Real-time effects of lateral positioning on regional ventilation and perfusion in an experimental model of acute respiratory distress syndrome

Low-volume lung injury encompasses local concentration of stresses in the vicinity of collapsed regions in heterogeneously ventilated lungs. We aimed to study the effects on ventilation and perfusion distributions of a sequential lateral positioning (30°) strategy using electrical impedance tomography imaging in a porcine experimental model of early acute respiratory distress syndrome (ARDS). We hypothesized that such strategy, including a real-time individualization of positive end-expiratory pressure (PEEP) whenever in lateral positioning, would provide attenuation of collapse in the dependent lung regions. A two-hit injury acute respiratory distress syndrome experimental model was established by lung lavages followed by injurious mechanical ventilation. Then, all animals were studied in five body positions in a sequential order, 15 min each: Supine 1; Lateral Left; Supine 2; Lateral Right; Supine 3. The following functional images were analyzed by electrical impedance tomography: ventilation distributions and regional lung volumes, and perfusion distributions. The induction of the acute respiratory distress syndrome model resulted in a marked fall in oxygenation along with low regional ventilation and compliance of the dorsal half of the lung (gravitational-dependent in supine position). Both the regional ventilation and compliance of the dorsal half of the lung greatly increased along of the sequential lateral positioning strategy, and maximally at its end. In addition, a corresponding improvement of oxygenation occurred. In conclusion, our sequential lateral positioning strategy, with sufficient positive end-expiratory pressure to prevent collapse of the dependent lung units during lateral positioning, provided a relevant diminution of collapse in the dorsal lung in a porcine experimental model of early acute respiratory distress syndrome

The Legacy of Invisible Man: Ralph Ellison's Influence on Fight Club.

This thesis explores the themes of Ralph Ellison's Invisible Man (1952) in comparison with Chuck Palahniuk's Fight Club (1996) through the views of the intradiegetic unnamed first- person narrators of both novels. Although they are of a different race, socio-economical standing, and era, they have a similar mindset which, on the one hand, criticizes the US capitalism and the work-oriented, materialistic American Dream, and on the other one, reflects Emersonian combination of nihilism and anarchy. Fight Club follows the ideas voiced in Invisible Man and adjusts them to the contemporary globalized society. The thesis is divided into three main chapters, each focusing on one major topic pursued by the narrators. The first chapter deals with the idea of dispossession, both as a material and spiritual separation from the world, which is the core of the narrators' process of self-liberation from the norms of society. Only when they lose all possessions, social bonds, and almost erase their identities, they can find their true (Emersonian) selves and freedom. The self is more analysed in the following chapter focused on the theme of social invisibility. The narrators are taken at face value by society, i.e. people concentrate only on their outward social markers and disregard their individual selves...

Odkaz Neviditelného: vliv Ralpha Ellisona na Klub rváčů.

Tato bakalářská práce zkoumá motivy románu Ralpha Ellisona Neviditelný (1952) v porovnání s románem Chucka Palahniuka Klub rváčů (1996) prostřednictvím názorů bezejmenných intradiegetických vypravěčů obou knih v první osobě. I když je každý jiné rasy, jsou z jiné doby a mají rozdílné socioekonomické postavení, zastávají podobné názory, které na jedné straně kritizují americký kapitalismus a pracovně orientovaný, materialistický americký sen a na druhé straně odráží Emersonovo propojení nihilismu a anarchie. Klub rváčů navazuje na myšlenky vyjádřené v Neviditelném a přizpůsobuje je současné globalizované společnosti. Bakalářská práce je rozdělena do tří hlavních kapitol a každá se zabývá jedním z hlavních témat, kterým se vypravěči věnují. První kapitola rozebírá myšlenku "vyvlastnění", jako materiální i duševní separaci od světa, což je klíčový proces vypravěčů umožňující jim osvobození sebe sama od norem společnosti. Teprve když se zbaví veškerého vlastnictví, společenských vazeb a téměř i identit, naleznou své pravé (Emersonské) já a svobodu. Pojetím "já" se více zabývá druhá kapitola, která sleduje téma společenské neviditelnosti. Vypravěči jsou společností souzeni dle svého zevnějšku, tj. lidé se zaměřují pouze na jejich vnější společenské ukazatele a ignorují jejich individuální já. Postrádají...This thesis explores the themes of Ralph Ellison's Invisible Man (1952) in comparison with Chuck Palahniuk's Fight Club (1996) through the views of the intradiegetic unnamed first- person narrators of both novels. Although they are of a different race, socio-economical standing, and era, they have a similar mindset which, on the one hand, criticizes the US capitalism and the work-oriented, materialistic American Dream, and on the other one, reflects Emersonian combination of nihilism and anarchy. Fight Club follows the ideas voiced in Invisible Man and adjusts them to the contemporary globalized society. The thesis is divided into three main chapters, each focusing on one major topic pursued by the narrators. The first chapter deals with the idea of dispossession, both as a material and spiritual separation from the world, which is the core of the narrators' process of self-liberation from the norms of society. Only when they lose all possessions, social bonds, and almost erase their identities, they can find their true (Emersonian) selves and freedom. The self is more analysed in the following chapter focused on the theme of social invisibility. The narrators are taken at face value by society, i.e. people concentrate only on their outward social markers and disregard their individual selves....Department of Anglophone Literatures and CulturesÚstav anglofonních literatur a kulturFaculty of ArtsFilozofická fakult

Biomechanical model of interaction between ventilation and hemodynamics induced by mechanical ventilation

MUDr. Michal Otáhal Biomechanický model interakce oběhu a ventilace za podmínek UPV Abstrakt: Konvenční umělá plicní ventilace zajišťuje výměnu plynů při stavech respiračního selhání využitím přetlaku v dýchacím systému. Vzhledem k zásadní změně tlakových poměrů v hrudníku při konvenční umělé plicní ventilaci v jednotlivých fázích dechového cyklu dochází k významnému ovlivnění oběhu. Součástí ventilační strategie při kritickém respiračním selhání, tzv. ARDS (Acute Respiratory Distress Syndrom) jsou techniky recruitment manévrů (RM), které se používají k opětovnému provzdušnění zkolabovaných částí plicního parenchymu. Během těchto RM se používá významně vyšší přetlak v dýchacích cestách, než který se běžně užívá během tzv. protektivní přetlakové ventilace a ten může limitovat průtok plicním kapilárním řečištěm a významným způsobem ovlivnit hemodynamiku pacienta. Cílem práce bylo vyvinout optimalizovaný animální model ARDS, porovnat ovlivnění hemodynamiky při aplikaci jednotlivých recruitment manévrů a vytvořit simulační biomechanický model interakce ventilace a krevního oběhu a následně jej ověřit (nafitování) daty získanými při provedení jednotlivých typů RM při experimentálním animálním modelu ARDS. Výsledky z experimentálního animálního modelu i simulací na biomechanickém modelu ukazují, že hemodynamicky...MUDr. Michal Otáhal Biomechanický model interakce oběhu a ventilace za podmínek UPV Abstract: Conventional mechanical ventilation provides gas exchange in conditions of respiratory failure by application positive airway pressure in the respiratory system. Due to the significant change in pressure conditions inside the thorax during conventional artificial ventilation the circulation can be significantly affected. Recruitment maneuver (RM) techniques can be a part of ventilation strategy in patients with the Acute Respiratory Distress Syndrome (ARDS), that are used to re-aerate collapsed parts of the lung parenchyma. During these RMs a significantly higher airway pressure is used than in protective ventilation strategy, which can limit the flow through the lung capillary network and can significantly affect the systemic hemodynamics of the patient. The aim of this work was to develop an optimized animation model of ARDS, then to compare the influence that has the application of different types of recruitment maneuvers on hemodynamics and to create a biomechanical simulation model of interaction and blood circulation and its verification with data obtained during the implementation of different types of RM in the experimental animal ARDS model. Results from the experimental animal model and simulations...Anatomie a biomechanikaFaculty of Physical Education and SportFakulta tělesné výchovy a sport

Biomechanical model of interaction between ventilation and hemodynamics induced by mechanical ventilation

MUDr. Michal Otáhal Biomechanický model interakce oběhu a ventilace za podmínek UPV Abstract: Conventional mechanical ventilation provides gas exchange in conditions of respiratory failure by application positive airway pressure in the respiratory system. Due to the significant change in pressure conditions inside the thorax during conventional artificial ventilation the circulation can be significantly affected. Recruitment maneuver (RM) techniques can be a part of ventilation strategy in patients with the Acute Respiratory Distress Syndrome (ARDS), that are used to re-aerate collapsed parts of the lung parenchyma. During these RMs a significantly higher airway pressure is used than in protective ventilation strategy, which can limit the flow through the lung capillary network and can significantly affect the systemic hemodynamics of the patient. The aim of this work was to develop an optimized animation model of ARDS, then to compare the influence that has the application of different types of recruitment maneuvers on hemodynamics and to create a biomechanical simulation model of interaction and blood circulation and its verification with data obtained during the implementation of different types of RM in the experimental animal ARDS model. Results from the experimental animal model and simulations..

Embedded system inputs and outputs disturbing sources and the linear optocoupler behavior mathematical description

The paper reveals the possible sources of interference that can disrupt the function of inputs and outputs of embedded systems or interfere with correct interpretation of the input signals or the possibility of complete destruction of input and output circuits by these interferences. The issue of capping limits for analog signals with linear optocoupler and also use of designed limit voltage limiters are solved as well. In the last part the measured static and dynamic limiters characteristics are measured and linear optocoupler is described mathematically.The research work was performed to financial support of grant reg. No IGA/32/FAI/11/D and by the European Regional Development Fund under the project CEBIATech No.CZ.1.05/2.1.00/03.0089

Hypothermia versus Normothermia after Out-of-Hospital Cardiac Arrest

Background- Targeted temperature management is recommended for patients after cardiac arrest, but the supporting evidence is of low certainty. Methods- In an open-label trial with blinded assessment of outcomes, we randomly assigned 1900 adults with coma who had had an out-of-hospital cardiac arrest of presumed cardiac or unknown cause to undergo targeted hypothermia at 33°C, followed by controlled rewarming, or targeted normothermia with early treatment of fever (body temperature, ≥37.8°C). The primary outcome was death from any cause at 6 months. Secondary outcomes included functional outcome at 6 months as assessed with the modified Rankin scale. Prespecified subgroups were defined according to sex, age, initial cardiac rhythm, time to return of spontaneous circulation, and presence or absence of shock on admission. Prespecified adverse events were pneumonia, sepsis, bleeding, arrhythmia resulting in hemodynamic compromise, and skin complications related to the temperature management device. Results- A total of 1850 patients were evaluated for the primary outcome. At 6 months, 465 of 925 patients (50%) in the hypothermia group had died, as compared with 446 of 925 (48%) in the normothermia group (relative risk with hypothermia, 1.04; 95% confidence interval [CI], 0.94 to 1.14; P=0.37). Of the 1747 patients in whom the functional outcome was assessed, 488 of 881 (55%) in the hypothermia group had moderately severe disability or worse (modified Rankin scale score ≥4), as compared with 479 of 866 (55%) in the normothermia group (relative risk with hypothermia, 1.00; 95% CI, 0.92 to 1.09). Outcomes were consistent in the prespecified subgroups. Arrhythmia resulting in hemodynamic compromise was more common in the hypothermia group than in the normothermia group (24% vs. 17%, P<0.001). The incidence of other adverse events did not differ significantly between the two groups. Conclusions- In patients with coma after out-of-hospital cardiac arrest, targeted hypothermia did not lead to a lower incidence of death by 6 months than targeted normothermia

Oxygen targets and 6-month outcome after out of hospital cardiac arrest: a pre-planned sub-analysis of the targeted hypothermia versus targeted normothermia after Out-of-Hospital Cardiac Arrest (TTM2) trial

International audienceAbstract Background Optimal oxygen targets in patients resuscitated after cardiac arrest are uncertain. The primary aim of this study was to describe the values of partial pressure of oxygen values (PaO 2 ) and the episodes of hypoxemia and hyperoxemia occurring within the first 72 h of mechanical ventilation in out of hospital cardiac arrest (OHCA) patients. The secondary aim was to evaluate the association of PaO 2 with patients’ outcome. Methods Preplanned secondary analysis of the targeted hypothermia versus targeted normothermia after OHCA (TTM2) trial. Arterial blood gases values were collected from randomization every 4 h for the first 32 h, and then, every 8 h until day 3. Hypoxemia was defined as PaO 2  300 mmHg. Mortality and poor neurological outcome (defined according to modified Rankin scale) were collected at 6 months. Results 1418 patients were included in the analysis. The mean age was 64 ± 14 years, and 292 patients (20.6%) were female. 24.9% of patients had at least one episode of hypoxemia, and 7.6% of patients had at least one episode of severe hyperoxemia. Both hypoxemia and hyperoxemia were independently associated with 6-month mortality, but not with poor neurological outcome. The best cutoff point associated with 6-month mortality for hypoxemia was 69 mmHg (Risk Ratio, RR = 1.009, 95% CI 0.93–1.09), and for hyperoxemia was 195 mmHg (RR = 1.006, 95% CI 0.95–1.06). The time exposure, i.e., the area under the curve (PaO 2 -AUC), for hyperoxemia was significantly associated with mortality ( p = 0.003). Conclusions In OHCA patients, both hypoxemia and hyperoxemia are associated with 6-months mortality, with an effect mediated by the timing exposure to high values of oxygen. Precise titration of oxygen levels should be considered in this group of patients. Trial registration : clinicaltrials.gov NCT02908308 , Registered September 20, 2016

Ventilatory settings in the initial 72 h and their association with outcome in out-of-hospital cardiac arrest patients: a preplanned secondary analysis of the targeted hypothermia versus targeted normothermia after out-of-hospital cardiac arrest (TTM2) trial

International audienc