American journal of respiratory and critical care medicine
-
Am. J. Respir. Crit. Care Med. · May 2021
Factors Associated with Persistence of Severe Asthma from Late Adolescence to Early Adulthood.
Asthma severity in children generally starts mild but may progress and stay severe for unknown reasons. ⋯ Lung function and maternal smoking during pregnancy were significant predictors of severe asthma from late adolescence to early adulthood. Interventions to preserve lung function early may prevent disease progression.
-
Am. J. Respir. Crit. Care Med. · May 2021
Positive End-Expiratory Pressure, Pleural Pressure, and Regional Compliance During Pronation: An Experimental Study.
Rationale: The physiological basis of lung protection and the impact of positive end-expiratory pressure (PEEP) during pronation in acute respiratory distress syndrome are not fully elucidated. Objectives: To compare pleural pressure (Ppl) gradient, ventilation distribution, and regional compliance between dependent and nondependent lungs, and investigate the effect of PEEP during supination and pronation. Methods: We used a two-hit model of lung injury (saline lavage and high-volume ventilation) in 14 mechanically ventilated pigs and studied supine and prone positions. ⋯ Tidal recruitment was more evenly distributed (dependent and nondependent), hyperinflation lower, and lungs cephalocaudally longer in the prone position. Conclusions: In this lung injury model, pronation reduces the vertical pleural pressure gradient and homogenizes regional ventilation and compliance between the dependent and nondependent regions. Homogenization is much less dependent on the PEEP level in prone than in supine positon.