Na primeira fase todos os animais, controles e experimentais, foram anestesiados com pentobarbital, 60 mg!Kg. O cateter foi introduzido no espaço epidural, através de uma pequena abertura no ligamentum flavum, até o nível torácico médio e inflado com 20 microlitros de salina apenas nos grupos experimentais. Este estudo objetivou investigar a relação entre a lesão na medula e a compressão medular espinhal durante 5, 15, 30 ou 60 segundos. O exame neurológico quantitativo foi realizado com 4, 24 e 48 horas da compressão, para caracterizar a graduação da lesão nos diferentes grupos. O pior desempenho ocorreu com a compressão de 60 segundos independentemente do tempo do exame. Alguns animais morreram subitamente com edema pulmonar e um segundo estudo foi feito para elucidar este fato. O propósito desta segunda etapa foi mostrar um modelo experimental de edema agudo de pulmão neurogênico usando o cateter balão de Fogarty@ com 20 microlitros de salina durante 60 segundos de compressão (n = 17). Para se verificar a influência do agente anestésico foram utilizados dois tipos diferentes de anestésicos para se avaliar a influência da droga no edema pulmonar e foram formados 3 grupos: controle (1), compressão / pentobarbital, 60 mg/Kg (2) e compressão / xilasina, 10 mgIKg / ketamina, 75 mg lKg (3). Os resultados indicaram que houve diferença entre os grupos. No grupo do pentobarbital a pressão sistólica dobrou em relação ao basal, durante a compressão, no entanto este efeito foi menos pronunciado no grupo xilasina/ketamina. O índice pulmonar (100 x peso pulmonar / peso corporal) foi 0,395%0,018 no controle (1), aumentou para 0,499%0,060 no grupo (3), e foi máximo no grupo 2 (0,639%0,14; p=O,0018). O exame histológico da medula espinhal mostrou lesões no parênquima e hemorragia aguda. Comparando-se o índice pulmonar com o índice morfométrico por microscopia em parafina observou-se que o edema intra-alveolar relevante ocorreu somente para valores de índice pulmonar acima de 0,55. Na microscopia com maenificação de 6300 e 4000 foram evidenciadas alterações no endotélio capilar e no revestimento alveolar. O presente experimento sugere que o edema pulmonar induzido pela compressão espinhal é de natureza neurogênica, que o anestésico teve influência na gênesis do edema e que este é um método de produção de edema pulmonar neurogênico
Abstract: The author report an experience with 58 Wistar adult rats who sustained acute midthoracic spine cord injury due to Fogarty's balloon-compression technique. This experience was approved by the institutional animal care and use committee (CEEA-ffi-Unicamp). In the first step all the animaIs, sham and experimentals, were anesthetized with intraperitoneal pentobarbital 60 mg/Kg. The catheter was inserted into dorsal epidural space through a small hole made in the ligamentum flavum, advanced cranially to midthoracic spinallevel, and inflated with 20 microlitres of saline only in the experimental group. The present study was performed to investigate the relationship between the spine cord injury and the time of compression (5, 15, 30 or 60 seconds). Quantitative neurological outcome was presented with 4, 24 and 48 hours ttom the compression to characterize the graduation of injury in different groups. The poor outcome occured with 60 seconds compression independentely of the time of neurological examination. Some animaIs died suddenly with pulmonary edema and a second step investigation was done to elucidate it. The aim of this second study was to show a model of neurogenic pulmonary edema due to thoracic spine injury using a Fogarty's balloon containing 20 microlitres of saline during 60 seconds of compression (n = 17). There were used two different groups of anesthesics to compare the influence of the drugs on the pulmonary edema and three groups were constituted: sham (1), compression / pentobarbital, 60 mgI.Kg(2) and compression / xylasin, 10 mg/K.g / ketamin, 75 mg/Kg (3). The resuhs indicated that there were differences between the groups. In rats with pentobarbital anesthesia systolic blood pressure doubled the baseline value during compression, whereas this effect was less pronounced in the xylasine/ketamine group. The pulmonary index (100 x wet lung weight / bodyweight) was 0,395:1:0,018in sham (1), rose to 0,499:1:0,060in (3), and was maximum under group 2 (0,639:1:0,14;p=O,0018). Histologic examination of the spinal cord showed parenchymal ruptures and acute hemorrhage. Comparlson of the pulmonary index with morphometric evaluation of edema fluid-filled alveoli by light microscopy in paraffin sections, showed that relevant intra-alveolar edema occured only for index values above 0,55. On electron microscopy, endothelial alterations, and signs of damage of the alveolar lining cells were found. The present study showed that the anesthesic drug pentobarbital was very important for the formation of the lung edema. The present experience suggests that the pulmonary edema induced by spinal compression is of neurogenic nature, that the anesthesic drug used had an important participation in the genesis of edema and that it is a good method to produce neurogenic pulmonmy edema
Doutorado
Neurologia
Doutor em Ciências Médicas

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Pinto, Inês Isabel Ramos. "Comparison of heart measurements in thoracic radiographs before and after the treatment of pulmonary edema in dogs with degenerative mitral valve disease : a retrospective study of 18 clinical cases." Master's thesis, Universidade de Lisboa, Faculdade de Medicina Veterinária, 2019. http://hdl.handle.net/10400.5/18204.

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Dissertação de Mestrado Integrado em Medicina Veterinária
The Degenerative Mitral Valve Disease (DMVD) has the highest prevalence of all canine heart diseases accounting for 75-80% of the cases of dogs with cardiac disease. DMVD is characterized by having an evolutive nature. As the disease progresses the microscopic and macroscopic alterations of the mitral valve’s apparatus become more severe and gradually start preventing the valve’s normal function. One of the complications that may occur is the development of pulmonary edema. Overt pulmonary edema occurs when the capacity of the pulmonary lymphatic system is exceeded, leading to an increase in the extravascular water content of the lungs. The etiology and consequently the cure for DMVD are not currently known, hence the importance of understanding and developing tools that allow the monitoring of the disease. Even though the best way to assess and confirm the diagnosis of DMVD is through echocardiography, this exam requires additional expertise to be performed and interpreted, as well as substantial financial costs to the owner. Simultaneously, radiography of the thorax is widely available and cost-effective, which justifies the interest in studying the evolution of the radiographic measures Vertebral Heart Score (VHS) and Vertebral Left Atrium Size (VLAS) in dogs with DMVD. This retrospective study aims to compare heart measurements in thoracic radiographs before and after the treatment of pulmonary edema in 18 dogs with DMVD that were submitted to consultation in a french veterinary referral center. The main conclusion of this study is that the size of the left atrium and the cardiac silhouette decreases after the resolution of cardiogenic pulmonary edema when compared to the dimensions during its occurrence. Furthermore, this decrease in the left atrium’s size is detectable using the VLAS method, which confirms its value in monitoring the progression of the disease. Consequently, it is possible for those who do not have access to an echocardiographic exam, to use the VLAS method to follow the evolution of the left atrium’s size throughout the progression of DMVD. It was also verified that VLAS measurements have a positive correlation with echocardiographic measures of the left atrium, implying that when one increases the other does so as well, and vice-versa.
RESUMO - Comparação de medições cardíacas em radiografias torácicas antes e depois do tratamento de edema pulmonar em animais com Doença Degenerativa da Válvula Mitral: um estudo retrospetivo de 18 casos clínicos - A Doença Degenerativa da Válvula Mitral (DDVM) tem a prevalência mais alta de todas as doenças cardíacas caninas, representando 75-80% dos casos destes doentes. A DDVM é caracterizada pela sua natureza evolutiva. Assim à medida que a doença progride, as alterações microscópicas e macroscópicas da válvula mitral tornam-se mais graves e começam gradualmente a impedir o seu normal funcionamento. Uma das complicações que pode ocorrer é o desenvolvimento de edema pulmonar que sucede quando a capacidade do sistema linfático do pulmão é excedida, levando, por isso, à acumulação de conteúdo aquoso no compartimento extravascular dos mesmos. A etiologia e consequentemente a cura da DDVM não são atualmente conhecidas, dai a importância em perceber e desenvolver ferramentas que permitam a monitorização da doença. Embora a melhor maneira de determinar e confirmar o diagnóstico de DDVM seja através de uma ecocardiografia, este exame de diagnóstico representa um investimento para o proprietário, necessita de material caro e exige um nível de competência mais elevado para o realizar e interpretar. Simultaneamente, a realização de radiografias do tórax é uma técnica amplamente disponível e económica, o que justifica o interesse em estudar a evolução das medidas radiográficas Vertebral Heart Score (VHS) e Vertebral Left Atrium Size (VLAS) em cães com DDVM. O objetivo deste estudo retrospetivo prende-se com a comparação de medidas cardíacas, em radiografias da cavidade torácica, antes e depois do tratamento de edema pulmonar em 18 cães com DDVM que foram apresentados em consulta num centro hospitalar veterinário de referência francês. A principal conclusão deste estudo indica que o tamanho do átrio esquerdo e da silhueta cardíaca diminui depois da resolução do edema pulmonar de origem cardíaca, quando comparado com as dimensões durante a sua ocorrência. Adicionalmente, esta diminuição de tamanho do átrio esquerdo é detetável utilizando o método VLAS, o que confirma o seu valor na monitorização da progressão da doença. Consequentemente, é possível para aqueles que não têm acesso a um exame ecocardiográfico, utilizarem o método VLAS para seguir a evolução do tamanho do átrio esquerdo durante a progressão da DDVM. Também se verificou que as medições VLAS têm uma correlação positiva com as medidas ecocardiográficas do átrio esquerdo, o que implica que quando uma medida aumenta a outra aumenta também, e vice-versa.
N/A

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Málaque, Ceila Maria Sant\'Ana. "Estudo da ação do veneno de Tityus serrulatus sobre a expressão de transportadores de sódio e água em epitélio alveolar de rato." Universidade de São Paulo, 2012. http://www.teses.usp.br/teses/disponiveis/5/5160/tde-29102012-160001/.

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Acidentes escorpiônicos podem evoluir com edema pulmonar de origem cardiogênica e não cardiogênica. O clearance de edema pulmonar está relacionado principalmente ao transporte ativo de sódio do espaço alveolar para o interstício. O objetivo deste trabalho foi avaliar os efeitos do veneno de Tityus serrulatus e da dexametasona sobre a expressão dos transportadores de sódio e água e do TLR4 em pulmão de ratos. Foram utilizados ratos Wistar, divididos em três grupos: controle (salina); grupo Vn, que recebeu o veneno de T. serrulatus (3.8 mg/kg) por via intraperitoneal (ip), e o grupo Dx+Vn, que recebeu dexametasona (2.0 mg/kg) por via ip, uma hora antes da injeção do veneno. Os experimentos foram realizados uma hora após a injeção do veneno. Foram realizadas análise bioquímica e dosagens de citocinas no plasma. Nos pulmões foram estudados a expressão de -ENaC, Na+-K+- ATPase, NKCC1, AQP-5 e TRL4 através de western blotting, e a expressão do NF-kB e infiltração de células CD68+ (monócitos/macrófagos) e neutrófilos, através de imunoistoquímica. O veneno de T. serrulatus diminuiu a expressão pulmonar de -ENaC e AQP-5, enquanto aumentou a expressão do NKCC1. A dexametasona preveniu os efeitos do veneno sobre a expressão da -ENaC e NKCC1, mas não da AQP5. Não foi observada alteração da expressão da 1- Na+-K+-ATPase . A expressão do TLR4 foi maior nos animais envenenados que nos grupos Cont e Dx+Vn. O níveis plasmáticos de IL-6, IL-10 e TNF- estavam aumentados nos grupo Vn e Dx+Vn em relação ao controle. O infiltrado de células CD68+ foi maior no grupo Vn. A expressão de NF-kB e o infiltrado ne neutrófilos no tecido pulmonar foi semelhantes nos três grupos avaliados. Os resultados encontrados sugerem que o veneno de T. serrulatus tem efeito sobre as proteínas transportadoras de sódio em células do epitélio alveolar e também sobre a expressão do TLR4 em pulmão; a dexametasona pode regular essas ações
Scorpion envenomation can cause cardiogenic and noncardiogenic pulmonary edema. Pulmonary edema clearance is largely related to active Na+ transport out of the alveoli, rather than to reversal of Starling forces. Our objective was determine the effects of Tityus serrulatus venom and dexamethasone on the pulmonary expression of sodium and water transporters, and Toll-like receptor 4. Wistar rats were divided into groups and injected intraperitoneally: control (saline only); venom (T. serrulatus venom3.8 mg/kg body weight); and dexamethasone+venom (dexamethasone2.0 mg/kg body weight60 min before venom inoculation). At 60 min after venom inoculation, interleukin-6 and -10, together with tumor necrosis factor alpha, were analyzed in plasma. In lungs, we determined expression of the epithelial sodium channel alpha subunit; Na,K-ATPase alpha 1 subunit; Na-K-2Cl cotransporter, NKCC1; aquaporin 5; Toll-like receptor 4 (by Western blotting); and nuclear factor-kappa B. We determined CD68 and neutrophil counts by immunohistochemistry. In venom group lungs, the epithelial sodium channel alpha subunit and aquaporin 5 were markedly downregulated, whereas NKCC1 was elevated, although the Na,K-ATPase alpha 1 subunit was unaffected. Dexamethasone protected the epithelial sodium channel alpha subunit, NKCC1, and Toll-like receptor 4 but not aquaporin 5. Serum interleukin 6, interleukin 10, and tumor necrosis factor alpha were elevated in both groups, as was CD68 expression. Neutrophil counts and nuclear factor-kappa B expression were comparable across groups. Our data show that T. serrulatus venom alters sodium transport in alveolar epithelial cells and increases Toll-like receptor 4 expression. Dexamethasone appears to partially protect against those effects

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García, Bocanegra Raquel Teresa, Ruíz Victoria Eugenia de León, and Cadena Nicasio Alberto Dominguez. "“COMPLICACIONES ANESTÉSICAS MÁS FRECUENTES EN TRASPLANTE RENAL EN CENTRO MÉDICO ISSEMyM DEL 2003 AL 2011”." Tesis de Licenciatura, Medicina-Quimica, 2013. http://ri.uaemex.mx/handle/123456789/14096.

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TÍTULO: Complicaciones anestésicas más frecuentes en trasplante renal en Centro Médico ISSEMyM del 2003 al 2011. OBJETIVOS: Identificar cuales fueron las complicaciones anestésicas más frecuentes que se presentaron el el paciente sometido a trasplante renal en Centro Médico ISSEMYM del 2003 al 2011. MATERIAL Y MÉTODOS: Se realizó este estudio de tipo observacional, descriptivo, retrospectivo y trasversal. Donde se incluyó a todos los pacientes sometidos a trasplante renal en el periodo comprendido del 2003 al 2011. Se estudiaron la frecuencia de hipotensión, hipertensión, bradicardia, taquicardia, arritmias, acidosis persistente, edema agudo pulmonar, infarto agudo al miocardio, a través de análisis univariado. CONCLUSIONES: La principalcomplicación fue la acidosis tanto en transanestésico como pos anestésico. La cual no fue relevante para el éxito del trasplante, ya que es un estado fisiopatológico del paciente que no se agravó con el acto anestésico, solo persistió durante éste. Se concluye también que la técnica anestésica utilizada en Centro Médico ISSEMyM es segura ya que no compromete la hemodinámica del paciente, y la monitorización utilizada ayuda a detectar para dar un manejo oportuno en caso de presentarse alguna de estas.

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Xiao-yang, Wu David. "Lung lesion in experimental hydrostatic pulmonary edema /." [S.l : s.n.], 1994. http://www.ub.unibe.ch/content/bibliotheken_sammlungen/sondersammlungen/dissen_bestellformular/index_ger.html.

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Fehrenbach, Antonia, Heinz Fehrenbach, Thorsten Wittwer, Matthias Ochs, Thorsten Wahlers, and Joachim Richter. "Evaluation of Pulmonary Edema: Stereological versus Gravimetrical Analysis." Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2014. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-132491.

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Assessment of lung edema by gravimetrical analysis is a standard method to evaluate the severity of experimentally induced ischemia/reperfusion (IR) injury. The aim of this study was to compare gravimetrical assessment of pulmonary edema with a stereological approach which allows for qualitative and quantitative distinction between intravascular and edematous fluids by light microscopy. Eight experimental groups which differed in mode of preservation, ischemic storage and pharmacological treatments were studied in an extracorporeal rat lung model. Analysis of the pooled data showed that the wet/dry ratio values mainly reflected the amount of intra-alveolar edema (rs = 0.442; p = 0.0057) but only stereological assessment of edema formation revealed differences depending on the treatment used. Only stereological data correlated significantly with oxygen tension measured at the end of reperfusion (rs = –0.530; p = 0.0009). We conclude that gravimetry is of minor functional importance compared to assessment by stereological methods which prove to be a reliable and efficient tool for the evaluation of IR injury in the different experimental settings
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Fehrenbach, Antonia, Heinz Fehrenbach, Thorsten Wittwer, Matthias Ochs, Thorsten Wahlers, and Joachim Richter. "Evaluation of Pulmonary Edema: Stereological versus Gravimetrical Analysis." Karger, 2001. https://tud.qucosa.de/id/qucosa%3A27457.

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Assessment of lung edema by gravimetrical analysis is a standard method to evaluate the severity of experimentally induced ischemia/reperfusion (IR) injury. The aim of this study was to compare gravimetrical assessment of pulmonary edema with a stereological approach which allows for qualitative and quantitative distinction between intravascular and edematous fluids by light microscopy. Eight experimental groups which differed in mode of preservation, ischemic storage and pharmacological treatments were studied in an extracorporeal rat lung model. Analysis of the pooled data showed that the wet/dry ratio values mainly reflected the amount of intra-alveolar edema (rs = 0.442; p = 0.0057) but only stereological assessment of edema formation revealed differences depending on the treatment used. Only stereological data correlated significantly with oxygen tension measured at the end of reperfusion (rs = –0.530; p = 0.0009). We conclude that gravimetry is of minor functional importance compared to assessment by stereological methods which prove to be a reliable and efficient tool for the evaluation of IR injury in the different experimental settings.
Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

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Carter, Eric Alexander. "An investigation of extravascular lung water during exercise in those individuals susceptible to immersion pulmonary edema or high altitude pulmonary edema." Thesis, University of British Columbia, 2011. http://hdl.handle.net/2429/36739.

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Introduction: High altitude pulmonary edema (HAPE) is caused by hypoxic vasoconstriction, leading to increased pulmonary artery pressure (PPA). Increased PPA results in extravasation of fluid from the pulmonary capillaries to the interstitial space and inhibition of gas exchange. Immersion pulmonary edema (IPE) is likely the result of increased hydrostatic pressure due to water immersion combined with cold and physical exertion, further elevating PPA. During maximal exercise, some humans develop pulmonary edema independent of hypoxia or immersion; this is a possible cause of exercise-induced arterial hypoxemia (EIAH). Purpose: The purpose of this study was to 1) investigate the common mechanisms that are responsible for the development of HAPE, IPE, and EIAH; and 2) investigate the factors that determine an individual’s susceptibility to HAPE/IPE. Hypotheses: We hypothesize that 1) individuals susceptible to HAPE/IPE will develop increased extravascular lung water (EVLW) following exercise; and 2) these changes will not occur in HAPE/IPE-resistant controls. Methods: This study included 9 healthy fit participants who previously experienced HAPE or IPE. Participants performed a 45-minute maximal exercise task on a cycle ergometer. A matched control group of 9 participants with experience at altitude or immersion and no history of HAPE/IPE also performed the task. Diffusion capacity of CO (DLco) was measured before and after exercise. Computed tomography was used to confirm EVLW following exercise. Results: Both groups showed a significant reduction in lung density post-exercise (p=0.013). Participants susceptible to HAPE/IPE had a significantly lower density compared to resistant participants (p=0.037). DLco decreased significantly after exercise (p<0.001), without difference in the change between groups (p=0.77). Discussion: Because of the post-exercise increase in volume, the decrease in lung density should be considered to represent no change in EVLW. The decrease in DLco was consistent with results found in other studies. Lower lung density in HAPE/IPE-susceptible participants could be the result of damage caused by HAPE/IPE, increased vascular reactivity, or decreased lymphatics. Conclusion: Susceptibility to HAPE/IPE does not increase risk of developing EVLW during maximal exercise. Participants susceptible to HAPE/IPE displayed a significantly lower lung density that necessitates further research.

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Chang, David Wei-Péng. "ST. JUDE MEDICAL: PULMONARY EDEMA MONITORING IN PACEMAKERS AND ICDS." DigitalCommons@CalPoly, 2013. https://digitalcommons.calpoly.edu/theses/1112.

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Pulmonary edema occurs when fluid leaks from the pulmonary capillary network into the lung interstitium and alveoli. When the heart is not able to pump blood to the body efficiently, fluid can back up into the veins that take blood through the lungs to the left atrium. This then builds up the pressure in the blood vessels and fluid is pushed into the alveoli in the lungs. The fluid reduces normal oxygen movement through the lungs and can cause impaired gas exchange and respiratory failure. There are many causes of congestive heart failure that may lead to pulmonary edema such as heart attack, any diseases of the heart that weaken or stiffen the heart muscle, a leaking or narrowed heart valve, and sudden, severe high blood pressure. Pulmonary edema is a strong indicator of congestive heart failure in patients and therefore can be used as a gauge for congestive heart failure. One way to diagnose cardiogenic pulmonary edema constantly is through the continuous monitoring of the transthoracic impedance throughout the day. One method to achieve this constant monitoring is through the use of a cardiac pacemaker or an implantable cardioverter defibrillator (ICD). Many patients who are at risk of heart failure have these medical devices implanted already. In these implantable cardiac devices, the connected cardiac leads can be utilized to continually screen several impedance vectors for decreases in impedance in the thoracic cavity. A pacemaker or ICD that implements Pulmonary Edema Monitoring is designed to continuously monitor these impedance vectors and alert the patient to seek medical attention. This thesis will discuss the implementation of Pulmonary Edema Monitoring via screening of multiple impedance vectors in a pacemaker or implantable cardioverter defibrillator and the effectiveness of this monitoring method. Furthermore, the design, implementation, and testing of this feature will be explored in greater detail.

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Hui, Chi-hoi, and 許志海. "Nurse-led non-invasive mechanical ventilation guideline for acute pulmonary oedema patients in acute medical wards." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2011. http://hub.hku.hk/bib/B4658190X.

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Zwikler, Marvin Paul. "The effects of pulmonary fibrosis on the distribution of lung edema." Thesis, McGill University, 1993. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=26190.

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The normal lung with its air-filled alveoli is designed primarily to function in gas-exchange. Pulmonary edema, particularly in its alveolar flooding phase, is life-threatening because it interferes with this gas-exchange function. An important safety factor against alveolar flooding is the pulmonary interstitium that has a high compliance to accommodate edema fluid. We tested the hypothesis that if we decreased the compliance of the interstitium by experimental fibrosis, lung edema would be redistributed from the interstitium and predominantly flood alveoli. To study this, severe left lung fibrosis was produced in six dogs with radiation and bleomycin. Twenty-four months later, hydrostatic edema was induced by fluid infusion and lungs were studied pre- and post-edema with computed tomography (CT) scanning. Gravimetry and morphology were used to assess the amounts and distribution of edema between fibrotic left and control right lungs. Fibrosis, pre-edema, produced a 11-fold decrease in lung volume and a 2.2-fold increase in tissue density. We found, by CT and gravimetry, that similar amounts of water accumulated per unit volume in control and fibrotic lungs. Morphometry and semi-quantitative light microscopic grading showed a two-fold rise in the volume fractions of connective tissue and alveolar edema, and a 50% reduction of air and of interstitial edema in the fibrotic lobes. By electron microscopy, the interstitial edema in the fibrotic lungs was randomly distributed, whereas in the controls it was found primarily around extra-alveolar vessels and airways, not in the alveolo-capillary septa. We conclude that fibrosis profoundly affects the distribution of edema in the lung.

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Krause, Lauren Kendall. "Gene Expression patterns in High-Altitude Pulmonary Edema: A Gene Microway Analysis." Yale University, 2008. http://ymtdl.med.yale.edu/theses/available/etd-08152007-111828/.

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Multiple modulating genes and environmental factors have been implicated in the pathogenesis of high-altitude pulmonary edema (HAPE). However, at the present time, there exists an incomplete understanding of the molecular mechanisms and pathways which underlie constitutional susceptibility. Genome-wide measurements of gene expression in peripheral blood mononuclear cells (PBMCs) were performed using microarray technology. Comparison of gene expression profiles of HAPE-susceptible and resistant individuals resulted in the identification of several previously undescribed candidate genes. RhoA and Rho-kinase (ROCK), regulators of vascular smooth muscle contraction, were differentially regulated in the HAPE-susceptible cohort, as compared to both HAPE-resistant patients with acute mountain sickness (AMS+) and healthy controls (p=0.0014; p=0.0020). Furthermore, biological pathways involving RhoA and Rho-kinase were strongly upregulated in subjects with HAPE. These findings represent the first description of the RhoA/Rho-kinase signaling pathway in HAPE. Currently, few pharmacologic therapies have been demonstrated to be effective in the prevention and treatment of HAPE. The results of this study provide early evidence that Fasudil, a selective Rho-kinase inhibitor, may represent a novel therapeutic intervention effective in the prevention and/or treatment of high-altitude pulmonary edema.

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Tauriainen, M. Peter. "Negative pressure pulmonary edema, a clinical review and study of its pathophysiology." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1997. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp04/mq23521.pdf.

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Rossi, Patrik. "The role of the endothelin system in experimental acute lung injury with special reference to the formation of extra-vascular lung water /." Stockholm, 2006. http://diss.kib.ki.se/2006/91-7140-700-6/.

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Sentenac, Pierre. "Hypertension pulmonaire et remodelage cardiaque en lien avec l’hyper-débit survenant après chirurgie de résection pulmonaire : physiopathologie, mécanismes cellulaires et moléculaires, nouvelles thérapies ciblées." Thesis, Montpellier, 2020. http://www.theses.fr/2020MONTT034.

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L'objectif était d'étudier le remodelage vasculaire pulmonaire après pneumonectomie droite (PN) chez le rat, et d'explorer in vitro les mécanismes impliqués sur des cellules humaines soumises à un shear stress. Chez les patients, l'objectif était de déterminer l'incidence de dysfonctionnement ventriculaire droite (VD) précoce après résection pulmonaire majeure, évaluée par le strain longitudinal de la paroi latérale du VD (RVLW).Soixante rats mâles Sprague-Dawley ont subi soit une PN droite ou une chirurgie sham. Dix rats par groupe ont été sacrifiés au 3ème, 7ème et 28ème jours postopératoires (J3, J7, J28). Les altérations cardio-pulmonaires ont été étudiées par des analyses échocardiographiques, hémodynamiques et histologiques. Un antagoniste compétitif du récepteur β du facteur de croissance dérivé des plaquettes (PDGFR- β), appelé inhibiteur A4, a été administré entre J0 et J28 chez dix rats en prévention de l’HTP. In vitro, le shear stress a été reproduit à l'aide d'un système FlexCell ™ Tension. Un étirement cyclique pathologique (allongement de 18%) a été appliqué sur des cellules endothéliales pulmonaires (P-ECs) humaines pour évaluer l'impact sur la croissance des cellules musculaires lisses artérielles pulmonaires (PA-SMCs). Une étude prospective a été menée au CHU de Montpellier (France). Tous les patients opérés d’une chirurgie de résection pulmonaire majeure, sans hypertension pulmonaire ni dysfonction VD préexistante, étaient éligibles. Une échocardiographie standardisée (GE® Vivid iq ™) a été réalisée en préopératoire puis aux jours 1, 2 et 3 postopératoires par le même examinateur. Le critère d'évaluation était la survenue d'une dysfonction VD définie par un RVLW longitudinal strain supérieur à -15%. La pression artérielle pulmonaire (PAP) moyenne a progressivement augmenté dans le groupe PN pour atteindre 35 ±7 mmHg à J28 vs 18 ±4 (sham) (P=0.001), de même que la proportion d'artères pulmonaires distales muscularisées, 83 ±1% vs 5 ±1 respectivement (P<0.001), liée à une prolifération in situ de PA-SMC. La surface télé-diastolique du VD et l'épaisseur de la paroi latérale VD étaient doublées dans le groupe PN à J28. La fraction d'éjection du ventricule gauche était diminuée à J7 et J28 tandis que la fonction systolique VD était préservée. In vitro, la croissance des PA-SMCs humaines était significativement plus élevée avec le milieu de culture des P-ECs « stretchées » vs « non stretchées ». Cela a permis de mettre en évidence le rôle du shear stress sur la fonction paracrine de la P-EC. Le PDGF était le principal facteur de croissance impliqué. Chez le rat, un traitement par antagoniste du PDGFR-β a diminué la PAP systolique après PN, de 69 ±10 (PN) à 46 ±6 mmHg (PN+A4) (P=0.0005), et l'indice d'hypertrophie du VD de 0.52 ±0.09 à 0.42 ±0.06 respectivement (P=0.004). Entre Février 2017 et Juillet 2018, 110 patients ont été inclus, 92 ont été analysés, âge moyen 65 ±10 ans, 59% d'hommes, BPCO dans 41% des cas, 74 lobectomie (80%), 8 pneumonectomie (9%), 6 bilobectomie (7%). Le RVLW longitudinal strain s’altérait dans les trois premiers jours chez 55% des patients (IC 0.44—0.66), passant de -20 ±7% (J0) à -16 ±6 (J3) (P=0.002). Le strain des segments de la RVLW (basal, moyen et apex) était altéré de manière homogène. Un TAPSE altéré a été observé chez 15% des patients, préférentiellement après pneumonectomie ou bilobectomie qu'après lobectomie (P=0.04). Une HTP survenait chez 11% des patients. CONCLUSIONS: Chez le rat, la pneumonectomie droite a conduit à une HTP liée à une forte muscularisation des artères pulmonaires distales et associait un remodelage sélectif du VD. In vitro, le shear stress a modifié le contrôle paracrine des P-ECs sur la croissance des PA-SMCs. L'inhibitionsélective du PDGFR-β pourrait être une cible thérapeutique. Après chirurgie de résection pulmonaire majeure, le RVLW strain a montré un dysfonction précoce du VD chez environ 50% des patients
The objective was to investigate the consequences of right pneumonectomy (PN) on the pulmonary vascular bed in rats, and to explore in vitro the involved mechanisms in human cells. In patients, the objective was to determine the incidence of right ventricular (RV) dysfunction during the first three days after major pulmonary resection surgery, assessed by the RV lateral wall (RVLW) longitudinal strain, a new marker of RV function.Sixty Sprague-Dawley male rats randomly underwent either a right PN or sham surgery. Ten rats per group were sacrificed on postoperative days 3, 7 and 28 (D3, D7, D28). Cardiopulmonary alterations were investigated by echocardiographic, hemodynamic and histological analyses. A competitive antagonist of the platelet-derived growth factor (PDGF)-receptor β (named A4 inhibitor) was administered between D0 and D28 in ten rats to prevent PH development. In vitro, the shear stress was reproduced using a FlexCell™ Tension system. A pathological cyclic stretch (18% elongation) was applied on cultured human pulmonary endothelial cells (P-ECs) to investigate the impact on pulmonary artery smooth muscle cell (PA-SMC) growth. Growth factors were dosed in P-ECs using qRT-PCR. A prospective study was conducted in the Montpellier University Hospital (France). All patients undergoing a major pulmonary resection surgery, without pre-existing PH or RV dysfunction, were eligible. A standardized echocardiography (GE® Vivid iq™) was performed preoperatively and then on postoperative days 1, 2 and 3 by the same examiner. The endpoint was the occurrence of a RV dysfunction, defined by a RV lateral wall (RVLW) longitudinal strain greater than -15%.Mean pulmonary arterial pressure (mPAP) gradually increased in the PN group to reach 35 ±7 mmHg on D28 vs 18 ±4 in sham (P = 0.001), likewise the proportion of muscularized distal pulmonary arteries, 83 ±1% vs 5 ± 1 respectively (P < 0.001), related to in situ PA-SMC proliferation. The RV enddiastolic area and RV lateral wall thickness were doubled in the PN group on D28. The left ventricle ejection fraction decreased on D7 and D28 while the RV systolic function was maintained. In vitro, the human PA-SMC growth was significantly greater when seeded with stretched vs non stretched P-EC media, highlighting the role of shear stress on the P-EC paracrine function. The qRT PCR highlighted that the PDGF was the main growth factor involved. In rats, a treatment by PDGFR-β antagonist decreased the systolic PAP after pneumonectomy, from 69 ±10 (PN) to 46 ±6 mmHg (PN+A4) (P = 0.0005), and the RV hypertrophy index from 0.52 ± 0.09 to 0.42 ± 0.06 respectively (P = 0.004). Between February 2017 and July 2018, 110 patients were included, 92 were analyzed, mean age 65 ±10 years, 59% male, COPD in 41% of cases, 74 lobectomy (80%), 8 pneumonectomy (9%), 6 bilobectomy (7%). In the early postoperative period, the RVLW longitudinal strain was altered in 55% of patients (CI 0.44—0.66), and dropped from -20 ±7% (D0) to -16 ±6 (D3) (P = 0.002). The longitudinal strain of the RVLW segments (basal, middle and apex) was homogeneously altered. An altered TAPSE (less than 17 mm) was observed in 15% of patients, preferentially after pneumonectomy or bilobectomy than after lobectomy (P = 0.04). Pulmonary hypertension (defined by systolic PAP >35 mmHg) occurred in 11% of patients, and the systolic PAP increased from 19 ±9 (D0) to 21 ±11 (D3) mmHg (P = 0.006). CONCLUSIONS: In rats, right pneumonectomy led to PH related to high muscularisation of distal pulmonary arteries, and was associated with a selective RV remodeling. In vitro, the shear stress related to high blood flow altered the pulmonary endothelial paracrine control of SMC growth. Selective PDGFR-β inhibition could be a therapeutic target. After major pulmonary resection surgery, the RVLW longitudinal strain showed an early RV dysfunction in approximately 50% of patients

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Leja, Astrid. "The lectin-like TNF domain role in experimental models of pulmonary edema reabsorption and Trypanosoma brucei infection /." [S.l.] : [s.n.], 2004. http://deposit.ddb.de/cgi-bin/dokserv?idn=97288128X.

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Sales, Raquel Pinto. "Acute Respiratory Distress Syndrome (ARDS) is an inflammatory disease characterized by pulmonary edema, stiff lungs and hypoxemia." Universidade Federal do CearÃ, 2014. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=12672.

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Acute Respiratory Distress Syndrome (ARDS) is an inflammatory disease characterized by pulmonary edema, stiff lungs and hypoxemia. Patients with ARDS are more susceptible to VILI (ventilator induced lung injury). Under mechanical ventilation, lung stress and strain are the main determinants of VILI and in patients with muscle effort patient-ventilator asynchrony may enhance this phenomenon. Ventilation modes PCV and VCV with auto-flow can minimize patient-ventilator asynchrony, but then can liberate the offer of flow and tidal volume, compromising the protective ventilatory strategy in ARDS. This study aimed to evaluate the influence of muscle effort and patient-ventilator asynchrony on pulmonary stress and strain in a mechanic lung model of acute respiratory distress syndrome. An experimental bench study was performed, using a lung simulator, ASL 5000TM, in which was configured a lung model with restrictive respiratory mechanics with complacency of 25ml/cmH2O and resistance of 10 cmH2O/L/sec. Muscle effort was adjusted in three situations: no muscular effort (Pmus = 0), with inspiratory muscle effort (Pmus = -5 cmH2O) and inspiratory and expiratory effort (Pmus = -5/+5 cmH2O), all with breathe rate (b) of 20 bpm. Five ventilators were connected to the simulator through and endotracheal tube No 8.0 mm and adjusted on VCV, VCV with Auto-flowTM (in the ventilator in which it was available) and PCV modes, all with tidal volume (VT): 420 ml, PEEP: 10 cmH2O and breath rate set in two situations: b = 15 bpm (lower than b of the respiratory muscle effort) and b = 25 bpm (higher than b of the respiratory muscle effort). Variables analyzed were: maximum VT, alveolar pressure at the end of inspiration, effective PEEP, driving pressure, transpulmonary pressure at the end of inspiration and expiration, average transpulmonary pressure, inspiratory peak flow and analysis of mechanic curves. In the studied lung model the b of the ventilator adjusted higher of the b of the patient and not the muscle effort was the main determinant for the development of patient-ventilator asynchrony, causing large variations of the VT and pulmonary pressures, intensifying the lung stress and strain. The ventilatory modes had similar behavior, although VCV Auto-flowTM and PCV have presented slightly higher values of VT and pulmonary pressures. Thus it is concluded that the proper adjustment of the programed breath rate in the assisted/controlled modes can minimize patient-ventilator asynchrony, reducing lung stress and strain.
A SÃndrome da AngÃstia RespiratÃria Aguda (SARA) Ã uma doenÃa inflamatÃria caracterizada por edema pulmonar, pulmÃes rÃgidos e hipoxemia. Pacientes com SARA estÃo mais suscetÃveis Ã VILI (ventilator induced lung injury). Sob ventilaÃÃo mecÃnica, o stress e o strain pulmonares sÃo os principais determinantes da VILI e nos pacientes com esforÃo muscular a assincronia paciente-ventilador pode potencializar este fenÃmeno. Os modos ventilatÃrios PCV e VCV com AutoFlowÂ podem minimizar a assincronia paciente-ventilador, mas por outro lado podem liberar a oferta de fluxo e volume corrente, comprometendo a estratÃgia ventilatÃria protetora na SARA. Objetivou-se avaliar as influÃncias do esforÃo muscular e da assincronia paciente-ventilador sobre o âstrainâ e o âstressâ pulmonares em modelo pulmonar mecÃnico de sÃndrome da angÃstia respiratÃria aguda. Foi realizado um estudo experimental de bancada, utilizando um simulador de pulmÃo, ASL 5000Â no qual foi configurado um modelo pulmonar com mecÃnica respiratÃria restritiva, com complacÃncia de 25ml/cmH2O e resistÃncia de 10 cmH2O/L/sec. O esforÃo muscular foi ajustado em trÃs situaÃÃes: sem esforÃo muscular (Pmus=0), com esforÃo muscular inspiratÃrio (Pmus= -5cmH2O) e esforÃo inspiratÃrio e expiratÃrio (Pmus= -5/+5 cmH2O), todos com frequÃncia respiratÃria (f) de 20rpm. Ao simulador foram conectados cinco ventiladores atravÃs de um tubo orotraqueal nÂ 8,0 mm e ajustados nos modos VCV, VCV com sistema AutoFlowÂ (no ventilador que tinha o sistema disponÃvel) e PCV, todos com volume corrente (VC): 420 ml, PEEP: 10 cmH2O e frequÃncia respiratÃria programada em duas situaÃÃes: f=15rpm (< que a f de esforÃo muscular respiratÃrio) e f=25rpm (> que a f de esforÃo muscular respiratÃrio). As variÃveis analisadas foram: VC mÃximo, a pressÃo alveolar no final da inspiraÃÃo, PEEP efetiva, driving pressure, pressÃo transpulmonar no final da inspiraÃÃo e expiraÃÃo, pressÃo transpulmonar mÃdia, pico de fluxo inspiratÃrio e anÃlise das curvas de mecÃnica. No modelo pulmonar estudado a f do ventilador pulmonar ajustada acima da f do paciente e nÃo o esforÃo muscular o principal determinante para o desenvolvimento de assincronia paciente ventilador, causando grandes variaÃÃes de VC e pressÃes pulmonares, o que intensificou o stress e strain pulmonares. Os modos ventilatÃrios tiveram comportamento semelhante, embora os modos VCV AutoFlowÂ e PCV tenham apresentado valores discretamente maiores de VC e pressÃes pulmonares. Desta forma conclui-se que o ajuste adequado da frequÃncia programada nos modos assistido/controlado podem pode minimizar a assincronia paciente ventilador reduzindo o stress e strain pulmonares. Palavras-

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Rau, Anna. "Detektion eines Lungenödems mittels transpulmonaler Thermodilutionsmessung und quantitativer Computertomographie im Schafmodell." Doctoral thesis, Universitätsbibliothek Leipzig, 2014. http://nbn-resolving.de/urn:nbn:de:bsz:15-qucosa-132562.

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Das extravaskuläre Lungenwasser (EVLW) bezeichnet eine Akkumulation extravaskulärer Flüssigkeit im Lungengewebe und ist charakteristisch für das akute Lungenversagen (ALI/ARDS). Die bettseitige Messung des EVLWs eröffnet dem Kliniker die Möglichkeit einer frühzeitigen Detektion und Quantifizierung eines Lungenödems. Neben gravimetrischen und bildgebenden Methoden ist das transpulmonale Thermodilutionsverfahren ein bettseitiges Verfahren zur EVLW Bestimmung. Das transpulmonale Thermodilutionsverfahren findet entweder als Doppel- oder als Einzelindikatorverfahren Anwendung. Das Einzelindikatorverfahren ist aufgrund der einfacheren und kosteneffektiveren Handhabung zu einer weitverbreiteten Methode geworden. Trotz guter Validierung an einer Vielzahl von alternativen Methoden zur EVLW Messung ist die Einzelindikatormethode nicht vollends etabliert. Daher bedarf es der Überprüfung der Zuverlässigkeit der EVLW Bestimmung durch das Einzelindikator-Thermodilutionsverfahren anhand anderer Methoden, die zur Quantifizierung von Lungenödemen eingesetzt werden können. Diese Arbeit ist Teil eines interdisziplinären Forschungsprojektes der veterinär- und humanmedizinischen Fakultäten der Universität Leipzig zur Quantifizierung eines durch Applikation des alpha2-Rezeptotagonisten Xylazin induzierten Lungenschadens im Großtiermodell der Spezies Schaf. Neben der quantitativen Computertomographie (qCT) wurde das Einzelindikator-Thermo¬dilutions¬verfahren zur Quantifizierung eines möglichen Lungenödems eingesetzt. Hierfür wurden 16 Versuchsschafe narkotisiert und maschinell beatmet. In zwei Experimenten wurde niedrig dosiertes Xylazin (0,15 mg/kg) und in einem dritten Experiment hoch dosiertes Xylazin (0,3 mg/kg) intravenös verabreicht. Alle drei Versuchsabschnitte wurden in denselben Tieren mit jeweils mindestens 8 Wochen Zeitabstand durchgeführt. Vor und wiederholt nach der Xylazinapplikation wurden mittels qCT das Gesamtlungengewicht (MLunge) und das Gesamtlungenvolumen (VLunge), sowie mittels Einzelindikatorverfahren das EVLW bestimmt. Für die Auswertung wurde auch der auf das Körpergewicht bezogene EVLW Index (EVLWI) verwendet. In allen drei Versuchsabschnitten stiegen nach Xylazinapplikation MLunge und EVLWI an, VLunge hingegen sank erheblich ab. Der EVLWI Anstieg erreichte nach Xylazingabe nicht die Schwellenwerte für das akute Lungenversagen, sondern war vereinbar mit einem gering bis mäßig ausgeprägten Lungenödem. Die CT-basierten Parameter bestätigten dies. Vielmehr konnte mit der qCT der Nachweis von Atelektasen als wesentliche Ursache der Belüftungsstörung nachgewiesen werden. Die EVLW Messung ermöglichte darüber hinaus die Differenzierung zwischen einem mäßigen und einem ausgeprägten Lungenödem. Die vorliegende Arbeit zeigte weiterhin, dass das EVLW mit dem simultan mittels qCT bestimmten Parameter MLunge korrelierte. Für die vorliegende Xylazin-induzierten Lungenveränderung wies das Einzelindikator-Thermodilutionsverfahren jedoch bei der Überwachung von Veränderungen des EVLWs, d.h. im Sinne eines Verlaufsparameters, Schwächen auf. Zusammenfassend war die Detektion des erhöhten EVLWs nach Xylazinapplikation durch die Einzelindikator-Thermodilutionsmethode zum Nachweis und zur Quantifizierung und Differenzierung der Xylazin-induzierten Belüftungsstörung übereinstimmend mit den Ergebnissen der qCT gut möglich. Für die quantitative und differentialdiagnostische Beurteilung von CT Infiltraten ist das mittels Einzelindikator-Thermodilutionsverfahren bestimmte EVLW damit ein hilfreicher, bettseitig bestimmbarer Parameter.

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Brenckmann, Vivien. "Monitorage de l'inflammation pulmonaire par le monoxyde de carbone endogène exhalé dans un modèle de poumons humains : Application lors d'optimisation de greffons en perfusion pulmonaire Ex-Vivo avant transplantation pulmonaire. Étude BreathDiag-COe." Thesis, Université Grenoble Alpes, 2020. http://www.theses.fr/2020GRALS006.

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Pour pallier au manque de greffons pulmonaires, des techniques de perfusion pulmonaire ex-vivo (PPEV) ont été développées. Les critères d’évaluation sont basés sur les paramètres physiologiques comme la qualité des échanges gazeux, les résistances vasculaires pulmonaires, la formation d'œdème, et l’aspect général des poumons.La production endogène de monoxyde de carbone (CO) est influencée par les phénomènes inflammatoires et est plus particulièrement en lien avec les mécanismes d'ischémie-reperfusion.La mesure du CO exhalé (COe) est possible grâce à un spectromètre laser (ProCeas®). Cet appareil est précis (concentrations inférieures au Ppmv) et rapide permettant un monitorage cycle à cycle, en temps réel.Le but de l'étude était d’évaluer le taux de COe des greffons pulmonaires humains en cours de procédure de PPEV et de le comparer à l’acceptation des greffons, aux autres paramètres testés et au devenir à court terme des receveurs.Matériel et méthodeDes greffons pulmonaires ont été optimisés et évalués en PPEV normothermique. Les poumons étaient progressivement réchauffés, perfusés et ventilés. S'en suivait une phase d'évaluation (incluant des manœuvres de recrutement) durant deux à quatre heures.Le ProCeas® était connecté en dérivation sur le circuit ventilatoire. La production de CO était moyennée sur cinq minutes à la fin de chaque phase de recrutement.En fin de procédure de PPEV, la décision de transplanter les poumons était prise selon les critères habituels de l'équipe chirurgicale sans avoir connaissance des valeurs de COe .Résultats et Discussion21 procédures de PPEV ont eu lieux à l’hôpital Foch de Suresnes de Décembre 2018 à Juillet 2019, dont 13 greffons à « critères élargis » (CE) et 8 issus de donneurs après arrêt cardiaque (de la catégorie III de Maastricht) (DDAC-M3).La présence de sang dans les voies aériennes faussait les résultats de COe, ainsi trois procédures ont été exclues.Il n’y avait pas de différence de COe en fonction de l’origine CE ou DDAC-M3 des poumons.Sur les 18 greffons, deux ont été définitivement récusés à la greffe. Il y avait une tendance à un COe plus élevé pour les poumons récusés (p=0,068). Cette tendance était présente dès le début des procédures.Concernant les paramètres physiologiques testés lors des procédures de PPEV, le COe était corrélé à la consommation de glucose (r=0,64 ; p=0,04) et à la production de lactates (r=0,53 ; p= 0,025). Il y avait une relation non significative avec les résistances vasculaires (p = 0,062). Il n’y avait pas de lien entre COe et formation d’œdème ni avec le rapport PaO2/FiO2 per PPEV.Concernant les données post-opératoires, en séparant les greffons en 2 groupes (COe bas Vs COe élevé, limite fixée à 0,235 Ppmv), il y avait une tendance à de meilleures capacités d’hématose (PaO2/FiO2) à 24h (p=0,052) pour ceux ayant un taux de COe bas. Tous les poumons avec taux de COe élevé ont présenté un score DPG à 3 dans les 72h (p=0,088). Il y avait également une tendance à es durées plus longues de réanimation (6 jours (+-3,25) Vs 15 jours (+-3,83), p=0,06) et de durée totale en unité de soins continus (réanimation + soins intensifs) (14,5 jours (+-2,34) vs 19 jours (+-3,4) (p=0,07)) pour les greffons avec un taux de COe élevé.ConclusionLe taux de COe per PPEV pourrait être une aide supplémentaire et précoce dans l’évaluation des poumons. Il semble pouvoir également apporter une aide pronostique pour anticiper les soins de réanimation post opératoires
To compensate the lack of pulmonary grafts, ex-vivo lung perfusion techniques (EVLP) have been developed. The evaluation criteria are based on physiological parameters such as the quality of gas exchange, pulmonary vascular resistance, edema formation, and the general appearance of the lungs. The endogenous production of carbon monoxide (CO) is influenced by inflammatory phenomena and is more particularly linked to the mechanisms of ischemia-reperfusion.The measurement of exhaled CO (eCO) is possible thanks to a laser spectrometer (ProCeas®). This device is precise (concentrations lower than Ppmv) and fast allowing cycle-to-cycle monitoring, in real time.The aim of the study was to assess the eCO level of human lung grafts during the EVLP procedure and to compare it with the acceptance of the grafts, the other parameters tested and the short-term outcome of the recipients.Material and methodLung grafts have been optimized and evaluated in normothermic EVLP. The lungs were gradually warmed, perfused and ventilated. This was followed by an evaluation phase (including recruitment maneuvers) lasting two to four hours.The ProCeas® was connected in bypass to the ventilation circuit. CO production was averaged over five minutes at the end of each recruitment procedure.At the end of the EVLP procedure, the decision to transplant the lungs was taken according to the usual criteria of the surgical team without knowing the value of eCO.Results and discussion21 procedures took place at Foch Hospital in Suresnes from December 2018 to July 2019, including 13 grafts with extended criteria (EC) and 8 from donors after cardiac arrest (Category III of Maastricht) (DDCA-M3).The presence of blood in the airways distorted the eCO results, so three procedures were excluded.There was no difference in eCO based on the EC or DDCA-M3 origin of the lungs.Of the 18 grafts, two were definitively rejected at the graft. There was a tendency for higher eCO for the recused lungs (p=0.068). This trend was present from the start of the procedures.Regarding the physiological parameters tested during EVLP procedures, eCO was correlated with glucose consumption (r=0.64; p=0.04) and lactate production (r=0.53; p=0.025). There was a non-significant relationship with vascular resistance (p = 0.062). There was no link between eCO and edema formation or the PaO2/FiO2 relationship per PPEV.Concerning the post-operative data, by separating the grafts into 2 groups (low eCO Vs high eCO, limit fixed at 0,235 Ppmv), there was a tendency to better capacities of hemostasis (PaO2/FiO2) at 24h (p=0.052) for those with a low eCO level. All lungs with high eCO levels presented a PGD score of 3 within 72 hours (p=0.088). There was also a tendency for longer durations of resuscitation (6 days (+-3.25) vs 15 days (+-3.83), p = 0.06) and total duration in the continuing care unit (resuscitation + intensive care) (14.5 days (+-2.34) vs 19 days (+-3.4) (p = 0.07)) for grafts with a high COe level.ConclusionThe eCO level per EVLP could be an additional and early aid in the evaluation of the lungs.It also seems to be able to provide prognostic help to anticipate post-operative resuscitation care

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Lafargue, Mathieu. "Plasminogen Activator Inhibitor-1 (PAI-1) and Activated Protein C (aPC) Modulation Mechanisms of Pseudomonas aeruginosa Induced Pulmonary Edema." Thesis, Bordeaux 2, 2012. http://www.theses.fr/2012BOR22020/document.

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Une coagulopathie aigue endogène (EAC) est présente chez 25% des patients de traumatologie dès leur arrivée. Des résultats d’études récentes montrent que cette EAC est liée à l’activation de la voie de la protéine C (aPC). Quelques heures après, se développe un état pro-coagulant associant un niveau abaissé d’aPC et un taux plasmatique élevé de l’inhibiteur de l’activateur du plasminogene (PAI-1). Nous trouvons que l’incidence des pneumopathies associées à la ventilation est significativement augmentée chez ces patients sans toutefois connaître le rôle exact de ces anomalies de coagulation. Basé sur cette hypothèse central de susceptibilité augmentée a l’infection et plus particulièrement aux pneumopathie a P.aeruginosa (PA) le but de ce travail est d’identifier les mécanismes par lesquels PAI-1 et aPC peuvent moduler la perméabilité de la barrière alveolo capillaire et ceci a travers 3 objectifs spécifiques1 – Objectif 1 : déterminer les mécanismes par lequel PA augmente la perméabilité endothéliale. 2 – Objectif 2 : déterminer le rôle d’aPC dans la modulation des effets de PA sur l’œdème pulmonaire lésionnel.3 – Objectif 3 : déterminer le rôle de PAI-1 dans la modulation des effets de PA sur l’œdème pulmonaire lésionnel.En utilisant un inhibiteur spécifique des petites GTPases nous démontrons le rôle centrale joué par RhoA dans le développement de l’œdème pulmonaire induit par PA. PAI-1 et aPC sont impliquées dans le mécanisme lésionnel pulmonaire. aPC et l’inhibition de la voie du RhoA attenue le développement de l’œdème pulmonaire et diminue la dissémination systémique bactérienne. Cependant le blocage invivo de la voie de PAI-1 est associé à une surmortalité et à une augmentation de la charge bactérienne suggérant un rôle de PAI-1 dans l’activation de la réponse inflammatoire nécessaire a l’éradication de PA
A clinically significant acute endogenous coagulopathy (EAC) is present in 25% of major trauma patients upon arrival in the emergency department, before any fluid resuscitation. Results from recent clinical studies indicate that EAC is primarily caused by the activation of the anticoagulant protein C pathway. Several hours later, there is the development of a systemic procoagulant activity associated with low plasma levels of activated protein C (aPC) and an inhibition of the fibrinolysis caused by elevated plasma levels of plasminogen activator inhibitor 1 (PAI-1). We have found that the incidence of ventilator-associated pneumonia (VAP) is significantly increased in trauma patients with these coagulation abnormalities [6, 9]. However, whether these coagulation abnormalities play a mechanistic role in the increased susceptibility to nosocomial lung infection observed after severe posttraumatic hemorrhage is unknown. Thus, the central hypothesis is that the increased susceptibility to P. aeruginosa (PA) pneumonia following severe trauma with tissue hypoperfusion is mediated in part by these posttraumatic coagulation abnormalities within the airspaces of the lung. Specifically, in this work, we will identify through 3 specific aims the mechanisms by which PAI-1 and aPC modulate PA–mediated increase in alveolar-capillary barrier permeability.1 - Specific Aim 1: To determine the mechanisms by which PA increases lung endothelial permeability.2 - Specific Aim 2 : To determine the Role of aPC in modulating the effect of PA on the lung endothelial barrier function3 - Specific Aim 3 : To determine the Role of PAI-1 in modulating the effect of PA on the lung endothelial barrier functionIn the present work, we demonstrated the central role small GTPases RhoA plays in the increase of permeability induced by pseudomonas infection. PAI-1 and aPC are deeply involved in the control of early lung inflammation. aPC and inhibition of the RhoA pathway attenuates the development of pulmonary edema and decrease in the systemic dissemination of P. aeruginosa. However, in vivo disruption of PAI-1 signalling is associated with higher mortality at 24 h and significant increase in the bacterial burden suggesting that PAI-1 is required for the activation of the innate immune response necessary for the eradication of PA from the distal airspaces of the lung

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Prozesky, Leon. "A study of the pathology and pathogensis of myocardial lesions in gousiekte, a cardiotoxicosis of ruminants." Thesis, Pretoria : [s.n.], 2008. http://upetd.up.ac.za/thesis/available/etd-01212009-113853/.

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Veerassamy, Shalini. "Revisiting hemodynamic analysis of pulmonary edema after the onset of left ventricular dysfunction using a mathematical model of the cardiovascular system." Thesis, McGill University, 2000. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=31075.

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The aim of this project was to extend a mathematical model of the cardiovascular circulation, originally built by Burkhoff and Tyberg [6]. The model was implemented in Simulink and consists of 6 lumped vascular compartments interconnected by segments allowing unidirectional blood flow. A set of 6 differential equations describe changes in blood volume in the four systemic and two ventricular compartments as functions of time in terms of the pressure across each compartment and the resistances between them. The model was used to investigate why pulmonary venous pressure rises after the onset of left ventricular dysfunction. Special attention was given to the pericardial and peripheral resistance effects. Sensitivity analysis showed that our parameter values and ratios were more appropriate than those of Burkhoff and Tyberg [6]. We conclude that, although stressed volume has a fundamental role in raising the pulmonary venous pressure, contractile strength and systemic arterial resistance also contribute considerably.

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Wolk, Kendra E. "Influenza A Virus Inhibits Alveolar Fluid Clearance in BALB/c Mice." The Ohio State University, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=osu1337791191.

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Ayme, Karine. "Modifications de la fonction cardio-circulatoire induites par l'exercice immergé." Thesis, Aix-Marseille, 2014. http://www.theses.fr/2014AIXM5045/document.

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L'objectif général de notre travail de thèse a été d'évaluer le rapport bénéfice/risque cardiovasculaire de l'exercice immergé. L'exercice immergé est contraignant pour le système cardiovasculaire. Il est potentiellement responsable d'une majoration de la perméabilité et/ou du gradient de pression de la barrière alvéolo-capillaire. Cet effet passe par le biais d'un accroissement des charges cardiaque et respiratoire, une sécrétion de peptides natriurétiques et une hémodilution. L'exposition au froid, la consommation d'anti-inflammatoires non stéroïdiens et la réalisation d'un exercice de forte intensité majorent le risque de survenue d'un oedème pulmonaire d'immersion. L'exercice immergé a également des effets bénéfiques. La pratique d'un sport aquatique aurait le même effet anti-hypertenseur que les activités réalisées en ambiance sèche. Par ailleurs, des différences de sollicitation endothéliale pourraient exister, en fonction des modalités d'exercice ou de la position du sujet. L'exercice immergé pourrait être plus efficace sur la perte de poids et le contrôle des facteurs de risque cardiovasculaires métaboliques, par le biais des sécrétions endocrines qu'il induit. Enfin, le réchauffement cutané associé à l'immersion dans une eau thermiquement neutre semble cardio-protecteur
The aim of our PhD was to hold up the knowledge about risks and benefits of immersed exercise.Immersed exercise is a stress for cardiovascular system. It may result in an increase in permeability and/or pressure gradient, at the level of alveolar-capillary membrane. These effects result from an increase in cardiac and respiratory load, a natriuretic peptide secretion, and hemodilution. Exposure to cold, non-steroïdal anti-inflammatory drugs, and high intensity exercise increase the risk of a pulmonary oedema of immersion occurrence. Immersed exercise also have beneficial effects. Our observatsion suggest that immersed exercise have the hypotensive effects as ambient air exercise. Differences in endothelial stimulation may exist, depending on exercise modalities. Immersed exercise may even be more efficient on weight loss and cardiovascular risk factors control than ambient air exercise, through alterations in endocrine secretions. At the end, the global warming of the skin related to immersion in thermoneutral water appears to be cardio-protective

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Mason, Nicholas. "Mechanisms of altitude-related cough." Doctoral thesis, Universite Libre de Bruxelles, 2012. http://hdl.handle.net/2013/ULB-DIPOT:oai:dipot.ulb.ac.be:2013/209711.

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The original work presented in this thesis investigates some of the mechanisms that may be responsible for the aetiology of altitude-related cough. Particular attention is paid to its relationship to the long recognised, but poorly understood, changes in lung volumes that occur on ascent to altitude. The literature relevant to this thesis is reviewed in Chapter 1.

Widespread reports have long existed of a debilitating cough affecting visitors to high altitude that can incapacitate the sufferer and, on occasions, be severe enough to cause rib fractures (22, 34, 35). The prevalence of cough at altitude has been estimated to be between 22 and 42% at between 4200 and 4900 m in the Everest region of Nepal (10, 29). Traditionally the cough was attributed to the inspiration of the cold, dry air characteristic of the high altitude environment (37) but no attempts were made to confirm this aetiology. In the first formal study of cough at high altitude, nocturnal cough frequency was found to increase with increasing altitude during a trek to Everest Base Camp (5300 m) and massively so in 3 climbers on whom recordings were made up to 7000 m on Everest (8). After 9 days at 5300 m the citric acid cough threshold, a measure of the sensitivity of the cough reflex arc, was significantly reduced compared with both sea level and arrival at 5300 m.

During Operation Everest II, a simulated climb of Mount Everest in a hypobaric chamber, the majority of the subjects were troubled above 7000 m by pain and dryness in the throat and an irritating cough despite the chamber being maintained at a relative humidity of between 72 and 82% and a temperature of 23ºC (18). This argued against the widely held view that altitude-related cough was due to the inspiration of cold, dry air.

In the next major hypobaric chamber study, Operation Everest III, nocturnal cough frequency and citric acid cough threshold were measured on the 8 subjects in the study. The chamber temperature was maintained between 18 and 24ºC and relative humidity between 30 and 60% (24). This work is presented in Chapter 2 and, demonstrated an increase in nocturnal cough frequency with increasing altitude which immediately returned to control values on descent to sea level. Citric acid cough threshold was reduced at 8000 m compared to both sea level and 5000 m values. Changes in citric acid cough threshold at lower altitudes may not have been detected because of the constraints on subject numbers in the chamber. The study still however demonstrated an increase in clinical cough and a reduction in the citric acid cough threshold at extreme altitude, despite controlled environmental conditions, and thus refuted the long held belief that altitude-related cough is solely due to the inspiration of cold, dry air.

If altitude-related cough is not simply due to the inspiration of cold, dry air, other possible aetiologies are:

•\
Doctorat en Sciences médicales
info:eu-repo/semantics/nonPublished

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Prunet, Bertrand. "Contusion pulmonaire : aspects physiopathologiques et conséquences thérapeutiques." Thesis, Aix-Marseille, 2015. http://www.theses.fr/2015AIXM5001.

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L’association lésionnelle d’une contusion pulmonaire et d’un état de choc hémorragique est fréquente et constitue un réel chalenge thérapeutique. La prise en charge de ce choc va nécessiter une réanimation hémodynamique dans laquelle le remplissage vasculaire tient une place centrale. Mais dans ce contexte de poumon contus, il devra être raisonné car délétère sur le plan pulmonaire, notamment en terme d'oedème et d'altération de la compliance. Ce remplissage devra donc être titré, basé sur des objectifs tensionnels clairs et un monitorage hémodynamique fiable. L'utilisation de solutés à haut pouvoir d'expansion volémique (sérum salé hypertonique, colloïdes) présente un intérêt, de même que l'introduction précoce de vasopresseurs. Le monitorage hémodynamique permettra de conduire cette réanimation sur des objectifs de pression artérielle, sur des indices de précharge dépendance et sur la mesure de l'eau pulmonaire extravasculaire. Notre travail, basé sur des études expérimentales et cliniques, a pour objectif de caractériser les modalités actuelles de prise en charge d’une contusion pulmonaire, sur les plans hémodynamiques et respiratoires
Pulmonary contusion is often associated with hemorrhagic shock, constituting a challenge in trauma care. For patients who have sustained lung contusions, fluid resuscitation should be carefully performed, because injured lungs are particularly vulnerable to massive fluid infusions with an increased risk of pulmonary edema and compliance impairment. Fluid administration should be included in an optimized and goal directed resuscitation, based on blood pressure objectives and hemodynamical monitoring. The use of fluids with high volume-expanding capacities (hypertonic saline, colloids) is probably interesting, as well as early introduction of vasopressors. Hemodynamic monitoring will allow to conduct resuscitation on blood pressure objectives, on preload parameters and on extravascular lung water measurement.Our work, based on experimental and clinical studies, objective to characterize the current modalities of ventilatory and hemodynamical aspect of pulmonary contusion care

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Kuznetsova, Irina [Verfasser]. "Inhibition of the influenza A virus-induced, tubulin-dependent apical mislocalization of the Na+,K+-ATPase in infected cells: Improving vectorial water transport and pulmonary edema clearance / Irina Kuznetsova." Gießen : Universitätsbibliothek, 2020. http://d-nb.info/1216143633/34.

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El, Mdawar Marie Belle. "Études des mécanismes cellulaires et moléculaires impliqués dans le développement du syndrome de détresse respiratoire post-transfusionnel (TRALI)." Thesis, Strasbourg, 2018. http://www.theses.fr/2018STRAJ077.

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Le TRALI immunologique est un syndrome de détresse respiratoire aiguë rare, provoqué par la présence d’alloanticorps dans les produits transfusés. Il est classiquement étudié au moyen d’un modèle de souris qui reçoivent un anticorps monoclonal contre les molécules d’histocompatibilité de classe I, anti-H-2d. Or les mécanismes qui conduisent au TRALI restent encore largement incompris. Dans ce travail de thèse, je montre que l’inhibition des récepteurs P2X1 à l’ATP et du canal calcique TRPC6, diminue le développement des œdèmes péri-artériolaires pulmonaires lors d’un TRALI, suggérant un rôle des cellules musculaires lisses. Les expériences de déplétions cellulaires spécifiques montrent que les plaquettes et les neutrophiles ne sont pas nécessaires pour l’initiation du TRALI, contrairement à ce qui avait été montré par d’autres équipes. Les monocytes et/ou les macrophages sont par contre indispensables. J’ai aussi développé un modèle de TRALI immunologique utilisant des souris transgéniques pour le récepteur humain FcγRIIA, et un anticorps recombinant muni d’une partie Fc d’IgG1 humaine. Mes travaux montrent que le TRALI est plus sévère dans les souris transgéniques, accompagné d’une activation plus importante des plaquettes et des neutrophiles. Ce modèle permet d’envisager l’étude des mécanismes du TRALI sous un nouvel angle, plus proche de la physiopathologie humaine, ainsi que celle de la contribution des parties Fc des anticorps humains
Immunological TRALI is a rare acute respiratory distress syndrome induced by the presence of alloantibodies in transfused products. A mouse model using a monoclonal antibody against the major histocompatibility complex class I, anti-H-2d, is usually used to study its mechanisms. Nevertheless, there is a lack in our understanding regarding the course of events. In this thesis, I show that the inhibitions of the ATP-gated receptor P2X1 and of the TRPC6 channel reduce the development of periarteriolar pulmonary edema occurring during TRALI, pointing to a role of smooth muscles cells. Specific cell depletions show that platelets and neutrophils are dispensable for TRALI initiation, in contrast to previous reports. Monocytes and/or macrophages are however necessary. I also developed a model of immune TRALI using transgenic mice expressing the human receptor FcγRIIA, and a recombinant antibody with a human IgG1-Fc fragment. My work reveal a more severe TRALI response in transgenic mice, with enhanced activation of platelets and neutrophils. This model allow a finer study of mechanisms underlying TRALI, moving towards the human actors of the pathology. We can also use this novel approach to assess the contribution of human Fc fragment

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Junttila, E. (Eija). "Cardiovascular abnormalities after non-traumatic intracranial hemorrhage." Doctoral thesis, Oulun yliopisto, 2012. http://urn.fi/urn:isbn:9789526200200.

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Abstract Cardiovascular abnormalities are frequent after non-traumatic intracranial hemorrhage (NT-IH). They have mainly been studied in patients with subarachnoid hemorrhage (SAH), in which they have been reported to be associated with a poorer outcome. The aim of this observational clinical study was to evaluate cardiovascular abnormalities in patients with NT-IH requiring intensive care: clinical picture, predisposing factors and impact on outcome were examined. Additionally, the validity of cardiac output (CO) monitoring via uncalibrated arterial pressure waveform analysis (APCO, FloTrac/Vigileo™) was evaluated. The thesis was comprised of retrospective (n=229) and prospective (n=108) studies. The cardiovascular abnormalities evaluated were repolarization abnormalities (RAs) in electrocardiography (ECG), myocardial injury and dysfunction, and neurogenic pulmonary edema (NPE). Cardiovascular dysfunction severity was assessed using the Sequential Organ Failure Assessment cardiovascular (SOFAcv) score. Predisposing factors for RAs and NPE were examined. The one-year mortality and functional outcome were assessed. APCO was compared with the intermittent bolus thermodilution technique (TDCO). Cardiovascular abnormalities were almost universal after NT-IH and comparable after intracerebral hemorrhage (ICH) and SAH. Each RAs (QT interval prolongation, ischemic-like ECG changes and morphological end-repolarization abnormalities) had characteristic predisposing factors. The Acute Physiology And Chronic Health Evaluation (APACHE) II score ≥20 and systemic interleukin 6 concentration >40 pg/mL were independent predictors for NPE. In the retrospective study the mortality rate was 32% after SAH and 44% after ICH. In the prospective study the rates for mortality were 18% vs. 29% and for a poor functional outcome 41% vs. 69%, respectively. Ischemic-like ECG changes were associated with a poorer functional outcome. APCO underestimated CO compared to TDCO and was biased by low systemic vascular resistance (SVR). In conclusion, cardiovascular abnormalities after NT-IH are comparable after SAH and ICH. Predisposing factors for each RAs vary. Inflammatory mechanisms play an important role in NPE development. Ischemic-like ECG changes are associated with a poorer one-year functional outcome. The validity of APCO is insufficient and biased by low SVR in patients with NT-IH
Tiivistelmä Sydämen ja verenkierron toimintahäiriöt ovat yleisiä ei-traumaattisen aivoverenvuodon (NT-IH) jälkeen. Niitä on tutkittu lähinnä lukinkalvonalaisvuotopotilailla (SAV), joilla niiden on todettu olevan yhteydessä huonompaan ennusteeseen. Tässä havainnoivassa kliinisessä tutkimuksessa selvitettiin tehohoidettujen NT-IH -potilaiden sydämen ja verenkierron toimintahäiriöiden kliinistä oirekuvaa, altistavia tekijöitä ja vaikutusta ennusteeseen. Tutkimuksessa arvioitiin myös valtimopainekäyräanalyysiin perustuvan monitorointimenetelmän (APCO, FloTrac/Vigileo™) luotettavuutta mitattaessa sydämen minuuttitilavuutta. Väitöskirjatyö koostui retrospektiivisesta (n=229) ja prospektiivisesta (n=108) tutkimuksesta. Tutkittavia toimintahäiriöitä olivat elektrokardiografiassa (EKG) nähtävät repolarisaatiohäiriöt (RAs), sydänlihaksen vaurio ja supistumishäiriö sekä keuhkopöhö. Sydämen ja verenkierron toimintahäiriön yleistä vaikeusastetta arvioitiin SOFAcv -pisteytyksellä. RAs:lle ja keuhkopöhölle altistavia tekijöitä määritettiin. Potilaiden kuolleisuus ja toiminnallinen ennuste selvitettiin vuoden seuranta-aikana. APCO:a verrattiin lämpölaimennusmenetelmään (TDCO). Sydämen ja verenkierron toimintahäiriöitä esiintyi lähes kaikilla, eivätkä ne oirekuvaltaan eronneet aivokudoksen sisäistä vuotoa (ICH) ja SAV:a sairastavilla potilailla. Eri RAs:llä (QT-ajan pidentyminen, iskeemistyyppiset EKG-muutokset ja loppurepolarisaation morfologiset poikkeavuudet) oli kullekin ominaiset altistavat tekijät. APACHE II –pisteet ≥20 ja veren interleukiini 6 –pitoisuus >40 pg/ml ennustivat keuhkopöhön kehittymistä. Retrospektiivisessä aineistossa kuolleisuus oli 32 % SAV-potilailla ja 44 % ICH-potilailla. Prospektiivisessa aineistossa kuolleisuus ja huono toiminnallinen ennuste olivat vastaavasti 18 % vs. 29 % ja 41 % vs. 69 %. Iskeemistyypiset EKG-muutokset olivat yhteydessä huonompaan toiminnalliseen ennusteeseen. APCO aliarvioi TDCO:a matalan systeemiverenkierron vastuksen (SVR) kasvattaessa harhaa. Yhteenvetona todettakoon, että sydämen ja verenkierron toimintahäiriöt eivät eroa SAV- ja ICH-potilailla. Eri RAs:lle altistavat kullekin ominaiset tekijät. Tulehdukselliset mekanismit ovat keskeisiä keuhkopöhön kehittymisessä. Iskeemistyyppiset EKG-muutokset ovat yhteydessä huonompaan toiminnalliseen ennusteeseen. APCO:n luotettavuus NT-IH -potilailla on riittämätön, ja harhaa lisää matala SVR

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Royer, Françoise. "Toxicité pulmonaire de l'oxygène : étude dynamique des modifications de la filtration capillaire pulmonaire chez le chien exposé à l'oxygène pur normobare." Grenoble 1, 1987. http://www.theses.fr/1987GRE10006.

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Dissertations / Theses on the topic 'Edema pulmonar'

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