Respiratory Rehabilitation Bulletin Number 56 December 2013

Respiratory Rehabilitation Bulletin No 56 December 2013 Respiratory Rehabilitation Bulletin Number 56 December 2013 LIBRARY NEWS : LIBRARY CHRISTMAS ...
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Respiratory Rehabilitation Bulletin No 56 December 2013

Respiratory Rehabilitation Bulletin Number 56 December 2013 LIBRARY NEWS : LIBRARY CHRISTMAS OPENING HOURS The Trust library will be staffed at the following times over the Christmas period: Christmas Eve

8:00 - 2:00

Christmas Day

Unstaffed

Boxing Day

Unstaffed

Friday 27th Dec

9:00 - 5:00

Saturday 28th Dec Unstaffed Sunday 29th Dec

Unstaffed

Monday 30th Dec

9:00 - 5:00

New Year's Eve

9:00 - 3:00

New Year's Day

Unstaffed

Thursday 2nd Jan

Normal opening hours

American Journal of Respiratory and Critical Care Medicine Volume 188, Issue 10 (November 15, 2013) Vol. 188 No. 12 (December 15, 2013)  Sleep Apnea Is Associated with Subclinical Myocardial Injury in the Community. The ARIC-SHHS Study  Beneficial Hemodynamic Effects of Prone Positioning in Patients with Acute Respiratory Distress Syndrome NEJM (New England Journal of Medicine) November 21, 2013 Vol. 369 No. 21 November 28, 2013 Vol. 369 No. 22 December 5, 2013 Vol. 369 No. 23 December 12, 2013 Vol. 369 No. 24 

Ventilator-Induced Lung Injury

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Respiratory Rehabilitation Bulletin No 56 December 2013

JAMA (Journal of the American Medical Association) November 20, 2013, Vol 310, No. 19 November 27, 2013, Vol 310, No. 20 December 4, 2013, Vol 310, No. 21 December 11, 2013, Vol 310, No. 22 December 18, 2013, Vol 310, No. 23  Effect of CPAP on Blood Pressure in Patients With Obstructive Sleep Apnea and Resistant Hypertension: The HIPARCO Randomized Clinical Trial Physical Therapy November 2013, Volume 93, Issue 11 December 2013, Volume 93, Issue 12 No new articles Physiotherapy Canada Volume 65, Number 4, Fall 2013 Journal of Physiotherapy (Formerly the Australian Journal of Physiotherapy) September 2013 Vol.59 Issue 3 No new articles Intensive Care Medicine Volume 39, Number 12 December 2013 • Implementation of a combo videolaryngoscope for intubation in critically ill patients: a before–after comparative study Critical Care Medicine December 2013 - Volume 41 - Issue 12 

Repeated Derecruitments Accentuate Lung Injury During Mechanical Ventilation

American Journal of Respiratory and Critical Care Medicine

Volume 188, Issue 10 (November 15, 2013) Vol. 188 No. 12 (December 15, 2013)  Volume 188, Issue 10 (November 15, 2013) Sleep Apnea Is Associated with Subclinical Myocardial Injury in the Community. The ARIC-SHHS Study Gabriela Querejeta Roca, Susan Redline, Naresh Punjabi, Brian Claggett, Christie M. Ballantyne, Scott D. Solomon, and Amil M. Shah "Sleep Apnea Is Associated with Subclinical Myocardial Injury in the Community. The ARIC-SHHS Study", American Journal of Respiratory and Critical Care Medicine, Vol. 188, No. 12 (2013), pp. 1460-1465. doi: 10.1164/rccm.201309-1572OC Gabriela Querejeta Roca1, Susan Redline1, Naresh Punjabi2, Brian Claggett1, Christie M. Ballantyne3, Scott D. Solomon1, and Amil M. Shah1 + Author Affiliations1Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts2Division of Pulmonary and Critical Care Medicine, Johns Hopkins

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Respiratory Rehabilitation Bulletin No 56 December 2013 University School of Medicine, Baltimore, Maryland; and3Section of Cardiology, Baylor College of Medicine and Methodist DeBakey Heart and Vascular Center, Houston, Texas Abstract Rationale: Obstructive sleep apnea (OSA) is associated with cardiovascular morbidity and mortality, although the underlying mechanisms are not well understood. Objectives: We aimed to determine whether more severe OSA, measured by the Respiratory Disturbance Index (RDI), is associated with subclinical myocardial injury and increased myocardial wall stress. Methods: A total of 1,645 participants (62.5 ± 5.5 yr and 54% women) free of coronary heart disease and heart failure and participating in both the Atherosclerosis Risk in the Communities and the Sleep Heart Health Studies underwent overnight polysomnography and measurement of high-sensitivity troponin T (hs-TnT) and N-terminal pro B-type natriuretic peptide (NT-proBNP). Measurements and Main Results: OSA severity was defined using conventional clinical categories: none (RDI ≤ 5), mild (RDI 5–15), moderate (RDI 15–30), and severe (RDI > 30). Hs-TnT, but not NT-proBNP, was associated with OSA after adjusting for 17 potential confounders (P = 0.02). Over a median of 12.4 (interquartile range, 11.6–13.1) years followup, hs-TnT was related to risk of death or incident heart failure in all OSA categories (P ≤ 0.05 in each category). Conclusions: In middle-aged to older individuals, OSA severity is independently associated with higher levels of hs-TnT, suggesting that subclinical myocardial injury may play a role in the association between OSA and risk of heart failure. OSA was not associated with NTproBNP levels after adjusting for multiple possible confounders. KEYWORDS: sleep disorders, troponin T, NT-proBNP, risk factors 

Beneficial Hemodynamic Effects of Prone Positioning in Patients with Acute Respiratory Distress Syndrome Mathieu Jozwiak, Jean-Louis Teboul, Nadia Anguel, Romain Persichini, Serena Silva, Denis Chemla, Christian Richard, and Xavier Monnet "Beneficial Hemodynamic Effects of Prone Positioning in Patients with Acute Respiratory Distress Syndrome", American Journal of Respiratory and Critical Care Medicine, Vol. 188, No. 12 (2013), pp. 1428-1433. doi: 10.1164/rccm.201303-0593OC Mathieu Jozwiak,, Jean-Louis Teboul,, Nadia Anguel,, Romain Persichini,, Serena Silva,, Denis Chemla,3, Christian Richard,, and Xavier Monnet, + Author AffiliationsService de Réanimation Médicale and3Service de Physiologie, AP-HP, Hôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France; andHôpitaux Universitaires Paris-Sud, Faculté de Médecine Paris-Sud, Le Kremlin-Bicêtre, France Abstract Rationale: The effects of prone positioning during acute respiratory distress syndrome on all the components of cardiac function have not been investigated under protective ventilation and maximal alveolar recruitment. Objectives: To investigate the hemodynamic effects of prone positioning. Methods: We included 18 patients with acute respiratory distress syndrome ventilated with protective ventilation and an end-expiratory positive pressure titrated to a plateau pressure of 28–30 cm H2O. Before and within 20 minutes of starting prone positioning, hemodynamic, respiratory, intraabdominal pressure, and echocardiographic data were collected. Before prone positioning, preload reserve was assessed by a passive leg raising test. Measurements and Main Results: In all patients, prone positioning increased the ratio of arterial oxygen partial pressure over inspired oxygen fraction, the intraabdominal pressure, and the right and left cardiac preload. The pulmonary vascular resistance decreased along with the ratio of the right/left ventricular end-diastolic areas suggesting a decrease of the right ventricular afterload. In the nine patients with preload reserve, prone positioning significantly increased cardiac index (3.0 [2.3–3.5] to 3.6 [3.2–4.4] L/min/m2). In the remaining patients, cardiac index did not change despite a significant decrease in the pulmonary vascular resistance. Conclusions: In patients with acute respiratory distress syndrome under protective ventilation and maximal alveolar recruitment, prone positioning increased the cardiac index only in

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Respiratory Rehabilitation Bulletin No 56 December 2013 patients with preload reserve, emphasizing the important role of preload in the hemodynamic effects of prone positioning. KEYWORDS: acute respiratory distress syndrome, prone positioning, passive leg raising, pulmonary vascular resistance, intraabdominal pressure Print copy available at Royal Derby Hospital library

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NEJM (New England Journal of Medicine)

November 21, 2013 Vol. 369 No. 21 November 28, 2013 Vol. 369 No. 22 December 5, 2013 Vol. 369 No. 23 December 12, 2013 Vol. 369 No. 24  Review Article Ventilator-Induced Lung Injury Arthur S. Slutsky and V. Marco Ranieri Mechanical ventilation may cause injury to the ventilated lung. This article reviews the probable causes of such injury and ways to prevent it. N Engl J Med 2013; 369:2126-2136November 28, 2013DOI: 10.1056/NEJMra1208707 http://www.nejm.org/doi/full/10.1056/NEJMra1208707 ATHENS username and password required to access full-text

Back to top JAMA November 27, 2013, Vol 310, No. 20 December 4, 2013, Vol 310, No. 21 December 11, 2013, Vol 310, No. 22 December 18, 2013, Vol 310, No. 23

JAMA. 2013;310(22):2407-2415. Effect of CPAP on Blood Pressure in Patients With Obstructive Sleep Apnea and Resistant Hypertension: The HIPARCO Randomized Clinical Trial Miguel-Angel Martínez-García, Francisco Capote, Francisco Campos-Rodríguez, Patricia Lloberes, María Josefa Díaz de Atauri, María Somoza, Juan F. Masa, Mónica González, Lirios Sacristán, Ferrán Barbé, Joaquín Durán-Cantolla, Felipe Aizpuru, Eva Mañas, Bienvenido Barreiro, Mar Mosteiro, Juan J. Cebrián, Mónica de la Peña, Francisco García-Río, Andrés Maimó, Jordi Zapater, Concepción Hernández, Nuria Grau SanMarti, Josep María Montserrat, for the Spanish Sleep Network Abstract Importance More than 70% of patients with resistant hypertension have obstructive sleep apnea (OSA). However, there is little evidence about the effect of continuous positive airway pressure (CPAP) treatment on blood pressure in patients with resistant hypertension. Objective To assess the effect of CPAP treatment on blood pressure values and nocturnal blood pressure patterns in patients with resistant hypertension and OSA. Design, Setting, and Participants Open-label, randomized, multicenter clinical trial of

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Respiratory Rehabilitation Bulletin No 56 December 2013 parallel groups with blinded end point design conducted in 24 teaching hospitals in Spain involving 194 patients with resistant hypertension and an apnea-hypopnea index (AHI) of 15 or higher. Data were collected from June 2009 to October 2011. Interventions CPAP or no therapy while maintaining usual blood pressure control medication. Main Outcomes and Measures The primary end point was the change in 24-hour mean blood pressure after 12 weeks. Secondary end points included changes in other blood pressure values and changes in nocturnal blood pressure patterns. Both intention-to-treat (ITT) and per-protocol analyses were performed. Results A total of 194 patients were randomly assigned to receive CPAP (n = 98) or no CPAP (control; n = 96). The mean AHI was 40.4 (SD, 18.9) and an average of 3.8 antihypertensive drugs were taken per patient. Baseline 24-hour mean blood pressure was 103.4 mm Hg; systolic blood pressure (SBP), 144.2 mm Hg; and diastolic blood pressure (DBP), 83 mm Hg. At baseline, 25.8% of patients displayed a dipper pattern (a decrease of at least 10% in the average nighttime blood pressure compared with the average daytime blood pressure). The percentage of patients using CPAP for 4 or more hours per day was 72.4%. When the changes in blood pressure over the study period were compared between groups by ITT, the CPAP group achieved a greater decrease in 24-hour mean blood pressure (3.1 mm Hg [95% CI, 0.6 to 5.6]; P = .02) and 24-hour DBP (3.2 mm Hg [95% CI, 1.0 to 5.4]; P = .005), but not in 24-hour SBP (3.1 mm Hg [95% CI, −0.6 to 6.7]; P = .10) compared with the control group. Moreover, the percentage of patients displaying a nocturnal blood pressure dipper pattern at the 12-week followup was greater in the CPAP group than in the control group (35.9% vs 21.6%; adjusted odds ratio [OR], 2.4 [95% CI, 1.2 to 5.1]; P = .02). There was a significant positive correlation between hours of CPAP use and the decrease in 24-hour mean blood pressure (r = 0.29, P = .006), SBP (r = 0.25; P = .02), and DBP (r = 0.30, P = .005). Conclusions and Relevance Among patients with OSA and resistant hypertension, CPAP treatment for 12 weeks compared with control resulted in a decrease in 24hour mean and diastolic blood pressure and an improvement in the nocturnal blood pressure. http://jama.jamanetwork.com/article.aspx?articleid=1788459 Physical Therapy November 2013, Volume 93, Issue 11 December 2013, Volume 93, Issue 12 No new articles

Back to top Physiotherapy Canada Volume 65, Number 4, Fall 2013 No new articles Back to top Journal of Physiotherapy (Formerly the Australian Journal of Physiotherapy) September 2013 Vol.59 Issue 3 Back to top

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Respiratory Rehabilitation Bulletin No 56 December 2013 Intensive Care Medicine Volume 39, Number 12 December 2013 

Implementation of a combo videolaryngoscope for intubation in critically ill patients: a before–after comparative study Audrey De Jong, Noémie Clavieras, Matthieu Conseil, Yannael Coisel, Pierre-Henri Moury, Yvan Pouzeratte, Moussa Cisse, Fouad Belafia, Boris Jung, Gérald Chanques, Nicolas Molinari, Samir Jaber Original Volume 39, Issue 12 / December , 2013 Pages 2144 – 2152 Abstract Purpose Airway management in intensive care unit (ICU) patients is challenging. The main objective of this study was to compare the incidence of difficult laryngoscopy and/or difficult intubation between a combo videolaryngoscope and the standard Macintosh laryngoscope in critically ill patients. Methods In the context of the implementation of a quality-improvement process for airway management, we performed a prospective interventional monocenter before–after study which evaluated a new combo videolaryngoscope. The primary outcome was the incidence of difficult laryngoscopy (defined by Cormack grade 3–4) and/or difficult intubation (more than two attempts). The secondary outcomes were the severe life-threatening complications related to intubation in ICU and the rate of difficult intubation in cases of predicted difficult intubation evaluated by a specific score (MACOCHA score ≥3). Results Two hundred and ten non-selected consecutive intubation procedures were included, 140 in the standard laryngoscope group and 70 in the combo videolaryngoscope group. The incidence of difficult laryngoscopy and/or difficult intubation was 16 % in the laryngoscope group vs. 4 % in the combo videolaryngoscope group (p = 0.01). The severe life-threatening complications related to intubation did not differ between groups (16 vs. 14 %, p = 0.79). Among the 32 patients with a MACOCHA score ≥3, there were significantly more patients with difficult intubation in the standard laryngoscope group in comparison to the combo videolaryngoscope group [12/23 (57 %) vs. 0/9 (0 %), p < 0.01]. Conclusions The systematic use of a combo videolaryngoscope in ICU was associated with a decreased incidence of difficult laryngoscopy and/or difficult intubation. Keywords – Intubation – McGrath Mac – Videolaryngoscope – Macintosh – Critical care – Complications http://icmjournal.esicm.org/journal/134/39/12/3099_10.1007_s00134-013-30991/2013/Implementation_of_a_combo_videolaryngoscope_for_intubation_in_critically_ill_patie nts_a_beforeafter_comparative_study.pdf.html

Back to top  Critical Care Medicine December 2013 - Volume 41 - Issue 12 Full Text avaialbale via OVIDSP  Critical Care Medicine: December 2013 - Volume 41 - Issue 12 doi: 10.1097/CCM.0b013e3182986268 Online Laboratory Investigations Repeated Derecruitments Accentuate Lung Injury During Mechanical Ventilation

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Respiratory Rehabilitation Bulletin No 56 December 2013 Park, Hye Yun Ha, Sang Yun Lee, Shin Hye BSc Kim, Saji BSc Chang, Keun-Shik Jeon, Kyeongman , Um, Sang-Won Koh, Won-Jung Suh, Gee Young , Chung, Man Pyo Han, Joungho Kim, Hojoong Kwon, O. Jung AbstractObjectives: The aim of our study was to assess whether repeated derecruitments induced by the repetitive withdrawal of high positive end-expiratory pressure could induce lung injury in a swine model. Design: Prospective, randomized, experimental animal study. Setting: University laboratory. Subjects: Specific pathogen-free pigs (Choong–Ang Laboratory Animals, Seoul, Korea) weighing around 30 kg. Interventions: After lung injury was induced by repeated saline lavage, pigs were ventilated in pressure-limited mode with the highest possible positive end-expiratory pressure with a tidal volume of 8 mL/kg and maximum inspiratory pressure of 30 cm H2O. With this initial ventilator setting, the control group (n = 5) received ventilation without derecruitments for 4 hours, and in the derecruitment group (n = 5), derecruitments were repeatedly induced by intentional disconnection of the ventilatory circuit for 30 seconds every 5 minutes for 4 hours. Measurements and Main Results: After the initial increase in positive end-expiratory pressure, the Pao2 increased to greater than 450 mm Hg in both groups. The Pao2 remained at greater than 450 mm Hg in the control group persistently, but in the derecruitment group, Pao2 significantly decreased to 427.7 mm Hg (adjusted p = 0.03) after 2 hours and remained significant for the rest of the study. Paco2, oxygenation index, and alveolar-arterial oxygen gradient also significantly increased after 2 hours compared with the control group. However, the variables of respiratory mechanics except for minute volume at 2-hour point showed no difference between the two groups for the duration of the study. Histologically, significant bronchiolar injury was observed in the dependent portion of the derecruitment group compared with the controls (p = 0.03), but not in the nondependent area of the lung. Conclusions: Repeated derecruitments exacerbated lung injury, particularly at the bronchiolar level in the dependent portion. Strategies to minimize this type of injury should be incorporated when designing optimal ventilator strategies in acute respiratory distress syndrome patients. Copyright © 2013 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins Back to top

The Library and Knowledge Service are currently reviewing current awareness services in order to ensure they best meet the needs of Trust staff. The future of the bulletins will be influenced by the responses we receive to this short survey. We would be grateful if you could participate, and are interested in your views even if you do not read the bulletins you receive. The questions should take no more than five minutes to complete, please follow the link below. http://www.smart-survey.co.uk/v.asp?i=1600nlxmj Produced by: David Hodgkinson (Librarian) Library and Knowledge Service, Education Centre, Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3NE Email to: [email protected]

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Respiratory Rehabilitation Bulletin No 56 December 2013 Phone extension: 88156 Date: 18/12/2013

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