Noninvasive Mechanical Ventilation in Helicopter Emergency Medical Services Saves Time and Oxygen and Improves Patient and Mission Safety: A Pilot Study.

Noninvasive mechanical ventilation (NIMV) is used increasingly in patients with severe respiratory distress and has clear benefits over standard medical therapy (SMT) in terms of patient safety. NIMV is particularly useful in cardiogenic acute pulmonary edema and in exacerbations of chronic obstructive pulmonary disease, both of which are frequent reasons for an emergency medical services dispatch. Early use of NIMV avoids complications in these patients in many cases. To date, the use of noninvasive positive-pressure ventilation in the air medical environment has been minimally researched. We evaluated NIMV versus SMT in the helicopter emergency medical services environment in patients with cardiogenic acute pulmonary edema and exacerbated chronic obstructive pulmonary disease. The parameters assessed were stabilization time, tolerance, safety, clinical response, and oxygen consumption. Bilevel noninvasive positive-pressure ventilation was the ventilatory mode used for all patients. The technique of NIMV in medical air transport is useful, easy to operate, and safe. It offers increased patient safety, reducing the need for invasive mechanical ventilation and its complications; better intervention times (35.8 minutes [NIMV] vs. 57.65 minutes [SMT], P < .05); improvement in aircraft operability; and a reduction in oxygen consumption (6.2 L/min vs. 9.8 L/min, P < .05), contributing to mission operability and safety.

Protective effect of diphenyl diselenide against peroxynitrite-mediated endothelial cell death: a comparison with ebselen.

Excess production of superoxide (O2(-)) and nitric oxide (NO) in blood vessel walls may occur early in atherogenesis leading to the formation of peroxynitrite, a strong oxidant and nitrating agent. This study was designed to determine the effect of diphenyl diselenide (PhSe)2, a synthetic organoselenium compound, in comparison with ebselen, on peroxynitrite-mediated endothelial damage. Experimental results showed that pre-incubation of BAEC (24 h) with low concentrations of (PhSe)2 (0.5 and 1 µM) protected the cells from peroxynitrite-dependent apoptosis and protein tyrosine nitration. The intracellular levels of GSH were almost completely depleted by peroxynitrite and, although the compounds did not restore its normal levels, (PhSe)2 per se significantly increased GSH in a concentration-dependent manner. Moreover, (PhSe)2, which was about two times more active as a GPx mimic than ebselen, induced a significantly higher increase in both cellular GPx expression and activity. Taking into account the kinetics of the reaction between peroxynitrite and (PhSe)2, our data indicate that (PhSe)2 protects BAEC against peroxynitrite-mediated cell damage not by a direct reaction, but rather by increasing cellular GPx expression as a consequence of enhanced nuclear translocation of Nrf-2, which together with the increase in intracellular GSH, may work catalytically to reduce peroxynitrite to nitrite.

Superoxide-mediated inactivation of nitric oxide and peroxynitrite formation by tobacco smoke in vascular endothelium: studies in cultured cells and smokers.

Tobacco smoke is known to cause nitric oxide ((*)NO) inactivation and endothelial dysfunction. In this work we evaluated the interplay between (.)NO and superoxide (O(2)(*-)) radicals and the consequent impact on (*)NO bioavailability and nitroxidative stress in bovine aortic endothelial cells exposed to cigarette smoke extract (CSE) and in smokers. Bovine aortic endothelial cells in the presence of CSE triggered O(2)(*-) production as indicated by spin-trapping electron paramagnetic resonance experiments. O(2)(*-) was produced both extracellulary (3.4 vs. 1.0 nmol.h(-1)*mg(-1); CSE vs. control; cytochrome c(3+) reduction assay) and intracellularly (40% inhibition of cytosolic aconitase). CSE also led to the production of peroxynitrite as evaluated by dihydrorhodamine oxidation and protein tyrosine nitration on cells. O(2)(*-) and peroxynitrite formation were decreased by ascorbate and alpha-tocopherol. Additionally, CSE led to the oxidation of endothelial nitric oxide synthase increasing the monomeric inactive form of endothelial nitric oxide synthase. Smokers and age-matched healthy volunteers were supplemented orally with 500 mg ascorbate plus 400 IU all-rac-alpha-tocopherol every 12 h for 165 days. Smokers had endothelial dysfunction compared with control subjects (95% confidence interval: 2.5, 8.3 vs. 10.6, 14.2; P < 0.05) as assessed by flow-mediated dilation of the brachial artery, and plasma levels of protein 3-nitrotyrosine were 1.4-fold higher. The loss of flow-mediated dilation in smokers reverted after a long-term antioxidant supplementation (95% confidence interval: 13.9, 19.9; P < 0.05), reaching values comparable with the control population. Our data indicate that elements on tobacco smoke, most likely through redox cycling, divert (*)NO toward peroxynitrite by inducing O(2)(*-) production in vascular endothelial cells both in vitro and in vivo.