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Topic:Cardiovascular Health

Cardiovascular health in horses encompasses the study of the heart and blood vessels, focusing on their structure, function, and associated disorders. The equine cardiovascular system is responsible for the circulation of blood, delivering oxygen and nutrients to tissues, and removing waste products. Research in this area includes the examination of cardiac anatomy, the electrophysiology of the heart, and common cardiovascular conditions such as arrhythmias, valvular diseases, and heart murmurs. Diagnostic tools such as echocardiography, electrocardiography, and cardiac biomarkers are utilized to assess cardiovascular function and detect abnormalities. This page compiles peer-reviewed research studies and scholarly articles that explore the physiological mechanisms, diagnostic approaches, and therapeutic strategies related to cardiovascular health in horses.
Effects of dexmedetomidine and xylazine on cardiovascular function during total intravenous anaesthesia with midazolam and ketamine and recovery quality and duration in horses.
Veterinary anaesthesia and analgesia    October 15, 2013   Volume 41, Issue 1 25-35 doi: 10.1111/vaa.12095
Hopster K, Müller C, Hopster-Iversen C, Stahl J, Rohn K, Kästner S.To compare cardiovascular effects and recovery quality and duration of total intravenous anaesthesia (TIVA) with xylazine-ketamine-midazolam or dexmedetomidine-ketamine-midazolam. Methods: Prospective, randomized experimental cross-over trial. Methods: Eight adult warmblood horses. Methods: After sedation with acepromazine and either xylazine [0.5 mg kg(-1) , intravenously (IV)] or dexmedetomidine (3.5 μg kg(-1) IV) anaesthesia was induced with ketamine and midazolam and maintained with a constant rate infusion (CRI) of xylazine (1 mg kg(-1)  hour(-1) ) [XKM] or dexmedetomidine (7 μg...
Cardiorespiratory and antinociceptive effects of two different doses of lidocaine administered to horses during a constant intravenous infusion of xylazine and ketamine.
BMC veterinary research    October 9, 2013   Volume 9 199 doi: 10.1186/1746-6148-9-199
Nóbrega Neto PI, Luna SP, Queiroz-Williams P, Mama KR, Steffey EP, Carregaro AB.This study investigated the antinociceptive effects of a constant rate infusion (CRI) of lidocaine during xylazine and ketamine anesthesia in horses and aimed to correlate these effects with cardiorespiratory variables, bispectral index (BIS) and plasma lidocaine concentrations. Six adult crossbred mares weighing 320-400 kg were anesthetized on three different occasions. Sedation was performed with xylazine (0.75 mg/kg IV) and anesthetic induction with guaifenesin (75 mg/kg IV) and ketamine (2 mg/kg IV). Anesthesia was maintained with 37.5 μg/kg/min of xylazine and 87.5 μg/kg/min of ketamine...
Prevalence and risk factors for cardiac diseases in a hospital-based population of 3,434 horses (1994-2011).
Journal of veterinary internal medicine    September 20, 2013   Volume 27, Issue 6 1563-1570 doi: 10.1111/jvim.12197
Leroux AA, Detilleux J, Sandersen CF, Borde L, Houben RM, Al Haidar A, Art T, Amory H.Risk factors for cardiac diseases in horses have not been explored in a large population of animals. Objective: To describe risk factors for various cardiac diseases in a hospital-based population of horses. Methods: Files of 3,434 horses admitted at the Internal Medicine Department of the Liege Equine Teaching Hospital between 1994 and 2011 were reviewed and of those, 284 were categorized as having moderate-to-severe cardiac disease. Methods: Observational study. After calculating prevalence for each cardiac disease, we tested whether breed (chi-square test) or sex, age, body weight (BW), and...
Effect of postoperative xylazine administration on cardiopulmonary function and recovery quality after isoflurane anesthesia in horses.
Veterinary surgery : VS    September 3, 2013   Volume 42, Issue 7 877-884 doi: 10.1111/j.1532-950X.2013.12050.x
Ida KK, Fantoni DT, Ibiapina BT, Souto MT, Zoppa AL, Silva LC, Ambrósio AM.To evaluate equine cardiopulmonary function and recovery quality after administration of 0.25 or 0.50 mg/kg xylazine intravenously (IV) during recovery. Methods: Randomized, blinded, prospective, clinical study. Methods: Horses (n = 20). Methods: During recovery after 3 hours of isoflurane anesthesia for arthroscopic surgery, horses were administered either 0.25 mg/kg (G25, n = 10) or 0.50 mg/kg (G50, n = 10) xylazine intravenously. Vital signs and arterial blood samples were obtained during recovery before sedation (baseline), 5, 10, 20, 30, and 45 minutes after xylazine and 30 minutes after ...
Noninvasive determination of atrial fibrillation cycle length by atrial colour tissue Doppler imaging in horses.
Equine veterinary journal    August 30, 2013   Volume 46, Issue 2 174-179 doi: 10.1111/evj.12108
Decloedt A, de Clercq D, van der Vekens N, Verheyen T, van Loon G.Atrial fibrillation cycle length (AFCL) is an indicator of atrial electrical remodelling during atrial fibrillation (AF). Objective: To compare AFCL measured invasively from an intra-atrial electrogram (AFCLEGM ) with AFCL measured noninvasively by atrial colour tissue Doppler imaging (AFCLTDI ). Methods: Prospective descriptive clinical study. Methods: Measurements were performed in 31 episodes of AF or flutter in 29 horses (588 ± 61 kg bwt, 9 ± 3 years old) admitted for transvenous electrical cardioversion. The AFCLEGM was measured from an intracardiac electrogram using a bipolar sensi...
Voltage changes in the lithium dilution cardiac output sensor after exposure to blood from horses given xylazine.
British journal of anaesthesia    August 30, 2013   Volume 112, Issue 2 367-369 doi: 10.1093/bja/aet298
Ambrisko TD, Moens Y.In a previous in vitro study using saline medium, the authors showed that certain drugs changed the voltages of lithium dilution cardiac output (LiDCO) sensors and also influenced their accuracy in measuring lithium concentrations. These two parameters correlated and so we examined whether such drug-sensor interaction exists when LiDCO sensor was exposed to xylazine in blood. Methods: Five healthy adult warm-blood horses were injected with 0.5 mg kg(-1) xylazine i.v. Physiological saline solution and venous blood were consecutively sampled through the same LiDCO sensor at 60, 45, 30, 15, and 0...
Pharmacodynamic evaluation of 4 angiotensin-converting enzyme inhibitors in healthy adult horses.
Journal of veterinary internal medicine    August 19, 2013   Volume 27, Issue 5 1185-1192 doi: 10.1111/jvim.12153
Afonso T, Giguère S, Rapoport G, Berghaus LJ, Barton MH, Coleman AE.Angiotensin-converting enzyme (ACE) inhibitors are used in horses with cardiovascular disorders despite the paucity of available data regarding their efficacy. Objective: The degree of serum ACE inhibition varies considerably between drugs. Methods: Eight healthy adult horses. Methods: Randomized prospective study. Horses were fasted overnight prior to receiving one of 4 ACE inhibitors intragastrically, administered at one of 2 dosages, using a randomized Latin square design (benazepril: 0.5 and 0.25 mg/kg; ramipril: 0.3 and 0.1 mg/kg; quinapril: 0.25 and 0.125 mg/kg; perindopril: 0.1 and 0.05...
Physiological responses of young thoroughbred horses to intermittent high-intensity treadmill training.
Acta veterinaria Scandinavica    August 17, 2013   Volume 55, Issue 1 59 doi: 10.1186/1751-0147-55-59
Ohmura H, Matsui A, Hada T, Jones JH.Training of young Thoroughbred horses must balance development of cardiopulmonary function and aerobic capacity with loading of the musculoskeletal system that can potentially cause structural damage and/or lameness. High-speed equine treadmills are sometimes used to supplement exercise on a track in the training of young Thoroughbreds because the horse can run at high speeds but without the added weight of a rider. We tested the hypothesis that intermittent high-intensity exercise on a treadmill of young Thoroughbred horses entering training can enhance development of aerobic capacity (VO2max...
Unwise human intervention in the physiology by neglecting venous return may possibly contribute to lung hemorrhage and vein remodeling in racing horses.
Journal of applied physiology (Bethesda, Md. : 1985)    August 3, 2013   Volume 115, Issue 3 412 doi: 10.1152/japplphysiol.00470.2013
Pancheva AV, Panchev VS, Pancheva MV.No abstract available
Impact of health disorders and culling reasons on functional and biological longevity in Warmblood breeding stallions.
Veterinary journal (London, England : 1997)    July 30, 2013   Volume 197, Issue 2 273-279 doi: 10.1016/j.tvjl.2013.02.026
König von Borstel U, Bernhard V.The objective of this study was to compare the impact of health disorders and reasons for culling on the functional and biological longevity of warmblood breeding stallions using semi-parametric survival analysis accounting for competing risks. Complete breeding records were collected from 455 warmblood stallions serving between 1975 and 2010 at Marbach State Stud in Germany. The median length of life (18.0 years) was twice as long as the median length of service (9.0 years). However, both figures increased significantly over the time period examined (e.g., functional longevity increased from ...
Cardiovascular effects of dobutamine and phenylephrine infusion in sevoflurane-anesthetized Thoroughbred horses.
The Journal of veterinary medical science    July 5, 2013   Volume 75, Issue 11 1443-1448 doi: 10.1292/jvms.13-0104
Ohta M, Kurimoto S, Ishikawa Y, Tokushige H, Mae N, Nagata S, Mamada M.To determine dose-dependent cardiovascular effects of dobutamine and phenylephrine during anesthesia in horses, increasing doses of dobutamine and phenylephrine were infused to 6 healthy Thoroughbred horses. Anesthesia was induced with xylazine, guaifenesin and thiopental and maintained with sevoflurane at 2.8% of end-tidal concentration in all horses. The horses were positioned in right lateral recumbency and infused 3 increasing doses of dobutamine (0.5, 1.0 and 2.0 µg/kg/min) for 15 min each dose. Following to 30 min of reversal period, 3 increasing doses of phenylephrine (0.25, 0.5 and 1....
Acetazolamide attenuates transvascular fluid flux in equine lungs during intense exercise.
The Journal of physiology    July 1, 2013   Volume 591, Issue 18 4499-4513 doi: 10.1113/jphysiol.2013.257956
Vengust M, Staempfli H, Viel L, Swenson ER, Heigenhauser G.  During intense exercise in horses the transvascular fluid flux in the pulmonary circulation (Jv-a) represents 4% of cardiac output (Q). This fluid flux has been attributed to an increase in pulmonary transmural hydrostatic forces, increases in perfused microvascular surface area, and reversible alterations in capillary permeability under conditions of high flow and pressure. Erythrocyte fluid efflux, however, accounts for a significant fraction of Jv-a. In the lung the Jacobs-Stewart cycle occurs with diffusion of CO2 into alveolar space with possible accompanying chloride (Cl-) and water ...
Long-term follow-up of atrial function after cardioversion of atrial fibrillation in horses.
Veterinary journal (London, England : 1997)    June 30, 2013   Volume 197, Issue 3 583-588 doi: 10.1016/j.tvjl.2013.05.032
Decloedt A, Verheyen T, Van Der Vekens N, Sys S, De Clercq D, van Loon G.Atrial fibrillation (AF) causes atrial electrical and contractile remodelling in horses. The aim of this study was to quantify left atrial (LA) contractile function and its time course of recovery after cardioversion of naturally-occurring AF in horses. The study population included 42 AF horses which were successfully treated using transvenous electrical cardioversion TVEC (n=39) or quinidine sulfate (n=3), with trivial or mild mitral regurgitation present in 25 horses. Thirty-seven healthy horses were used as controls. AF duration was estimated based on the history and previous examinations....
Hypertensive cardiomyopathy in horses: 5 cases (1995-2011).
Journal of the American Veterinary Medical Association    June 22, 2013   Volume 243, Issue 1 126-130 doi: 10.2460/javma.243.1.126
Navas de Solis C, Slack J, Boston RC, Reef VB.To describe the prognosis and clinical, echocardiographic, and pathological features of hypertensive cardiomyopathy in horses. Methods: Retrospective case series. Methods: 5 horses with cardiac hypertrophy and systemic hypertension. Methods: Demographics, history, physical and cardiological examination findings, diagnosis, clinical progression, prognosis, and pathological findings were obtained from medical records. Results: The primary diagnosis was chronic laminitis in 3 horses and chronic renal failure in 2. Persistent tachycardia, hypertension, chronic laminitis, or a combination of these ...
Effect of retrobulbar nerve block on heart rate variability during enucleation in horses under general anesthesia.
Veterinary ophthalmology    June 6, 2013   Volume 17, Issue 3 170-174 doi: 10.1111/vop.12061
Oel C, Gerhards H, Gehlen H.Analysis of any effect of retrobulbar block during ocular surgery on heart rate variability and oculocardiac reflex. Methods: Prospective study. Methods: Horses (n = 16) undergoing eye enucleation due to chronic ophthalmologic diseases. Methods: Eye enucleation was performed under general anesthesia. The horses were randomly assigned to the first (inhalation anesthesia only, n = 10) or second group (inhalation and local retrobulbar anesthesia, n = 6). The retrobulbar block was performed using 12 mL of mepivacaine hydrochloride 2%. ECG data were taken by a Telemetric ECG before, during, and aft...
The ECG in cardiovascular-relevant animal models of electrophysiology.
Herzschrittmachertherapie & Elektrophysiologie    June 6, 2013   Volume 24, Issue 2 84-91 doi: 10.1007/s00399-013-0260-z
Kaese S, Frommeyer G, Verheule S, van Loon G, Gehrmann J, Breithardt G, Eckardt L.The most frequently used animal species in experimental cardiac electrophysiology are mice, rabbits, and dogs. Murine and human electrocardiograms (ECGs) show salient differences, including the occurrence of a pronounced J-wave and a less distinctive T-wave in the murine ECG. Mouse models can resemble human cardiac arrhythmias, although mice differ from human in cardiac electrophysiology. Thus, arrhythmia mechanisms in mice may differ from those in humans and should be transferred to the human situation with caution. Further relevant cardiovascular animal models are rabbits, dogs, and minipigs...
Atrial natriuretic peptide and cardiac troponin I concentrations in healthy Warmblood horses and in Warmblood horses with mitral regurgitation at rest and after exercise.
Journal of veterinary cardiology : the official journal of the European Society of Veterinary Cardiology    May 16, 2013   Volume 15, Issue 2 105-121 doi: 10.1016/j.jvc.2012.12.003
Trachsel DS, Schwarzwald CC, Bitschnau C, Grenacher B, Weishaupt MA.Atrial natriuretic peptide (ANP) and cardiac troponin I (cTnI) serve as biomarkers for increased cardiac pressure/volume loading and for myocardial stress or damage. The objective was to describe the time course of plasma ANP concentrations (CpANP) and plasma cTnI concentrations (CpcTnI) in horses with mitral regurgitation (MR) compared to healthy horses at rest and after exercise, and to describe the relationship of CpANP with cardiac dimensions and intracardiac pressures. Methods: 15 healthy Warmblood horses and 7 Warmblood horses with MR. Methods: Cardiac dimensions at rest were measured us...
Endocardial fibroelastosis in a quarterhorse mare.
Journal of comparative pathology    May 4, 2013   Volume 149, Issue 2-3 318-321 doi: 10.1016/j.jcpa.2013.03.007
Cushing TL.A 4-year-old crossbred Quarterhorse mare was submitted to the Clemson Veterinary Diagnostic Center for necropsy examination with a chronic history of inappetence, weight loss and lethargy. Prior to death the horse had developed mild diarrhoea and began showing evidence of colic. Necropsy examination revealed a markedly enlarged heart due predominantly to marked dilation of the right atrium, tortuous congested mesenteric blood vessels, marked ascites, pleural effusion and pulmonary oedema. Further examination of the heart showed the endocardium of the left side of the heart, including the mitra...
Transit of micro-bubbles through the pulmonary circulation of Thoroughbred horses during exercise.
Research in veterinary science    May 2, 2013   Volume 95, Issue 2 644-647 doi: 10.1016/j.rvsc.2013.04.002
La Gerche A, Daffy JR, Mooney DJ, Forbes G, Davie AJ.It has been observed that microbubbles may pass through the pulmonary circulation of dogs and humans during exercise. In humans, this phenomenon has been associated with lower pulmonary artery pressures, enhanced right ventricular function and greater exercise capacity. In the exercising Thoroughbred horse, extraordinarily high cardiac outputs exert significant pulmonary vascular stresses. The aim of this study was to determine, using contrast echocardiography, whether Thoroughbred horses performing strenuous exercise developed pulmonary transit of agitated contrast microbubbles (PTAC). At res...
Effects of single hyperinflation using a sustained high pressure manoeuvre during inhalation anaesthesia in horses.
Veterinary journal (London, England : 1997)    April 28, 2013   Volume 197, Issue 3 892-895 doi: 10.1016/j.tvjl.2013.03.009
Santos M, Ibancovichi JA, López-Sanromán FJ, Tendillo FJ.The effect of a single hyperinflation using a sustained high-pressure manoeuvre (SHPM) during inhalation anaesthesia was evaluated in horses. Twenty-eight client-owned male horses were recruited; 14 were operated on in dorsal recumbency and 14 in lateral recumbency. For each category, horses were randomly allocated to either the 'breathing spontaneously' or 'mechanically ventilated' group. After 30 min of anaesthesia, baseline cardiorespiratory parameters were collected and a SHPM of 50 cmH2O during 50s was undertaken. In the group of horses breathing spontaneously and positioned in dorsal rec...
Seek and ye shall find: cardiac arrhythmias in the horse.
Equine veterinary journal    April 10, 2013   Volume 45, Issue 3 270-272 doi: 10.1111/evj.12054
Physick-Sheard PW.No abstract available
Hypercapnic respiratory acidosis: a protective or harmful strategy for critically ill newborn foals? Vengust M.This paper reviews both the beneficial and adverse effects of permissive hypercapnic respiratory acidosis in critically ill newborn foals. It has been shown that partial carbon dioxide pressure (PCO2) above the traditional safe range (hypercapnia), has beneficial effects on the physiology of the respiratory, cardiovascular, and nervous system in neonates. In human neonatal critical care medicine permissive hypercapnic acidosis is generally well-tolerated by patients and is more beneficial to their wellbeing than normal carbon dioxide (CO2) pressure or normocapnia. Even though adverse effects o...
Effect of breed, sex, age and body weight on echocardiographic measurements in the equine species.
Research in veterinary science    March 26, 2013   Volume 95, Issue 1 255-260 doi: 10.1016/j.rvsc.2013.02.014
Al-Haidar A, Farnir F, Deleuze S, Sandersen CF, Leroux AA, Borde L, Cerri S, Amory H.Little is known about the effect of various animal's signalment variables on echocardiographic reference values in the equine species. This study was performed to evaluate the effect of sex, breed, age and body weight (BW) on echocardiographic measurements in the equine species. Echocardiography was performed on 212 ponies or horses of various breeds, aged from 1 day to 37 years old (mean±SD: 7.8 ± 5.8 years), BW 38-890 kg (mean ± SD: 421 ± 133 kg), and free of cardiac disease. Fifty of those animals aged from 2 months to 35 years old (mean ± SD: 11.6 ± 6.4 years old); BW 77-662 kg (mean...
Near-fatal misuse of medical tape around an endotracheal tube connector during inhalation anesthesia in a horse.
The Canadian veterinary journal = La revue veterinaire canadienne    March 2, 2013   Volume 53, Issue 9 978-982 
Gregson R, Clutton RE.A 7-year-old gelded Irish sports horse weighing 650 kg was anesthetized on 2 consecutive days for lavage of a septic right radio-carpal joint. On both occasions the endotracheal tube connector, which had been bound in medical tape to produce an airtight seal, functioned as a unidirectional valve during mechanical ventilation, retarding expiration, imposing positive end expiratory pressure (PEEP), and probably continuous positive airway pressure (CPAP). The equipment dysfunction was not identified on either occasion despite close inspection prompted by progressive increases in airway pressure a...
Normal electrocardiographic QT interval in race-fit Standardbred horses at rest and its rate dependence during exercise.
Journal of veterinary cardiology : the official journal of the European Society of Veterinary Cardiology    February 22, 2013   Volume 15, Issue 1 23-31 doi: 10.1016/j.jvc.2012.08.002
Pedersen PJ, Kanters JK, Buhl R, Klaerke DA.Cardiac repolarization, measured as QT and Tpeak to Tend (TpTe) intervals on the ECG, is important, as irregularities caused by diseases, ventricular hypertrophy, drugs and genetic defects can trigger arrhythmias which predispose human patients to syncope and sudden cardiac death. In horses, repolarization is not well described and therefore QT analysis cannot yet be used diagnostically. Therefore, we sought to describe reference values for the normal QT and TpTe intervals in Standardbreds and to determine the best method for heart rate (HR) correction. Methods: 30 Standardbreds. Methods: QT a...
Hemodynamic effects of 6% hydroxyethyl starch infusion in sevoflurane-anesthetized thoroughbred horses.
The Journal of veterinary medical science    February 15, 2013   Volume 75, Issue 7 841-845 doi: 10.1292/jvms.12-0426
Ohta M, Kurimoto S, Tokushige H, Kuroda T, Ishikawa Y.To determine hemodynamic effects of hydroxyethyl starch (HES) infusion during anesthesia in horses, incremental doses of 6% HES were administered to 6 healthy Thoroughbred horses. Anesthesia was induced with xylazine, guaifenesin and thiopental and maintained with sevoflurane at 2.8% of end-tidal concentration in all horses. The horses were positioned in right lateral recumbency and administered 3 intravenous dose of 6% HES (5 ml/kg) over 15 min with 15-min intervals in addition to constant infusion of lactated Ringer's solution at 10 ml/kg/hr. Hemodynamic parameters were measured before and e...
Contracted foal syndrome associated with multiple malformations in two foals.
Anatomia, histologia, embryologia    February 14, 2013   Volume 43, Issue 1 71-74 doi: 10.1111/ahe.12030
Binanti D, Zani DD, De Zani D, Turci T, Zavaglia G, Riccaboni P.Congenital anomalies in horses are very rare, and contracted foal syndrome is one of the most commonly reported. This malformation is characterized by contraction of the joints of the forelimbs and/or hindlimbs. In addition, the syndrome can be characterized by vertebral column malformations, such as scoliosis or torticollis, and cranial deformity. The present report describes the radiological and necroscopical findings of multiple rare malformations in two foals. Both foals showed skeletal abnormalities and fenestration of the abdominal cavity. Other pathological findings include a interventr...
Seasonal variation in maintenance of phenylephrine-induced tone in isolated equine digital arteries under hypoxic or hyperoxic conditions in vitro.
Research in veterinary science    February 12, 2013   Volume 94, Issue 3 725-727 doi: 10.1016/j.rvsc.2013.01.010
Borer-Weir KE, Bailey SR, Harris PA, Menzies-Gow NJ, Elliott J.Digital vasoconstriction, ischaemia and hypoxia may predispose to acute laminitis. Laminitis incidence varies seasonally, peaking in spring and summer. Direct seasonal influences on equine digital artery (EDA) contractility have not been investigated. This study assessed seasonal variation in maintenance of phenylephrine (PHE)-induced tone in isolated EDAs under hypoxic (95% nitrogen) and hyperoxic (95% oxygen) conditions. The objective was to measure change in arterial tone over time after constriction to a plateau with PHE. Tone was measured at plateau and over time and percentage change cal...
Multi-species comparative analysis of the equine ACE gene identifies a highly conserved potential transcription factor binding site in intron 16.
PloS one    February 8, 2013   Volume 8, Issue 2 e55434 doi: 10.1371/journal.pone.0055434
Hamilton NA, Tammen I, Raadsma HW.Angiotensin converting enzyme (ACE) is essential for control of blood pressure. The human ACE gene contains an intronic Alu indel (I/D) polymorphism that has been associated with variation in serum enzyme levels, although the functional mechanism has not been identified. The polymorphism has also been associated with cardiovascular disease, type II diabetes, renal disease and elite athleticism. We have characterized the ACE gene in horses of breeds selected for differing physical abilities. The equine gene has a similar structure to that of all known mammalian ACE genes. Nine common single nuc...
Mechanical ventilation and respiratory mechanics during equine anesthesia.
The Veterinary clinics of North America. Equine practice    February 5, 2013   Volume 29, Issue 1 51-67 doi: 10.1016/j.cveq.2012.12.002
Moens Y.The mechanical ventilation of horses during anesthesia remains a crucial option for optimal anesthetic management, if the possible negative cardiovascular side effects are managed, because this species is prone to hypercapnia and hypoxemia. The combined use of capnography and pitot-based spirometry provide complementary information on ventilation and respiratory mechanics, respectively. This facilitates management of mechanical ventilation in conditions of changing respiratory system compliance (ie, laparoscopy) and when investigating new ventilatory strategies including alveolar recruitment m...
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