Identifying and managing patient–ventilator asynchrony: An international survey.

Objective: To describe the main factors associated with proper recognition and management of patient ventilator asynchronies (PVA). Design: Analytical cross-sectional study. Setting: International study conducted in 20 countries through an online survey. Participants: Physicians, respiratory therapists, nurses and physiotherapists that are currently working at the Intensive Care Unit (ICU). Main variables of interest: Univariate and multivariate logistic regression models were used to establish associations between all variables (profession, training in mechanical ventilation, type of training program, years of experience and ICU characteristics) with the ability of HCPs to correctly identify and manage 6 PVA. Results: A total of 431 HCPs answered a validated survey. The main factors associated with the proper recognition of PVA were: specific training program in mechanical ventilation (MV) (OR 2.27; 95% CI 1.14-4.52; p = 0.019), courses with more than 100 hours completed (OR 2.28; 95% CI 1.29-4.03; p = 0.005) and the number of intensive care unit (ICU) beds (OR 1.037; 95% CI 1.01-1.06; p = 0.005). The main factor that influenced PVA management was recognizing 6 PVA correctly (OR 118.98; 95%CI 35.25-401.58; p < 0.001). Conclusion: Identifying and managing PVA using ventilator waveform analysis is influenced by many factors including specific training programs in MV, number of ICU beds and the recognized number of PVA.pre-print169 K

The Effect Of A Minor Constituent Of Essential Oil From Citrus Aurantium: The Role Of β-myrcene In Preventing Peptic Ulcer Disease

The monoterpene β-myrcene has been widely used in cosmetics, food and beverages, and it is normally found in essential oil from citrus fruit. The aim of this study was to investigate the anti-ulcer effects of β-myrcene on experimental models of ulcers that are induced by ethanol, NSAIDs (non-steroidal anti-inflammatory drugs), stress, Helicobacter pylori, ischaemia-reperfusion injury (I/R) and cysteamine in order to compare with the essential oil of Citrus aurantium and its major compound limonene. The results indicate that the oral administration of β-myrcene at a dose of 7.50 mg/kg has important anti-ulcer activity with significantly decreased gastric and duodenal lesions as well as increased gastric mucus production. The results showed treatment with β-myrcene caused a significant increase in mucosal malondialdehyde level (MDA), an important index of oxidative tissue damage. The β-myrcene was also endowed with marked enhancement of antioxidant enzyme activity from GR system as evidenced by the decreased activity of superoxide dismutase (SOD) and increased levels of glutathione peroxidase (GPx), glutathione reductase (GR), and total glutathione in gastric tissue. Our results also shown that treatment with β-myrcene is not involved with thioredoxin reductase (TrxR) activity. Our results reveal, for the first time, the importance of β-myrcene as an inhibitor of gastric and duodenal ulcers and demonstrate that an increase in the levels of gastric mucosa defence factors is involved in the anti-ulcer activity of β-myrcene. © 2014 Elsevier Ireland Ltd. All rights reserved.21211119Vonkeman, H.E., Klok, R.M., Postma, M.J., Brouwers, J.R.B.J., Van De Laar, M.A.F.J., Direct medical costs of serious gastrointestinal ulcers among users of NSAIDs (2007) Drugs and Aging, 24 (8), pp. 681-690. , http://aging.adisonline.com/pt/re/dra/pdfhandler.00002512-200724080- 00005.pdf;jsessionid=GKGXyhGvRVt6JF22snhwLmCLNWrs24mQ95N7SqwkJl4WrQCKymdB!- 362743511!181195628!8091!-1, DOI 10.2165/00002512-200724080-00005Tang, R.S., Chan, F.K., Therapeutic management of recurrent peptic ulcer disease (2012) Drugs, 72, pp. 1605-1616Ramakrishnan, K., Salinas, R.C., Peptic ulcer disease (2007) Am. Fam. Physician, 76, pp. 1005-1012Saghaie, F., Karimi, I., Jouyban, A., Samini, M., Effects of captopril on the cysteamine-induced duodenal ulcer in the rat (2012) Exp. Toxicol. Pathol., 64, pp. 373-377Halliwell, B., Gutteridge, J.M.C., (2006) Free Radicals in Biology and Medicine, , fourth ed. Oxford University Press UKGünther, E., (1949) The Essential Oils. The Constituents of Essential Oils. New York, pp. 8-8. , E. Günther (Ed.)Moraes, T.M., Kushima, H., Moleiro, F.C., Santos, R.C., Rocha, L.R.M., Marques, M.O., Vilegas, W., Hiruma-Lima, C.A., Effects of limonene and essential oil from Citrus aurantium on gastric mucosa: Role of prostaglandins and gastric mucus secretion (2009) Chem. Biol. Interact., 180, pp. 499-505Leung, A.Y., (1980) Encyclopedia of Commom Natural Ingredients Used in Food, Drugs and Cosmetics, , third ed. Wiley New YorkPolo, C.M., Moraes, T.M., Pellizzon, C.H., Marques, M.O., Rocha, L.R., Hiruma-Lima, C.A., Gastric ulcers in middle-aged rats: The healing effect of essential oil from Citrus aurantium L. (Rutaceae) (2012) Evid. Based Complement Altern. Med., 1, p. 20. , doi: 10.1155/2012/509451Moraes, T.M., Rozza, A.L., Kushima, H., Pellizzon, C.H., Rocha, L.R.M., Hiruma-Lima, C.A., Healing actions of essential oils from Citrus aurantium and d-limonene in the gastric Mucosa: The roles of VEGF, PCNA, and COX-2 in cell proliferation (2013) J. Med. Food, 16, pp. 1162-1167Wagner, H., Multitarget therapy - The future of treatment for more than just functional dyspepsia (2006) Phytomedicine, 13 (SUPPL. 1), pp. 122-129. , DOI 10.1016/j.phymed.2006.03.021, PII S0944711306000778Chen, H.Y., Ye, X.L., Cui, X.L., He, K., Jin, Y.N., Chen, Z., Li, X.G., Cytotoxicity and antihyperglycemic effect of minor constituents from Rhizoma coptis in HepG2 cells (2011) Fitoterapia, 83, pp. 67-73Olfert, E.D., Cross, B.M., McWilliam, A.A., (1993) Guide to the Care and Use of Experimental Animals, , Canadian Council on Animal Care Ottawa, Ontario pp. 1-213Robert, A., Nezamis, J.E., Lancaster, C., Hanchar, A.J., Cytoprotection by prostaglandins in rats. Prevention of gastric necrosis produced by alcohol, HCl, NaOH, hypertonic NaCl, and thermal injury (1979) Gastroenterology, 77 (3), pp. 433-443Rainsford, K.D., Gastric ulcerogenicity of non-steroidal anti-inflammatory drugs in mice with mucosa sensitized by cholinomimetic treatment (1987) Journal of Pharmacy and Pharmacology, 39 (8), pp. 669-672Allen, J.C., Halimton, R.J., (2000) Rancidity and Foods, , Blackie Academic and Professional London, UKAlder, R., (1984) Breakdown in Human Adaptation to Stress, p. 653. , Martinus Ninjihoff BostonUeda, S., Yoshikawa, T., Takahashi, S., Ichikawa, H., Yasuda, M., Oyamada, H., Tanigawa, T., Kondo, M., Role of free radicals and lipid peroxidation in gastric mucosal injury induced by ischemia-reperfusion in rats (1989) Scandinavian Journal of Gastroenterology, Supplement, 24 (162), pp. 55-58Szabo, S., Mechanisms of mucosal injury in the stomach and duodenum: Time-sequence analysis of morphologic, functional, biochemical and histochemical studies (1987) Scandinavian Journal of Gastroenterology, Supplement, 22 (SUPPL. 127), pp. 21-28Rafatullah, S., Tariq, M., Al-Yahya, M.A., Mossa, J.S., Ageel, A.M., Evaluation of turmeric (Curcuma longa) for gastric and duodenal antiulcer activity in rats (1990) Journal of Ethnopharmacology, 29 (1), pp. 25-34Curtis, G.H., Macnaughton, W.K., Gall, D.G., Wallace, J.L., Intraluminal pH modulates gastric prostaglandin synthesis (1995) Can. J. Physiol. Pharmacol., 73, pp. 130-134Matsuda, H., Li, Y., Yoshikawa, M., Gastroprotections of escins Ia, Ib, IIa, and IIb on ethanol-induced gastric mucosal lesions in rats (1999) European Journal of Pharmacology, 373 (1), pp. 63-70. , DOI 10.1016/S0014-2999(99)00249-6, PII S0014299999002496Ohkawa, H., Ohishi, N., Yagi, K., Assay for lipid peroxides in animal tissues by thiobarbituric acid reaction (1979) Analytical Biochemistry, 95 (2), pp. 351-358. , DOI 10.1016/0003-2697(79)90738-3Anderson, M.E., Determination of glutathione and glutathione disulfide in biological samples (1985) Methods in Enzymology, VOL. 113, pp. 548-555Yoshikawa, T., Naito, Y., Kishi, A., Tomii, T., Kaneko, T., Iinuma, S., Ichikawa, H., Kondo, M., Role of active oxygen, lipid peroxidation, and antioxidants in the pathogenesis of gastric mucosal injury induced by indomethacin in rats (1993) Gut, 34 (6), pp. 732-737Carlberg, I., Mannervik, B., Glutathione reductase (1985) Methods in Enzymology, VOL. 113, pp. 484-490Winterbourn, C.C., Hawkins, R.E., Brian, M., Carrell, R.W., The estimation of red cell superoxide dismutase activity (1975) J. Lab. Clin. Med., 85, pp. 337-341Krawisz, J.E., Sharon, P., Stenson, W.F., Quantitative assay for acute intestinal inflammation based on myeloperoxidase activity. Assessment of inflammation in rat and hamster models (1984) Gastroenterology, 87 (6), pp. 1344-1350(2006) Manual Clinical and Laboratory Standards Institute. Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria That Grow Aerobically: Approved standards-6a Ed. Performance Standards for Antimicrobial Susceptibility Testing. Sixteenth Informational Supplement M100-S16 (Tab 2J), , CLSI Clinical and Laboratory Standards Institute, Wayne, PAFranke, A., Teyssen, S., Singer, M.V., Alcohol-related diseases of the esophagus and stomach (2005) Digestive Diseases, 23 (3-4), pp. 204-213. , DOI 10.1159/000090167Siegmund, S., Animal models in gastrointestinal alcohol research - A short appraisal of the different models and their results (2003) Best Pract. Res. Clin. Gastroenterol., 17, pp. 519-542Repetto, M.G., Llesuy, S.F., Antioxidant properties of natural compounds used in popular medicine for gastric ulcers (2002) Brazilian Journal of Medical and Biological Research, 35 (5), pp. 523-534Gandhi, M.N., Siva, R.C., Pari, P., Tejal, G., Role of leukotrienes in NSAID induced gastric ulceration and inflammation in Wistar rats (2012) Asian Pac. J. Trop. Dis., pp. 215-219Wallace, J.L., Pathogenesis of NSAID-induced gastroduodenal mucosal injury (2001) Best Practice and Research in Clinical Gastroenterology, 15 (5), pp. 691-703. , DOI 10.1053/bega.2001.0229Wallace, J.L., Granger, D.N., The cellular and molecular basis of gastric mucosal defense (1996) FASEB Journal, 10 (7), pp. 731-740Brodie, D.A., Hanson, H.M., A study of the factors involved in the production of gastric ulcers by the restraint technique (1960) Gastroenterology, 38, pp. 353-360Ji, C., Fan, D., Li, W., Guo, L., Liang, Z., Xu, R., Zhang, J., Evaluation of the anti-ulcerogenic activity of the antidepressants duloxetine, amitriptyline, fluoxetine and mirtazapine in different models of experimental gastric ulcer in rats (2012) Eur. J. Pharmacol., 691, pp. 46-51Laine, L., Takeuchi, K., Tarnawski, A., Gastric mucosal defense and cytoprotection: Bench to bedside (2008) Gastroenterology, 135 (1), pp. 41-60. , DOI 10.1053/j.gastro.2008.05.030, PII S0016508508007944Abdallah, D.M., El-Abhar, H.S., Abdel-Aziz, D.H., TEMPOL, a membrane permeable radical scavenger, attenuates gastric mucosal damage induced by ischemia-reperfusion: A key role for superoxide anion (2009) Eur. J. Pharmacol., 603, pp. 93-97Wallace, J.L., Miller, M.J.S., Nitric oxide in mucosal defense: A little goes a long way (2000) Gastroenterology, 119 (2), pp. 512-520Khomenko, T., Kolodney, J., Pinto, J.T., McLaren, G.D., Deng, X., Chen, L., Tolstanova, G., Szabo, S., New mechanistic explanation for the localization of ulcers in the rat duodenum: Role of iron and selective uptake of cysteamine (2012) Arch. Biochem. Biophys., 525, pp. 60-70Ji, C.X., Fan, D.S., Li, W., Guo, L., Xu, Z.L., Liang, R.M., Zhang, J.J., Evaluation of the anti-ulcerogenic activity of the antidepressants duloxetine, amitriptyline, fluoxetine and mirtazapine in different models of experimental gastric ulcer in rats (2012) Eur. J. Pharmacol., 691, pp. 46-51Allen, A., Flemstrom, G., Gastroduodenal mucus bicarbonate barrier: Protection against acid and pepsin (2005) Cell Physiol.: Am. J. Physiol., 288, pp. 1-19Brzozowski, T., Konturek, P.C., Mierzwa, M., Drozdowicz, D., Bielanski, W., Kwiecien, S., Konturek, S.J., Hahn, E.G., Effect of probiotics and triple eradication therapy on the cyclooxygenase (COX)-2 expression, apoptosis, and functional gastric mucosal impairment in Helicobacter pylori-infected Mongolian gerbils (2006) Helicobacter, 11, pp. 10-20Mei, S., Gu, H., Yang, X., Guo, H., Liu, Z., Cao, W., Prolonged exposure to insulin induces mitochondrion-derived oxidative stress through increasing mitochondrial cholesterol content in hepatocytes (2012) Endocrinology, 153, pp. 2120-2129Mustacich, D., Powis, G., Thioredoxin reductase (2000) Biochemical Journal, 346 (1), pp. 1-8. , DOI 10.1042/0264-6021:3460001Ciftci, O., Ozdemir, I., Tanyildizi, S., Yildiz, S., Ogozturk, H., Antioxidantive effects of curcumin, β-myrcene, 1,8 cineole against 2,3,7,8-tetrachlorodibenzo-p-dioxin-induced oxidative stress in rats liver (2011) Toxicol. Ind. Health, 27, pp. 447-453Nervi, G., Liatopoulou, S., Cavallaro, L., Does Helicobacter pylori infection eradication modify peptic ulcer prevalence? A 10 years endoscopical survey (2006) World J. Gastroenterol., 12, pp. 2398-240