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Search Results: 1 - 10 of 433380 matches for " Antonio M Esquinas Rodriguez "
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Mechanical insufflation-exsufflation in prevention of post-extubation acute respiratory failure: most welcome but must be used cautiously in critically ill patients
Antonio M Esquinas Rodriguez, Egbert Pravinkumar
Critical Care , 2012, DOI: 10.1186/cc11373
Abstract: However, some important practical issues need to be considered before the use of mechanical insufflation-exsuflation (MI-E) in the post-extubation period can be generalized, especially in patients needing NIV: (a) MI-E application requires that the NIV mask be disconnected, resulting in positive pressure loss, alveolar collapse, and desaturation. (b) MI-E devices do not have entrained oxygen. Hence, any rapid desaturation episode will require immediate reconnection to NIV. (c) Assessment of the effective management of bronchial secretions can prove difficult because of the lack of an objective or specific scoring system. (d) In some situations requiring several MI-E sessions, frequent disconnection from NIV can lead to prolonged use of post-extubation NIV. (e) MI-E may be difficult to perform or may lead to poor compliance in cases of unplanned extubation, moderate to severe hypoxemic acute respiratory failure (ARF) after extubation, agitation/anxiety, and tachypnea. (f) The effectiveness of MI-E should be studied beyond 48 hours, as late-onset extubation failures and post-extubation NIV failures are due mostly to ineffective secretion clearance [5].In conclusion, we believe that this original study could have an impact on the management and prevention of post-extubation ARF in a select group of patients. However, owing to the above-mentioned reasons, the use of MI-E cannot be generalized to all patient populations.ARF: acute respiratory failure; MI-E: mechanical insufflation-exsuflation; NIV: noninvasive mechanical ventilation.The authors declare that they have no competing interests.
Mechanical ventilation in emergency departments: Non invasive or invasive mechanical ventilation. Where is the answer?
Antonio M Esquinas Rodriguez, Roberto Cosentini, Peter J Papadakos
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine , 2012, DOI: 10.1186/1757-7241-20-40
Abstract:
Clinical review: Humidifiers during non-invasive ventilation - key topics and practical implications
Antonio M Esquinas Rodriguez, Raffaele Scala, Arie Soroksky, Ahmed BaHammam, Alan de Klerk, Arschang Valipour, Davide Chiumello, Claude Martin, Anne E Holland
Critical Care , 2012, DOI: 10.1186/cc10534
Abstract: The human airway has an important role in heating and humidifying inspired gas, and recovering heat and moisture from expired gas. The amount of water vapor in a gas mixture can be measured as absolute humidity (AH) or relative humidity (RH) in relation to the temperature. AH is the total water present in the gas (mg H2O/L) and RH is the amount of water present expressed as the percentage of maximum carrying capacity at a given temperature [1]. The human airway must provide gas at core temperature and 100% RH at the alveolar surface in order to optimize gas exchange and protect lung tissue [2].Non-invasive ventilation (NIV) is a mechanical ventilation modality that does not utilize an invasive artificial airway (endotracheal tube or tracheostomy tube) [3]. NIV is usually delivered through a nasal or oro-nasal mask so the inspired gas passes through the upper airway where it is conditioned. Like during spontaneous breathing, patients under NIV require adequate humidification and heating of the inspired air (that is, gas conditioning) [3]. NIV delivers inspired air at high flow rates, which may overwhelm the usual airway humidification mechanisms. Inadequate gas conditioning has been associated with anatomical and functional deterioration of nasal mucosa (ciliary activity, mucus secretion, local blood flow, nasal resistance). In addition, there are also negative effects on tolerance to NIV when a patient breathes inadequately humidified air [1,3-5] (Table 1).Metaplastic changes and keratinization of the nasal epithelium and submucosa have been reported in patients on home-NIV when the level of humidification was inadequate for long periods [5]. These histopathological findings were confirmed by our recent survey, which found similar structural changes of the nasal mucosa in four patients with acute respiratory failure treated for 7 days with NIV without a humidification system added (unpublished data; Figure 1). This suggests that changes in the nasal mucosa occur rel
Heat and Moisture Exchangers and Humidification Efficacy in Pediatrics: Effects of Ventilator Settings and ETT Leakage
Alan de Klerk,Antonio M. Esquinas
Critical Care Research and Practice , 2012, DOI: 10.1155/2012/585280
Abstract:
Heat and Moisture Exchangers and Humidification Efficacy in Pediatrics: Effects of Ventilator Settings and ETT Leakage
Alan de Klerk,Antonio M. Esquinas
Critical Care Research and Practice , 2012, DOI: 10.1155/2012/585280
Abstract:
Comment on “Humidification with High-Flow Nasal Cannula and Airway Epithelial Cells: Caution, Still Learning from an Extremely Complex Environment”
Antonio M. Esquinas,Naomi Kondo Nakagawa,Luiz Fernando Ferraz Da Silva
Pulmonary Medicine , 2012, DOI: 10.1155/2012/368713
Abstract:
Comment on “Humidification with High-Flow Nasal Cannula and Airway Epithelial Cells: Caution, Still Learning from an Extremely Complex Environment”
Antonio M. Esquinas,Naomi Kondo Nakagawa,Luiz Fernando Ferraz Da Silva
Pulmonary Medicine , 2012, DOI: 10.1155/2012/368713
Abstract:
Goal-Directed Mechanical Ventilation: Are We Aiming at the Right Goals? A Proposal for an Alternative Approach Aiming at Optimal Lung Compliance, Guided by Esophageal Pressure in Acute Respiratory Failure
Arie Soroksky,Antonio Esquinas
Critical Care Research and Practice , 2012, DOI: 10.1155/2012/597932
Abstract: Patients with acute respiratory failure and decreased respiratory system compliance due to ARDS frequently present a formidable challenge. These patients are often subjected to high inspiratory pressure, and in severe cases in order to improve oxygenation and preserve life, we may need to resort to unconventional measures. The currently accepted ARDSNet guidelines are characterized by a generalized approach in which an algorithm for PEEP application and limited plateau pressure are applied to all mechanically ventilated patients. These guidelines do not make any distinction between patients, who may have different chest wall mechanics with diverse pathologies and different mechanical properties of their respiratory system. The ability of assessing pleural pressure by measuring esophageal pressure allows us to partition the respiratory system into its main components of lungs and chest wall. Thus, identifying the dominant factor affecting respiratory system may better direct and optimize mechanical ventilation. Instead of limiting inspiratory pressure by plateau pressure, PEEP and inspiratory pressure adjustment would be individualized specifically for each patient's lung compliance as indicated by transpulmonary pressure. The main goal of this approach is to specifically target transpulmonary pressure instead of plateau pressure, and therefore achieve the best lung compliance with the least transpulmonary pressure possible. 1. Introduction Patients with severe respiratory failure exhibiting decreased respiratory system compliance with hypoxemia or carbon dioxide retention are often difficult to ventilate and or oxygenate with current guidelines that limit applied plateau pressure. Furthermore, applying mechanical ventilation while limiting plateau pressure without assessment of respiratory system mechanics may result in application of inappropriate positive end expiratory pressure (PEEP) and inspiratory pressures. Thus, while these guidelines recommend a certain limit of plateau pressure, they do not take into consideration chest wall mechanics, which can only be assessed by partitioning respiratory system into its components by esophageal balloon and assessment of pleural pressure. Without partitioning of the respiratory system into its components, one cannot ascertain and identify the factors contributing to low respiratory system compliance. Identifying the dominant factor affecting respiratory system compliance by measuring transpulmonary pressure may better direct and optimize mechanical ventilation. Thus, instead of limiting mechanical ventilation
Noninvasive mechanical ventilation for very old patients with limitations of care: is the ICU the most appropriate setting?
Raffaele Scala, Antonio Esquinas
Critical Care , 2012, DOI: 10.1186/cc11352
Abstract: Bearing this scenario in mind, we wonder whether the intensive care unit (ICU) is the best setting for NIV in 'older elderly DNI patients' [2,3]. While the use of NIV in patients with acute respiratory failure without preset limitations on life-sustaining treatment may be implemented in different settings (ICUs, respiratory ICUs (RICUs), and emergency rooms), depending on the typology of acute syndrome and the likelihood of success, the ideal care for 'DNI patients' is likely to be more appropriate outside the ICU [2]. In fact, for these patients for whom endotracheal intubation is questionable or care is centered largely on symptom palliation or both, NIV failure requires the intensification of comfort measures only, adequately performed in totally or partially 'open' environments [2,3]. The option of NIV in end-of-life decisions is emerging in European RICUs, where a large majority of DNI patients are treated by pulmonologists [3]. This is not surprising, as RICUs differ substantially from ICUs in terms of patient population, staffing, monitoring, and use of NIV as the preferred ventilatory approach [4]. Furthermore, a recent American survey showed that the stated use of NIV and the confidence in its utility in end-of-life patients were greater for pulmonologists than for intensivists [5]. A pulmonologist's point of view may be influenced by caring for end-stage respiratory patients over the entire spectrum of their illness as opposed to the greater focus on acute care among intensivists.In conclusion, the assignment of 'older elderly DNI patients' to an environment, such as the ICU, that was originally designed to treat patients without preset limitations of care (that is, invasive mechanical ventilation) raises financial and ethical concerns, namely (a) the questionable cost-utility ratio of allocating the precious limited ICU resources for patients whose needs may be met by lower levels of care (that is, nurse workload) and (b) the inappropriateness of a 'close
Pectinmethylesterase extraction from orange solid wastes: Optimization and comparison between conventional and ultrasound-assisted treatments  [PDF]
Antonio D. Rodriguez-Lopez, Luis Mayor, María M. Galfarsoro, Jorge Martinez-Otalo, Esperanza M. Garcia-Castello
Agricultural Sciences (AS) , 2013, DOI: 10.4236/as.2013.49B008
Abstract:

During orange juice production, a half of fresh oranges weight is considered as production waste (peels, pulp, seeds, orange leaves and damaged orange fruits). An alternative for the management of these wastes is their treatment by addition of lime and a latter pressing, obtaining a press cake and a press liquor rich in sugars (10° Brix) and citric acid, protein, pectin and ethanol. For non-thermal concentration of press liquor to obtain citruss molasses (65°-70° Brix), the removal of pectin is necessary. Traditionally, depectinization of juices has been done by using pectinmethylesterase (PME) enzymes from external sources. In this work it performed the extraction of PME enzymes from orange peels to obtain the optimum extraction conditions. Two different methods of solventextraction were compared (conventional andultrasound-assisted methods). For the conventional extraction experiments, a central composite design with three variables ([NaCl], pH and time) and five replicates of the center point was used. For ultrasound-assisted extraction, experiments were done at pH = 5.5 and [NaCl] = 1.25M), varying extraction time (1-30 min). Response variables were PME activity, protein content and a ratio between them, named PME effectiveness (ηPME). At the same experimental conditions (pH =5.5, [NaCl] = 1.25 M, t = 15 min) it was found that conventional extractions led to slightly better results in terms of ηPME than ultrasound-assisted extraction method.

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