The Effects of Sleep Hypoxia on Coagulant Factors and Hepatic Inflammation in Emphysematous Rats

OBJECTIVES: To develop a sleep hypoxia (SH) in emphysema (SHE) rat model and to explore whether SHE results in more severe hepatic inflammation than emphysema alone and whether the inflammation changes levels of coagulant/anticoagulant factors synthesized in the liver. METHODS: Seventy-five rats were put into 5 groups: SH control (SHCtrl), treated with sham smoke exposure (16 weeks) and SH exposure (12.5% O(2), 3 h/d, latter 8 weeks); emphysema control (ECtrl), smoke exposure and sham SH exposure (21% O(2)); short SHE (SHEShort), smoke exposure and short SH exposure (1.5 h/d); mild SHE (SHEMild), smoke exposure and mild SH exposure (15% O(2)); standard SHE (SHEStand), smoke exposure and SH exposure. Therefore, ECtrl, SHEShort, SHEMild and SHEStand group were among emphysematous groups. Arterial blood gas (ABG) data was obtained during preliminary tests. After exposure, hepatic inflammation (interleukin -6 [IL-6] mRNA and protein, tumor necrosis factor α [TNFα] mRNA and protein) and liver coagulant/anticoagulant factors (antithrombin [AT], fibrinogen [FIB] and Factor VIII [F VIII]) were evaluated. SPSS 11.5 software was used for statistical analysis. RESULTS: Characteristics of emphysema were obvious in emphysematous groups and ABGs reached SH criteria on hypoxia exposure. Hepatic inflammation parameters and coagulant factors are the lowest in SHCtrl and the highest in SHEStand while AT is the highest in SHCtrl and the lowest in SHEStand. Inflammatory cytokines of liver correlate well with coagulant factors positively and with AT negatively. CONCLUSIONS: When SH is combined with emphysema, hepatic inflammation and coagulability enhance each other synergistically and produce a more significant liver-derivative inflammatory and prothrombotic status

Several clinical interests regarding lung volume reduction surgery for severe emphysema: meta-analysis and systematic review of randomized controlled trials

<p>Abstract</p> <p>Objectives</p> <p>We aim to address several clinical interests regarding lung volume reduction surgery (LVRS) for severe emphysema using meta-analysis and systematic review of randomized controlled trials (RCTs).</p> <p>Methods</p> <p>Eight RCTs published from 1999 to 2010 were identified and synthesized to compare the efficacy and safety of LVRS vs conservative medical therapy. One RCT was obtained regarding comparison of median sternotomy (MS) and video-assisted thoracoscopic surgery (VATS). And three RCTs were available evaluating clinical efficacy of using bovine pericardium for buttressing, autologous fibrin sealant and BioGlue, respectively.</p> <p>Results</p> <p>Odds ratio (95%CI), expressed as the mortality of group A (the group underwent LVRS) versus group B (conservative medical therapies), was 5.16(2.84, 9.35) in 3 months, 3(0.94, 9.57) in 6 months, 1.05(0.82, 1.33) in 12 months, respectively. On the 3^rd, 6^thand 12^thmonth, all lung function indices of group A were improved more significantly as compared with group B. PaO2 and PaCO2 on the 6^thand 12^thmonth showed the same trend. 6MWD of group A on the 6^thmonth and 12^thmonth were improved significantly than of group B, despite no difference on the 3^rdmonth. Quality of life (QOL) of group A was better than of group B in 6 and 12 months. VATS is preferred to MS, due to the earlier recovery and lower cost. And autologous fibrin sealant and BioGlue seems to be the efficacious methods to reduce air leak following LVRS.</p> <p>Conclusions</p> <p>LVRS offers the more benefits regarding survival, lung function, gas exchange, exercise capacity and QOL, despite the higher mortality in initial three postoperative months. LVRS, with the optimization of surgical approach and material for reinforcement of the staple lines, should be recommended to patients suffering from severe heterogeneous emphysema.</p

Subjective sleep quality during average volume assured pressure support (AVAPS) ventilation in patients with hypercapnic COPD. A Physiological Pilot Study.

Non-invasive Positive Pressure Ventilation (NPPV) is an advanced treatment (1) aimed to improve both physiological (2-4) and clinical outcomes (5-7), including sleep (8-10), during the long-term management of patients with Chronic Respiratory Failure (CRF) due to severe hypercapnic Chronic Obstructive Pulmonary Disease (COPD). Several studies evaluating the nocturnal application of mask ventilation in stable COPD patients (11-13) have shown a limited effectiveness of pressure based modes of NPPV in this patient group. However, further studies have shown that compliance to ventilation may influence the long-term efficacy of this treatment as patients who are compliant with NPPV are able to maintain arterial blood gase (ABG) improvements over 6-months when compared with those who discontinued this therapy (14).A new NPPV modality, called Average Volume Assured Pressure Support (AVAPS), combines both the pressure and volume characteristics of ventilation and, accordingly, delivers a range of inspiratory pressures to guarantee a pre-fixed inspiratory tidal volume. This hybrid mode of ventilation has been studied in intubated patients with acute respiratory failure (15) and in patients with chronic hypoventilation linked to obesity (16,17) and other conditions (16). Under these circumstances AVAPS is able to induce high pulmonary volumes and reduce muscle workload, thus providing physiological benefits and comfort similar to those achieved by pressure support (PS) modes. However, positive effects on sleep quality have not yet been confirmed.This pilot evaluated short-term compliance, night-time efficacy and physiological responses to Average Volume Assured Pressure Support (AVAPS) ventilation in patients with stable hypercapnic COPD

Cheyne-stokes respiration in patients with heart failure: prevalence, causes, consequences and treatments

Cheyne-Stokes respiration (CSR) is characterized by a pattern of cyclic oscillations of tidal volume and respiratory rate with periods of hyperpnea alternating with hypopnea or apnea in patients with heart failure. CSR harms the failing heart through intermittent hypoxia brought about by apnea and hypopnea and recurrent sympathetic surges. CSR impairs the quality of life and increases cardiac mortality in patients with heart failure. Thus, CSR should actively be pursued in patients with severe heart failure. When CSR persists despite optimal therapy of heart failure, noninvasive adaptive servoventilation is currently the most promising treatment