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Sample records for invasive mechanical ventilation

  1. Modern non-invasive mechanical ventilation turns 25.

    PubMed

    Díaz Lobato, Salvador; Mayoralas Alises, Sagrario

    2013-11-01

    The history of non-invasive mechanical ventilation goes back more than 100 years, but it was not until 1987 when what we could call "modern" non-invasive mechanical ventilation was developed. The description of Delaubier and Rideau of a patient with Duchenne's disease who had been effectively ventilated through a nasal mask marked the start of a new era in the history of non-invasive mechanical ventilation. Over these last 25years, we have witnessed exponential growth in its use, field of activity and technological advances on an exciting fast-paced track. We believe that it is time to review the main milestones that have marked the development of non-invasive mechanical ventilation to date, while paying homage to this therapeutic method that has contributed so much to the advancement of respiratory medicine in the last 25years. PMID:23347549

  2. Non invasive monitoring in mechanically ventilated pediatric patients.

    PubMed

    Al-Subu, Awni M; Rehder, Kyle J; Cheifetz, Ira M; Turner, David A

    2014-12-01

    Cardiopulmonary monitoring is a key component in the evaluation and management of critically ill patients. Clinicians typically rely on a combination of invasive and non-invasive monitoring to assess cardiac output and adequacy of ventilation. Recent technological advances have led to the introduction: of continuous non-invasive monitors that allow for data to be obtained at the bedside of critically ill patients. These advances help to identify hemodynamic changes and allow for interventions before complications occur. In this manuscript, we highlight several important methods of non-invasive cardiopulmonary monitoring, including capnography, transcutaneous monitoring, pulse oximetry, and near infrared spectroscopy. PMID:25119483

  3. [Non-invasive mechanical ventilation in the pre- and intraoperative period and difficult airway].

    PubMed

    Esquinas, A M; Jover, J L; Úbeda, A; Belda, F J

    2015-11-01

    Non-invasive mechanical ventilation is a method of ventilatory assistance aimed at increasing alveolar ventilation, thus achieving, in selected subjects, the avoidance of endotracheal intubation and invasive mechanical ventilation, with the consequent improvement in survival. There has been a systematic review and study of the technical, clinical experiences, and recommendations concerning the application of non-invasive mechanical ventilation in the pre- and intraoperative period. The use of prophylactic non-invasive mechanical ventilation before surgery that involves significant alterations in the ventilatory function may decrease the incidence of postoperative respiratory complications. Its intraoperative use will mainly depend on the type of surgery, type of anaesthetic technique, and the clinical status of the patient. Its use allows greater anaesthetic depth without deterioration of oxygenation and ventilation of patients. PMID:25702198

  4. Pressure versus volume controlled modes in invasive mechanical ventilation.

    PubMed

    Garnero, A J; Abbona, H; Gordo-Vidal, F; Hermosa-Gelbard, C

    2013-05-01

    The first generation of mechanical ventilators were controlled and cycled by pressure. Unfortunately, they did not allow control of the delivered tidal volume under changes in the dynamics of the respiratory system. This led to a second generation of ventilators that allowed volume control, hence favoring the ventilatory strategy based on normalization of the arterial gases. Studies conducted in the 1980s which related lung injury to the high ventilator pressures utilized while treating acute respiratory distress syndrome patients renewed interest in pressure-controlled mechanical ventilation. In addition, new evidence became available, leading to the development of pulmonary protective strategies aiming at preventing the progression of ventilator-induced lung injury. This review provides a detailed description of the control of pressure or volume using certain ventilatory modes, and offers a general view of their advantages and disadvantages, based on the latest available evidence. PMID:23260264

  5. Non-invasive mechanical ventilation: the benefits of the BiPAP system.

    PubMed

    Teba, L; Marks, P; Benzo, R

    1996-01-01

    Many of the complications with endotracheal intubation and invasive mechanical ventilation can be avoided with the use of non-invasive mechanical ventilation (NIMV). This technique has been especially successful in treating patients with acute respiratory failure (ARF). NIMV improves gas exchange, avoids complications caused by endotracheal intubation, and allows patients to talk and take medications orally. This article reviews our experiences treating 27 patients with ARF with a BiPAP (bi-level positive airway pressure) ventilator. This is a portable unit which allows for selection of different modes of ventilation and adjustment of inspiratory and expiratory pressures. Non-invasive mechanical ventilation should be considered in patients presenting with ARF who are hemodynamically stable and in whom spontaneous breathing is preserved. PMID:8599242

  6. Resolution of obstructive atelectasis with non-invasive mechanical ventilation.

    PubMed

    Mirambeaux Villalona, Rosa; Mayoralas Alises, Sagrario; Díaz Lobato, Salvador

    2014-10-01

    Bronchoscopy is a commonly used technique in patients with atelectasis due to mucus plugs. We present here the case of an 82-year-old patient with a history of Meige's syndrome who developed acute respiratory failure due to atelectasis of the right upper lobe associated with hospital-acquired pneumonia. The patient had a severely reduced level of consciousness, significant work-of-breathing and severe hypercapnic acidosis, all of which contraindicated bronchoscopy. Bi-level noninvasive mechanical ventilation (NIMV) was initiated by way of a face mask. Progress was favourable, with clear clinical and gasometric improvement. The chest X-ray performed 12hours later showed complete resolution of the atelectasis. These data suggest that NIMV may be useful in the treatment of atelectasis is some critical patients. PMID:24411928

  7. [Non-invasive mechanical ventilation in postoperative patients. A clinical review].

    PubMed

    Esquinas, A M; Jover, J L; Úbeda, A; Belda, F J

    2015-11-01

    Non-invasive ventilation (NIV) is a method of ventilatory support that is increasing in importance day by day in the management of postoperative respiratory failure. Its role in the prevention and treatment of atelectasis is particularly important in the in the period after thoracic and abdominal surgeries. Similarly, in the transplanted patient, NIV can shorten the time of invasive mechanical ventilation, reducing the risk of infectious complications in these high-risk patients. It has been performed A systematic review of the literature has been performed, including examining the technical, clinical experiences and recommendations concerning the application of NIV in the postoperative period. PMID:25892605

  8. [The effect of non-invasive mechanical ventilation in postoperative respiratory failure].

    PubMed

    Ozyılmaz, Ezgi; Kaya, Akın

    2012-01-01

    Postoperative respiratory failure is related with the highest mortality and morbidity among all perioperative complications. The most common underlying mechanism of postoperative respiratory failure is the development of atelectasis. Anaesthesia, medications which cause respiratory depression, high FiO2 use, postoperative pain and disruption of muscle forces due to surgery leads to decrease in functional residual capacity and results in atelectasis formation. Atelectasis causes severe hypoxemia due to ventilation, perfusion mismatch, shunt and increased peripheral vascular resistance. Intrathoracic positive pressure is an effective therapeutic option in both prevention and treatment of atelectasis. Non-invasive mechanical ventilation is related with a lower mortality and morbidity rate due to lack of any potential complication risks of endotracheal intubation. Non-invasive mechanical ventilation can be applied as prophylactic or curative. Both of these techniques are related with lower reintubation rates, nosocomial infections, duration of hospitalization and mortality in patients with postoperative respiratory failure. The differences of this therapy from standard application and potential complications should be well known in order to improve prognosis in these group of patients. The primary aim of this review is to underline the pathogenesis of postoperative respiratory failure. The secondary aim is to clarify the optimum method, effect and complications of non-invasive mechanical ventilation therapy under the light of the studies which was performed in specific patient groups. PMID:22779943

  9. [Non-invasive mechanical ventilation in the treatment of acute heart failure].

    PubMed

    Alfonso Megido, Joaquín; González Franco, Alvaro

    2014-03-01

    When acute heart failure progresses and there is acute cardiogenic pulmonary edema, routine therapeutic measures should be accompanied by other measures that help to correct oxygenation of the patient. The final and most drastic step is mechanical ventilation. Non-invasive ventilation has been developed in the last few years as a method that attempts to improve oxygenation without the need for intubation, thus, in theory, reducing morbidity and mortality in these patients. The present article describes the controversies surrounding the results of this technique and discusses its indications. The article also discusses how to start non-invasive ventilation in patients with acute pulmonary edema from a practical point of view. PMID:24930085

  10. [Non-invasive mechanical ventilation therapy in patients with heart failure].

    PubMed

    Dursunoğlu, Dursun; Dursunoğlu, Neşe

    2012-05-01

    Non-invasive mechanical ventilation (NIMV) therapy in patients with acute heart failure (HF) improves left ventricular functions via decreasing left ventricular afterload and reduces intubation rate and short-term mortality. In patients with chronic HF, NIMV therapy eliminates central and obstructive apneas and Cheyne-Stokes respiration, and improves morbidity. There are essentially three modes of NIMV that are used in the treatment of HF: Continuous positive airway pressure (CPAP), bilevel positive airway pressure (BIPAP) and adaptive servo-ventilation (ASV). Hereby, NIMV therapy in patients with acute and chronic HF is reviewed as well as methods, indications, effectiveness and complications. PMID:22381927

  11. Non-invasive mechanical ventilation and epidural anesthesia for an emergency open cholecystectomy.

    PubMed

    Yurtlu, Bülent Serhan; Köksal, Bengü; Hancı, Volkan; Turan, Işıl Özkoçak

    2016-01-01

    Non-invasive ventilation is an accepted treatment modality in both acute exacerbations of respiratory diseases and chronic obstructive lung disease. It is commonly utilized in the intensive care units, or for postoperative respiratory support in post-anesthesia care units. This report describes intraoperative support in non-invasive ventilation to neuroaxial anesthesia for an emergency upper abdominal surgery. PMID:27591472

  12. Pathophysiological Basis of Acute Respiratory Failure on Non-Invasive Mechanical Ventilation

    PubMed Central

    Romero-Dapueto, C; Budini, H; Cerpa, F; Caceres, D; Hidalgo, V; Gutiérrez, T; Keymer, J; Pérez, R; Molina, J; Giugliano-Jaramillo, C

    2015-01-01

    Noninvasive mechanical ventilation (NIMV) was created for patients who needed noninvasive ventilator support, this procedure decreases the complications associated with the use of endotracheal intubation (ETT). The application of NIMV has acquired major relevance in the last few years in the management of acute respiratory failure (ARF), in patients with hypoxemic and hypercapnic failure. The main advantage of NIMV as compared to invasive mechanical ventilation (IMV) is that it can be used earlier outside intensive care units (ICUs). The evidence strongly supports its use in patients with COPD exacerbation, support in weaning process in chronic obstructive pulmonary disease (COPD) patients, patients with acute cardiogenic pulmonary edema (ACPE), and Immunosuppressed patients. On the other hand, there is poor evidence that supports the use of NIMV in other pathologies such as pneumonia, acute respiratory distress syndrome (ARDS), and during procedures as bronchoscopy, where its use is still controversial because the results of these studies are inconclusive against the decrease in the rate of intubation or mortality. PMID:26312101

  13. [Amyotrophic neuralgia associated with bilateral phrenic paralysis treated with non-invasive mechanical ventilation].

    PubMed

    García García, María Del Carmen; Hernández Borge, Jacinto; Antona Rodríguez, María José; Pires Gonçalves, Pedro; García García, Gema

    2015-09-01

    Amyotrophic neuralgia is an uncommon neuropathy characterized by severe unilateral shoulder pain. Isolated or concomitant involvement of other peripheral motor nerves depending on the brachial plexus such as phrenic or laryngeal nerves is unusual(1). Its etiology is unknown, yet several explanatory factors have been proposed. Phrenic nerve involvement, either unilateral or bilateral, is exceedingly rare. Diagnosis relies on anamnesis, functional and imaging investigations and electromyogram. We report the case of a 48-year-old woman with a past history of renal transplantation due to proliferative glomerulonephritis with subsequent transplant rejection, who was eventually diagnosed with amyotrophic neuralgia with bilateral phrenic involvement, and who required sustained non-invasive mechanical ventilation. PMID:26049960

  14. Clinical challenges in mechanical ventilation.

    PubMed

    Goligher, Ewan C; Ferguson, Niall D; Brochard, Laurent J

    2016-04-30

    Mechanical ventilation supports gas exchange and alleviates the work of breathing when the respiratory muscles are overwhelmed by an acute pulmonary or systemic insult. Although mechanical ventilation is not generally considered a treatment for acute respiratory failure per se, ventilator management warrants close attention because inappropriate ventilation can result in injury to the lungs or respiratory muscles and worsen morbidity and mortality. Key clinical challenges include averting intubation in patients with respiratory failure with non-invasive techniques for respiratory support; delivering lung-protective ventilation to prevent ventilator-induced lung injury; maintaining adequate gas exchange in severely hypoxaemic patients; avoiding the development of ventilator-induced diaphragm dysfunction; and diagnosing and treating the many pathophysiological mechanisms that impair liberation from mechanical ventilation. Personalisation of mechanical ventilation based on individual physiological characteristics and responses to therapy can further improve outcomes. PMID:27203509

  15. Clinical review: Helmet and non-invasive mechanical ventilation in critically ill patients

    PubMed Central

    2013-01-01

    Non-invasive mechanical ventilation (NIV) has proved to be an excellent technique in selected critically ill patients with different forms of acute respiratory failure. However, NIV can fail on account of the severity of the disease and technical problems, particularly at the interface. The helmet could be an alternative interface compared to face mask to improve NIV success. We performed a clinical review to investigate the main physiological and clinical studies assessing the efficacy and related issues of NIV delivered with a helmet. A computerized search strategy of MEDLINE/PubMed (January 2000 to May 2012) and EMBASE (January 2000 to May 2012) was conducted limiting the search to retrospective, prospective, nonrandomized and randomized trials. We analyzed 152 studies from which 33 were selected, 12 physiological and 21 clinical (879 patients). The physiological studies showed that NIV with helmet could predispose to CO2 rebreathing and increase the patients' ventilator asynchrony. The main indications for NIV were acute cardiogenic pulmonary edema, hypoxemic acute respiratory failure (community-acquired pneumonia, postoperative and immunocompromised patients) and hypercapnic acute respiratory failure. In 9 of the 21 studies the helmet was compared to a face mask during either continous positive airway pressure or pressure support ventilation. In eight studies oxygenation was similar in the two groups, while the intubation rate was similar in four and lower in three studies for the helmet group compared to face mask group. The outcome was similar in six studies. The tolerance was better with the helmet in six of the studies. Although these data are limited, NIV delivered by helmet could be a safe alternative to the face mask in patients with acute respiratory failure. PMID:23680299

  16. Flexible bronchoscopy during non-invasive positive pressure mechanical ventilation: are two better than one?

    PubMed

    Scala, Raffaele

    2016-09-01

    Flexible bronchoscopy (FBO) and non-invasive positive pressure ventilation (NIPPV) are largely applied in respiratory and general intensive care units. FBO plays a crucial role for the diagnosis of lung infiltrates of unknown origin and for the treatment of airways obstruction due to bronchial mucous plugging and hemoptysis in critical patients. NIPPV is the first-choice ventilatory strategy for acute respiratory failure (ARF) of different causes as it could be used as prevention or as alternative to the conventional mechanical ventilation (CMV) via endotracheal intubation (ETI). Some clinical scenarios represent contraindications for these techniques such as severe ARF in spontaneous breathing patients for FBO and accumulated tracheo-bronchial secretions in patients with depressed cough for NIPPV. In these contexts, the decision of performing ETI should carefully consider the risk of CMV-correlated complications. An increasing amount of published data suggested the use of FBO during NIPPV in ARF in order to avoid/reduce the need of ETI. Despite a strong rationale for the combined use of the two techniques, there is not still enough evidence for a large-scale application of this strategy in all different clinical scenarios. The majority of the available data are in favor of the "help" given by NIPPV to diagnostic FBO in high-risk spontaneously breathing patients with severe hypoxemia. Preliminary findings report the successful "help" given by early FBO to NIPPV in patients with hypoxemic-hypercapnic ARF who are likely to fail because of hypersecretion. Synergy of FBO and NIPPV application is emerging also to perform ETI in challenging situations, such as predicted difficult laringoscopy and NPPV failure in severely hypoxemic patients. This combined approach should be performed only in centers showing a wide experience with both NIPPV and FBO, where close monitoring and ETI facilities are promptly available. PMID:27012292

  17. Mechanical Ventilation

    MedlinePlus

    ... or husband or next of kin). It is important that you talk with your family members and your doctors about using a ventilator and what you would like to happen in different situations. The more clearly you explain your values and choices to friends, loved ones and doctors, ...

  18. Invasive Mechanical Ventilation in California Over 2000–2009: Implications for Emergency Medicine

    PubMed Central

    Mudumbai, Seshadri C.; Barr, Juli; Scott, Jennifer; Mariano, Edward R.; Bertaccini, Edward; Nguyen, Hieu; Memtsoudis, Stavros G.; Cason, Brian; Phibbs, Ciaran S.; Wagner, Todd

    2015-01-01

    Introduction Patients who require invasive mechanical ventilation (IMV) often represent a sequence of care between the emergency department (ED) and intensive care unit (ICU). Despite being the most populous state, little information exists to define patterns of IMV use within the state of California. Methods We examined data from the masked Patient Discharge Database of California’s Office of Statewide Health Planning and Development from 2000–2009. Adult patients who received IMV during their stay were identified using the International Classification of Diseases 9th Revision and Clinical Modification procedure codes (96.70, 96.71, 96.72). Patients were divided into age strata (18–34yr, 35–64yr, and >65yr). Using descriptive statistics and regression analyses, for IMV discharges during the study period, we quantified the number of ED vs. non-ED based admissions; changes in patient characteristics and clinical outcome; evaluated the marginal costs for IMV; determined predictors for prolonged acute mechanical ventilation (PAMV, i.e. IMV>96hr); and projected the number of IMV discharges and ED-based admissions by year 2020. Results There were 696,634 IMV discharges available for analysis. From 2000–2009, IMV discharges increased by 2.8%/year: n=60,933 (293/100,000 persons) in 2000 to n=79,868 (328/100,000 persons) in 2009. While ED-based admissions grew by 3.8%/year, non-ED-based admissions remained stable (0%). During 2000–2009, fastest growth was noted for 1) the 35–64 year age strata; 2) Hispanics; 3) patients with non-Medicare public insurance; and 4) patients requiring PAMV. Average total patient cost-adjusted charges per hospital discharge increased by 29% from 2000 (from $42,528 to $60,215 in 2014 dollars) along with increases in the number of patients discharged to home and skilled nursing facilities. Higher marginal costs were noted for younger patients (ages 18–34yr), non-whites, and publicly insured patients. Some of the strongest

  19. The effects of the semirecumbent position on hemodynamic status in patients on invasive mechanical ventilation: prospective randomized multivariable analysis

    PubMed Central

    2013-01-01

    Introduction Adopting the 45° semirecumbent position in mechanically ventilated critically ill patients is recommended, as it has been shown to reduce the incidence of ventilator-associated pneumonia. Although the benefits to the respiratory system are clear, it is not known whether elevating the head of the bed results in hemodynamic instability. We examined the effect of head of bed elevation (HBE) on hemodynamic status and investigated the factors that influence mean arterial pressure (MAP) and central venous oxygen saturation (ScvO2) when patients were positioned at 0°, 30°, and 45°. Methods Two hundred hemodynamically stable adults on invasive mechanical ventilation admitted to a multidisciplinary surgical intensive care unit were recruited. Patients' characteristics included catecholamine and sedative doses, the original angle of head of bed elevation (HBE), the level of positive end expiratory pressure (PEEP), duration and mode of mechanical ventilation. A sequence of HBE positions (0°, 30°, and 45°) was adopted in random order, and MAP and ScvO2 were measured at each position. Patients acted as their own controls. The influence of degree of HBE and of the covariables on MAP and ScvO2 was analyzed by using liner mixed models. Additionally, uni- and multivariable logistic regression models were used to indentify risk factors for hypotension during HBE, defined as MAP <65 mmHg. Results Changing HBE from supine to 45° caused significant reductions in MAP (from 83.8 mmHg to 71.1 mmHg, P < 0.001) and ScvO2 (76.1% to 74.3%, P < 0.001). Multivariable modeling revealed that mode and duration of mechanical ventilation, the norepinephrine dose, and HBE had statistically significant influences. Pressure-controlled ventilation was the most influential risk factor for hypotension when HBE was 45° (odds ratio (OR) 2.33, 95% confidence interval (CI), 1.23 to 4.76, P = 0.017). Conclusions HBE to the 45° position is associated with significant decreases in MAP and

  20. Inhalation therapy in mechanical ventilation

    PubMed Central

    Maccari, Juçara Gasparetto; Teixeira, Cassiano; Gazzana, Marcelo Basso; Savi, Augusto; Dexheimer-Neto, Felippe Leopoldo; Knorst, Marli Maria

    2015-01-01

    Patients with obstructive lung disease often require ventilatory support via invasive or noninvasive mechanical ventilation, depending on the severity of the exacerbation. The use of inhaled bronchodilators can significantly reduce airway resistance, contributing to the improvement of respiratory mechanics and patient-ventilator synchrony. Although various studies have been published on this topic, little is known about the effectiveness of the bronchodilators routinely prescribed for patients on mechanical ventilation or about the deposition of those drugs throughout the lungs. The inhaled bronchodilators most commonly used in ICUs are beta adrenergic agonists and anticholinergics. Various factors might influence the effect of bronchodilators, including ventilation mode, position of the spacer in the circuit, tube size, formulation, drug dose, severity of the disease, and patient-ventilator synchrony. Knowledge of the pharmacological properties of bronchodilators and the appropriate techniques for their administration is fundamental to optimizing the treatment of these patients. PMID:26578139

  1. Lights and shadows of non-invasive mechanical ventilation for chronic obstructive pulmonary disease (COPD) exacerbations

    PubMed Central

    Lopez-Campos, Jose Luis; Jara-Palomares, Luis; Muñoz, Xavier; Bustamante, Víctor; Barreiro, Esther

    2015-01-01

    Despite the overwhelming evidence justifying the use of non-invasive ventilation (NIV) for providing ventilatory support in chronic obstructive pulmonary disease (COPD) exacerbations, recent studies demonstrated that its application in real-life settings remains suboptimal. European clinical audits have shown that 1) NIV is not invariably available, 2) its availability depends on countries and hospital sizes, and 3) numerous centers declare their inability to provide NIV to all of the eligible patients presenting throughout the year. Even with an established indication, the use of NIV in acute respiratory failure due to COPD exacerbations faces important challenges. First, the location and personnel using NIV should be carefully selected. Second, the use of NIV is not straightforward despite the availability of technologically advanced ventilators. Third, NIV therapy of critically ill patients requires a thorough knowledge of both respiratory physiology and existing ventilatory devices. Accordingly, an optimal team-training experience, the careful selection of patients, and special attention to the selection of devices are critical for optimizing NIV outcomes. Additionally, when applied, NIV should be closely monitored, and endotracheal intubation should be promptly available in the case of failure. Another topic that merits careful consideration is the use of NIV in the elderly. This patient population is particularly fragile, with several physiological and social characteristics requiring specific attention in relation to NIV. Several other novel indications should also be critically examined, including the use of NIV during fiberoptic bronchoscopy or transesophageal echocardiography, as well as in interventional cardiology and pulmonology. The present narrative review aims to provide updated information on the use of NIV in acute settings to improve the clinical outcomes of patients hospitalized for COPD exacerbations. PMID:25829958

  2. Another brick in the wall of needs for invasive ventilation?

    PubMed Central

    2014-01-01

    Ventilator-induced lung injury and ventilator-induced diaphragmatic dysfunction are major complications in mechanically ventilated patients with acute respiratory failure. Invasive ventilation adds a further burden by increasing the risk of infections. An approach that protects both lung and diaphragm is pivotal. Mirabella and colleagues compared conventional controlled ventilation with a mode that combines several potentially lung-protective properties - non-invasively applied neurally adjusted ventilatory assist - in an animal experiment. This approach seemed to be as effective but potentially more lung-protective. Although the experimental setup and results cannot be translated directly to the clinical setting, they should motivate us to further study this innovative approach. PMID:25029382

  3. Mechanical ventilation in children.

    PubMed

    Kendirli, Tanil; Kavaz, Asli; Yalaki, Zahide; Oztürk Hişmi, Burcu; Derelli, Emel; Ince, Erdal

    2006-01-01

    Mechanical ventilation can be lifesaving, but > 50% of complications in conditions that require intensive care are related to ventilatory support, particularly if it is prolonged. We retrospectively evaluated the medical records of patients who had mechanical ventilation in the Pediatric Intensive Care Unit (PICU) during a follow-up period between January 2002-May 2005. Medical records of 407 patients were reviewed. Ninety-one patients (22.3%) were treated with mechanical ventilation. Ages of all patients were between 1-180 (median: 8) months. The mechanical ventilation time was 18.8 +/- 14.1 days. Indication of mechanical ventilation could be divided into four groups as respiratory failure (64.8%), cardiovascular failure (19.7%), central nervous system disease (9.8%) and safety airway (5.4%). Tracheostomy was performed in four patients. The complication ratio of mechanically ventilated children was 42.8%, and diversity of complications was as follows: 26.3% atelectasia, 17.5% ventilator-associated pneumonia, 13.1% pneumothorax, 5.4% bleeding, 4.3% tracheal edema, and 2.1% chronic lung disease. The mortality rate of mechanically ventilated patients was 58.3%, but the overall mortality rate in the PICU was 12.2%. In conclusion, there are few published epidemiological data on the follow-up results and mortality in infants and children who are mechanically ventilated. PMID:17290566

  4. The last months of life of people with amyotrophic lateral sclerosis in mechanical invasive ventilation: a qualitative study.

    PubMed

    Veronese, Simone; Valle, Alessandro; Chiò, Adriano; Calvo, Andrea; Oliver, David

    2014-12-01

    In Italy 10-30% of patients who die with amyotrophic lateral sclerosis are invasively ventilated. It is difficult to predict when patients will die and when a specialist palliative care service may effectively be involved. Nineteen semi-structured interviews with informal family carers who looked after these patients who had died in last 10 years were undertaken to ascertain their experiences in the final stages of the disease. The mean survival after tracheostomy was 30 months (median 24 months). Fifty-eight percent of the patients had not wanted to be tracheostomized before the procedure, but often felt pressured into the decision to have a tracheostomy. Following the procedure the individual quality of life decreased for many patients and carers. In last 4-6 months both carers and patients were aware of a clear deterioration and reported cognitive-communication impairment, local infections and sepsis, pressure sores, the need for indwelling catheters and the use of sedative-analgesic drugs. The study shows that tracheostomy is often undertaken with little discussion. The end-of-life phase can be defined, with several indicators of deterioration, which could be triggers for the involvement of palliative care. PMID:24863495

  5. Tracheostomy in mechanical ventilation.

    PubMed

    Terragni, Pierpaolo; Faggiano, Chiara; Martin, Erica L; Ranieri, V Marco

    2014-08-01

    Airway access for mechanical ventilation (MV) can be provided either by orotracheal intubation (OTI) or tracheostomy tube. During episodes of acute respiratory failure, patients are commonly ventilated through an orotracheal tube that represents an easy and rapid initial placement of the airway device. OTI avoids acute surgical complications such as bleeding, nerve and posterior tracheal wall injury, and late complications such as wound infection and tracheal lumen stenosis that may emerge due to tracheostomy tube placement. Tracheostomy is often considered when MV is expected to be applied for prolonged periods or for the improvement of respiratory status, as this approach provides airway protection, facilitates access for secretion removal, improves patient comfort, and promotes progression of care in and outside the intensive care unit (ICU). The aim of this review is to assess the frequency and performance of different surgical or percutaneous dilational tracheostomy and timing and safety procedures associated with the use of fiberoptic bronchoscopy and ultrasounds. Moreover, we analyzed the performance based on National European surveys to assess the current tracheostomy practice in ICUs. PMID:25111644

  6. Invasive and non-invasive ventilation for prematurely born infants - current practice in neonatal ventilation.

    PubMed

    Greenough, Anne; Lingam, Ingran

    2016-02-01

    Non-invasive techniques, include nasal continuous positive airways pressure (nCPAP), nasal intermittent positive pressure ventilation (NIPPV) and heated, humidified, high flow cannula (HHFNC). Randomised controlled trials (RCTs) of nCPAP versus ventilation have given mixed results, but one demonstrated fewer respiratory problems during infancy. Meta-analysis demonstrated NIPPV rather than nCPAP provided better support post extubation. After extubation or initial support HHFNC has similar efficacy to CPAP. Invasive techniques include those that synchronise inflations with the patient's respiratory efforts. Assist control/ synchronised intermittent mandatory ventilation compared to non triggered modes only reduce the duration of ventilation. Further data are required to determine the efficacy of proportional assist ventilation and neurally adjusted ventilatory assist. Other techniques aim to minimise volutrauma. RCTs of volume targeted ventilation demonstrated reductions in BPD and respiratory medication usage at follow-up. Prophylactic high frequency oscillatory ventilation does not reduce BPD, but is associated with superior lung function at school age. PMID:26698269

  7. [Non invasive ventilation in the emergency setting].

    PubMed

    Wilhelm, Laetitia; Della Santa, Vincent; Hanhart, Walter-Alexandre

    2015-08-12

    Before the development of non invasive ventilation (NIV), endotracheal intubation was the only ventilatory therapy available in case of severe respiratory distress and acute respiratory failure. NIV used to be employed in intensive care settings only. Nowadays, the use of NIV has been democratized to include the emergency room, and the pre-hospital care setting for treatment of acute respiratory failure. Cardiogenic pulmonary edema and acute exacerbation of COPD are indications of choice, since NIV improves mortality. The efficiency of the therapy depends on early treatment; however, endotracheal intubation should not be delayed when it becomes necessary. PMID:26449102

  8. Non invasive ventilation as an additional tool for exercise training.

    PubMed

    Ambrosino, Nicolino; Cigni, Paolo

    2015-01-01

    Recently, there has been increasing interest in the use of non invasive ventilation (NIV) to increase exercise capacity. In individuals with COPD, NIV during exercise reduces dyspnoea and increases exercise tolerance. Different modalities of mechanical ventilation have been used non-invasively as a tool to increase exercise tolerance in COPD, heart failure and lung and thoracic restrictive diseases. Inspiratory support provides symptomatic benefit by unloading the ventilatory muscles, whereas Continuous Positive Airway Pressure (CPAP) counterbalances the intrinsic positive end-expiratory pressure in COPD patients. Severe stable COPD patients undergoing home nocturnal NIV and daytime exercise training showed some benefits. Furthermore, it has been reported that in chronic hypercapnic COPD under long-term ventilatory support, NIV can also be administered during walking. Despite these results, the role of NIV as a routine component of pulmonary rehabilitation is still to be defined. PMID:25874110

  9. Forced oscillation assessment of respiratory mechanics in ventilated patients

    PubMed Central

    Navajas, Daniel; Farré, Ramon

    2001-01-01

    The forced oscillation technique (FOT) is a method for non-invasively assessing respiratory mechanics that is applicable both in paralysed and non-paralysed patients. As the FOT requires a minimal modification of the conventional ventilation setting and does not interfere with the ventilation protocol, the technique is potentially useful to monitor patient mechanics during invasive and noninvasive ventilation. FOT allows the assessment of the respiratory system linearity by measuring resistance and reactance at different lung volumes or end-expiratory pressures. Moreover, FOT allows the physician to track the changes in patient mechanics along the ventilation cycle. Applying FOT at different frequencies may allow the physician to interpret patient mechanics in terms of models with pathophysiological interest. The current methodological and technical experience make possible the implementation of portable and compact computerised FOT systems specifically addressed to its application in the mechanical ventilation setting. PMID:11178220

  10. Mechanical ventilation for severe asthma.

    PubMed

    Leatherman, James

    2015-06-01

    Acute exacerbations of asthma can lead to respiratory failure requiring ventilatory assistance. Noninvasive ventilation may prevent the need for endotracheal intubation in selected patients. For patients who are intubated and undergo mechanical ventilation, a strategy that prioritizes avoidance of ventilator-related complications over correction of hypercapnia was first proposed 30 years ago and has become the preferred approach. Excessive pulmonary hyperinflation is a major cause of hypotension and barotrauma. An appreciation of the key determinants of hyperinflation is essential to rational ventilator management. Standard therapy for patients with asthma undergoing mechanical ventilation consists of inhaled bronchodilators, corticosteroids, and drugs used to facilitate controlled hypoventilation. Nonconventional interventions such as heliox, general anesthesia, bronchoscopy, and extracorporeal life support have also been advocated for patients with fulminant asthma but are rarely necessary. Immediate mortality for patients who are mechanically ventilated for acute severe asthma is very low and is often associated with out-of-hospital cardiorespiratory arrest before intubation. However, patients who have been intubated for severe asthma are at increased risk for death from subsequent exacerbations and must be managed accordingly in the outpatient setting. PMID:26033128

  11. A miniature mechanical ventilator for newborn mice.

    PubMed

    Kolandaivelu, K; Poon, C S

    1998-02-01

    Transgenic/knockout mice with pre-defined mutations have become increasingly popular in biomedical research as models of human diseases. In some instances, the resulting mutation may cause cardiorespiratory distress in the neonatal or adult animals and may necessitate resuscitation. Here we describe the design and testing of a miniature and versatile ventilator that can deliver varying ventilatory support modes, including conventional mechanical ventilation and high-frequency ventilation, to animals as small as the newborn mouse. With a double-piston body chamber design, the device circumvents the problem of air leakage and obviates the need for invasive procedures such as endotracheal intubation, which are particularly important in ventilating small animals. Preliminary tests on newborn mice as early as postnatal day O demonstrated satisfactory restoration of pulmonary ventilation and the prevention of respiratory failure in mutant mice that are prone to respiratory depression. This device may prove useful in the postnatal management of transgenic/knockout mice with genetically inflicted respiratory disorders. PMID:9475887

  12. Non-invasive ventilation in exacerbations of COPD

    PubMed Central

    Ambrosino, Nicolino; Vagheggini, Guido

    2007-01-01

    Randomized controlled trials have confirmed the evidence and helped to define when and where non invasive mechanical ventilation (NIV) should be the first line treatment of acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Noninvasive ventilation has its best indication in moderate-to-severe respiratory acidosis in patients with AECOPD. For this indication, studies conducted in ICU, in wards and in accident and emergency departments confirmed its effectiveness in preventing endotracheal intubation and reducing mortality. The skill of the health care team promotes proper NIV utilization and improves the patient outcome. Patients with severe acidosis or with altered levels of consciousness due to hypercapnic acute respiratory failure are exposed to high risk of NIV failure. In these patients a NIV trial may be attempted in closely monitored clinical settings where prompt endotracheal intubation may be assured. PMID:18268921

  13. [Non-invasive mechanical ventilation with a facial interface during sedation for a percutaneous endoscopic gastrostomy in a patient with amyotrophic lateral sclerosis].

    PubMed

    González-Frasquet, M C; García-Covisa, N; Vidagany-Espert, L; Herranz-Gordo, A; Llopis-Calatayud, J E

    2015-11-01

    Amyotrophic lateral sclerosis is a chronic neurodegenerative disease of the central nervous system which affects the motor neurons and produces a progressive muscle weakness, leading to atrophy and muscle paralysis, and ultimately death. Performing a percutaneous endoscopic gastrostomy with sedation in patients with amyotrophic lateral sclerosis can be a challenge for the anesthesiologist. The case is presented of a 76-year-old patient who suffered from advanced stage amyotrophic lateral sclerosis, ASA III, in which a percutaneous endoscopic gastrostomy was performed with deep sedation, for which non-invasive ventilation was used as a respiratory support to prevent hypoventilation and postoperative respiratory complications. PMID:25804680

  14. Ventilator-associated lung injury during assisted mechanical ventilation.

    PubMed

    Saddy, Felipe; Sutherasan, Yuda; Rocco, Patricia R M; Pelosi, Paolo

    2014-08-01

    Assisted mechanical ventilation (MV) may be a favorable alternative to controlled MV at the early phase of acute respiratory distress syndrome (ARDS), since it requires less sedation, no paralysis and is associated with less hemodynamic deterioration, better distal organ perfusion, and lung protection, thus reducing the risk of ventilator-associated lung injury (VALI). In the present review, we discuss VALI in relation to assisted MV strategies, such as volume assist-control ventilation, pressure assist-control ventilation, pressure support ventilation (PSV), airway pressure release ventilation (APRV), APRV with PSV, proportional assist ventilation (PAV), noisy ventilation, and neurally adjusted ventilatory assistance (NAVA). In summary, we suggest that assisted MV can be used in ARDS patients in the following situations: (1) Pao(2)/Fio(2) >150 mm Hg and positive end-expiratory pressure ≥ 5 cm H(2)O and (2) with modalities of pressure-targeted and time-cycled breaths including more or less spontaneous or supported breaths (A-PCV [assisted pressure-controlled ventilation] or APRV). Furthermore, during assisted MV, the following parameters should be monitored: inspiratory drive, transpulmonary pressure, and tidal volume (6 mL/kg). Further studies are required to determine the impact of novel modalities of assisted ventilation such as PAV, noisy pressure support, and NAVA on VALI. PMID:25105820

  15. Improving non-invasive ventilation documentation.

    PubMed

    Smith, Matthew; Elkheir, Natalie

    2014-01-01

    Record keeping for patients on non-invasive ventilation (NIV) at St. Georges Hospital is poor. The initial NIV prescription is often not recorded, and changes to the NIV prescription or the rationale for the changes (ABG results) are also poorly documented. This leads to confusion for nurses/doctors as to what the correct settings are, meaning patients could receive ineffective ventilation. The use of NIV is also poorly recorded by nursing staff meaning that doctors are unsure if the prescribed NIV is being achieved. This can lead to treatment being escalated unnecessarily in the event of treatment failure. Non-invasive ventilation (NIV) is the provision of ventilatory support in the form of positive pressure via the patient's upper airway using a mask or similar device. NIV is indicated for treatment of acute hypercapnic respiratory failure, of which there are many causes, though COPD is the indication in up to 70% of cases.[1] British Thoracic Society (BTS) guidelines for NIV suggest that the rationale for commencing a patient on NIV and the proposed settings should be clearly documented.[2] Clinicians cannot effectively tailor changes to the patients NIV settings if this information is not clearly recorded, which could lead to increased time requiring NIV or NIV failure. Three main areas were considered important to measure for this project. The initial prescription of the NIV, changes to the NIV settings, and nursing documentation surrounding NIV. A baseline measurement of NIV documentation for two weeks found NIV documentation to globally very poor. NIV was formally prescribed 29% of the time, full detail of intended settings were documented 57% of the time, the decision to commence NIV was discussed with the respiratory consultant/SpR just 29% of the time and on no occasion was a decision regarding escalation of treatment recorded. Eighteen changes were made to the NIV settings. These were formally prescribed 22% of the time and detail of the intended

  16. Non-invasive Ventilation in Premature Infants: Based on Evidence or Habit

    PubMed Central

    Garg, Shalabh; Sinha, Sunil

    2013-01-01

    Despite surfactant and mechanical ventilation being the standard of care for preterm infants with respiratory failure, non-invasive respiratory support is increasingly being employed in neonatal units. The latter can be accomplished in a variety of ways but none of them have been proven so far to be superior to intubation and mechanical ventilation. Nonetheless, they appear to be safe and effective in experienced hands. This article relates to the use of non-invasive forms of respiratory support and evidence is reviewed from the clinical trials which have evaluated the use of these techniques. PMID:24404523

  17. Sleep and Mechanical Ventilation in Critical Care.

    PubMed

    Blissitt, Patricia A

    2016-06-01

    Sleep disturbances in critically ill mechanically ventilated patients are common. Although many factors may potentially contribute to sleep loss in critical care, issues around mechanical ventilation are among the more complex. Sleep deprivation has systemic effects that may prolong the need for mechanical ventilation and length of stay in critical care and result in worse outcomes. This article provides a brief review of the physiology of sleep, physiologic changes in breathing associated with sleep, and the impact of mechanical ventilation on sleep. A summary of the issues regarding research studies to date is also included. Recommendations for the critical care nurse are provided. PMID:27215357

  18. The basis and basics of mechanical ventilation.

    PubMed

    Bone, R C; Eubanks, D H

    1991-06-01

    The development of mechanical ventilators and the procedures for their application began with the simple foot pump developed by Fell O'Dwyer in 1888. Ventilators have progressed through three generations, beginning with intermittent positive pressure breathing units such as the Bird and Bennett device in the 1960s. These were followed by second-generation units--represented by the Bennett MA-2 ventilator--in the 1970s, and the third-generation microprocessor-controlled units of today. During this evolutionary process clinicians recognized Types I and II respiratory failure as being indicators for mechanical ventilatory support. More recently investigators have expanded, clarified, and clinically applied the physiology of the work of breathing (described by Julius Comroe and other pioneers) to muscle fatigue, requiring ventilatory support. A ventilator classification system can help the clinician understand how ventilators function and under what conditions they may fail to operate as desired. Pressure-support ventilation is an example of how industry has responded to a clinical need--that is, to unload the work of breathing. All positive pressure ventilators generate tidal volumes by using power sources such as medical gas cylinders, air compressors, electrically driven turbines, or piston driven motors. Positive end-expiratory pressures, synchronized intermittent mandatory ventilation, pressure support ventilation, pressure release ventilation, and mandatory minute ventilation, are examples of the special functions available on modern ventilators. Modern third-generation ventilators use microprocessors to control operational functions and monitors. Because these units have incorporated the experience learned from earlier ventilators, it is imperative that clinicians understand basic ventilator operation and application in order to most effectively prescribe and assess their use. PMID:2036934

  19. Echocardiography in a Patient on Mechanical Ventilation.

    PubMed

    Sachdeva, Ankush

    2015-07-01

    Cardiopulmonary interactions or effects of spontaneous and mechanical ventilation (MV) were first documented in the year 1733. Stephen Hales showed that the blood pressure of healthy individual fell during spontaneous inspiration and he later went on to discover the ventilator. A year later Kussmaul described pulsus paradoxus (inspiratory absence of radial pulse) in patients with tubercular pericarditis. Echocardiography can help to diagnose a wide variety of cardiovascular diseases and can guide therapeutic decisions in patients on mechanical ventilation. PMID:26731826

  20. Exercise oscillatory ventilation: Mechanisms and prognostic significance

    PubMed Central

    Dhakal, Bishnu P; Lewis, Gregory D

    2016-01-01

    Alteration in breathing patterns characterized by cyclic variation of ventilation during rest and during exercise has been recognized in patients with advanced heart failure (HF) for nearly two centuries. Periodic breathing (PB) during exercise is known as exercise oscillatory ventilation (EOV) and is characterized by the periods of hyperpnea and hypopnea without interposed apnea. EOV is a non-invasive parameter detected during submaximal cardiopulmonary exercise testing. Presence of EOV during exercise in HF patients indicates significant impairment in resting and exercise hemodynamic parameters. EOV is also an independent risk factor for poor prognosis in HF patients both with reduced and preserved ejection fraction irrespective of other gas exchange variables. Circulatory delay, increased chemosensitivity, pulmonary congestion and increased ergoreflex signaling have been proposed as the mechanisms underlying the generation of EOV in HF patients. There is no proven treatment of EOV but its reversal has been noted with phosphodiesterase inhibitors, exercise training and acetazolamide in relatively small studies. In this review, we discuss the mechanistic basis of PB during exercise and the clinical implications of recognizing PB patterns in patients with HF. PMID:27022457

  1. Comparison of conventional mechanical ventilation and synchronous independent lung ventilation (SILV) in the treatment of unilateral lung injury.

    PubMed

    Hurst, J M; DeHaven, C B; Branson, R D

    1985-08-01

    Eight patients presenting with severe unilateral pulmonary injury responded poorly to conventional mechanical ventilation. Synchronous independent lung ventilation (SILV) was employed to provide support of ventilation and oxygenation without creating the ventilation/perfusion (V/Q) mismatch observed during conventional ventilation. All patients demonstrated improved oxygenation (mean increase, 80 torr) during SILV with the FIO2 unchanged from previous therapy. Invasive hemodynamic monitoring in five of eight patients showed no difference in the commonly measured cardiopulmonary parameters with the two forms of mechanical ventilation. Peak inspiratory pressure (PIP), continuous positive airway pressure (CPAP), and pressure change secondary to tidal volume delivery to the uninvolved lung were significantly less during SILV. SILV is an effective method of improving oxygenation in patients with severe unilateral pulmonary injury. PMID:3894680

  2. Humidification during Mechanical Ventilation in the Adult Patient

    PubMed Central

    Al Ashry, Haitham S.; Modrykamien, Ariel M.

    2014-01-01

    Humidification of inhaled gases has been standard of care in mechanical ventilation for a long period of time. More than a century ago, a variety of reports described important airway damage by applying dry gases during artificial ventilation. Consequently, respiratory care providers have been utilizing external humidifiers to compensate for the lack of natural humidification mechanisms when the upper airway is bypassed. Particularly, active and passive humidification devices have rapidly evolved. Sophisticated systems composed of reservoirs, wires, heating devices, and other elements have become part of our usual armamentarium in the intensive care unit. Therefore, basic knowledge of the mechanisms of action of each of these devices, as well as their advantages and disadvantages, becomes a necessity for the respiratory care and intensive care practitioner. In this paper, we review current methods of airway humidification during invasive mechanical ventilation of adult patients. We describe a variety of devices and describe the eventual applications according to specific clinical conditions. PMID:25089275

  3. Mechanisms of Perineural Invasion.

    PubMed

    Bakst, Richard L; Wong, Richard J

    2016-04-01

    Perineural invasion (PNI) is the neoplastic invasion of nerves. PNI is widely recognized as an important adverse pathological feature of many malignancies, including pancreatic, prostate, and head and neck cancers and is associated with a poor prognosis. Despite widespread acknowledgment of the clinical significance of PNI, the mechanisms underlying its pathogenesis remain largely unknown. Recent theories of PNI pathogenesis have placed a significant emphasis on the active role of the nerve microenvironment, with PNI resulting from well-orchestrated reciprocal interactions between cancer and host. Elucidating the mechanisms involved in PNI may translate into targeted therapies for this ominous process. PMID:27123385

  4. Exhaled breath condensate collection in the mechanically ventilated patient.

    PubMed

    Carter, Stewart R; Davis, Christopher S; Kovacs, Elizabeth J

    2012-05-01

    Collection of exhaled breath condensate (EBC) is a non-invasive means of sampling the airway-lining fluid of the lungs. EBC contains numerous measurable mediators, whose analysis could change the management of patients with certain pulmonary diseases. While initially popularized in investigations involving spontaneously breathing patients, an increasing number of studies have been performed using EBC in association with mechanical ventilation. Collection of EBC in mechanically ventilated patients follows basic principles of condensation, but is influenced by multiple factors. Effective collection requires selection of a collection device, adequate minute ventilation, low cooling temperatures, and sampling times of greater than 10 min. Condensate can be contaminated by saliva, which needs to be filtered. Dilution of samples occurs secondary to distilled water in vapors and humidification in the ventilator circuit. Dilution factors may need to be employed when investigating non-volatile biomarkers. Storage and analysis should occur promptly at -70 °C to -80 °C to prevent rapid degradation of samples. The purpose of this review is to examine and describe methodologies and problems of EBC collection in mechanically ventilated patients. A straightforward and safe framework has been established to investigate disease processes in this population, yet technical aspects of EBC collection still exist that prevent clinical practicality of this technology. These include a lack of standardization of procedure and analysis of biomarkers, and of normal reference ranges for mediators in healthy individuals. Once these procedural aspects have been addressed, EBC could serve as a non-invasive alternative to invasive evaluation of lungs in mechanically ventilated patients. PMID:22398157

  5. New modes of assisted mechanical ventilation.

    PubMed

    Suarez-Sipmann, F

    2014-05-01

    Recent major advances in mechanical ventilation have resulted in new exciting modes of assisted ventilation. Compared to traditional ventilation modes such as assisted-controlled ventilation or pressure support ventilation, these new modes offer a number of physiological advantages derived from the improved patient control over the ventilator. By implementing advanced closed-loop control systems and using information on lung mechanics, respiratory muscle function and respiratory drive, these modes are specifically designed to improve patient-ventilator synchrony and reduce the work of breathing. Depending on their specific operational characteristics, these modes can assist spontaneous breathing efforts synchronically in time and magnitude, adapt to changing patient demands, implement automated weaning protocols, and introduce a more physiological variability in the breathing pattern. Clinicians have now the possibility to individualize and optimize ventilatory assistance during the complex transition from fully controlled to spontaneous assisted ventilation. The growing evidence of the physiological and clinical benefits of these new modes is favoring their progressive introduction into clinical practice. Future clinical trials should improve our understanding of these modes and help determine whether the claimed benefits result in better outcomes. PMID:24507472

  6. Prolonged Mechanical Ventilation (PMV): When is it Justified in ICU?

    PubMed

    Trivedi, Trupti H

    2015-10-01

    Over years, the number of patients requiring prolonged mechanical ventilation (PMV) in ICU has increased. Trends in the numbers of patients requiring PMV are of interest to health service planners because they consume a disproportionate amount of healthcare resources, and have high illness costs.1 PMV is defined as need of invasive mechanical ventilation for consecutive 21 days for at least 6 hours per day. With improvement in ICU care more patients survive acute respiratory failure and with that number of patients requiring PMV is likely to increase further. In a large multi centric study in United Kingdom the incidence PMV was 4.4 per 100 ICU admissions, and 6.3 per 100 ventilated ICU admissions. Also these patients used 29.1% of all general ICU bed days, had longer hospital stay after ICU discharge than non-PMV patients and had higher hospital mortality (40.3% vs 33.8%, P = 0.02).2. PMID:27608685

  7. Mechanical ventilation and mobilization: comparison between genders.

    PubMed

    Daniel, Christiane Riedi; Alessandra de Matos, Carla; Barbosa de Meneses, Jessica; Bucoski, Suzane Chaves Machado; Fréz, Andersom Ricardo; Mora, Cintia Teixeira Rossato; Ruaro, João Afonso

    2015-04-01

    [Purpose] To investigate the impact of gender on mobilization and mechanical ventilation in hospitalized patients in an intensive care unit. [Subjects and Methods] A retrospective cross-sectional study was conducted of the medical records of 105 patients admitted to a general intensive care unit. The length of mechanical ventilation, length of intensive care unit stay, weaning, time to sitting out of bed, time to performing active exercises, and withdrawal of sedation exercises were evaluated in addition to the characteristics of individuals, reasons for admission and risk scores. [Results] Women had significantly lower values APACHE II scores, duration of mechanical ventilation, time to withdrawal of sedation and time to onset of active exercises. [Conclusion] Women have a better functional response when admitted to the intensive care unit, spending less time ventilated and performing active exercises earlier. PMID:25995558

  8. [Weaning from mechanical ventilation. Weaning categories and weaning concepts].

    PubMed

    Geiseler, J; Kelbel, C

    2016-04-01

    The international classification of three weaning categories (simple weaning, difficult weaning, prolonged weaning) has been modified in the German weaning guidelines: the group of prolonged weaning has been subclassified into weaning without noninvasive ventilation (NIV), weaning with NIV, if necessary with continuing NIV in the form of home mechanical ventilation, and weaning failure.Strategies to prevent prolonged weaning comprise daily interruption of sedation, daily screening of capability of spontaneous breathing by a spontaneous breathing trial (SBT) and early implementation of NIV instead of continuing invasive mechanical ventilation especially in hypercapnic patients. The comorbidity left heart failure plays a major role in weaning failure and need for re-intubation-in this case early diagnosis and if necessary modification of heart therapy are important.Specialised weaning-centres offer the option for successful weaning for about 50-60 % of patients declared as unweanable by usual intensive care units. A multimodal therapy concept with respiratory therapists, physiotherapists and speech therapy is necessary to reach this goal. In case of weaning failure a professional discharge management to invasive home mechanical ventilation is important. Competent care by physicians in the out-of-hospital area is restricted by the sectoral division of responsibility by the German health care system. Improvement in this area is urgently needed. PMID:27084181

  9. Pulmonary perfusion during anesthesia and mechanical ventilation.

    PubMed

    Hedenstierna, G

    2005-06-01

    Cardiac output and the pulmonary perfusion can be affected by anesthesia and by mechanical ventilation. The changes contribute to impeded oxygenation of the blood. The major determinant of perfusion distribution in the lung is the relation between alveolar and pulmonary capillary pressures. Perfusion increases down the lung, due to hydrostatic forces. Since atelectasis is located in dependent lung regions, perfusion of non-ventilated lung parenchyma is common, producing shunt of around 8-10% of cardiac output. In addition, non-gravitational inhomogeneity of perfusion, that can be greater than the gravitational inhomogeneity, adds to impeded oxygenation of blood. Essentially all anaesthetics exert some, although mild, cardiodepressant action with one exception, ketamine. Ketamine may also increase pulmonary artery pressure, whereas other agents have little effect on pulmonary vascular tone. Mechanical ventilation impedes venous return and pushes blood flow downwards to dependent lung regions, and the effect may be striking with higher levels of PEEP. During one-lung anesthesia, there is shunt blood flow both in the non-ventilated and the ventilated lung, and shunt can be much larger in the ventilated lung than thought of. Recruitment manoeuvres shall be directed to the ventilated lung and other physical and pharmacological measures can be taken to manipulate blood flow in one lung anesthesia. PMID:15886595

  10. Iatrogenic pneumothorax related to mechanical ventilation

    PubMed Central

    Hsu, Chien-Wei; Sun, Shu-Fen

    2014-01-01

    Pneumothorax is a potentially lethal complication associated with mechanical ventilation. Most of the patients with pneumothorax from mechanical ventilation have underlying lung diseases; pneumothorax is rare in intubated patients with normal lungs. Tension pneumothorax is more common in ventilated patients with prompt recognition and treatment of pneumothorax being important to minimize morbidity and mortality. Underlying lung diseases are associated with ventilator-related pneumothorax with pneumothoraces occurring most commonly during the early phase of mechanical ventilation. The diagnosis of pneumothorax in critical illness is established from the patients’ history, physical examination and radiological investigation, although the appearances of a pneumothorax on a supine radiograph may be different from the classic appearance on an erect radiograph. For this reason, ultrasonography is beneficial for excluding the diagnosis of pneumothorax. Respiration-dependent movement of the visceral pleura and lung surface with respect to the parietal pleura and chest wall can be easily visualized with transthoracic sonography given that the presence of air in the pleural space prevents sonographic visualization of visceral pleura movements. Mechanically ventilated patients with a pneumothorax require tube thoracostomy placement because of the high risk of tension pneumothorax. Small-bore catheters are now preferred in the majority of ventilated patients. Furthermore, if there are clinical signs of a tension pneumothorax, emergency needle decompression followed by tube thoracostomy is widely advocated. Patients with pneumothorax related to mechanical ventilation who have tension pneumothorax, a higher acute physiology and chronic health evaluation II score or PaO2/FiO2 < 200 mmHg were found to have higher mortality. PMID:24834397

  11. 46 CFR 154.1200 - Mechanical ventilation system: General.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 5 2010-10-01 2010-10-01 false Mechanical ventilation system: General. 154.1200 Section... Equipment Cargo Area: Mechanical Ventilation System § 154.1200 Mechanical ventilation system: General. (a... cargo handling equipment must have a fixed, exhaust-type mechanical ventilation system. (b)...

  12. Mechanical Ventilation and ARDS in the ED

    PubMed Central

    Mohr, Nicholas M.; Miller, Christopher N.; Deitchman, Andrew R.; Castagno, Nicole; Hassebroek, Elizabeth C.; Dhedhi, Adam; Scott-Wittenborn, Nicholas; Grace, Edward; Lehew, Courtney; Kollef, Marin H.

    2015-01-01

    BACKGROUND: There are few data regarding mechanical ventilation and ARDS in the ED. This could be a vital arena for prevention and treatment. METHODS: This study was a multicenter, observational, prospective, cohort study aimed at analyzing ventilation practices in the ED. The primary outcome was the incidence of ARDS after admission. Multivariable logistic regression was used to determine the predictors of ARDS. RESULTS: We analyzed 219 patients receiving mechanical ventilation to assess ED ventilation practices. Median tidal volume was 7.6 mL/kg predicted body weight (PBW) (interquartile range, 6.9-8.9), with a range of 4.3 to 12.2 mL/kg PBW. Lung-protective ventilation was used in 122 patients (55.7%). The incidence of ARDS after admission from the ED was 14.7%, with a mean onset of 2.3 days. Progression to ARDS was associated with higher illness severity and intubation in the prehospital environment or transferring facility. Of the 15 patients with ARDS in the ED (6.8%), lung-protective ventilation was used in seven (46.7%). Patients who progressed to ARDS experienced greater duration in organ failure and ICU length of stay and higher mortality. CONCLUSIONS: Lung-protective ventilation is infrequent in patients receiving mechanical ventilation in the ED, regardless of ARDS status. Progression to ARDS is common after admission, occurs early, and worsens outcome. Patient- and treatment-related factors present in the ED are associated with ARDS. Given the limited treatment options for ARDS, and the early onset after admission from the ED, measures to prevent onset and to mitigate severity should be instituted in the ED. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT01628523; URL: www.clinicaltrials.gov PMID:25742126

  13. Cardiac output estimation using pulmonary mechanics in mechanically ventilated patients

    PubMed Central

    2010-01-01

    The application of positive end expiratory pressure (PEEP) in mechanically ventilated (MV) patients with acute respiratory distress syndrome (ARDS) decreases cardiac output (CO). Accurate measurement of CO is highly invasive and is not ideal for all MV critically ill patients. However, the link between the PEEP used in MV, and CO provides an opportunity to assess CO via MV therapy and other existing measurements, creating a CO measure without further invasiveness. This paper examines combining models of diffusion resistance and lung mechanics, to help predict CO changes due to PEEP. The CO estimator uses an initial measurement of pulmonary shunt, and estimations of shunt changes due to PEEP to predict CO at different levels of PEEP. Inputs to the cardiac model are the PV loops from the ventilator, as well as the oxygen saturation values using known respiratory inspired oxygen content. The outputs are estimates of pulmonary shunt and CO changes due to changes in applied PEEP. Data from two published studies are used to assess and initially validate this model. The model shows the effect on oxygenation due to decreased CO and decreased shunt, resulting from increased PEEP. It concludes that there is a trade off on oxygenation parameters. More clinically importantly, the model also examines how the rate of CO drop with increased PEEP can be used as a method to determine optimal PEEP, which may be used to optimise MV therapy with respect to the gas exchange achieved, as well as accounting for the impact on the cardiovascular system and its management. PMID:21108836

  14. Cardiac output estimation using pulmonary mechanics in mechanically ventilated patients.

    PubMed

    Sundaresan, Ashwath; Chase, J Geoffrey; Hann, Christopher E; Shaw, Geoffrey M

    2010-01-01

    The application of positive end expiratory pressure (PEEP) in mechanically ventilated (MV) patients with acute respiratory distress syndrome (ARDS) decreases cardiac output (CO). Accurate measurement of CO is highly invasive and is not ideal for all MV critically ill patients. However, the link between the PEEP used in MV, and CO provides an opportunity to assess CO via MV therapy and other existing measurements, creating a CO measure without further invasiveness.This paper examines combining models of diffusion resistance and lung mechanics, to help predict CO changes due to PEEP. The CO estimator uses an initial measurement of pulmonary shunt, and estimations of shunt changes due to PEEP to predict CO at different levels of PEEP. Inputs to the cardiac model are the PV loops from the ventilator, as well as the oxygen saturation values using known respiratory inspired oxygen content. The outputs are estimates of pulmonary shunt and CO changes due to changes in applied PEEP. Data from two published studies are used to assess and initially validate this model.The model shows the effect on oxygenation due to decreased CO and decreased shunt, resulting from increased PEEP. It concludes that there is a trade off on oxygenation parameters. More clinically importantly, the model also examines how the rate of CO drop with increased PEEP can be used as a method to determine optimal PEEP, which may be used to optimise MV therapy with respect to the gas exchange achieved, as well as accounting for the impact on the cardiovascular system and its management. PMID:21108836

  15. Home mechanical ventilation monitoring software: measure more or measure better?

    PubMed

    Luján, Manel; Sogo, Ana; Monsó, Eduard

    2012-05-01

    In recent years, there has been an increasing interest in knowing the consequences of the patient-ventilator interaction in non-invasive mechanical ventilation. Therefore, several ventilator manufacturers have incorporated into their devices the possibility to monitor ventilation on-line and download the data stored in their internal memories. However, there is not a consensus as to how these data should be presented, and said devices have still not been sufficiently validated to be used systematically in clinical practice. The objective of the present study is to develop a critical, argumentative analysis of the technical characteristics for determining the monitor variables used in the different software programs incorporated in commercial ventilators. Likewise, the study contemplates the presentation of the measurements on the screen display, emphasizing the advantages and defects of each one and analyzing their behavior in common clinical practice situations, such as changes in the interface or the presence of accidental leaks. In addition, solution mechanisms are proposed for establishing future directives for the parameters that are important for clinicians, as well as the manner for providing and interpreting said information. PMID:22206599

  16. [The applied value of BiPAP mechanical ventilation via facial of nasal mask before or after ordinary mechanical ventilation].

    PubMed

    Chen, P

    1998-01-01

    To expore the applied value of BiPAP ventilator before or after regular ventilation, 44 patients who had indicators of regular mechanical ventilation and 4 patients who had difficulty of getting free from endotracheal intubation mechanical ventilation were ventilated with BiPAP ventilator via facial or nasal mask. The results showed that 13/44 patients had good responses and avoided receiving regular mechanical ventilation with endotracheal intubation or incision. BiPAP ventilation was also effective in patients who were dependent on regular mechanical ventilatin. PMID:10682574

  17. Brazilian recommendations of mechanical ventilation 2013. Part 2

    PubMed Central

    Barbas, Carmen Sílvia Valente; Ísola, Alexandre Marini; Farias, Augusto Manoel de Carvalho; Cavalcanti, Alexandre Biasi; Gama, Ana Maria Casati; Duarte, Antonio Carlos Magalhães; Vianna, Arthur; Serpa Neto, Ary; Bravim, Bruno de Arruda; Pinheiro, Bruno do Valle; Mazza, Bruno Franco; de Carvalho, Carlos Roberto Ribeiro; Toufen Júnior, Carlos; David, Cid Marcos Nascimento; Taniguchi, Corine; Mazza, Débora Dutra da Silveira; Dragosavac, Desanka; Toledo, Diogo Oliveira; Costa, Eduardo Leite; Caser, Eliana Bernadete; Silva, Eliezer; Amorim, Fabio Ferreira; Saddy, Felipe; Galas, Filomena Regina Barbosa Gomes; Silva, Gisele Sampaio; de Matos, Gustavo Faissol Janot; Emmerich, João Claudio; Valiatti, Jorge Luis dos Santos; Teles, José Mario Meira; Victorino, Josué Almeida; Ferreira, Juliana Carvalho; Prodomo, Luciana Passuello do Vale; Hajjar, Ludhmila Abrahão; Martins, Luiz Claudio; Malbouisson, Luis Marcelo Sá; Vargas, Mara Ambrosina de Oliveira; Reis, Marco Antonio Soares; Amato, Marcelo Brito Passos; Holanda, Marcelo Alcântara; Park, Marcelo; Jacomelli, Marcia; Tavares, Marcos; Damasceno, Marta Cristina Paulette; Assunção, Murillo Santucci César; Damasceno, Moyzes Pinto Coelho Duarte; Youssef, Nazah Cherif Mohamed; Teixeira, Paulo José Zimmermann; Caruso, Pedro; Duarte, Péricles Almeida Delfino; Messeder, Octavio; Eid, Raquel Caserta; Rodrigues, Ricardo Goulart; de Jesus, Rodrigo Francisco; Kairalla, Ronaldo Adib; Justino, Sandra; Nemer, Sergio Nogueira; Romero, Simone Barbosa; Amado, Verônica Moreira

    2014-01-01

    Perspectives on invasive and noninvasive ventilatory support for critically ill patients are evolving, as much evidence indicates that ventilation may have positive effects on patient survival and the quality of the care provided in intensive care units in Brazil. For those reasons, the Brazilian Association of Intensive Care Medicine (Associação de Medicina Intensiva Brasileira - AMIB) and the Brazilian Thoracic Society (Sociedade Brasileira de Pneumologia e Tisiologia - SBPT), represented by the Mechanical Ventilation Committee and the Commission of Intensive Therapy, respectively, decided to review the literature and draft recommendations for mechanical ventilation with the goal of creating a document for bedside guidance as to the best practices on mechanical ventilation available to their members. The document was based on the available evidence regarding 29 subtopics selected as the most relevant for the subject of interest. The project was developed in several stages, during which the selected topics were distributed among experts recommended by both societies with recent publications on the subject of interest and/or significant teaching and research activity in the field of mechanical ventilation in Brazil. The experts were divided into pairs that were charged with performing a thorough review of the international literature on each topic. All the experts met at the Forum on Mechanical Ventilation, which was held at the headquarters of AMIB in São Paulo on August 3 and 4, 2013, to collaboratively draft the final text corresponding to each sub-topic, which was presented to, appraised, discussed and approved in a plenary session that included all 58 participants and aimed to create the final document. PMID:25295817

  18. Brazilian recommendations of mechanical ventilation 2013. Part I

    PubMed Central

    2014-01-01

    Perspectives on invasive and noninvasive ventilatory support for critically ill patients are evolving, as much evidence indicates that ventilation may have positive effects on patient survival and the quality of the care provided in intensive care units in Brazil. For those reasons, the Brazilian Association of Intensive Care Medicine (Associação de Medicina Intensiva Brasileira - AMIB) and the Brazilian Thoracic Society (Sociedade Brasileira de Pneumologia e Tisiologia - SBPT), represented by the Mechanical Ventilation Committee and the Commission of Intensive Therapy, respectively, decided to review the literature and draft recommendations for mechanical ventilation with the goal of creating a document for bedside guidance as to the best practices on mechanical ventilation available to their members. The document was based on the available evidence regarding 29 subtopics selected as the most relevant for the subject of interest. The project was developed in several stages, during which the selected topics were distributed among experts recommended by both societies with recent publications on the subject of interest and/or significant teaching and research activity in the field of mechanical ventilation in Brazil. The experts were divided into pairs that were charged with performing a thorough review of the international literature on each topic. All the experts met at the Forum on Mechanical Ventilation, which was held at the headquarters of AMIB in São Paulo on August 3 and 4, 2013, to collaboratively draft the final text corresponding to each sub-topic, which was presented to, appraised, discussed and approved in a plenary session that included all 58 participants and aimed to create the final document. PMID:25210957

  19. Brazilian recommendations of mechanical ventilation 2013. Part 2

    PubMed Central

    2014-01-01

    Perspectives on invasive and noninvasive ventilatory support for critically ill patients are evolving, as much evidence indicates that ventilation may have positive effects on patient survival and the quality of the care provided in intensive care units in Brazil. For those reasons, the Brazilian Association of Intensive Care Medicine (Associação de Medicina Intensiva Brasileira - AMIB) and the Brazilian Thoracic Society (Sociedade Brasileira de Pneumologia e Tisiologia - SBPT), represented by the Mechanical Ventilation Committee and the Commission of Intensive Therapy, respectively, decided to review the literature and draft recommendations for mechanical ventilation with the goal of creating a document for bedside guidance as to the best practices on mechanical ventilation available to their members. The document was based on the available evidence regarding 29 subtopics selected as the most relevant for the subject of interest. The project was developed in several stages, during which the selected topics were distributed among experts recommended by both societies with recent publications on the subject of interest and/or significant teaching and research activity in the field of mechanical ventilation in Brazil. The experts were divided into pairs that were charged with performing a thorough review of the international literature on each topic. All the experts met at the Forum on Mechanical Ventilation, which was held at the headquarters of AMIB in São Paulo on August 3 and 4, 2013, to collaboratively draft the final text corresponding to each sub-topic, which was presented to, appraised, discussed and approved in a plenary session that included all 58 participants and aimed to create the final document. PMID:25410835

  20. Brazilian recommendations of mechanical ventilation 2013. Part I

    PubMed Central

    Barbas, Carmen Sílvia Valente; Ísola, Alexandre Marini; Farias, Augusto Manoel de Carvalho; Cavalcanti, Alexandre Biasi; Gama, Ana Maria Casati; Duarte, Antonio Carlos Magalhães; Vianna, Arthur; Serpa, Ary; Bravim, Bruno de Arruda; Pinheiro, Bruno do Valle; Mazza, Bruno Franco; de Carvalho, Carlos Roberto Ribeiro; Toufen, Carlos; David, Cid Marcos Nascimento; Taniguchi, Corine; Mazza, Débora Dutra da Silveira; Dragosavac, Desanka; Toledo, Diogo Oliveira; Costa, Eduardo Leite; Caser, Eliana Bernardete; Silva, Eliezer; Amorim, Fabio Ferreira; Saddy, Felipe; Galas, Filomena Regina Barbosa Gomes; Silva, Gisele Sampaio; de Matos, Gustavo Faissol Janot; Emmerich, João Claudio; Valiatti, Jorge Luis dos Santos; Teles, José Mario Meira; Victorino, Josué Almeida; Ferreira, Juliana Carvalho; Prodomo, Luciana Passuello do Vale; Hajjar, Ludhmila Abrahão; Martins, Luiz Cláudio; Malbouisson, Luiz Marcelo Sá; Vargas, Mara Ambrosina de Oliveira; Reis, Marco Antonio Soares; Amato, Marcelo Brito Passos; Holanda, Marcelo Alcântara; Park, Marcelo; Jacomelli, Marcia; Tavares, Marcos; Damasceno, Marta Cristina Paulette; Assunção, Murillo Santucci César; Damasceno, Moyzes Pinto Coelho Duarte; Youssef, Nazah Cherif Mohamad; Teixeira, Paulo José Zimmermann; Caruso, Pedro; Duarte, Péricles Almeida Delfino; Messeder, Octavio; Eid, Raquel Caserta; Rodrigues, Ricardo Goulart; de Jesus, Rodrigo Francisco; Kairalla, Ronaldo Adib; Justino, Sandra; Nemer, Sérgio Nogueira; Romero, Simone Barbosa; Amado, Verônica Moreira

    2014-01-01

    Perspectives on invasive and noninvasive ventilatory support for critically ill patients are evolving, as much evidence indicates that ventilation may have positive effects on patient survival and the quality of the care provided in intensive care units in Brazil. For those reasons, the Brazilian Association of Intensive Care Medicine (Associação de Medicina Intensiva Brasileira - AMIB) and the Brazilian Thoracic Society (Sociedade Brasileira de Pneumologia e Tisiologia - SBPT), represented by the Mechanical Ventilation Committee and the Commission of Intensive Therapy, respectively, decided to review the literature and draft recommendations for mechanical ventilation with the goal of creating a document for bedside guidance as to the best practices on mechanical ventilation available to their members. The document was based on the available evidence regarding 29 subtopics selected as the most relevant for the subject of interest. The project was developed in several stages, during which the selected topics were distributed among experts recommended by both societies with recent publications on the subject of interest and/or significant teaching and research activity in the field of mechanical ventilation in Brazil. The experts were divided into pairs that were charged with performing a thorough review of the international literature on each topic. All the experts met at the Forum on Mechanical Ventilation, which was held at the headquarters of AMIB in São Paulo on August 3 and 4, 2013, to collaboratively draft the final text corresponding to each sub-topic, which was presented to, appraised, discussed and approved in a plenary session that included all 58 participants and aimed to create the final document. PMID:25028944

  1. Patient Machine Interface for the Control of Mechanical Ventilation Devices

    PubMed Central

    Grave de Peralta, Rolando; Gonzalez Andino, Sara; Perrig, Stephen

    2013-01-01

    The potential of Brain Computer Interfaces (BCIs) to translate brain activity into commands to control external devices during mechanical ventilation (MV) remains largely unexplored. This is surprising since the amount of patients that might benefit from such assistance is considerably larger than the number of patients requiring BCI for motor control. Given the transient nature of MV (i.e., used mainly over night or during acute clinical conditions), precluding the use of invasive methods, and inspired by current research on BCIs, we argue that scalp recorded EEG (electroencephalography) signals can provide a non-invasive direct communication pathway between the brain and the ventilator. In this paper we propose a Patient Ventilator Interface (PVI) to control a ventilator during variable conscious states (i.e., wake, sleep, etc.). After a brief introduction on the neural control of breathing and the clinical conditions requiring the use of MV we discuss the conventional techniques used during MV. The schema of the PVI is presented followed by a description of the neural signals that can be used for the on-line control. To illustrate the full approach, we present data from a healthy subject, where the inspiration and expiration periods during voluntary breathing were discriminated with a 92% accuracy (10-fold cross-validation) from the scalp EEG data. The paper ends with a discussion on the advantages and obstacles that can be forecasted in this novel application of the concept of BCI. PMID:24961620

  2. Flow measurement in mechanical ventilation: a review.

    PubMed

    Schena, Emiliano; Massaroni, Carlo; Saccomandi, Paola; Cecchini, Stefano

    2015-03-01

    Accurate monitoring of flow rate and volume exchanges is essential to minimize ventilator-induced lung injury. Mechanical ventilators employ flowmeters to estimate the amount of gases delivered to patients and use the flow signal as a feedback to adjust the desired amount of gas to be delivered. Since flowmeters play a crucial role in this field, they are required to fulfill strict criteria in terms of dynamic and static characteristics. Therefore, mechanical ventilators are equipped with only the following kinds of flowmeters: linear pneumotachographs, fixed and variable orifice meters, hot wire anemometers, and ultrasonic flowmeters. This paper provides an overview of these sensors. Their working principles are described together with their relevant advantages and disadvantages. Furthermore, the most promising emerging approaches for flowmeters design (i.e., fiber optic technology and three dimensional micro-fabrication) are briefly reviewed showing their potential for this application. PMID:25659299

  3. Early non-invasive ventilation treatment for severe influenza pneumonia.

    PubMed

    Masclans, J R; Pérez, M; Almirall, J; Lorente, L; Marqués, A; Socias, L; Vidaur, L; Rello, J

    2013-03-01

    The role of non-invasive ventilation (NIV) in acute respiratory failure caused by viral pneumonia remains controversial. Our objective was to evaluate the use of NIV in a cohort of (H1N1)v pneumonia. Usefulness and success of NIV were assessed in a prospective, observational registry of patients with influenza A (H1N1) virus pneumonia in 148 Spanish intensive care units (ICUs) in 2009-10. Significant variables for NIV success were included in a multivariate analysis. In all, 685 patients with confirmed influenza A (H1N1)v viral pneumonia were admitted to participating ICUs; 489 were ventilated, 177 with NIV. The NIV was successful in 72 patients (40.7%), the rest required intubation. Low Acute Physiology and Chronic Health Evaluation (APACHE) II, low Sequential Organ Failure Assessment (SOFA) and absence of renal failure were associated with NIV success. Success of NIV was independently associated with fewer than two chest X-ray quadrant opacities (OR 3.5) and no vasopressor requirement (OR 8.1). However, among patients with two or more quadrant opacities, a SOFA score ≤7 presented a higher success rate than those with SOFA score >7 (OR 10.7). Patients in whom NIV was successful required shorter ventilation time, shorter ICU stay and hospital stay than NIV failure. In patients in whom NIV failed, the delay in intubation did not increase mortality (26.5% versus 24.2%). Clinicians used NIV in 25.8% of influenza A (H1N1)v viral pneumonia admitted to ICU, and treatment was effective in 40.6% of them. NIV success was associated with shorter hospital stay and mortality similar to non-ventilated patients. NIV failure was associated with a mortality similar to those who were intubated from the start. PMID:22404211

  4. Anxiety and Agitation in Mechanically Ventilated Patients

    PubMed Central

    Tate, Judith Ann; Dabbs, Annette Devito; Hoffman, Leslie; Milbrandt, Eric; Happ, Mary Beth

    2013-01-01

    During an ethnography conducted in an intensive care unit (ICU), we found that anxiety and agitation occurred frequently, and were important considerations in the care of 30 patients weaning from prolonged mechanical ventilation. We conducted a secondary analysis to (a) describe characteristics of anxiety and agitation experienced by mechanically ventilated patients; (b) explore how clinicians recognize and interpret anxiety and agitation and (c) describe strategies and interventions used to manage anxiety and agitation with mechanically ventilated patients. We constructed the Anxiety-Agitation in Mechanical Ventilation Model to illustrate the multidimensional features of symptom recognition and management. Patients’ ability to interact with the environment served as a basis for identification and management of anxiety or agitation. Clinicians’ attributions about anxiety or agitation and “knowing the patient” contributed to their assessment of patient responses. Clinicians chose strategies to overcome either the stimulus or patient’s appraisal of risk of the stimulus. This article contributes to the body of knowledge about symptom recognition and management in the ICU by providing a comprehensive model to guide future research and practice. PMID:21908706

  5. A Medical Student Workshop in Mechanical Ventilation.

    ERIC Educational Resources Information Center

    And Others; Kushins, Lawrence G.

    1980-01-01

    In order to teach applied respiratory physiology to medical students, the anesthesiology faculty at the University of Florida College of Medicine has designed and implemented a course that includes a laboratory workshop in mechanical ventilation of an animal model that allows students to apply and expand their knowledge. (JMD)

  6. Complementary home mechanical ventilation techniques. SEPAR Year 2014.

    PubMed

    Chiner, Eusebi; Sancho-Chust, José N; Landete, Pedro; Senent, Cristina; Gómez-Merino, Elia

    2014-12-01

    This is a review of the different complementary techniques that are useful for optimizing home mechanical ventilation (HMV). Airway clearance is very important in patients with HMV and many patients, particularly those with reduced peak cough flow, require airway clearance (manual or assisted) or assisted cough techniques (manual or mechanical) and suctioning procedures, in addition to ventilation. In the case of invasive HMV, good tracheostomy cannula management is essential for success. HMV patients may have sleep disturbances that must be taken into account. Sleep studies including complete polysomnography or respiratory polygraphy are helpful for identifying patient-ventilator asynchrony. Other techniques, such as bronchoscopy or nutritional support, may be required in patients on HMV, particularly if percutaneous gastrostomy is required. Information on treatment efficacy can be obtained from HMV monitoring, using methods such as pulse oximetry, capnography or the internal programs of the ventilators themselves. Finally, the importance of the patient's subjective perception is reviewed, as this may potentially affect the success of the HMV. PMID:25138799

  7. Assessment of mechanical ventilation parameters on respiratory mechanics.

    PubMed

    Pidaparti, Ramana M; Koombua, Kittisak; Ward, Kevin R

    2012-01-01

    Better understanding of airway mechanics is very important in order to avoid lung injuries for patients undergoing mechanical ventilation for treatment of respiratory problems in intensive-care medicine, as well as pulmonary medicine. Mechanical ventilation depends on several parameters, all of which affect the patient outcome. As there are no systematic numerical investigations of the role of mechanical ventilation parameters on airway mechanics, the objective of this study was to investigate the role of mechanical ventilation parameters on airway mechanics using coupled fluid-solid computational analysis. For the airway geometry of 3 to 5 generations considered, the simulation results showed that airflow velocity increased with increasing airflow rate. Airway pressure increased with increasing airflow rate, tidal volume and positive end-expiratory pressure (PEEP). Airway displacement and airway strains increased with increasing airflow rate, tidal volume and PEEP form mechanical ventilation. Among various waveforms considered, sine waveform provided the highest airflow velocity and airway pressure while descending waveform provided the lowest airway pressure, airway displacement and airway strains. These results combined with optimization suggest that it is possible to obtain a set of mechanical ventilation strategies to avoid lung injuries in patients. PMID:22136584

  8. [Monitorization of respiratory mechanics in the ventilated patient].

    PubMed

    García-Prieto, E; Amado-Rodríguez, L; Albaiceta, G M

    2014-01-01

    Monitoring during mechanical ventilation allows the measurement of different parameters of respiratory mechanics. Accurate interpretation of these data can be useful for characterizing the situation of the different components of the respiratory system, and for guiding ventilator settings. In this review, we describe the basic concepts of respiratory mechanics, their interpretation, and their potential use in fine-tuning mechanical ventilation. PMID:24199991

  9. Pitfalls of mechanical ventilation in Thailand.

    PubMed

    Bunburaphong, Thananchai

    2014-01-01

    Pitfalls in the respiratory care and mechanical ventilation for patients continue to prevail in intensive care unit (ICU) or in some hospital wards in Thailand. There are two reasons that explain this phenomenon. Firstly, there are no professional respiratory therapists in Thailand. Secondly, most caregivers do not possess the adequate knowledge and skills requiredfor respiratory care and for initiating, maintaining and weaning patients off mechanical ventilation. Physicians and nurses have to practice in respiratory care and mechanical ventilation without participating in adequate training during their undergraduate studies and postgraduate training. In reality, physicians pay almost no attention to respiratory care. They leave the respiratory toilet, ventilator changes and monitoring of the patients to nurses who have many other tasks to attend to. To solve this problem will require restructuring of the Thai healthcare system. The Parliament will need to pass a "Respiratory Therapy Profession Act" to certify "respiratory therapists " as a new, registered health profession. The Office of the Civil Service Commission has to take the responsibility for creating the job title and a job description for respiratory therapists. Academic institutes have to provide training courses in respiratory therapy and grant appropriate levels of diplomas or certificates in respiratory therapy. Did actics and clinical skills required for respiratory care have to be sufficiently integrated into the curricula for medical students as well as nursing students. Physicians and nurses need to master their skills and acquired appropriate knowledge in respiratory care and mechanical ventilation until we can assure the necessary number of registered or certified respiratory therapists here in Thailand to help avoid such pitfalls. PMID:24855857

  10. Intermittent daytime mouthpiece ventilation successfully augments nocturnal non-invasive ventilation, controlling ventilatory failure and maintaining patient independence.

    PubMed

    Ward, Karen; Ford, Verity; Ashcroft, Helen; Parker, Robert

    2015-01-01

    A 53-year-old woman with spinal muscular atrophy and a 7-year history of nocturnal non-invasive ventilation (NIV) use via nasal mask and chinstrap was admitted electively. Outpatient review suggested symptomatic hypercapnia and hypoxaemia. Use of her usual NIV resulted in early morning respiratory acidosis due to excess mouth leak, and continuous face mask NIV was instigated while in hospital. Once stabilised, she elected to return to nasal ventilation. At outpatient review, respiratory acidosis reoccurred despite diurnal use of NIV. Using the patient's routine ventilator and a novel mouthpiece and trigger algorithm, intermittent daytime mouthpiece ventilation (MPV) was introduced alongside overnight NIV. Control of respiratory failure was achieved and, vitally, independent living maintained. Intermittent MPV was practicable and effective where the limits of ventilator tolerance had otherwise been reached. MPV may reduce the need for tracheostomy ventilation and this case serves as a reminder of the increasing options routinely available to NIV clinicians. PMID:26160549

  11. History of Mechanical Ventilation. From Vesalius to Ventilator-induced Lung Injury.

    PubMed

    Slutsky, Arthur S

    2015-05-15

    Mechanical ventilation is a life-saving therapy that catalyzed the development of modern intensive care units. The origins of modern mechanical ventilation can be traced back about five centuries to the seminal work of Andreas Vesalius. This article is a short history of mechanical ventilation, tracing its origins over the centuries to the present day. One of the great advances in ventilatory support over the past few decades has been the development of lung-protective ventilatory strategies, based on our understanding of the iatrogenic consequences of mechanical ventilation such as ventilator-induced lung injury. These strategies have markedly improved clinical outcomes in patients with respiratory failure. PMID:25844759

  12. [Home mechanical ventilation-tracheostomy ventilation, for the long-term and variation].

    PubMed

    Yamamoto, Makoto

    2006-12-01

    We experienced long-term ventilation for 30 patients mostly with amyotrophic lateral sclerosis (ALS). For long-term ventilation by tracheostomy positive pressure ventilation (TPPV), we must set tidal volume (TV) over 600 ml, because setting 400 ml as TV usually applied in Japan, often develops atelectasis which causes frequent or serious pneumonia. To avoid both the elevation of airway pressure and hyper ventilation, the following intervals are needed: 10 times/min for breathing frequency and 2 seconds for exhaling time. In the cases with ventilator induced lung injury (VILI), it is necessary to lower the TV and to treat with steroid pulse therapy. In the transitional stage from non-invasive positive pressure ventilation (NPPV) to TPPV, we conduct tracheostomy for suction of the sputum. In that stage, by using a cuffless tracheal canule, we can continue NPPV. As another method in that stage, we recommend biphasic management by NPPV at daytime and TPPV at nighttime with a bi-level ventilator. This method can provide certain ventilation also during sleep. When the respiratory failure proceeds further, we manage the ventilation with a bi-level ventilator on TPPV, because a bi-level ventilator is also good adapting to assist spontaneous breathing in that stage. And if the patient does not have bulbar paralysis, the patient can utter by air leakage with using bi-level ventilator and flattening the cuff of the tracheal canule. PMID:17469348

  13. Use of dexmedetomidine to facilitate non-invasive ventilation

    PubMed Central

    DeMuro, Jonas P; Mongelli, Michael N; Hanna, Adel F

    2013-01-01

    Patients with chronic obstructive pulmonary disease and congestive heart failure exacerbations, as well as pneumonia benefit from the use of non-invasive ventilation (NIV), due to increased patient comfort and a reduced incidence of ventilator-associated pneumonia. However, some patients do not tolerate NIV due to anxiety or agitation, and traditionally physicians have withheld sedation from these patients due to concerns of loss of airway protection and respiratory depression. We report our recent experience with a 91-year-old female who received NIV for acute respiratory distress secondary to pneumonia. The duration of NIV was a total time period of 86 h, using the bilevel positive airway pressure mode via a full face mask. The patient was initially agitated with the NIV, but with the addition of the dexmedetomidine, she tolerated it well. The dexmedetomidine was administered without a loading dose, as a continuous infusion ranging from 0.2 to 0.5 mcg/kg/hr, titrated to a Ramsey score of three. This case illustrates the safe use of dexmedetomidine to facilitate NIV, and improve compliance, which may reduce ICU length of stay. PMID:24459626

  14. Neurally adjusted non-invasive ventilation in patients with chronic obstructive pulmonary disease: does patient-ventilator synchrony matter?

    PubMed

    Nava, Stefano; Pisani, Lara

    2014-01-01

    Patient-ventilator interaction represents an important clinical challenge during non-invasive ventilation (NIV). Doorduin and colleagues' study shows that non-invasive neurally adjusted ventilatory assist (NAVA) improves patient-ventilator interaction compared with pressure support ventilation in patients with chronic obstructive pulmonary disease. There is no doubt nowadays that NAVA is the most effective mode of improving the synchrony between patient and machine, but the key question for the clinicians is whether or not this will make a difference to the patient's outcome. The results of the study still do not clarify this issue because of the very low clinically important dyssynchrony, like wasted efforts, in the population studied. Air leaks play an important role in determining patient-ventilator interaction and therefore NIV success or failure. Apart from the use of a dedicated NIV ventilator or specific modes of ventilation like NAVA, the clinicians should be aware that the choice of interface, the humidification system and the appropriate sedation are key factors in improving patient-ventilator synchrony. PMID:25672776

  15. Bilateral Scapulohumeral Ankylosis after Prolonged Mechanical Ventilation.

    PubMed

    van Lotten, Manon L; Schreinemakers, J Rieneke; van Noort, Arthur; Rademakers, Maarten V

    2016-09-01

    This case demonstrates a rarely reported bilateral scapulohumeral bony ankylosis. A young woman developed extensive heterotopic ossifications (HOs) in both shoulder joints after being mechanically ventilated for several months at the intensive care unit in a comatose status. She presented with a severe movement restriction of both shoulder joints. Surgical resection of the bony bridges was performed in 2 separate sessions with a significant improvement of shoulder function afterwards. No postoperative complications, pain, or recurrence of HOs were noted at 1-year follow-up. Mechanical ventilation, immobilization, neuromuscular blockage, and prolonged sedation are known risk factors for the development of HOs in the shoulder joints. Relatively early surgical resection of the HOs can be performed safely in contrary to earlier belief. Afterwards, nonsteroidal anti-inflammatory drugs and/or radiation therapy can be possible treatment modalities to prevent recurrence of HOs. PMID:27583120

  16. Bilateral Scapulohumeral Ankylosis after Prolonged Mechanical Ventilation

    PubMed Central

    Schreinemakers, J. Rieneke; van Noort, Arthur; Rademakers, Maarten V.

    2016-01-01

    This case demonstrates a rarely reported bilateral scapulohumeral bony ankylosis. A young woman developed extensive heterotopic ossifications (HOs) in both shoulder joints after being mechanically ventilated for several months at the intensive care unit in a comatose status. She presented with a severe movement restriction of both shoulder joints. Surgical resection of the bony bridges was performed in 2 separate sessions with a significant improvement of shoulder function afterwards. No postoperative complications, pain, or recurrence of HOs were noted at 1-year follow-up. Mechanical ventilation, immobilization, neuromuscular blockage, and prolonged sedation are known risk factors for the development of HOs in the shoulder joints. Relatively early surgical resection of the HOs can be performed safely in contrary to earlier belief. Afterwards, nonsteroidal anti-inflammatory drugs and/or radiation therapy can be possible treatment modalities to prevent recurrence of HOs. PMID:27583120

  17. Emergency Department Treatment of the Mechanically Ventilated Patient.

    PubMed

    Spiegel, Rory; Mallemat, Haney

    2016-02-01

    Mechanical ventilation has a long and storied history, but until recently the process required little from the emergency physician. In the modern emergency department, critically ill patients spend a longer period under the care of the emergency physician, requiring a greater understanding of ventilator management. This article serves as an introduction to mechanical ventilation and a user-friendly bedside guide. PMID:26614242

  18. Volumetric capnography in the mechanically ventilated patient.

    PubMed

    Blanch, L; Romero, P V; Lucangelo, U

    2006-06-01

    Expiratory capnogram provides qualitative information on the waveform patterns associated with mechanical ventilation and quantitative estimation of expired CO2. Volumetric capnography simultaneously measures expired CO2 and tidal volume and allows identification of CO2 from 3 sequential lung compartments: apparatus and anatomic dead space, from progressive emptying of alveoli and alveolar gas. Lung heterogeneity creates regional differences in CO2 concentration and sequential emptying contributes to the rise of the alveolar plateau and to the steeper the expired CO2 slope. The concept of dead space accounts for those lung areas that are ventilated but not perfused. In patients with sudden pulmonary vascular occlusion due to pulmonary embolism, the resultant high V/Q mismatch produces an increase in alveolar dead space. Calculations derived from volumetric capnography are useful to suspect pulmonary embolism at the bedside. Alveolar dead space is large in acute lung injury and when the effect of positive end-expiratory pressure (PEEP) is to recruit collapsed lung units resulting in an improvement of oxygenation, alveolar dead space may decrease, whereas PEEP-induced overdistension tends to increase alveolar dead space. Finally, measurement of physiologic dead space and alveolar ejection volume at admission or the trend during the first 48 hours of mechanical ventilation might provide useful information on outcome of critically ill patients with acute lung injury or acute respiratory distress syndrome. PMID:16682932

  19. Mechanisms Regulating Glioma Invasion

    PubMed Central

    Paw, Ivy; Carpenter, Richard C.; Watabe, Kounosuke; Debinski, Waldemar; Lo, Hui-Wen

    2015-01-01

    Glioblastoma (GBM) is the most aggressive, deadliest, and most common brain malignancy in adults. Despite the advances made in surgical techniques, radiotherapy and chemotherapy, the median survival for GBM patients has remained at a mere 14 months. GBM poses several unique challenges to currently available treatments for the disease. For example, GBM cells have the propensity to aggressively infiltrate/invade into the normal brain tissues and along the vascular tracks, which prevents complete resection of all malignant cells and limits the effect of localized radiotherapy while sparing normal tissue. Although anti-angiogenic treatment exerts anti-edematic effect in GBM, unfortunately, tumors progress with acquired increased invasiveness. Therefore, it is an important task to gain a deeper understanding of the intrinsic and post-treatment invasive phenotypes of GBM in hopes that the gained knowledge would lead to novel GBM treatments that are more effective and less toxic. This review will give an overview of some of the signaling pathways that have been shown to positively and negatively regulate GBM invasion, including, the PI3K/Akt, Wnt, sonic hedgehog-GLI1, and microRNAs. The review will also discuss several approaches to cancer therapies potentially altering GBM invasiveness. PMID:25796440

  20. Collective fluid mechanics of honeybee nest ventilation

    NASA Astrophysics Data System (ADS)

    Gravish, Nick; Combes, Stacey; Wood, Robert J.; Peters, Jacob

    2014-11-01

    Honeybees thermoregulate their brood in the warm summer months by collectively fanning their wings and creating air flow through the nest. During nest ventilation workers flap their wings in close proximity in which wings continuously operate in unsteady oncoming flows (i.e. the wake of neighboring worker bees) and near the ground. The fluid mechanics of this collective aerodynamic phenomena are unstudied and may play an important role in the physiology of colony life. We have performed field and laboratory observations of the nest ventilation wing kinematics and air flow generated by individuals and groups of honeybee workers. Inspired from these field observations we describe here a robotic model system to study collective flapping wing aerodynamics. We microfabricate arrays of 1.4 cm long flapping wings and observe the air flow generated by arrays of two or more fanning robotic wings. We vary phase, frequency, and separation distance among wings and find that net output flow is enhanced when wings operate at the appropriate phase-distance relationship to catch shed vortices from neighboring wings. These results suggest that by varying position within the fanning array honeybee workers may benefit from collective aerodynamic interactions during nest ventilation.

  1. Intraoperative mechanical ventilation strategies for one-lung ventilation.

    PubMed

    Şentürk, Mert; Slinger, Peter; Cohen, Edmond

    2015-09-01

    One-lung ventilation (OLV) has two major challenges: oxygenation and lung protection. The former is mainly because the ventilation of one lung is stopped while the perfusion continues; the latter is mainly because the whole ventilation is applied to only one lung. Recommendations for maintaining the oxygenation and methods of lung protection can contradict each other (such as high vs. low inspiratory oxygen fraction (FiO2), high vs. low tidal volume (TV), etc.). In light of the (very few) randomized clinical trials, this review focuses on a recent strategy for OLV, which includes a possible decrease in FiO2, lower TVs, positive end-expiratory pressure (PEEP) to the dependent lung, continuous positive airway pressure (CPAP) to the non-dependent lung and recruitment manoeuvres. Other applications such as anaesthetic choice and fluid management can affect the success of ventilatory strategy; new developments have changed the classical approach in this respect. PMID:26643100

  2. Newer nonconventional modes of mechanical ventilation.

    PubMed

    Singh, Preet Mohinder; Borle, Anuradha; Trikha, Anjan

    2014-07-01

    The conventional modes of ventilation suffer many limitations. Although they are popularly used and are well-understood, often they fail to match the patient-based requirements. Over the years, many small modifications in ventilators have been incorporated to improve patient outcome. The ventilators of newer generation respond to patient's demands by additional feedback systems. In this review, we discuss the popular newer modes of ventilation that have been accepted in to clinical practice. Various intensive care units over the world have found these modes to improve patient ventilator synchrony, decrease ventilator days and improve patient safety. The various modes discusses in this review are: Dual control modes (volume assured pressure support, volume support), Adaptive support ventilation, proportional assist ventilation, mandatory minute ventilation, Bi-level airway pressure release ventilation, (BiPAP), neurally adjusted ventilatory assist and NeoGanesh. Their working principles with their advantages and clinical limitations are discussed in brief. PMID:25114434

  3. Newer nonconventional modes of mechanical ventilation

    PubMed Central

    Singh, Preet Mohinder; Borle, Anuradha; Trikha, Anjan

    2014-01-01

    The conventional modes of ventilation suffer many limitations. Although they are popularly used and are well-understood, often they fail to match the patient-based requirements. Over the years, many small modifications in ventilators have been incorporated to improve patient outcome. The ventilators of newer generation respond to patient's demands by additional feedback systems. In this review, we discuss the popular newer modes of ventilation that have been accepted in to clinical practice. Various intensive care units over the world have found these modes to improve patient ventilator synchrony, decrease ventilator days and improve patient safety. The various modes discusses in this review are: Dual control modes (volume assured pressure support, volume support), Adaptive support ventilation, proportional assist ventilation, mandatory minute ventilation, Bi-level airway pressure release ventilation, (BiPAP), neurally adjusted ventilatory assist and NeoGanesh. Their working principles with their advantages and clinical limitations are discussed in brief. PMID:25114434

  4. Effects of mechanical ventilation on diaphragm function and biology.

    PubMed

    Gayan-Ramirez, G; Decramer, M

    2002-12-01

    The pathophysiological mechanisms of weaning from mechanical ventilation are not fully known, but there is accumulating evidence that mechanical ventilation induces inspiratory muscle dysfunction. Recently, several animal models have provided potential mechanisms for mechanical ventilation-induced effects on muscle function. In patients, weaning difficulties are associated with inspiratory muscle weakness and reduced endurance capacity. Animal studies demonstrated that diaphragm force was already decreased after 12 h of controlled mechanical ventilation and this worsened with time spent on the ventilator. Diaphragmatic myofibril damage observed after 3-days controlled mechanical ventilation was inversely correlated with maximal diaphragmatic force. Downregulation of the diaphragm insulin-like growth factor-I and MyoD/myogenin messenger ribonucleic acid occurred after 24 h and diaphragmatic oxidative stress and increased protease activity after 18 h. In keeping with these findings, diaphragm fibre atrophy was shown after 12 h and reduced diaphragm mass was reported after 48 h of controlled mechanical ventilation. These animal studies show that early alterations in diaphragm function develop after short-term mechanical ventilation. These alterations may contribute to the difficulties in weaning from mechanical ventilation seen in patients. Strategies to preserve respiratory muscle mass and function during mechanical ventilation should be developed. These may include: adaptation of medication, training of the diaphragm, stabilisation of the catabolic state and pharmacotherapy. PMID:12503720

  5. New strategies for mechanical ventilation. Lung protective ventilation.

    PubMed

    Wilmoth, D

    1999-12-01

    Although research is ongoing, and there are no definitive data to mandate the final answer to the question of which ventilation strategies result in the most optimal outcomes, the consensus of clinicians today suggests that we limit FIO2 to nontoxic levels, limit ventilating pressures and volumes, and use PEEP levels adequate to recruit alveoli and prevent tidal collapse. The critical care nurse must remain vigilant in his or her review of current literature to maintain knowledge of the current recommendations for optimal MV strategies. PMID:10855109

  6. The influence of music during mechanical ventilation and weaning from mechanical ventilation: A review.

    PubMed

    Hetland, Breanna; Lindquist, Ruth; Chlan, Linda L

    2015-01-01

    Mechanical ventilation (MV) causes many distressing symptoms. Weaning, the gradual decrease in ventilator assistance leading to termination of MV, increases respiratory effort, which may exacerbate symptoms and prolong MV. Music, a non-pharmacological intervention without side effects may benefit patients during weaning from mechanical ventilatory support. A narrative review of OVID Medline, PsychINFO, and CINAHL databases was conducted to examine the evidence for the use of music intervention in MV and MV weaning. Music intervention had a positive impact on ventilated patients; 16 quantitative and 2 qualitative studies were identified. Quantitative studies included randomized clinical trials (10), case controls (3), pilot studies (2) and a feasibility study. Evidence supports music as an effective intervention that can lesson symptoms related to MV and promote effective weaning. It has potential to reduce costs and increase patient satisfaction. However, more studies are needed to establish its use during MV weaning. PMID:26227333

  7. Mechanical Ventilation and Clinical Outcomes in Patients with Acute Myocardial Infarction: A Retrospective Observational Study

    PubMed Central

    Pesaro, Antonio Eduardo P.; Katz, Marcelo; Katz, Jason N.; Barbas, Carmen Sílvia Valente; Makdisse, Marcia R.; Correa, Alessandra G.; Franken, Marcelo; Pereira, Carolina; Serrano, Carlos V.; Lopes, Renato D.

    2016-01-01

    Purpose Patients with acute myocardial infarction (AMI) and respiratory impairment may be treated with either invasive or non-invasive mechanical ventilation (MV). However, there has been little testing of non-invasive MV in the setting of AMI. Our objective was to evaluate the incidence and associated clinical outcomes of patients with AMI who were treated with non-invasive or invasive MV. Methods This was a retrospective observational study in which consecutive patients with AMI (n = 1610) were enrolled. The association between exclusively non-invasive MV, invasive MV and outcomes was assessed by multivariable models. Results Mechanical ventilation was used in 293 patients (54% invasive and 46% exclusively non-invasive). In-hospital mortality rates for patients without MV, with exclusively non-invasive MV, and with invasive MV were 4.0%, 8.8%, and 39.5%, respectively (P<0.001). The median lengths of hospital stay were 6 (5.8–6.2), 13 (11.2–4.7), and 28 (18.0–37.9) days, respectively (P<0.001). Exclusively non-invasive MV was not associated with in-hospital death (adjusted HR = 0.90, 95% CI 0.40–1.99, P = 0.79). Invasive MV was strongly associated with a higher risk of in-hospital death (adjusted HR = 3.07, 95% CI 1.79–5.26, P<0.001). Conclusions In AMI setting, 18% of the patients required MV. Almost half of these patients were treated with exclusively non-invasive strategies with a favorable prognosis, while patients who needed to be treated invasively had a three-fold increase in the risk of death. Future prospective randomized trials are needed to compare the effectiveness of invasive and non-invasive MV for the initial approach of respiratory failure in AMI patients. PMID:26977804

  8. Patient experiences during awake mechanical ventilation

    PubMed Central

    Prime, Danille; Arkless, Paul; Fine, Jonathan; Winter, Stephen; Wakefield, Dorothy B.; Scatena, Robyn

    2016-01-01

    Background Sedation practices in an ICU have shifted significantly in the past 20 years toward the use of minimizing sedation in mechanically ventilated patients. While minimizing sedation is clearly in the best interest of patients, data are lacking about how this approach affects patients’ experiences. Methods We interviewed mechanically ventilated patients receiving minimal sedation, over a 6-month period in an ICU, in order to explore their emotional, comfort, and communication experiences. Their responses were compared with the responses of their available family members regarding their attitudes and perceptions of the patients’ experiences. Results Seventy-five percent of the patients agreed or strongly agreed that they experienced pain, and 50% agreed or strongly agreed that they were comfortable. Half of the patients agreed or strongly agreed that they preferred to be kept awake. Five patients (31%) indicated that they were frustrated while 17 relatives (89%) agreed or strongly agreed that the patients were frustrated. When controlling for age and gender of respondents, family members perceived higher levels of patient pain (least square [LS] mean [95% CI]: 4.2 [3.7, 4.7] vs. 3.1 [2.5, 3.8]; p=0.022), frustration (LS mean [95% CI]: 4.2 [3.7, 4.6] vs. 3.2 [2.6, 3.9]; p=0.031), and adequate communication with nurses and doctors (LS mean [95% CI]: 3.9 [3.5, 4.4] vs. 3.1 [2.4, 3.7]; p=0.046) than the patients themselves. Conclusion Patients tolerated minimal sedation without significant frustration while mechanically ventilated despite experiencing discomfort. Patient and family member perceptions of the patient experience may differ, especially in regards to pain and frustration. The use of a communication tool can facilitate understanding of patient experiences and preferences. PMID:26908386

  9. Estimates of the demand for mechanical ventilation in the United States during an influenza pandemic.

    PubMed

    Meltzer, Martin I; Patel, Anita; Ajao, Adebola; Nystrom, Scott V; Koonin, Lisa M

    2015-05-01

    An outbreak in China in April 2013 of human illnesses due to avian influenza A(H7N9) virus provided reason for US public health officials to revisit existing national pandemic response plans. We built a spreadsheet model to examine the potential demand for invasive mechanical ventilation (excluding "rescue therapy" ventilation). We considered scenarios of either 20% or 30% gross influenza clinical attack rate (CAR), with a "low severity" scenario with case fatality rates (CFR) of 0.05%-0.1%, or a "high severity" scenario (CFR: 0.25%-0.5%). We used rates-of-influenza-related illness to calculate the numbers of potential clinical cases, hospitalizations, admissions to intensive care units, and need for mechanical ventilation. We assumed 10 days ventilator use per ventilated patient, 13% of total ventilator demand will occur at peak, and a 33.7% weighted average mortality risk while on a ventilator. At peak, for a 20% CAR, low severity scenario, an additional 7000 to 11,000 ventilators will be needed, averting a pandemic total of 35,000 to 55,000 deaths. A 30% CAR, high severity scenario, will need approximately 35,000 to 60,500 additional ventilators, averting a pandemic total 178,000 to 308,000 deaths. Estimates of deaths averted may not be realized because successful ventilation also depends on sufficient numbers of suitably trained staff, needed supplies (eg, drugs, reliable oxygen sources, suction apparatus, circuits, and monitoring equipment) and timely ability to match access to ventilators with critically ill cases. There is a clear challenge to plan and prepare to meet demands for mechanical ventilators for a future severe pandemic. PMID:25878301

  10. [Mechanical ventilation in chronic ventilatory insufficiency].

    PubMed

    Schucher, B; Magnussen, H

    2007-10-01

    Mechanical ventilation has become an important treatment option in chronic ventilatory failure. There are different diseases which lead to ventilatory failure and to home mechanical ventilation (HMV). A primary loss of in- and expiratory muscle strength is the reason for respiratory deterioration in neuromuscular disease. In most of these diseases ventilatory failure develops because of the progressive character of muscular damage. Initially, ventilatory failure can be found during night-time. In the case of hypercapnia at daytime, life expectancy is strongly reduced, especially in amyotrophic lateral sclerosis and Duchenne muscular dystrophy. HMV leads to a prolongation of life and to an increase in quality of life, if bulbar involvement is not severe. Impressive clinical improvements under HMV have been found in restrictive disorders of the rib cage like kyphoscoliosis or posttuberculosis sequelae, with an increase of quality of life, walking distance and a decrease in pulmonary hypertension. Only few data are published about long-term results of HMV in Obesity Hypoventilation. In terms of retrospective analyses of clinical data HMV seems to improve survival in this population. Some patients only need CPAP treatment, but most patients have to be treated with ventilatory support. The application of HMV in patients with chronic ventilatory failure due to chronic obstructive pulmonary disease (COPD) is growing, but there are controversial results in randomised clinical trials. Analysis of these data suggest better results of HMV in patients with severe hypercapnia, with the application of higher effective ventilatory pressure and a ventilator mode with a significant reduction in the work of breathing. Under such conditions HMV leads to a reduction of hypercapnia, an improvement in sleep quality, walking distance and quality of life, but until now there is no evidence in reduction of mortality in COPD. PMID:17620231

  11. Academic Emergency Medicine Physicians’ Knowledge of Mechanical Ventilation

    PubMed Central

    Wilcox, Susan R.; Strout, Tania D.; Schneider, Jeffrey I.; Mitchell, Patricia M.; Smith, Jessica; Lutfy-Clayton, Lucienne; Marcolini, Evie G.; Aydin, Ani; Seigel, Todd A.; Richards, Jeremy B.

    2016-01-01

    Introduction Although emergency physicians frequently intubate patients, management of mechanical ventilation has not been emphasized in emergency medicine (EM) education or clinical practice. The objective of this study was to quantify EM attendings’ education, experience, and knowledge regarding mechanical ventilation in the emergency department. Methods We developed a survey of academic EM attendings’ educational experiences with ventilators and a knowledge assessment tool with nine clinical questions. EM attendings at key teaching hospitals for seven EM residency training programs in the northeastern United States were invited to participate in this survey study. We performed correlation and regression analyses to evaluate the relationship between attendings’ scores on the assessment instrument and their training, education, and comfort with ventilation. Results Of 394 EM attendings surveyed, 211 responded (53.6%). Of respondents, 74.5% reported receiving three or fewer hours of ventilation-related education from EM sources over the past year and 98 (46%) reported receiving between 0–1 hour of education. The overall correct response rate for the assessment tool was 73.4%, with a standard deviation of 19.9. The factors associated with a higher score were completion of an EM residency, prior emphasis on mechanical ventilation during one’s own residency, working in a setting where an emergency physician bears primary responsibility for ventilator management, and level of comfort with managing ventilated patients. Physicians’ comfort was associated with the frequency of ventilator changes and EM management of ventilation, as well as hours of education. Conclusion EM attendings report caring for mechanically ventilated patients frequently, but most receive fewer than three educational hours a year on mechanical ventilation, and nearly half receive 0–1 hour. Physicians’ performance on an assessment tool for mechanical ventilation is most strongly

  12. Ethical challenges in home mechanical ventilation: A secondary analysis

    PubMed Central

    Dybwik, Knut; Nielsen, Erik Waage; Brinchmann, Berit Støre

    2012-01-01

    The aim of this study was to explore the ethical challenges in home mechanical ventilation based on a secondary analysis of qualitative empirical data. The data included perceptions of healthcare professionals in hospitals and community health services and family members of children and adults using home mechanical ventilation. The findings show that a number of ethical challenges, or dilemmas, arise at all levels in the course of treatment: deciding who should be offered home mechanical ventilation, respect for patient and family wishes, quality of life, dignity and equal access to home mechanical ventilation. Other challenges were the impacts home mechanical ventilation had on the patient, the family, the healthcare services and the allocation of resources. A better and broader understanding of these issues is crucial in order to improve the quality of care for both patient and family and assist healthcare professionals involved in home mechanical ventilation to make decisions for the good of the patient and his or her family. PMID:22183963

  13. The growing role of noninvasive ventilation in patients requiring prolonged mechanical ventilation.

    PubMed

    Hess, Dean R

    2012-06-01

    For many patients with chronic respiratory failure requiring ventilator support, noninvasive ventilation (NIV) is preferable to invasive support by tracheostomy. Currently available evidence does not support the use of nocturnal NIV in unselected patients with stable COPD. Several European studies have reported benefit for high intensity NIV, in which setting of inspiratory pressure and respiratory rate are selected to achieve normocapnia. There have also been studies reporting benefit for the use of NIV as an adjunct to exercise training. NIV may be useful as an adjunct to airway clearance techniques in patients with cystic fibrosis. Accumulating evidence supports the use of NIV in patients with obesity hypoventilation syndrome. There is considerable observational evidence supporting the use of NIV in patients with chronic respiratory failure related to neuromuscular disease, and one randomized controlled trial reported that the use of NIV was life-prolonging in patients with amyotrophic lateral sclerosis. A variety of interfaces can be used to provide NIV in patients with stable chronic respiratory failure. The mouthpiece is an interface that is unique in this patient population, and has been used with success in patients with neuromuscular disease. Bi-level pressure ventilators are commonly used for NIV, although there are now a new generation of intermediate ventilators that are portable, have a long battery life, and can be used for NIV and invasive applications. Pressure support ventilation, pressure controlled ventilation, and volume controlled ventilation have been used successfully for chronic applications of NIV. New modes have recently become available, but their benefits await evidence to support their widespread use. The success of NIV in a given patient population depends on selection of an appropriate patient, selection of an appropriate interface, selection of an appropriate ventilator and ventilator settings, the skills of the clinician, the

  14. New puzzles for the use of non-invasive ventilation for immunosuppressed patients.

    PubMed

    Barbas, Carmen Sílvia Valente; Serpa Neto, Ary

    2016-01-01

    On October 27, 2015, Lemile and colleagues published an article in JAMA entitled "Effect of Noninvasive Ventilation vs. Oxygen Therapy on Mortality among Immunocompromised Patients with Acute Respiratory Failure: A Randomized Clinical Trial", which investigated the effects of non-invasive ventilation (NIV) in 28-day mortality of 374 critically ill immunosuppressed patients. The authors found that among immunosuppressed patients admitted to the intensive care unit (ICU) with hypoxemic acute respiratory failure, early NIV compared with oxygen therapy alone did not reduce 28-day mortality. Furthermore, different from the previous publications, there were no significant differences in ICU-acquired infections, duration of mechanical ventilation, or lengths of ICU or hospital stays. The study power was limited, median oxygen flow used was higher than used before or 9 L/min, NIV settings provided tidal volumes higher than what is considered protective nowadays or from 7 to 10 mL/kg of ideal body weight and the hypoxemic respiratory failure was moderate to severe (median PaO2/FIO2 was around 140), a group prone to failure in noninvasive ventilatory support. Doubts arose regarding the early use of NIV in immunosuppressed critically ill patients with non-hypercapnic hypoxemic respiratory failure that need to be solved in the near future. PMID:26904233

  15. New puzzles for the use of non-invasive ventilation for immunosuppressed patients

    PubMed Central

    Serpa Neto, Ary

    2016-01-01

    On October 27, 2015, Lemile and colleagues published an article in JAMA entitled “Effect of Noninvasive Ventilation vs. Oxygen Therapy on Mortality among Immunocompromised Patients with Acute Respiratory Failure: A Randomized Clinical Trial”, which investigated the effects of non-invasive ventilation (NIV) in 28-day mortality of 374 critically ill immunosuppressed patients. The authors found that among immunosuppressed patients admitted to the intensive care unit (ICU) with hypoxemic acute respiratory failure, early NIV compared with oxygen therapy alone did not reduce 28-day mortality. Furthermore, different from the previous publications, there were no significant differences in ICU-acquired infections, duration of mechanical ventilation, or lengths of ICU or hospital stays. The study power was limited, median oxygen flow used was higher than used before or 9 L/min, NIV settings provided tidal volumes higher than what is considered protective nowadays or from 7 to 10 mL/kg of ideal body weight and the hypoxemic respiratory failure was moderate to severe (median PaO2/FIO2 was around 140), a group prone to failure in noninvasive ventilatory support. Doubts arose regarding the early use of NIV in immunosuppressed critically ill patients with non-hypercapnic hypoxemic respiratory failure that need to be solved in the near future. PMID:26904233

  16. Comparison of exercise capacity in COPD and other etiologies of chronic respiratory failure requiring non-invasive mechanical ventilation at home: retrospective analysis of 1-year follow-up

    PubMed Central

    Salturk, Cuneyt; Karakurt, Zuhal; Takir, Huriye Berk; Balci, Merih; Kargin, Feyza; Mocin, Ozlem Yazıcıoglu; Gungor, Gokay; Ozmen, Ipek; Oztas, Selahattin; Yalcinsoy, Murat; Evin, Ruya; Ozturk, Murat; Adiguzel, Nalan

    2015-01-01

    Introduction The objective of this study was to compare the change in 6-minute walking distance (6MWD) in 1 year as an indicator of exercise capacity among patients undergoing home non-invasive mechanical ventilation (NIMV) due to chronic hypercapnic respiratory failure (CHRF) caused by different etiologies. Methods This retrospective cohort study was conducted in a tertiary pulmonary disease hospital in patients who had completed 1-year follow-up under home NIMV because of CHRF with different etiologies (ie, chronic obstructive pulmonary disease [COPD], obesity hypoventilation syndrome [OHS], kyphoscoliosis [KS], and diffuse parenchymal lung disease [DPLD]), between January 2011 and January 2012. The results of arterial blood gas (ABG) analyses and spirometry, and 6MWD measurements with 12-month interval were recorded from the patient files, in addition to demographics, comorbidities, and body mass indices. The groups were compared in terms of 6MWD via analysis of variance (ANOVA) and multiple linear regression (MLR) analysis (independent variables: analysis age, sex, baseline 6MWD, baseline forced expiratory volume in 1 second, and baseline partial carbon dioxide pressure, in reference to COPD group). Results A total of 105 patients with a mean age (± standard deviation) of 61±12 years of whom 37 had COPD, 34 had OHS, 20 had KS, and 14 had DPLD were included in statistical analysis. There were no significant differences between groups in the baseline and delta values of ABG and spirometry findings. Both univariate ANOVA and MLR showed that the OHS group had the lowest baseline 6MWD and the highest decrease in 1 year (linear regression coefficient −24.48; 95% CI −48.74 to −0.21, P=0.048); while the KS group had the best baseline values and the biggest improvement under home NIMV (linear regression coefficient 26.94; 95% CI −3.79 to 57.66, P=0.085). Conclusion The 6MWD measurements revealed improvement in exercise capacity test in CHRF patients receiving

  17. [Non-invasive ventilation in kyphoscoliosis. A comparison of a volumetric ventilator and a BIPAP support pressure device].

    PubMed

    Laserna, E; Barrot, E; Beiztegui, A; Quintana, E; Hernández, A; Castillo, J; Belaustegui, A

    2003-01-01

    Non-invasive intermittent positive pressure ventilation (NIPPV) at home is the treatment of choice for patients with chronic respiratory insufficiency secondary to severe kyphoscoliosis. Our aim was to compare clinical course, blood gases and lung function after one month of domiciliary NIPPV with two types of ventilator and to assess sleep pattern changes in patients enrolled in a prospective, randomized crossover study. Ten patients with chronic respiratory insufficiency due to kyphoscoliosis were enrolled and randomly assigned to the first device. After one month of use, the patients underwent clinical and functional examinations and polysomnographic studies while using the ventilator. The same protocol was applied with the second device after a ten-day washout period. Baseline polysomnographs showed fragmented sleep with low percentages of deep non-REM sleep and of REM sleep, as well as respiratory patterns characterized by very high frequencies coinciding with significant desaturations. In all cases symptoms and arterial blood gas improvements were significant, with no differences between the two treatment periods. The percentages of time spent with SaO2 below 90% of reference in sleep studies were significantly lower than baseline with both ventilators. All but one patient had better tolerance of the bilevel positive airway pressure (BIPAP) support mode than of the volumetric ventilator. Our study shows that NIPPV is equally effective for patients with kyphoscoliosis whether administered with a volumetric ventilator or a BIPAP device. Subjective response and tolerance seem to be slightly better with BIPAP. PMID:12550014

  18. Comparison and Evaluation of the Effects of Administration of Postoperative Non-Invasive Mechanical Ventilation Methods (CPAP and BIPAP) on Respiratory Mechanics and Gas Exchange in Patients Undergoing Abdominal Surgery

    PubMed Central

    Yağlıoğlu, Hatice; Köksal, Güniz Meyancı; Erbabacan, Emre; Ekici, Birsel

    2015-01-01

    Objective The aim of our study is to investigate the effect of two different methods of continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BIPAP) and oxygen support under spontaneous ventilation on respiration mechanics, gas exchange, dry mouth and face mask lesion during an early postoperative period in patients undergoing upper abdominal surgery. Methods Eighty patients undergoing elective abdominal surgery with laparotomy, between the age of 25 and 75 years and American Society of Anesthesiologists Physical Status score (ASA) II–III with chronic obstructive pulmonary disease (COPD) diagnosis were included to the study. Subjects were randomly allocated in to four groups. During the first postoperative hour, the first group received BIPAP, second group received high-flow CPAP, third group received low-flow CPAP and fourth group received deep breathing exercises, respiratory physiotherapy and O2 therapy. Preoperative, postoperative before and after treatment PaO2, PaCO2, SpO2, tidal volume (TV), respiratory rate (RR) levels were recorded. Subjects with dry mouth or face mask lesion were recorded. Results In all groups, PaO2 and TV measurements were higher at the postoperative first hour than the postoperative zero hour. We found that low-flow CPAP increased PaO2 and SpO2 values more, and TV levels were higher in the postoperative period than the preoperative period. PaCO2 levels were elevated at the zero hour postoperatively and at the end of the first hour; they decreased approximately to preoperative values, except in the fourth group. Conclusion Administration of prophylactic respiratory support can prevent the deterioration of pulmonary functions and hypoxia in patients with COPD undergoing upper abdominal surgery. In addition, we found that low-flow CPAP had better effects on PaO2, SpO2, TV compared to other techniques. PMID:27366506

  19. Optimal Delivery of Aerosols to Infants During Mechanical Ventilation

    PubMed Central

    Azimi, Mandana; Hindle, Michael

    2014-01-01

    Abstract Purpose: The objective of this study was to determine optimal aerosol delivery conditions for a full-term (3.6 kg) infant receiving invasive mechanical ventilation by evaluating the effects of aerosol particle size, a new wye connector, and timing of aerosol delivery. Methods: In vitro experiments used a vibrating mesh nebulizer and evaluated drug deposition fraction and emitted dose through ventilation circuits containing either a commercial (CM) or new streamlined (SL) wye connector and 3-mm endotracheal tube (ETT) for aerosols with mass median aerodynamic diameters of 880 nm, 1.78 μm, and 4.9 μm. The aerosol was released into the circuit either over the full inhalation cycle (T1 delivery) or over the first half of inhalation (T2 delivery). Validated computational fluid dynamics (CFD) simulations and whole-lung model predictions were used to assess lung deposition and exhaled dose during cyclic ventilation. Results: In vitro experiments at a steady-state tracheal flow rate of 5 L/min resulted in 80–90% transmission of the 880-nm and 1.78-μm aerosols from the ETT. Based on CFD simulations with cyclic ventilation, the SL wye design reduced depositional losses in the wye by a factor of approximately 2–4 and improved lung delivery efficiencies by a factor of approximately 2 compared with the CM device. Delivery of the aerosol over the first half of the inspiratory cycle (T2) reduced exhaled dose from the ventilation circuit by a factor of 4 compared with T1 delivery. Optimal lung deposition was achieved with the SL wye connector and T2 delivery, resulting in 45% and 60% lung deposition for optimal polydisperse (∼1.78 μm) and monodisperse (∼2.5 μm) particle sizes, respectively. Conclusions: Optimization of selected factors and use of a new SL wye connector can substantially increase the lung delivery efficiency of medical aerosols to infants from current values of <1–10% to a range of 45–60%. PMID:24299500

  20. Update on clinical trials in home mechanical ventilation.

    PubMed

    Hodgson, Luke E; Murphy, Patrick B

    2016-02-01

    Home mechanical ventilation (HMV) is an increasingly common intervention and is initiated for a range of pathological processes, including neuromuscular disease (NMD), chronic obstructive pulmonary disease (COPD) and obesity related respiratory failure. There have been important recent data published in this area, which helps to guide practice by indicating which populations may benefit from this intervention and the optimum method of setting up and controlling sleep disordered breathing. Recent superficially conflicting data has been published regarding HMV in COPD, with a trial in post-exacerbation patients suggesting no benefit, but in stable chronic hypercapnic patients suggesting a clear and sustained mortality benefit. The two studies are critiqued and the potential reasons for the differing results are discussed. Early and small trial data is frequently contradicted with larger randomised controlled trials and this has been the case with diaphragm pacing being shown to be potentially harmful in the latest data, confirming the importance of non-invasive ventilation (NIV) in NMD such as motor neurone disease. Advances in ventilator technology have so far appeared quicker than the clinical data to support their use; although small and often unblinded, the current data suggests equivalence to standard modes of NIV, but with potential comfort benefits that may enhance adherence. The indications for NIV have expanded since its inception, with an effort to treat sleep disordered breathing as a result of chronic heart failure (HF). The SERVE-HF trial has recently demonstrated no clear advantage to this technology and furthermore detected a potentially deleterious effect, with a worsening of all cause and cardiovascular mortality in the treated group compared to controls. The review serves to provide the reader with a critical review of recent advances in the field of sleep disordered breathing and HMV. PMID:26904266

  1. Update on clinical trials in home mechanical ventilation

    PubMed Central

    Hodgson, Luke E.

    2016-01-01

    Home mechanical ventilation (HMV) is an increasingly common intervention and is initiated for a range of pathological processes, including neuromuscular disease (NMD), chronic obstructive pulmonary disease (COPD) and obesity related respiratory failure. There have been important recent data published in this area, which helps to guide practice by indicating which populations may benefit from this intervention and the optimum method of setting up and controlling sleep disordered breathing. Recent superficially conflicting data has been published regarding HMV in COPD, with a trial in post-exacerbation patients suggesting no benefit, but in stable chronic hypercapnic patients suggesting a clear and sustained mortality benefit. The two studies are critiqued and the potential reasons for the differing results are discussed. Early and small trial data is frequently contradicted with larger randomised controlled trials and this has been the case with diaphragm pacing being shown to be potentially harmful in the latest data, confirming the importance of non-invasive ventilation (NIV) in NMD such as motor neurone disease. Advances in ventilator technology have so far appeared quicker than the clinical data to support their use; although small and often unblinded, the current data suggests equivalence to standard modes of NIV, but with potential comfort benefits that may enhance adherence. The indications for NIV have expanded since its inception, with an effort to treat sleep disordered breathing as a result of chronic heart failure (HF). The SERVE-HF trial has recently demonstrated no clear advantage to this technology and furthermore detected a potentially deleterious effect, with a worsening of all cause and cardiovascular mortality in the treated group compared to controls. The review serves to provide the reader with a critical review of recent advances in the field of sleep disordered breathing and HMV. PMID:26904266

  2. Non-invasive ventilation in acute respiratory failure in children

    PubMed Central

    Abadesso, Clara; Nunes, Pedro; Silvestre, Catarina; Matias, Ester; Loureiro, Helena; Almeida, Helena

    2012-01-01

    The aim of this paper is to assess the clinical efficacy of non-invasive ventilation (NIV) in avoiding endotracheal intubation (ETI), to demonstrate clinical and gasometric improvement and to identify predictive risk factors associated with NIV failure. An observational prospective clinical study was carried out. Included Patients with acute respiratory disease (ARD) treated with NIV, from November 2006 to January 2010 in a Pediatric Intensive Care Unit (PICU). NIV was used in 151 patients with acute respiratory failure (ARF). Patients were divided in two groups: NIV success and NIV failure, if ETI was required. Mean age was 7.2±20.3 months (median: 1 min: 0,3 max.: 156). Main diagnoses were bronchiolitis in 102 (67.5%), and pneumonia in 44 (29%) patients. There was a significant improvement in respiratory rate (RR), heart rate (HR), pH, and pCO2 at 2, 6, 12 and 24 hours after NIV onset (P<0.05) in both groups. Improvement in pulse oximetric saturation/fraction of inspired oxygen (SpO2/FiO2) was verified at 2, 4, 6, 12 and 24 hours after NIV onset in the success group (P<0.001). In the failure group, significant SpO2/FiO2 improvement was only observed in the first 4 hours. NIV failure occurred in 34 patients (22.5%). Risk factors for NIV failure were apnea, prematurity, pneumonia, and bacterial co-infection (P<0.05). Independent risk factors for NIV failure were apneia (P<0.001; odds ratio 15.8; 95% confidence interval: 3.42–71.4) and pneumonia (P<0.001, odds ratio 31.25; 95% confidence interval: 8.33–111.11). There were no major complications related with NIV. In conclusion this study demonstrates the efficacy of NIV as a form of respiratory support for children and infants with ARF, preventing clinical deterioration and avoiding ETI in most of the patients. Risk factors for failure were related with immaturity and severe infection. PMID:22802994

  3. The effect of mechanical ventilator settings during ventilator hyperinflation techniques: a bench-top analysis.

    PubMed

    Thomas, P J

    2015-01-01

    Ventilator hyperinflations are used by physiotherapists for the purpose of airway clearance in intensive care. There is limited data to guide the selection of mechanical ventilator modes and settings that may achieve desired flow patterns for ventilator hyperinflation. A mechanical ventilator was connected to two lung simulators and a respiratory mechanics monitor. Peak inspiratory (PIFR) and expiratory flow rates (PEFR) were measured during manipulation of ventilator modes (pressure support ventilation [PSV], volume-controlled synchronised intermittent mandatory ventilation [VC-SIMV] and pressure-controlled synchronised intermittent mandatory ventilation [PC-SIMV]) and ventilator settings (including set tidal volume, positive end-expiratory pressure, inspiratory flow rate, inspiratory pause, pressure support, inspiratory time and/or inflation pressure). Additionally, each trial was conducted with high (0.05 l/cmH2O) and low (0.01 l/cmH2O) compliance settings on the lung simulators. Each trial was dichotomised into success or failure under three categories (attainment of PIFR-PEFR less than or equal to 0.9, PEFR/PIFR greater than 17 l/min, PEFR greater than or equal to 40 l/min). A total of 232 trials were conducted (96 VC-SIMV, 96 PC-SIMV, 40 PSV). A greater proportion of VC-SIMV trials were ceased due to high peak inspiratory pressures (35%). However, VC-SIMV trials were more likely to be successful at meeting all three outcome measures (26 VC-SIMV trials, 7 PC-SIMV trials, 0 PSV trials). It was found that manipulation of settings in VC-SIMV mode appears more successful than PSV and PC-SIMV for ventilator hyperinflations. PMID:25579293

  4. State of the evidence: mechanical ventilation with PEEP in patients with cardiogenic shock

    PubMed Central

    Wiesen, Jonathan; Ornstein, Moshe; Tonelli, Adriano R; Menon, Venu; Ashton, Rendell W

    2014-01-01

    The need to provide invasive mechanical ventilatory support to patients with myocardial infarction and acute left heart failure is common. Despite the large number of patients requiring mechanical ventilation in this setting, there are remarkably few data addressing the ideal mode of respiratory support in such patients. Although there is near universal acceptance regarding the use of non-invasive positive pressure ventilation in patients with acute pulmonary oedema, there is more concern with invasive positive pressure ventilation owing to its more significant haemodynamic impact. Positive end-expiratory pressure (PEEP) is almost universally applied in mechanically ventilated patients due to benefits in gas exchange, recruitment of alveolar units, counterbalance of hydrostatic forces leading to pulmonary oedema and maintenance of airway patency. The limited available clinical data suggest that a moderate level of PEEP is safe to use in severe left ventricular (LV) dysfunction and cardiogenic shock, and may provide haemodynamic benefits as well in LV failure which exhibits afterload-sensitive physiology. PMID:23539555

  5. Spatial distribution of ventilation and perfusion: mechanisms and regulation.

    PubMed

    Glenny, Robb W; Robertson, H Thomas

    2011-01-01

    With increasing spatial resolution of regional ventilation and perfusion, it has become more apparent that ventilation and blood flow are quite heterogeneous in the lung. A number of mechanisms contribute to this regional variability, including hydrostatic gradients, pleural pressure gradients, lung compressibility, and the geometry of the airway and vascular trees. Despite this marked heterogeneity in both ventilation and perfusion, efficient gas exchange is possible through the close regional matching of the two. Passive mechanisms, such as the shared effect of gravity and the matched branching of vascular and airway trees, create efficient gas exchange through the strong correlation between ventilation and perfusion. Active mechanisms that match local ventilation and perfusion play little if no role in the normal healthy lung but are important under pathologic conditions. PMID:23737178

  6. Amyotrophic Lateral Sclerosis Patients' Perspectives on Use of Mechanical Ventilation.

    ERIC Educational Resources Information Center

    Young, Jenny M.; And Others

    1994-01-01

    Interviewed 13 amyotrophic lateral sclerosis patients. All believed that they alone should make decision regarding use of mechanical ventilation. Factors they considered important were quality of life, severity of disability, availability of ventilation by means of nasal mask, possible admission to long-term care facility, ability to discontinue…

  7. Ammonia emissions from two mechanically ventilated UK livestock buildings

    NASA Astrophysics Data System (ADS)

    Demmers, T. G. M.; Burgess, L. R.; Short, J. L.; Phillips, V. R.; Clark, J. A.; Wathes, C. M.

    Ammonia emission rates from livestock buildings are required to construct an accurate emission inventory for the UK. Ventilation and ammonia emission rates from a fattening pig unit and a broiler house, both mechanically ventilated, were estimated using fan wheel anemometers and thermal converters with a chemiluminescence NO x-analyser to measure the ventilation rate and the ammonia concentration, respectively. The estimated ammonia emission factors were 46.9 and 16.6 kg lu -1 a -1 for the fattening pig unit and the broiler house, respectively. Both emission factors were within the range reported in the literature. A tracer gas (CO) method, based on a constant tracer release rate, was validated for measuring ventilation rates from naturally ventilated livestock buildings. Air inlets and outlets were identified using the air temperature or tracer concentration in the opening. Tracer concentration was found to be a more suitable criterion than temperature. In both houses, a significant correlation between the estimated ventilation rate using the tracer method and the measured ventilation rate using fan wheel anemometers was found. The ventilation rate was underestimated by 12 and 6% for the piggery and broiler house, respectively. The instantaneous ammonia emission derived from the tracer gas method was lower than the ammonia emission derived from the fan wheel anemometer method by 14 and 16% for the piggery and broiler house, respectively. The ventilation and ammonia emission estimates using the tracer method were within acceptable range from the ventilation and emission rates measured using measuring fans, but because of its accuracy and simplicity the fan wheel anemometer method is preferred for long-term measurements of ventilation rate in mechanically ventilated buildings.

  8. MECHANICAL VENTILATION FOR THE LUNG TRANSPLANT RECIPIENT

    PubMed Central

    Barnes, Lindsey; Reed, Robert M.; Parekh, Kalpaj R.; Bhama, Jay K.; Pena, Tahuanty; Rajagopal, Srinivasan; Schmidt, Gregory A.; Klesney-Tait, Julia A.; Eberlein, Michael

    2015-01-01

    Mechanical ventilation (MV) is an important aspect in the intraoperative and early postoperative management of lung transplant (LTx)-recipients. There are no randomized-controlled trials of LTx-recipient MV strategies; however there are LTx center experiences and international survey studies reported. The main early complication of LTx is primary graft dysfunction (PGD), which is similar to the adult respiratory distress syndrome (ARDS). We aim to summarize information pertinent to LTx-MV, as well as PGD, ARDS, and intraoperative MV and to synthesize these available data into recommendations. Based on the available evidence, we recommend lung-protective MV with low-tidal-volumes (≤6 mL/kg predicted body weight [PBW]) and positive end-expiratory pressure for the LTx-recipient. In our opinion, the MV strategy should be based on donor characteristics (donor PBW as a parameter of actual allograft size), rather than based on recipient characteristics; however this donor-characteristics-based protective MV is based on indirect evidence and requires validation in prospective clinical studies. PMID:26495241

  9. Personalizing mechanical ventilation for acute respiratory distress syndrome.

    PubMed

    Berngard, S Clark; Beitler, Jeremy R; Malhotra, Atul

    2016-03-01

    Lung-protective ventilation with low tidal volumes remains the cornerstone for treating patient with acute respiratory distress syndrome (ARDS). Personalizing such an approach to each patient's unique physiology may improve outcomes further. Many factors should be considered when mechanically ventilating a critically ill patient with ARDS. Estimations of transpulmonary pressures as well as individual's hemodynamics and respiratory mechanics should influence PEEP decisions as well as response to therapy (recruitability). This summary will emphasize the potential role of personalized therapy in mechanical ventilation. PMID:27076966

  10. Variability in Mechanical Ventilation: What's All the Noise About?

    PubMed

    Naik, Bhiken I; Lynch, Carl; Durbin, Charles G

    2015-08-01

    Controlled mechanical ventilation is characterized by a fixed breathing frequency and tidal volume. Physiological and mathematical models have demonstrated the beneficial effects of varying tidal volume and/or inspiratory pressure during positive-pressure ventilation. The addition of noise (random changes) to a monotonous nonlinear biological system, such as the lung, induces stochastic resonance that contributes to the recruitment of collapsed alveoli and atelectatic lung segments. In this article, we review the mechanism of physiological pulmonary variability, the principles of noise and stochastic resonance, and the emerging understanding that there are beneficial effects of variability during mechanical ventilation. PMID:25691765

  11. Personalizing mechanical ventilation for acute respiratory distress syndrome

    PubMed Central

    Beitler, Jeremy R.; Malhotra, Atul

    2016-01-01

    Lung-protective ventilation with low tidal volumes remains the cornerstone for treating patient with acute respiratory distress syndrome (ARDS). Personalizing such an approach to each patient’s unique physiology may improve outcomes further. Many factors should be considered when mechanically ventilating a critically ill patient with ARDS. Estimations of transpulmonary pressures as well as individual’s hemodynamics and respiratory mechanics should influence PEEP decisions as well as response to therapy (recruitability). This summary will emphasize the potential role of personalized therapy in mechanical ventilation. PMID:27076966

  12. Mechanical ventilation causes airway distension with proinflammatory sequelae in mice.

    PubMed

    Nickles, Hannah T; Sumkauskaite, Migle; Wang, Xin; Wegner, Ingmar; Puderbach, Michael; Kuebler, Wolfgang M

    2014-07-01

    The pathogenesis of ventilator-induced lung injury has predominantly been attributed to overdistension or mechanical opening and collapse of alveoli, whereas mechanical strain on the airways is rarely taken into consideration. Here, we hypothesized that mechanical ventilation may cause significant airway distension, which may contribute to the pathological features of ventilator-induced lung injury. C57BL/6J mice were anesthetized and mechanically ventilated at tidal volumes of 6, 10, or 15 ml/kg body wt. Mice were imaged by flat-panel volume computer tomography, and central airways were segmented and rendered in 3D for quantitative assessment of airway distension. Alveolar distension was imaged by intravital microscopy. Functional dead space was analyzed in vivo, and proinflammatory cytokine release was analyzed in isolated, ventilated tracheae. CT scans revealed a reversible, up to 2.5-fold increase in upper airway volume during mechanical ventilation compared with spontaneous breathing. Airway distension was most pronounced in main bronchi, which showed the largest volumes at tidal volumes of 10 ml/kg body wt. Conversely, airway distension in segmental bronchi and functional dead space increased almost linearly, and alveolar distension increased even disproportionately with higher tidal volumes. In isolated tracheae, mechanical ventilation stimulated the release of the early-response cytokines TNF-α and IL-1β. Mechanical ventilation causes a rapid, pronounced, and reversible distension of upper airways in mice that is associated with an increase in functional dead space. Upper airway distension is most pronounced at moderate tidal volumes, whereas higher tidal volumes redistribute preferentially to the alveolar compartment. Airway distension triggers proinflammatory responses and may thus contribute relevantly to ventilator-induced pathologies. PMID:24816486

  13. Mechanical ventilation interacts with endotoxemia to induce extrapulmonary organ dysfunction

    PubMed Central

    O'Mahony, D Shane; Liles, W Conrad; Altemeier, William A; Dhanireddy, Shireesha; Frevert, Charles W; Liggitt, Denny; Martin, Thomas R; Matute-Bello, Gustavo

    2006-01-01

    Introduction Multiple organ dysfunction syndrome (MODS) is a common complication of sepsis in mechanically ventilated patients with acute respiratory distress syndrome, but the links between mechanical ventilation and MODS are unclear. Our goal was to determine whether a minimally injurious mechanical ventilation strategy synergizes with low-dose endotoxemia to induce the activation of pro-inflammatory pathways in the lungs and in the systemic circulation, resulting in distal organ dysfunction and/or injury. Methods We administered intraperitoneal Escherichia coli lipopolysaccharide (LPS; 1 μg/g) to C57BL/6 mice, and 14 hours later subjected the mice to 6 hours of mechanical ventilation with tidal volumes of 10 ml/kg (LPS + MV). Comparison groups received ventilation but no LPS (MV), LPS but no ventilation (LPS), or neither LPS nor ventilation (phosphate-buffered saline; PBS). Results Myeloperoxidase activity and the concentrations of the chemokines macrophage inflammatory protein-2 (MIP-2) and KC were significantly increased in the lungs of mice in the LPS + MV group, in comparison with mice in the PBS group. Interestingly, permeability changes across the alveolar epithelium and histological changes suggestive of lung injury were minimal in mice in the LPS + MV group. However, despite the minimal lung injury, the combination of mechanical ventilation and LPS resulted in chemical and histological evidence of liver and kidney injury, and this was associated with increases in the plasma concentrations of KC, MIP-2, IL-6, and TNF-α. Conclusion Non-injurious mechanical ventilation strategies interact with endotoxemia in mice to enhance pro-inflammatory mechanisms in the lungs and promote extra-pulmonary end-organ injury, even in the absence of demonstrable acute lung injury. PMID:16995930

  14. Non-invasive ventilation in immunocompromised patients with acute hypoxemic respiratory failure

    PubMed Central

    Del Sorbo, Lorenzo; Jerath, Angela; Dres, Martin

    2016-01-01

    The survival rate of immunocompromised patients has improved over the past decades in light of remarkable progress in diagnostic and therapeutic options. Simultaneously, there has been an increase in the number of immunocompromised patients with life threatening complications requiring intensive care unit (ICU) treatment. ICU admission is necessary in up to 15% of patients with acute leukemia and 20% of bone marrow transplantation recipients, and the main reason for ICU referral in this patient population is acute hypoxemic respiratory failure, which is associated with a high mortality rate, particularly in patients requiring endotracheal intubation. The application of non-invasive ventilation (NIV), and thus the avoidance of endotracheal intubation and invasive mechanical ventilation with its side effects, appears therefore of great importance in this patient population. Early trials supported the benefits of NIV in these settings, and the 2011 Canadian guidelines for the use of NIV in critical care settings suggest the use of NIV in immune-compromised patients with a grade 2B recommendation. However, the very encouraging results from initial seminal trials were not confirmed in subsequent observational and randomized clinical studies, questioning the beneficial effect of NIV in immune-compromised patients. Based on these observations, a French group led by Azoulay decided to assess whether early intermittent respiratory support with NIV had a role in reducing the mortality rate of immune-compromised patients with non-hypercapnic hypoxemic respiratory failure developed in less than 72 h, and hence conducted a multicenter randomized controlled trial (RCT) in experienced ICUs in France. This perspective reviews the findings from their RCT in the context of the current critical care landscape, and in light of recent results from other trials focused on the early management of acute hypoxemic respiratory failure. PMID:27076972

  15. Heliox Improves Carbon Dioxide Removal during Lung Protective Mechanical Ventilation.

    PubMed

    Beurskens, Charlotte J; Brevoord, Daniel; Lagrand, Wim K; van den Bergh, Walter M; Vroom, Margreeth B; Preckel, Benedikt; Horn, Janneke; Juffermans, Nicole P

    2014-01-01

    Introduction. Helium is a noble gas with low density and increased carbon dioxide (CO2) diffusion capacity. This allows lower driving pressures in mechanical ventilation and increased CO2 diffusion. We hypothesized that heliox facilitates ventilation in patients during lung-protective mechanical ventilation using low tidal volumes. Methods. This is an observational cohort substudy of a single arm intervention study. Twenty-four ICU patients were included, who were admitted after a cardiac arrest and mechanically ventilated for 3 hours with heliox (50% helium; 50% oxygen). A fixed protective ventilation protocol (6 mL/kg) was used, with prospective observation for changes in lung mechanics and gas exchange. Statistics was by Bonferroni post-hoc correction with statistical significance set at P < 0.017. Results. During heliox ventilation, respiratory rate decreased (25 ± 4 versus 23 ± 5 breaths min(-1), P = 0.010). Minute volume ventilation showed a trend to decrease compared to baseline (11.1 ± 1.9 versus 9.9 ± 2.1 L min(-1), P = 0.026), while reducing PaCO2 levels (5.0 ± 0.6 versus 4.5 ± 0.6 kPa, P = 0.011) and peak pressures (21.1 ± 3.3 versus 19.8 ± 3.2 cm H2O, P = 0.024). Conclusions. Heliox improved CO2 elimination while allowing reduced minute volume ventilation in adult patients during protective mechanical ventilation. PMID:25548660

  16. Heliox Improves Carbon Dioxide Removal during Lung Protective Mechanical Ventilation

    PubMed Central

    Beurskens, Charlotte J.; Brevoord, Daniel; Lagrand, Wim K.; van den Bergh, Walter M.; Vroom, Margreeth B.; Preckel, Benedikt; Horn, Janneke; Juffermans, Nicole P.

    2014-01-01

    Introduction. Helium is a noble gas with low density and increased carbon dioxide (CO2) diffusion capacity. This allows lower driving pressures in mechanical ventilation and increased CO2 diffusion. We hypothesized that heliox facilitates ventilation in patients during lung-protective mechanical ventilation using low tidal volumes. Methods. This is an observational cohort substudy of a single arm intervention study. Twenty-four ICU patients were included, who were admitted after a cardiac arrest and mechanically ventilated for 3 hours with heliox (50% helium; 50% oxygen). A fixed protective ventilation protocol (6 mL/kg) was used, with prospective observation for changes in lung mechanics and gas exchange. Statistics was by Bonferroni post-hoc correction with statistical significance set at P < 0.017. Results. During heliox ventilation, respiratory rate decreased (25 ± 4 versus 23 ± 5 breaths min−1, P = 0.010). Minute volume ventilation showed a trend to decrease compared to baseline (11.1 ± 1.9 versus 9.9 ± 2.1 L min−1, P = 0.026), while reducing PaCO2 levels (5.0 ± 0.6 versus 4.5 ± 0.6 kPa, P = 0.011) and peak pressures (21.1 ± 3.3 versus 19.8 ± 3.2 cm H2O, P = 0.024). Conclusions. Heliox improved CO2 elimination while allowing reduced minute volume ventilation in adult patients during protective mechanical ventilation. PMID:25548660

  17. Institutional care for long-term mechanical ventilation in Canada: A national survey

    PubMed Central

    Rose, Louise; McKim, Douglas; Katz, Sherri; Leasa, David; Nonoyama, Mika; Pedersen, Cheryl; Avendano, Monica; Goldstein, Roger

    2014-01-01

    INTRODUCTION: No national Canadian data define resource requirements and care delivery for ventilator-assisted individuals (VAIs) requiring long-term institutional care. Such data will assist in planning health care services to this population. OBJECTIVE: To describe institutional and patient characteristics, prevalence, equipment used, care elements and admission barriers for VAIs requiring long-term institutional care. METHODS: Centres were identified from a national inventory and snowball referrals. The survey weblink was provided from December 2012 to April 2013. Weekly reminders were sent for six weeks. RESULTS: The response rate was 84% (54 of 64), with 44 adult and 10 pediatric centres providing data for 428 VAIs (301 invasive ventilation; 127 noninvasive ventilation [NIV]), equivalent to 1.3 VAIs per 100,000 population. An additional 106 VAIs were on wait lists in 18 centres. More VAIs with progressive neuromuscular disease received invasive ventilation than NIV (P<0.001); more VAIs with chronic obstructive pulmonary disease (P<0.001), obesity hypoventilation syndrome (P<0.001) and central hypoventilation syndrome (P=0.02) required NIV. All centres used positive pressure ventilators, 21% diaphragmatic pacing, 15% negative pressure and 13% phrenic nerve stimulation. Most centres used lung volume recruitment (55%), manually (71%) and mechanically assisted cough (55%). Lack of beds and provincial funding were common admission barriers. CONCLUSIONS: Variable models and care practices exist for institutionalized care of Canadian VAIs. Patient prevalence was 1.3 per 100,000 Canadians. PMID:25184510

  18. Exposure to mechanical ventilation promotes tolerance to ventilator-induced lung injury by Ccl3 downregulation.

    PubMed

    Blázquez-Prieto, Jorge; López-Alonso, Inés; Amado-Rodríguez, Laura; Batalla-Solís, Estefanía; González-López, Adrián; Albaiceta, Guillermo M

    2015-10-15

    Inflammation plays a key role in the development of ventilator-induced lung injury (VILI). Preconditioning with a previous exposure can damp the subsequent inflammatory response. Our objectives were to demonstrate that tolerance to VILI can be induced by previous low-pressure ventilation, and to identify the molecular mechanisms responsible for this phenomenon. Intact 8- to 12-wk-old male CD1 mice were preconditioned with 90 min of noninjurious ventilation [peak pressure 17 cmH2O, positive end-expiratory pressure (PEEP) 2 cmH2O] and extubated. Seven days later, preconditioned mice and intact controls were submitted to injurious ventilation (peak pressure 20 cmH2O, PEEP 0 cmH2O) for 2 h to induce VILI. Preconditioned mice showed lower histological lung injury scores, bronchoalveolar lavage albumin content, and lung neutrophilic infiltration after injurious ventilation, with no differences in Il6 or Il10 expression. Microarray analyses revealed a downregulation of Calcb, Hspa1b, and Ccl3, three genes related to tolerance phenomena, in preconditioned animals. Among the previously identified genes, only Ccl3, which encodes the macrophage inflammatory protein 1 alpha (MIP-1α), showed significant differences between intact and preconditioned mice after high-pressure ventilation. In separate, nonconditioned animals, treatment with BX471, a specific blocker of CCR1 (the main receptor for MIP-1α), decreased lung damage and neutrophilic infiltration caused by high-pressure ventilation. We conclude that previous exposure to noninjurious ventilation induces a state of tolerance to VILI. Downregulation of the chemokine gene Ccl3 could be the mechanism responsible for this effect. PMID:26472813

  19. Systemic inflammation associated with mechanical ventilation among extremely preterm infants

    PubMed Central

    Bose, Carl L.; Laughon, Matthew M.; Allred, Elizabeth N.; O’Shea, T. Michael; Van Marter, Linda J.; Ehrenkranz, Richard A.; Fichorova, Raina N.; Leviton, Alan

    2012-01-01

    Little evidence is available to document that mechanical ventilation is an antecedent of systemic inflammation in preterm humans. We obtained blood on postnatal day 14 from 726 infants born before the 28th week of gestation and measured the concentrations of 25 inflammation-related proteins. We created multivariable models to assess the relationship between duration of ventilation and protein concentrations in the top quartile. Compared to newborns ventilated for fewer than 7 days (N=247), those ventilated for 14 days (N=330) were more likely to have elevated blood concentrations of pro-inflammatory cytokines (IL-1β, TNF-α), chemokines (IL-8, MCP-1), an adhesion molecule (ICAM-1), and a matrix metalloprotease (MMP-9), and less likely to have elevated blood concentrations of two chemokines (RANTES, MIP-1β), a matrix metalloproteinase (MMP-1), and a growth factor (VEGF). Newborns ventilated for 7-13 days (N=149) had systemic inflammation that approximated the pattern of newborns ventilated for 14 days. These relationships were not confounded by chorioamnionitis or antenatal corticosteroid exposure, and were not altered appreciably among infants with and without bacteremia. These findings suggest that two weeks of ventilation are more likely than shorter durations of ventilation to be accompanied by high blood concentrations of pro-inflammatory proteins indicative of systemic inflammation, and by low concentrations of proteins that might protect from inflammation-mediated organ injury. PMID:23148992

  20. Numerical investigation of pulmonary drug delivery under mechanical ventilation conditions

    NASA Astrophysics Data System (ADS)

    Banerjee, Arindam; van Rhein, Timothy

    2012-11-01

    The effects of mechanical ventilation waveform on fluid flow and particle deposition were studied in a computer model of the human airways. The frequency with which aerosolized drugs are delivered to mechanically ventilated patients demonstrates the importance of understanding the effects of ventilation parameters. This study focuses specifically on the effects of mechanical ventilation waveforms using a computer model of the airways of patient undergoing mechanical ventilation treatment from the endotracheal tube to generation G7. Waveforms were modeled as those commonly used by commercial mechanical ventilators. Turbulence was modeled with LES. User defined particle force models were used to model the drag force with the Cunningham correction factor, the Saffman lift force, and Brownian motion force. The endotracheal tube (ETT) was found to be an important geometric feature, causing a fluid jet towards the right main bronchus, increased turbulence, and a recirculation zone in the right main bronchus. In addition to the enhanced deposition seen at the carinas of the airway bifurcations, enhanced deposition was also seen in the right main bronchus due to impaction and turbulent dispersion resulting from the fluid structures created by the ETT. Authors acknowledge financial support through University of Missouri Research Board Award.

  1. Preemptive mechanical ventilation can block progressive acute lung injury

    PubMed Central

    Sadowitz, Benjamin; Jain, Sumeet; Kollisch-Singule, Michaela; Satalin, Joshua; Andrews, Penny; Habashi, Nader; Gatto, Louis A; Nieman, Gary

    2016-01-01

    Mortality from acute respiratory distress syndrome (ARDS) remains unacceptable, approaching 45% in certain high-risk patient populations. Treating fulminant ARDS is currently relegated to supportive care measures only. Thus, the best treatment for ARDS may lie with preventing this syndrome from ever occurring. Clinical studies were examined to determine why ARDS has remained resistant to treatment over the past several decades. In addition, both basic science and clinical studies were examined to determine the impact that early, protective mechanical ventilation may have on preventing the development of ARDS in at-risk patients. Fulminant ARDS is highly resistant to both pharmacologic treatment and methods of mechanical ventilation. However, ARDS is a progressive disease with an early treatment window that can be exploited. In particular, protective mechanical ventilation initiated before the onset of lung injury can prevent the progression to ARDS. Airway pressure release ventilation (APRV) is a novel mechanical ventilation strategy for delivering a protective breath that has been shown to block progressive acute lung injury (ALI) and prevent ALI from progressing to ARDS. ARDS mortality currently remains as high as 45% in some studies. As ARDS is a progressive disease, the key to treatment lies with preventing the disease from ever occurring while it remains subclinical. Early protective mechanical ventilation with APRV appears to offer substantial benefit in this regard and may be the prophylactic treatment of choice for preventing ARDS. PMID:26855896

  2. Preemptive mechanical ventilation can block progressive acute lung injury.

    PubMed

    Sadowitz, Benjamin; Jain, Sumeet; Kollisch-Singule, Michaela; Satalin, Joshua; Andrews, Penny; Habashi, Nader; Gatto, Louis A; Nieman, Gary

    2016-02-01

    Mortality from acute respiratory distress syndrome (ARDS) remains unacceptable, approaching 45% in certain high-risk patient populations. Treating fulminant ARDS is currently relegated to supportive care measures only. Thus, the best treatment for ARDS may lie with preventing this syndrome from ever occurring. Clinical studies were examined to determine why ARDS has remained resistant to treatment over the past several decades. In addition, both basic science and clinical studies were examined to determine the impact that early, protective mechanical ventilation may have on preventing the development of ARDS in at-risk patients. Fulminant ARDS is highly resistant to both pharmacologic treatment and methods of mechanical ventilation. However, ARDS is a progressive disease with an early treatment window that can be exploited. In particular, protective mechanical ventilation initiated before the onset of lung injury can prevent the progression to ARDS. Airway pressure release ventilation (APRV) is a novel mechanical ventilation strategy for delivering a protective breath that has been shown to block progressive acute lung injury (ALI) and prevent ALI from progressing to ARDS. ARDS mortality currently remains as high as 45% in some studies. As ARDS is a progressive disease, the key to treatment lies with preventing the disease from ever occurring while it remains subclinical. Early protective mechanical ventilation with APRV appears to offer substantial benefit in this regard and may be the prophylactic treatment of choice for preventing ARDS. PMID:26855896

  3. Fatal brain gas embolism during non-invasive positive pressure ventilation

    PubMed Central

    Rivara, Claire B; Chevrolet, Jean-Claude; Gasche, Yvan; Charbonney, Emmanuel

    2008-01-01

    Gas embolism is a dreaded complication following invasive medical procedures, traumatic lung injury and decompression accidents. We report a case of fatal gas embolism following the use of non-invasive ventilation (NIV) with bilevel positive airway pressure (BiPAP). The patient initially underwent left bronchial artery embolisation for massive haemoptysis in the context of severe tuberculotic sequels. Under NIV and after heavy coughing he became hemiparetic and his level of consciousness suddenly dropped. Computed tomography of the brain showed multiple air embolism and ischaemic lesions were confirmed by magnetic resonance imaging. Echocardiographic investigations showed no intracardiac defect. Vasculo-pulmonary abnormalities in the context of heavy coughing and non-invasive ventilation may have played a major role in the occurrence of this event. New neurological events in a patient with tuberculotic sequels or any known vascular pulmonary abnormalities and NIV should raise the suspicion of brain gas embolism. PMID:21716825

  4. Clinical management of stressors perceived by patients on mechanical ventilation.

    PubMed

    Thomas, Loris A

    2003-02-01

    Psychological and psychosocial stressors perceived by the mechanically ventilated patient include intensive care unit environmental factors, communication factors, stressful symptoms, and the effectiveness of interventions. The studies reviewed in this article showed four stressors commonly identified by mechanically ventilated patients including dyspnea, anxiety, fear, and pain. Few interventional studies to reduce these stressors are available in the literature. Four interventions including hypnosis and relaxation, patient education and information sharing, music therapy, and supportive touch have been investigated in the literature and may be helpful in reducing patient stress. The advanced practice nurse is instrumental in the assessment of patient-perceived stressors while on the ventilator, and in the planning and implementation of appropriate interventions to reduce stressors and facilitate optimal ventilation, weaning, or both. PMID:12574705

  5. [Invasive ventilation. Classification, technique and clinical experiences with BiPAP/APRV (Biphasic Positive Airway Pressure/Airway Pressure Release Ventilation)].

    PubMed

    Antonsen, K; Jacobsen, E; Pedersen, J E; Porsborg, P A; Bonde, J

    1996-01-22

    BiPAP (bilevel or biphasic positive airway pressure) and APRV (airway pressure release ventilation) are new, and from a technical viewpoint closely related techniques recently introduced to the field of invasive ventilatory support. BiPAP/APRV can be described as a pressure controlled continuous high flow positive airway pressure system with a time-cycled change between a high inspiratory pressure level and a lower expiratory pressure level. Due to highly sensitive valves placed in the inspiratory and expiratory part of the system, unrestricted spontaneous breathing is possible at any moment of the mechanically supported ventilatory cycle. During invasive ventilation BiPAP offers potential advantages by allowing unrestricted spontaneous breathing thus reducing the need for sedation and facilitating weaning. APRV has primarily been investigated in conditions of moderate to severe acute lung injury and it seems that APRV is associated with less detrimental effects on the cardiopulmonary system compared to conventional ventilatory strategies. Apart from a review of the literature the article gives a classification and a technical description of the systems and focuses on the practical approach to BiPAP/APRV, e.g. the initiation and adjustment of respiratory support and the weaning from ventilatory support when applying these techniques. PMID:8638300

  6. Noninvasive mechanical ventilation in chronic obstructive pulmonary disease and in acute cardiogenic pulmonary edema.

    PubMed

    Rialp Cervera, G; del Castillo Blanco, A; Pérez Aizcorreta, O; Parra Morais, L

    2014-03-01

    Noninvasive ventilation (NIV) with conventional therapy improves the outcome of patients with acute respiratory failure due to hypercapnic decompensation of chronic obstructive pulmonary disease (COPD) or acute cardiogenic pulmonary edema (ACPE). This review summarizes the main effects of NIV in these pathologies. In COPD, NIV improves gas exchange and symptoms, reducing the need for endotracheal intubation, hospital mortality and hospital stay compared with conventional oxygen therapy. NIV may also avoid reintubation and may decrease the length of invasive mechanical ventilation. In ACPE, NIV accelerates the remission of symptoms and the normalization of blood gas parameters, reduces the need for endotracheal intubation, and is associated with a trend towards lesser mortality, without increasing the incidence of myocardial infarction. The ventilation modality used in ACPE does not affect the patient prognosis. PMID:23158869

  7. Airflow analysis in mechanically ventilated obstructed rooms

    NASA Astrophysics Data System (ADS)

    Priest, John Brian

    1999-11-01

    Local and mean air velocities and standard deviations were measured in realistic rooms. Obstructions represented occupants and equipment in the rooms, internal heat loads varied and supply air temperature differed from room averages. Experimental setups differed for the isothermal and nonisothermal tests. Room dimensions for isothermal tests were 2.44 m high by 4.88 x 4.88 m. Ten different obstruction ratios using three different inlet types were analyzed. Obstructions covered 0 to 30% floor area and from 0 to 75% of room height. Air was supplied at ventilation rates ranging between 0.8 and 1.1 m 3/s. Room dimensions for the nonisothermal tests were 2.44 m high by 3.66 x 7.32 m. Obstruction differences between solid versus open partitions for farrowing crates were investigated for three commercially available inlets using two ventilation loads. Ventilation rates were 0.11 to 1.18 m 3/s, simulating cold and warm weather ventilation conditions, respectively. Based on these data and theoretical calculations, a kinetic energy model that predicts average room air velocity and energy level was developed as a practical room air flow design and analysis tool. It was recommended that designers interested in using CFD as a tool should use a three dimensional laminar model for acceptable qualitative flow results. It was concluded that for typical room flowrates and inlet types the room air distribution system is obstruction ratio independent. Local velocities and standard deviations varied with each obstruction setup and inlet combination. However, average air velocities and turbulence intensities were not influenced by obstruction setups or inlet configurations. The decay rate of mean velocity kinetic energy in the bulk flow region was independent of obstructions and inlets. Room average kinetic energy was a function of the supplied kinetic energy within the supply jet plus internal kinetic energy resulting from internal heat load (convective energy).

  8. Clinical review: Respiratory mechanics in spontaneous and assisted ventilation

    PubMed Central

    Grinnan, Daniel C; Truwit, Jonathon Dean

    2005-01-01

    Pulmonary disease changes the physiology of the lungs, which manifests as changes in respiratory mechanics. Therefore, measurement of respiratory mechanics allows a clinician to monitor closely the course of pulmonary disease. Here we review the principles of respiratory mechanics and their clinical applications. These principles include compliance, elastance, resistance, impedance, flow, and work of breathing. We discuss these principles in normal conditions and in disease states. As the severity of pulmonary disease increases, mechanical ventilation can become necessary. We discuss the use of pressure–volume curves in assisting with poorly compliant lungs while on mechanical ventilation. In addition, we discuss physiologic parameters that assist with ventilator weaning as the disease process abates. PMID:16277736

  9. Mechanical exsufflation, noninvasive ventilation, and new strategies for pulmonary rehabilitation and sleep disordered breathing.

    PubMed Central

    Bach, J. R.

    1992-01-01

    Manual and mechanical exsufflation are important but underutilized ways to clear airway secretions. These methods are especially useful when used in concert with noninvasive intermittent positive airway pressure ventilatory assistance to facilitate extubation and ventilator weaning. This can be used as much as 24 hours a day as an alternative to tracheostomy ventilation or body ventilator use for patients with paralytic restrictive ventilatory insufficiency. These techniques expedite community management of ventilator assisted individuals by avoiding tracheostomy and need for invasive suctioning and ongoing wound care. For these techniques to be effective and to prevent further suppression of ventilatory drive, supplemental oxygen administration must be avoided unless pO2 is less than 60 mm Hg despite normalization of pCO2. Custom molded interfaces for the delivery of noninvasive intermittent positive airway pressure ventilatory assistance can also be used to facilitate the delivery of variable inspiratory expiratory positive airway pressure for patients with obstructive sleep apnea. Noninvasive intermittent positive airway pressure ventilatory assistance or body ventilator use can rest the respiratory muscles of patients with advanced chronic obstructive pulmonary disease. This and pulmonary rehabilitation programs geared to exercise reconditioning are therapeutic options that significantly improve the quality of life of these patients. For both paralytic restrictive and obstructive pulmonary patients, these techniques decrease cost and frequency of hospitalizations. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4 Fig. 5 Fig. 6 PMID:1586868

  10. Weaning from mechanical ventilation in paediatrics. State of the art.

    PubMed

    Valenzuela, Jorge; Araneda, Patricio; Cruces, Pablo

    2014-03-01

    Weaning from mechanical ventilation is one of the greatest volume and strength issues in evidence-based medicine in critically ill adults. In these patients, weaning protocols and daily interruption of sedation have been implemented, reducing the duration of mechanical ventilation and associated morbidity. In paediatrics, the information reported is less consistent, so that as yet there are no reliable criteria for weaning and extubation in this patient group. Several indices have been developed to predict the outcome of weaning. However, these have failed to replace clinical judgement, although some additional measurements could facilitate this decision. PMID:23542044

  11. Cost comparison of mechanically ventilated patients across the age span

    PubMed Central

    Hayman, William R.; Leuthner, Steven R.; Laventhal, Naomi T.; Brousseau, David; Lagatta, Joanne M.

    2016-01-01

    Objective to compare use of mechanical ventilation and hospital costs across ventilated patients of all ages, preterm through adults, in a nationally-representative sample. Study Design secondary analysis of the 2009 Agency for Healthcare Research and Quality National Inpatient Sample. Results 1,107,563 (2.8%) patients received mechanical ventilation. For surviving ventilated patients, median costs for infants ≤32 weeks’ gestation were $51,000–$209,000, whereas median costs for older patients were lower, from $17,000–$25,000. For non-surviving ventilated patients, median costs were $27,000–$39,000 except at the extremes of age; the median cost was $10,000 for <24 week newborns, and $14,000 for 91+ year adults. Newborns of all gestational ages had a disproportionate share of hospital costs relative to their total volume. Conclusions Most ICU resources at the extremes of age are not directed toward non-surviving patients. From a perinatal perspective, attention should be directed toward improving outcomes and reducing costs for all infants, not just at the earliest gestational ages. PMID:26468935

  12. Lung hyperinflation by mechanical ventilation versus isolated tracheal aspiration in the bronchial hygiene of patients undergoing mechanical ventilation

    PubMed Central

    Assmann, Crisiela Brum; Vieira, Paulo José Cardoso; Kutchak, Fernanda; Rieder, Marcelo de Mello; Forgiarini, Soraia Genebra Ibrahim; Forgiarini Junior, Luiz Alberto

    2016-01-01

    Objective To determine the efficacy of lung hyperinflation maneuvers via a mechanical ventilator compared to isolated tracheal aspiration for removing secretions, normalizing hemodynamics and improving lung mechanics in patients on mechanical ventilation. Methods This was a randomized crossover clinical trial including patients admitted to the intensive care unit and on mechanical ventilation for more than 48 hours. Patients were randomized to receive either isolated tracheal aspiration (Control Group) or lung hyperinflation by mechanical ventilator (MVH Group). Hemodynamic and mechanical respiratory parameters were measured along with the amount of aspirated secretions. Results A total of 50 patients were included. The mean age of the patients was 44.7 ± 21.6 years, and 31 were male. Compared to the Control Group, the MVH Group showed greater aspirated secretion amount (3.9g versus 6.4g, p = 0.0001), variation in mean dynamic compliance (-1.3 ± 2.3 versus -2.9 ± 2.3; p = 0.008), and expired tidal volume (-0.7 ± 0.0 versus -54.1 ± 38.8, p = 0.0001) as well as a significant decrease in peak inspiratory pressure (0.2 ± 0.1 versus 2.5 ± 0.1; p = 0.001). Conclusion In the studied sample, the MVH technique led to a greater amount of aspirated secretions, significant increases in dynamic compliance and expired tidal volume and a significant reduction in peak inspiratory pressure. PMID:27096673

  13. Long Term Non-Invasive Ventilation in Children: Impact on Survival and Transition to Adult Care

    PubMed Central

    Chatwin, Michelle; Tan, Hui-Leng; Bush, Andrew; Rosenthal, Mark; Simonds, Anita Kay

    2015-01-01

    Background The number of children receiving domiciliary ventilatory support has grown over the last few decades driven largely by the introduction and widening applications of non-invasive ventilation. Ventilatory support may be used with the intention of increasing survival, or to facilitate discharge home and/or to palliate symptoms. However, the outcome of this intervention and the number of children transitioning to adult care as a consequence of longer survival is not yet clear. Methods In this retrospective cohort study, we analysed the outcome in children (<17 years) started on home NIV at Royal Brompton Hospital over an 18 year period 1993-2011. The aim was to establish for different diagnostic groups: survival rate, likelihood of early death depending on diagnosis or discontinuation of ventilation, and the proportion transitioning to adult care. Results 496 children were commenced on home non invasive ventilation; follow-up data were available in 449 (91%). Fifty six per cent (n=254) had neuromuscular disease. Ventilation was started at a median age (IQR) 10 (3-15) years. Thirteen percent (n=59) were less than 1 year old. Forty percent (n=181) have transitioned to adult care. Twenty four percent (n=109) of patients have died, and nine percent (n=42) were able to discontinue ventilatory support. Conclusion Long term ventilation is associated with an increase in survival in a range of conditions leading to ventilatory failure in children, resulting in increasing numbers surviving to adulthood. This has significant implications for planning transition and adult care facilities. PMID:25933065

  14. 46 CFR 154.1205 - Mechanical ventilation system: Standards.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 46 Shipping 5 2013-10-01 2013-10-01 false Mechanical ventilation system: Standards. 154.1205 Section 154.1205 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) CERTAIN BULK DANGEROUS CARGOES SAFETY STANDARDS FOR SELF-PROPELLED VESSELS CARRYING BULK LIQUEFIED GASES Design, Construction...

  15. 46 CFR 154.1205 - Mechanical ventilation system: Standards.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 46 Shipping 5 2011-10-01 2011-10-01 false Mechanical ventilation system: Standards. 154.1205 Section 154.1205 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) CERTAIN BULK DANGEROUS CARGOES SAFETY STANDARDS FOR SELF-PROPELLED VESSELS CARRYING BULK LIQUEFIED GASES Design, Construction...

  16. 46 CFR 154.1205 - Mechanical ventilation system: Standards.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 46 Shipping 5 2014-10-01 2014-10-01 false Mechanical ventilation system: Standards. 154.1205 Section 154.1205 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) CERTAIN BULK DANGEROUS CARGOES SAFETY STANDARDS FOR SELF-PROPELLED VESSELS CARRYING BULK LIQUEFIED GASES Design, Construction...

  17. 46 CFR 154.1205 - Mechanical ventilation system: Standards.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 46 Shipping 5 2012-10-01 2012-10-01 false Mechanical ventilation system: Standards. 154.1205 Section 154.1205 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) CERTAIN BULK DANGEROUS CARGOES SAFETY STANDARDS FOR SELF-PROPELLED VESSELS CARRYING BULK LIQUEFIED GASES Design, Construction...

  18. Pulse oximetry performance in mechanically ventilated newborn infants.

    PubMed

    Solevåg, Anne L; Solberg, Marianne T; Šaltytė-Benth, Jūratė

    2015-08-01

    Pulse oximetry is widely used to target oxygenation in newborn infants. In a retrospective chart review of 138 mechanically ventilated infants, pulse oximetry overestimated blood oxygen saturation compared to arterial blood gas analyses. Despite improvements in pulse oximeter technology, pulse oximetry performance in sick newborns should still be under scrutiny. PMID:26067867

  19. 46 CFR 154.1205 - Mechanical ventilation system: Standards.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 5 2010-10-01 2010-10-01 false Mechanical ventilation system: Standards. 154.1205 Section 154.1205 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) CERTAIN BULK DANGEROUS CARGOES SAFETY STANDARDS FOR SELF-PROPELLED VESSELS CARRYING BULK LIQUEFIED GASES Design, Construction and Equipment Cargo Area:...

  20. Computational tool for modeling and simulation of mechanically ventilated patients.

    PubMed

    Serna, Leidy Y; Hernandez, Alher M; Mananas, Miguel A

    2010-01-01

    The mechanical ventilator settings in patients with respiratory diseases like chronic obstructive pulmonary disease (COPD) during episodes of acute respiratory failure (ARF) is not a simple task that in most cases is successful based on the experience of physicians. This paper describes an interactive tool based in mathematical models, developed to make easier the study of the interaction between a mechanical ventilator and a patient. It describes all stages of system development, including simulated ventilatory modes, the pathologies of interest and interaction between the user and the system through a graphical interface developed in Matlab and Simulink. The developed computational tool allows the study of most widely used ventilatory modes and its advantages in the treatment of different kind of patients. The graphical interface displays all variables and parameters in the common way of last generation mechanical ventilators do and it is totally interactive, making possible its use by clinical personal, hiding the complexity of implemented mathematical models to the user. The evaluation in different clinical simulated scenes adjusts properly with recent findings in mechanical ventilation scientific literature. PMID:21096101

  1. Mechanical Ventilation as a Therapeutic Tool to Reduce ARDS Incidence.

    PubMed

    Nieman, Gary F; Gatto, Louis A; Bates, Jason H T; Habashi, Nader M

    2015-12-01

    Trauma, hemorrhagic shock, or sepsis can incite systemic inflammatory response syndrome, which can result in early acute lung injury (EALI). As EALI advances, improperly set mechanical ventilation (MV) can amplify early injury into a secondary ventilator-induced lung injury that invariably develops into overt ARDS. Once established, ARDS is refractory to most therapeutic strategies, which have not been able to lower ARDS mortality below the current unacceptably high 40%. Low tidal volume ventilation is one of the few treatments shown to have a moderate positive impact on ARDS survival, presumably by reducing ventilator-induced lung injury. Thus, there is a compelling case to be made that the focus of ARDS management should switch from treatment once this syndrome has become established to the application of preventative measures while patients are still in the EALI stage. Indeed, studies have shown that ARDS incidence is markedly reduced when conventional MV is applied preemptively using a combination of low tidal volume and positive end-expiratory pressure in both patients in the ICU and in surgical patients at high risk for developing ARDS. Furthermore, there is evidence from animal models and high-risk trauma patients that superior prevention of ARDS can be achieved using preemptive airway pressure release ventilation with a very brief duration of pressure release. Preventing rather than treating ARDS may be the way forward in dealing with this recalcitrant condition and would represent a paradigm shift in the way that MV is currently practiced. PMID:26135199

  2. Mechanical ventilation of patients with acute lung injury.

    PubMed

    Sessler, C N

    1998-10-01

    Ventilatory management of patients with acute lung injury (ALI), particularly its most severe subset, acute respiratory distress syndrome (ARDS), is complex. Newer lung protective strategies emphasize measures to enhance alveolar recruitment and avoid alveolar overdistention, thus minimizing the risk of ventilator-induced lung injury (VILI). Key components of such strategies include the use of smaller-than-conventional tidal volumes which maintain peak transpulmonary pressure below the pressure associated with overdistention, and titration of positive end-expiratory pressure to promote maximal alveolar recruitment. Novel techniques, including prone positioning, inverse ratio ventilation, tracheal gas insufflation, and high frequency ventilation, are considerations in severe ARDS. No single approach is best for all patients; adjustment of ventilatory parameters to individual characteristics, such as lung mechanics and gas exchange, is required. PMID:9891634

  3. Non-invasive ventilation with neurally adjusted ventilatory assist in newborns.

    PubMed

    Stein, Howard; Beck, Jennifer; Dunn, Michael

    2016-06-01

    Neurally adjusted ventilatory assist (NAVA) is a mode of ventilation in which both the timing and degree of ventilatory assist are controlled by the patient. Since NAVA uses the diaphragm electrical activity (Edi) as the controller signal, it is possible to deliver synchronized non-invasive NAVA (NIV-NAVA) regardless of leaks and to monitor continuously patient respiratory pattern and drive. Advantages of NIV-NAVA over conventional modes include improved patient-ventilator interaction, reliable respiratory monitoring and self-regulation of respiratory support. In theory, these characteristics make NIV-NAVA an ideal mode to provide effective, appropriate non-invasive support to newborns with respiratory insufficiency. NIV-NAVA has been successfully used clinically in neonates as a mode of ventilation to prevent intubation, to allow early extubation, and as a novel way to deliver nasal continuous positive airway pressure. The use of NAVA in neonates is described with an emphasis on studies and clinical experience with NIV-NAVA. PMID:26899957

  4. [Noninvasive mechanical ventilation in patients with stable severe COPD].

    PubMed

    Schucher, B; Zerbst, J; Baumann, H J

    2004-06-01

    Noninvasive positive pressure ventilation in patients with stable chronic obstructive pulmonary disease. The role of non-invasive positive pressure ventilation (NIPPV) is well documented in patients with restrictive thoracic diseases like kyphoscoliosis, tuberculosis sequelae or neuromuscular disease. There is also a good evidence for the use of NIPPV in acute respiratory failure in patients with an exacerbation of COPD. The application of NIPPV in patients with chronic respiratory failure is growing, but there is less evidence than in restrictive disorders. NIPPV can unload the respiratory muscles in patients with chronic hypercapnic COPD and so alleviates fatigue of the respiratory pump, but improvement in the maximal inspiratory pressure (Pi (max)) is small or even absent. An improvement of sleep quality has also postulated, there was an increase in total sleep time and sleep effectiveness when using higher inspiratory pressure. An increase of the walking distance was shown in short term studies, only. In most studies, there was an increase in quality of life as a main topic. Mortality was unchanged in the two long-term randomised controlled studies. Current data suggest a possible role of NIPPV in patients with severe hypercapnia. A high effective inspiratory pressure and a ventilator mode with a significant reduction in the work of breathing should be choosen. NIPPV should be started in hospital, a close reassessment must be performed. Patients who accepted NIPPV in the first weeks had a good compliance for long-term use. PMID:15216436

  5. Microbial profiling of dental plaque from mechanically ventilated patients.

    PubMed

    Sands, Kirsty M; Twigg, Joshua A; Lewis, Michael A O; Wise, Matt P; Marchesi, Julian R; Smith, Ann; Wilson, Melanie J; Williams, David W

    2016-02-01

    Micro-organisms isolated from the oral cavity may translocate to the lower airways during mechanical ventilation (MV) leading to ventilator-associated pneumonia (VAP). Changes within the dental plaque microbiome during MV have been documented previously, primarily using culture-based techniques. The aim of this study was to use community profiling by high throughput sequencing to comprehensively analyse suggested microbial changes within dental plaque during MV. Bacterial 16S rDNA gene sequences were obtained from 38 samples of dental plaque sampled from 13 mechanically ventilated patients and sequenced using the Illumina platform. Sequences were processed using Mothur, applying a 97 % gene similarity cut-off for bacterial species level identifications. A significant 'microbial shift' occurred in the microbial community of dental plaque during MV for nine out of 13 patients. Following extubation, or removal of the endotracheal tube that facilitates ventilation, sampling revealed a decrease in the relative abundance of potential respiratory pathogens and a compositional change towards a more predominantly (in terms of abundance) oral microbiota including Prevotella spp., and streptococci. The results highlight the need to better understand microbial shifts in the oral microbiome in the development of strategies to reduce VAP, and may have implications for the development of other forms of pneumonia such as community-acquired infection. PMID:26690690

  6. Automated mechanical ventilation: adapting decision making to different disease states.

    PubMed

    Lozano-Zahonero, S; Gottlieb, D; Haberthür, C; Guttmann, J; Möller, K

    2011-03-01

    The purpose of the present study is to introduce a novel methodology for adapting and upgrading decision-making strategies concerning mechanical ventilation with respect to different disease states into our fuzzy-based expert system, AUTOPILOT-BT. The special features are: (1) Extraction of clinical knowledge in analogy to the daily routine. (2) An automated process to obtain the required information and to create fuzzy sets. (3) The controller employs the derived fuzzy rules to achieve the desired ventilation status. For demonstration this study focuses exclusively on the control of arterial CO(2) partial pressure (p(a)CO(2)). Clinical knowledge from 61 anesthesiologists was acquired using a questionnaire from which different disease-specific fuzzy sets were generated to control p(a)CO(2). For both, patients with healthy lung and with acute respiratory distress syndrome (ARDS) the fuzzy sets show different shapes. The fuzzy set "normal", i.e., "target p(a)CO(2) area", ranges from 35 to 39 mmHg for healthy lungs and from 39 to 43 mmHg for ARDS lungs. With the new fuzzy sets our AUTOPILOT-BT reaches the target p(a)CO(2) within maximal three consecutive changes of ventilator settings. Thus, clinical knowledge can be extended, updated, and the resulting mechanical ventilation therapies can be individually adapted, analyzed, and evaluated. PMID:21069471

  7. Mechanical Ventilation Boot Camp: A Simulation-Based Pilot Study

    PubMed Central

    Yee, Jennifer; Fuenning, Charles; George, Richard; Hejal, Rana; Haines, Nhi; Dunn, Diane; Gothard, M. David; Ahmed, Rami A.

    2016-01-01

    Objectives. Management of mechanically ventilated patients may pose a challenge to novice residents, many of which may not have received formal dedicated critical care instruction prior to starting their residency training. There is a paucity of data regarding simulation and mechanical ventilation training in the medical education literature. The purpose of this study was to develop a curriculum to educate first-year residents on addressing and troubleshooting ventilator alarms. Methods. Prospective evaluation was conducted of seventeen residents undergoing a twelve-hour three-day curriculum. Residents were assessed using a predetermined critical action checklist for each case, as well as pre- and postcurriculum multiple-choice cognitive knowledge questionnaires and confidence surveys. Results. Significant improvements in cognitive knowledge, critical actions, and self-reported confidence were demonstrated. The mean change in test score from before to after intervention was +26.8%, and a median score increase of 25% was noted. The ARDS and the mucus plugging cases had statistically significant improvements in critical actions, p < 0.001. A mean increase in self-reported confidence was realized (1.55 to 3.64), p = 0.049. Conclusions. A three-day simulation curriculum for residents was effective in increasing competency, knowledge, and confidence with ventilator management. PMID:26949545

  8. Non-invasive ventilation in chronic obstructive pulmonary disease: management of acute type 2 respiratory failure.

    PubMed

    Roberts, C M; Brown, J L; Reinhardt, A K; Kaul, S; Scales, K; Mikelsons, C; Reid, K; Winter, R; Young, K; Restrick, L; Plant, P K

    2008-10-01

    Non-invasive ventilation (NIV) in the management of acute type 2 respiratory failure in patients with chronic obstructive pulmonary disease (COPD) represents one of the major technical advances in respiratory care over the last decade. This document updates the 2002 British Thoracic Society guidance and provides a specific focus on the use of NIV in COPD patients with acute type 2 respiratory failure. While there are a variety of ventilator units available most centres now use bi-level positive airways pressure units and this guideline refers specifically to this form of ventilatory support although many of the principles encompassed are applicable to other forms of NIV. The guideline has been produced for the clinician caring for COPD patients in the emergency and ward areas of acute hospitals. PMID:18975486

  9. Ventilation distribution and chest wall mechanics in microgravity

    NASA Technical Reports Server (NTRS)

    Paiva, M.; Wantier, M.; Verbanck, S.; Engel, L. A.; Prisk, G. K.; Guy, H. J. B.; West, J. B.

    1997-01-01

    The effect of gravity on lung ventilation distribution and the mechanisms of the chest wall were investigated. The following tests were performed with the respiratory monitoring system of the Anthorack, flown onboard Spacelab D2 mission: single breath washout (SBW), multiple breath washout (MBW) and argon rebreathing (ARB). In order to study chest wall mechanisms in microgravity, a respiratory inductive plethysmograph was used. The SBW tests did not reach statistical significance, while the ARB tests showed that gravity independent inhomogeneity of specific ventilation is larger than gravity dependent inhomogeneity. In which concerns the chest wall mechanisms, the analysis on the four astronauts during the normal respirations of the relaxation maneuver showed a 40 percent increase on the abdominal contribution to respiration.

  10. [Lung-brain interaction in the mechanically ventilated patient].

    PubMed

    López-Aguilar, J; Fernández-Gonzalo, M S; Turon, M; Quílez, M E; Gómez-Simón, V; Jódar, M M; Blanch, L

    2013-10-01

    Patients with acute lung injury or acute respiratory distress syndrome (ARDS) admitted to the ICU present neuropsychological alterations, which in most cases extend beyond the acute phase and have an important adverse effect upon quality of life. The aim of this review is to deepen in the analysis of the complex interaction between lung and brain in critically ill patients subjected to mechanical ventilation. This update first describes the neuropsychological alterations occurring both during the acute phase of ICU stay and at discharge, followed by an analysis of lung-brain interactions during mechanical ventilation, and finally explores the etiology and mechanisms leading to the neurological disorders observed in these patients. The management of critical patients requires an integral approach focused on minimizing the deleterious effects over the short, middle or long term. PMID:23260265

  11. Effect of PEEP on regional ventilation and perfusion in the mechanically ventilated preterm lamb

    SciTech Connect

    Schlessel, J.S.; Susskind, H.; Joel, D.D.; Bossuyt, A.; Harrold, W.H.; Zanzi, I.; Chanana, A.D. )

    1989-08-01

    Improvement of gas exchange through closer matching of regional ventilation (V) and lung perfusion (Q) with the application of positive end-expiratory pressure (PEEP) was evaluated in vivo in six mechanically ventilated preterm lambs (107-126 days/145 days gestation). Changes in V and Q were determined from in vivo scintigraphic measurements in four lung regions with inhaled radioactive 81mKr, and infused {sup 81m}Kr/dextrose and/or ({sup 99m}Tc)MAA as PEEP was applied at 2, 4, and 6 cm H{sub 2}O in each animal. Dynamic compliance varied between 0.02 and 0.40 ml/cm H{sub 2}O, which was consistent with surfactant deficiency. As PEEP was increased, the regional distribution of Q shifted from the rostral to the caudal lung regions (p less than 0.02 to less than 0.05), while that of V remained unchanged. Regional V/Q matching improved together with a trend towards improvement of arterial blood gases as PEEP was increased from 2 to 4 cm H{sub 2}O. Pulmonary scintigraphy offers a noninvasive methodology for the quantitative assessment of regional V and Q matching in preterm lambs and may be clinically applicable to ventilated neonates.

  12. NanoClusters Enhance Drug Delivery in Mechanical Ventilation

    NASA Astrophysics Data System (ADS)

    Pornputtapitak, Warangkana

    The overall goal of this thesis was to develop a dry powder delivery system for patients on mechanical ventilation. The studies were divided into two parts: the formulation development and the device design. The pulmonary system is an attractive route for drug delivery since the lungs have a large accessible surface area for treatment or drug absorption. For ventilated patients, inhaled drugs have to successfully navigate ventilator tubing and an endotracheal tube. Agglomerates of drug nanoparticles (also known as 'NanoClusters') are fine dry powder aerosols that were hypothesized to enable drug delivery through ventilator circuits. This Thesis systematically investigated formulations of NanoClusters and their aerosol performance in a conventional inhaler and a device designed for use during mechanical ventilation. These engineered powders of budesonide (NC-Bud) were delivered via a MonodoseRTM inhaler or a novel device through commercial endotracheal tubes, and analyzed by cascade impaction. NC-Bud had a higher efficiency of aerosol delivery compared to micronized stock budesonide. The delivery efficiency was independent of ventilator parameters such as inspiration patterns, inspiration volumes, and inspiration flow rates. A novel device designed to fit directly to the ventilator and endotracheal tubing connections and the MonodoseRTM inhaler showed the same efficiency of drug delivery. The new device combined with NanoCluster formulation technology, therefore, allowed convenient and efficient drug delivery through endotracheal tubes. Furthermore, itraconazole (ITZ), a triazole antifungal agent, was formulated as a NanoCluster powder via milling (top-down process) or precipitation (bottom-up process) without using any excipients. ITZ NanoClusters prepared by wet milling showed better aerosol performance compared to micronized stock ITZ and ITZ NanoClusters prepared by precipitation. ITZ NanoClusters prepared by precipitation methods also showed an amorphous state

  13. Postoperative Pulmonary Dysfunction and Mechanical Ventilation in Cardiac Surgery

    PubMed Central

    Badenes, Rafael; Lozano, Angels; Belda, F. Javier

    2015-01-01

    Postoperative pulmonary dysfunction (PPD) is a frequent and significant complication after cardiac surgery. It contributes to morbidity and mortality and increases hospitalization stay and its associated costs. Its pathogenesis is not clear but it seems to be related to the development of a systemic inflammatory response with a subsequent pulmonary inflammation. Many factors have been described to contribute to this inflammatory response, including surgical procedure with sternotomy incision, effects of general anesthesia, topical cooling, and extracorporeal circulation (ECC) and mechanical ventilation (VM). Protective ventilation strategies can reduce the incidence of atelectasis (which still remains one of the principal causes of PDD) and pulmonary infections in surgical patients. In this way, the open lung approach (OLA), a protective ventilation strategy, has demonstrated attenuating the inflammatory response and improving gas exchange parameters and postoperative pulmonary functions with a better residual functional capacity (FRC) when compared with a conventional ventilatory strategy. Additionally, maintaining low frequency ventilation during ECC was shown to decrease the incidence of PDD after cardiac surgery, preserving lung function. PMID:25705516

  14. Communicating While Receiving Mechanical Ventilation: Texting With a Smartphone.

    PubMed

    Shiber, Joseph; Thomas, Ayesha; Northcutt, Ashley

    2016-03-01

    Two young adults with severe facial injuries were receiving care in the trauma/surgical intensive care unit at a tertiary care, level I trauma center in the southeastern United States. Both patients were able to communicate by texting on their cellphones to family members, friends, and caregivers in the intensive care unit. Patients who are awake and already have experience texting with a smartphone or other electronic handheld device may be able to communicate well while receiving mechanical ventilation. PMID:26932926

  15. Respiratory mechanics studied by forced oscillations during artificial ventilation.

    PubMed

    Peslin, R; Felicio da Silva, J; Duvivier, C; Chabot, F

    1993-06-01

    Potential advantages of the forced oscillation technique over other methods for monitoring total respiratory mechanics during artificial ventilation are that it does not require patient relaxation, and that additional information may be derived from the frequency dependence of the real (Re) and imaginary (Im) parts of respiratory impedance. We wanted to assess feasibility and usefulness of the forced oscillation technique in this setting and therefore used the approach in 17 intubated patients, mechanically ventilated for acute respiratory failure. Sinusoidal pressure oscillations at 5, 10 and 20 Hz were applied at the airway opening, using a specially devised loudspeaker-type generator placed in parallel with the ventilator. Real and imaginary parts were corrected for the flow-dependent impedance of the endotracheal tube; they usually exhibited large variations during the respiratory cycle, and were computed separately for the inspiratory and expiratory phases. In many instances the real part was larger during inspiration, probably due to the larger respiratory flow, and decreased with increasing frequency. The imaginary part of respiratory impedance usually increased with increasing frequency during expiration, as expected for a predominately elastic system, but often varied little, or even decreased, with increasing frequency during inspiration. In most patients, the data were inconsistent with the usual resistance-inertance-compliance model. A much better fit was obtained with a model featuring central airways and a peripheral pathway in parallel with bronchial compliance. The results obtained with the latter model suggest that dynamic airway compression occurred during passive expiration in a number of patients. We conclude that the use of forced oscillation is relatively easy to implement during mechanical ventilation, that it allows the study of respiratory mechanics at various points in the respiratory cycle, and may help in detecting expiratory flow

  16. High-frequency oscillatory ventilation compared with conventional mechanical ventilation in the treatment of respiratory failure in preterm infants. The HIFI Study Group.

    PubMed

    1989-01-12

    We conducted a multicenter randomized clinical trial to compare the efficacy and safety of high-frequency ventilation with that of conventional mechanical ventilation in the treatment of respiratory failure in preterm infants. Of 673 preterm infants weighing between 750 and 2000 g, 346 were assigned to receive conventional mechanical ventilation and 327 to receive high-frequency oscillatory ventilation. The incidence of bronchopulmonary dysplasia was similar in the two groups (high-frequency ventilation, 40 percent; conventional mechanical ventilation, 41 percent; P = 0.79). High-frequency ventilation did not reduce mortality (18 percent, vs. 17 percent with conventional ventilation; P = 0.73) or the level of ventilatory support during the first 28 days. The crossover rate from high-frequency ventilation to conventional mechanical ventilation was greater than the crossover rate from mechanical to high-frequency ventilation (26 vs. 17 percent; P = 0.01). High-frequency ventilation, as compared with conventional mechanical ventilation, was associated with an increased incidence of pneumoperitoneum of pulmonary origin (3 vs. 1 percent; P = 0.05), grades 3 and 4 intracranial hemorrhage (26 vs. 18 percent; P = 0.02), and periventricular leukomalacia (12 vs. 7 percent; P = 0.05). These results suggest that high-frequency oscillatory ventilation, as used in this trial, does not offer any advantage over conventional mechanical ventilation in the treatment of respiratory failure in preterm infants, and it may be associated with undesirable side effects. PMID:2643039

  17. Leaky ryanodine receptors contribute to diaphragmatic weakness during mechanical ventilation.

    PubMed

    Matecki, Stefan; Dridi, Haikel; Jung, Boris; Saint, Nathalie; Reiken, Steven R; Scheuermann, Valérie; Mrozek, Ségolène; Santulli, Gaetano; Umanskaya, Alisa; Petrof, Basil J; Jaber, Samir; Marks, Andrew R; Lacampagne, Alain

    2016-08-01

    Ventilator-induced diaphragmatic dysfunction (VIDD) refers to the diaphragm muscle weakness that occurs following prolonged controlled mechanical ventilation (MV). The presence of VIDD impedes recovery from respiratory failure. However, the pathophysiological mechanisms accounting for VIDD are still not fully understood. Here, we show in human subjects and a mouse model of VIDD that MV is associated with rapid remodeling of the sarcoplasmic reticulum (SR) Ca(2+) release channel/ryanodine receptor (RyR1) in the diaphragm. The RyR1 macromolecular complex was oxidized, S-nitrosylated, Ser-2844 phosphorylated, and depleted of the stabilizing subunit calstabin1, following MV. These posttranslational modifications of RyR1 were mediated by both oxidative stress mediated by MV and stimulation of adrenergic signaling resulting from the anesthesia. We demonstrate in the murine model that such abnormal resting SR Ca(2+) leak resulted in reduced contractile function and muscle fiber atrophy for longer duration of MV. Treatment with β-adrenergic antagonists or with S107, a small molecule drug that stabilizes the RyR1-calstabin1 interaction, prevented VIDD. Diaphragmatic dysfunction is common in MV patients and is a major cause of failure to wean patients from ventilator support. This study provides the first evidence to our knowledge of RyR1 alterations as a proximal mechanism underlying VIDD (i.e., loss of function, muscle atrophy) and identifies RyR1 as a potential target for therapeutic intervention. PMID:27457930

  18. Use of volume-targeted non-invasive bilevel positive airway pressure ventilation in a patient with amyotrophic lateral sclerosis*,**

    PubMed Central

    Diaz-Abad, Montserrat; Brown, John Edward

    2014-01-01

    Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease in which most patients die of respiratory failure. Although volume-targeted non-invasive bilevel positive airway pressure (BPAP) ventilation has been studied in patients with chronic respiratory failure of various etiologies, its use in ALS has not been reported. We present the case of a 66-year-old woman with ALS and respiratory failure treated with volume-targeted BPAP ventilation for 15 weeks. Weekly data downloads showed that disease progression was associated with increased respiratory muscle weakness, decreased spontaneous breathing, and increased use of non-invasive positive pressure ventilation, whereas tidal volume and minute ventilation remained relatively constant. PMID:25210968

  19. Hypervirulent Klebsiella pneumoniae induced ventilator-associated pneumonia in mechanically ventilated patients in China.

    PubMed

    Yan, Q; Zhou, M; Zou, M; Liu, W-e

    2016-03-01

    The purpose of this study was to investigate the clinical characteristics of hypervirulent K. pneumoniae (hvKP) induced ventilator-associated pneumonia (VAP) and the microbiological characteristics and epidemiology of the hvKP strains. A retrospective study of 49 mechanically ventilated patients with K. pneumoniae induced VAP was conducted at a university hospital in China from January 2014 to December 2014. Clinical characteristics and K. pneumoniae antimicrobial susceptibility and biofilm formation were analyzed. Genes of capsular serotypes K1, K2, K5, K20, K54 and K57 and virulence factors plasmid rmpA(p-rmpA), iroB, iucA, mrkD, entB, iutA, ybtS, kfu and allS were also evaluated. Multilocus sequence typing (MLST) and random amplified polymorphic DNA (RAPD) analyses were used to study the clonal relationship of the K. pneumoniae strains. Strains possessed p-rmpA and iroB and iucA were defined as hvKP. Of 49 patients, 14 patients (28.6 %) were infected by hvKP. Antimicrobial resistant rate was significantly higher in cKP than that in hvKP. One ST29 K54 extended-spectrum-beta-lactamase (ESBL) producing hvKP strain was detected. The prevalence of K1 and K2 in hvKP was 42.9 % and 21.4 %, respectively. The incidences of K1, K2, K20, p-rmpA, iroB, iucA, iutA, Kfu and alls were significantly higher in hvKP than those in cKP. ST23 was dominant among hvKP strains, and all the ST23 strains had identical RAPD pattern. hvKP has become a common pathogen of VAP in mechanically ventilated patients in China. Clinicians should increase awareness of hvKP induced VAP and enhance epidemiologic surveillance. PMID:26753990

  20. Recurrent Recruitment Manoeuvres Improve Lung Mechanics and Minimize Lung Injury during Mechanical Ventilation of Healthy Mice

    PubMed Central

    Reiss, Lucy Kathleen; Kowallik, Anke; Uhlig, Stefan

    2011-01-01

    Introduction Mechanical ventilation (MV) of mice is increasingly required in experimental studies, but the conditions that allow stable ventilation of mice over several hours have not yet been fully defined. In addition, most previous studies documented vital parameters and lung mechanics only incompletely. The aim of the present study was to establish experimental conditions that keep these parameters within their physiological range over a period of 6 h. For this purpose, we also examined the effects of frequent short recruitment manoeuvres (RM) in healthy mice. Methods Mice were ventilated at low tidal volume VT = 8 mL/kg or high tidal volume VT = 16 mL/kg and a positive end-expiratory pressure (PEEP) of 2 or 6 cmH2O. RM were performed every 5 min, 60 min or not at all. Lung mechanics were followed by the forced oscillation technique. Blood pressure (BP), electrocardiogram (ECG), heart frequency (HF), oxygen saturation and body temperature were monitored. Blood gases, neutrophil-recruitment, microvascular permeability and pro-inflammatory cytokines in bronchoalveolar lavage (BAL) and blood serum as well as histopathology of the lung were examined. Results MV with repetitive RM every 5 min resulted in stable respiratory mechanics. Ventilation without RM worsened lung mechanics due to alveolar collapse, leading to impaired gas exchange. HF and BP were affected by anaesthesia, but not by ventilation. Microvascular permeability was highest in atelectatic lungs, whereas neutrophil-recruitment and structural changes were strongest in lungs ventilated with high tidal volume. The cytokines IL-6 and KC, but neither TNF nor IP-10, were elevated in the BAL and serum of all ventilated mice and were reduced by recurrent RM. Lung mechanics, oxygenation and pulmonary inflammation were improved by increased PEEP. Conclusions Recurrent RM maintain lung mechanics in their physiological range during low tidal volume ventilation of healthy mice by preventing atelectasis and

  1. [Sleep-apnea syndrome, mechanical ventilation and critical care in Archivos de Bronconeumología (December 2009-December 2010)].

    PubMed

    Abad Fernández, Araceli; Pumarega, Irene Cano; Hernández, Concepción; Sampol, Gabriel; Terán-Santos, Joaquín

    2011-01-01

    The present study aims to review all the major articles on respiratory sleep disorders, mechanical ventilation, and respiratory critical care published in the last year in Archivos de bronconeumología. Between December 2009 and November 2010, 15 studies on these topics were published in Archivos de bronconeumología. Ten of these studies dealt with respiratory sleep disorders, consisting of six original articles, one special article, one review article, one letter to the editor and one supplement on chronic obstructive pulmonary disease and its association with sleep apneas. Five articles were published on non-invasive mechanical ventilation: one editorial, one special article, one article in a supplement and two original articles. As in previous years, there was a marked difference in the number of articles published on non-invasive mechanical ventilation and sleep-apnea syndrome, with a greater number of articles being published on the latter. Although some articles highlight the importance of the place where ventilation is commenced, no study specifically dealing with intermediate care units was published in Archivos de bronconeumología in 2010. This absence could be interpreted as a result of the low implantation of this type of unit in Spain, contrasting with the high activity undertaken in this field by pneumology services. PMID:21300219

  2. Transient-state mechanisms of wind-induced burrow ventilation.

    PubMed

    Turner, J Scott; Pinshow, Berry

    2015-01-15

    Burrows are common animal habitations, yet living in a burrow presents physiological challenges for its inhabitants because the burrow isolates them from sources and sinks for oxygen, carbon dioxide, water vapor and ammonia. Conventionally, the isolation is thought to be overcome by either diffusion gas exchange within the burrow or some means of capturing wind energy to power steady or quasi-steady bulk flows of air through it. Both are examples of what may be called 'DC' models, namely steady to quasi-steady flows powered by steady to quasi-steady winds. Natural winds, however, are neither steady nor quasi-steady, but are turbulent, with a considerable portion of the energy contained in so-called 'AC' (i.e. unsteady) components, where wind velocity varies chaotically and energy to power gas exchange is stored in some form. Existing DC models of burrow gas exchange do not account for this potentially significant source of energy for ventilation. We present evidence that at least two AC mechanisms operate to ventilate both single-opening burrows (of the Cape skink, Trachylepis capensis) and double-opening model burrows (of Sundevall's jird, Meriones crassus). We propose that consideration of the physiological ecology and evolution of the burrowing habit has been blinkered by the long neglect of AC ventilation. PMID:25609780

  3. [Fat embolism syndrome in skeletal trauma: particularities of the diagnosis, economic aspects and the role of non-invasive ventilation in intensive care].

    PubMed

    Davydova, N S; Shen', N P; Boltaev, P G; Vasilenko, P B; Skorokhodova, L A

    2014-01-01

    The article deals with a multicenter study that demonstrates the possibility and feasibility of noninvasive ventilation in patients with skeletal trauma complicated wiith fat embolism syndrome. The authors found additional criteria for the severity of the condition of patients with trauma. Important criteria for the choose a type of ventilation (non-invasive and invasive) is the lack of consciousness, desynchronization of a patient with ventilator and the need for a specialized regimes or miorelaxation to synchronize with the respirator. PMID:25549488

  4. Communication of mechanically ventilated patients in intensive care units

    PubMed Central

    Martinho, Carina Isabel Ferreira; Rodrigues, Inês Tello Rato Milheiras

    2016-01-01

    Objective The aim of this study was to translate and culturally and linguistically adapt the Ease of Communication Scale and to assess the level of communication difficulties for patients undergoing mechanical ventilation with orotracheal intubation, relating these difficulties to clinical and sociodemographic variables. Methods This study had three stages: (1) cultural and linguistic adaptation of the Ease of Communication Scale; (2) preliminary assessment of its psychometric properties; and (3) observational, descriptive-correlational and cross-sectional study, conducted from March to August 2015, based on the Ease of Communication Scale - after extubation answers and clinical and sociodemographic variables of 31 adult patients who were extubated, clinically stable and admitted to five Portuguese intensive care units. Results Expert analysis showed high agreement on content (100%) and relevance (75%). The pretest scores showed a high acceptability regarding the completion of the instrument and its usefulness. The Ease of Communication Scale showed excellent internal consistency (0.951 Cronbach's alpha). The factor analysis explained approximately 81% of the total variance with two scale components. On average, the patients considered the communication experiences during intubation to be "quite hard" (2.99). No significant correlation was observed between the communication difficulties reported and the studied sociodemographic and clinical variables, except for the clinical variable "number of hours after extubation" (p < 0.05). Conclusion This study translated and adapted the first assessment instrument of communication difficulties for mechanically ventilated patients in intensive care units into European Portuguese. The preliminary scale validation suggested high reliability. Patients undergoing mechanical ventilation reported that communication during intubation was "quite hard", and these communication difficulties apparently existed regardless of the

  5. Inhibition of Janus kinase signaling during controlled mechanical ventilation prevents ventilation-induced diaphragm dysfunction

    PubMed Central

    Smith, Ira J.; Godinez, Guillermo L.; Singh, Baljit K.; McCaughey, Kelly M.; Alcantara, Raniel R.; Gururaja, Tarikere; Ho, Melissa S.; Nguyen, Henry N.; Friera, Annabelle M.; White, Kathy A.; McLaughlin, John R.; Hansen, Derek; Romero, Jason M.; Baltgalvis, Kristen A.; Claypool, Mark D.; Li, Wei; Lang, Wayne; Yam, George C.; Gelman, Marina S.; Ding, Rongxian; Yung, Stephanie L.; Creger, Daniel P.; Chen, Yan; Singh, Rajinder; Smuder, Ashley J.; Wiggs, Michael P.; Kwon, Oh-Sung; Sollanek, Kurt J.; Powers, Scott K.; Masuda, Esteban S.; Taylor, Vanessa C.; Payan, Donald G.; Kinoshita, Taisei; Kinsella, Todd M.

    2014-01-01

    Controlled mechanical ventilation (CMV) is associated with the development of diaphragm atrophy and contractile dysfunction, and respiratory muscle weakness is thought to contribute significantly to delayed weaning of patients. Therefore, therapeutic strategies for preventing these processes may have clinical benefit. The aim of the current study was to investigate the role of the Janus kinase (JAK)/signal transducer and activator of transcription 3 (STAT3) signaling pathway in CMV-mediated diaphragm wasting and weakness in rats. CMV-induced diaphragm atrophy and contractile dysfunction coincided with marked increases in STAT3 phosphorylation on both tyrosine 705 (Tyr705) and serine 727 (Ser727). STAT3 activation was accompanied by its translocation into mitochondria within diaphragm muscle and mitochondrial dysfunction. Inhibition of JAK signaling during CMV prevented phosphorylation of both target sites on STAT3, eliminated the accumulation of phosphorylated STAT3 within the mitochondria, and reversed the pathologic alterations in mitochondrial function, reduced oxidative stress in the diaphragm, and maintained normal diaphragm contractility. In addition, JAK inhibition during CMV blunted the activation of key proteolytic pathways in the diaphragm, as well as diaphragm atrophy. These findings implicate JAK/STAT3 signaling in the development of diaphragm muscle atrophy and dysfunction during CMV and suggest that the delayed extubation times associated with CMV can be prevented by inhibition of Janus kinase signaling.—Smith, I. J., Godinez, G. L., Singh, B. K., McCaughey, K. M., Alcantara, R. R., Gururaja, T., Ho, M. S., Nguyen, H. N., Friera, A. M., White, K. A., McLaughlin, J. R., Hansen, D., Romero, J. M., Baltgalvis, K. A., Claypool, M. D., Li, W., Lang, W., Yam, G. C., Gelman, M. S., Ding, R., Yung, S. L., Creger, D. P., Chen, Y., Singh, R., Smuder, A. J., Wiggs, M. P., Kwon, O.-S., Sollanek, K. J., Powers, S. K., Masuda, E. S., Taylor, V. C., Payan, D. G

  6. Secretion movement during manual lung inflation and mechanical ventilation.

    PubMed

    Jones, Alice Y M

    2002-09-01

    This project aimed to investigate the direction of artificial sputum movement during mechanical ventilation (MV) and bagging (MH) using a tube model. Three solutions of artificial sputum (ultrasonic gel, viscosity 100, 200 and 300 poise (P)) were prepared. About 1 ml of gel was placed in a glass tube connected to a test lung at one end and, via a pneumotachograph, to either a mechanical ventilator or a self-inflating bag, at the other. The position of the gel in the tube was recorded before and after 20 artificial breaths. Simultaneous breath-to-breath respiratory mechanics were measured. The procedure was repeated three times for each gel viscosity, with a fresh experimental set up for each measurement. Results showed that the distance travelled from the lung was significantly greater with MH compared with MV (P < 0.001). The lower the gel viscosity, the further the gel moved from the lung with both ventilatory modes (P < 0.001). MH was superior to MV for secretion mobilisation in a tube model. PMID:12208090

  7. Brief mechanical ventilation impacts airway cartilage properties in neonatal lambs

    PubMed Central

    Kim, Minwook; Pugarelli, Joan; Miller, Thomas L.; Wolfson, Marla R.; Dodge, George R.; Shaffer, Thomas H.

    2012-01-01

    Ultrasound imaging allows in vivo assessment of tracheal kinetics and cartilage structure. To date, the impact of mechanical ventilation (MV) on extracellular matrix (ECM) in airway cartilage is unclear, but an indication of its functional and structural change may support the development of protective therapies. The objective of this study was to characterize changes in mechanical properties of the neonatal airway during MV with alterations in cartilage ECM. Trachea segments were isolated in a neonatal lamb model; ultrasound dimensions and pressure-volume relationships were measured on sham (no MV; n = 6) and MV (n = 7) airways for 4 h. Tracheal cross-sections were harvested at 4 h, tissues were fixed and stained, and Fourier transform infrared imaging spectroscopy (FT-IRIS) was performed. Over 4 h of MV, bulk modulus (28%) and elastic modulus (282%) increased. The MV tracheae showed higher collagen, proteoglycan content, and collagen integrity (new tissue formation); whereas no changes were seen in the controls. These data are clinically relevant in that airway properties can be correlated with MV and changes in cartilage extracellular matrix. Mechanical ventilation increases the in vivo dimensions of the trachea, and is associated with evidence of airway tissue remodeling. Injury to the neonatal airway from MV may have relevance for the development of tracheomalacia. We demonstrated active airway tissue remodeling during MV using a FT-IRIS technique which identifies changes in ECM. PMID:22170596

  8. Impact of tongue biofilm removal on mechanically ventilated patients

    PubMed Central

    Santos, Paulo Sérgio da Silva; Mariano, Marcelo; Kallas, Monira Samaan; Vilela, Maria Carolina Nunes

    2013-01-01

    Objective To evaluate the effectiveness of a tongue cleaner in the removal of tongue biofilm in mechanically ventilated patients. Methods Tongue biofilm and tracheal secretion samples were collected from a total of 50 patients: 27 in the study group (SG) who were intubated or tracheostomized under assisted ventilation and treated with the tongue cleaner and 23 in the control group (CG) who did not undergo tongue cleaning. Oral and tracheal secretion cultures of the SG (initially and after 5 days) and the CG (at a single time-point) were performed to evaluate the changes in bacterial flora. Results The median age of the SG patients was 77 years (45-99 years), and that of the CG patients was 79 years (21-94 years). The length of hospital stay ranged from 17-1,370 days for the SG with a median stay of 425 days and from 4-240 days for the CG with a median stay of 120 days. No significant differences were found when the dental plaque indexes were compared between the SG and the CG. There was no correlation between the index and the length of hospital stay. The same bacterial flora was found in the dental plaque of 9 of the 27 SG patients before and after the tongue scraper was used for 5 days compared with the CG (p=0.683). Overall, 7 of the 27 SG patients had positive bacterial cultures for the same strains in both tongue biofilm and tracheal secretions compared with the CG (p=0.003). Significant similarities in strain resistance and susceptibility of the assessed microorganisms were observed between oral and tracheal microflora in 6/23 cases in the CG (p=0.006). Conclusion The use of a tongue cleaner is effective at reducing tongue biofilm in patients on mechanical ventilation and facilitates oral hygiene interventions performed by caregivers. Clinical Trials Registry NCT01294943 PMID:23887759

  9. Analysis of resting salivation rate in patients with amyotrophic lateral sclerosis using tracheostomy invasive ventilation.

    PubMed

    Matsuda, Chiharu; Shimizu, Toshio; Nakayama, Yuki; Haraguchi, Michiko; Mochizuki, Yoko; Hakuta, Chiyoko; Taira, Masato; Numayama, Takaya; Kinoshita, Masanobu

    2016-07-28

    Patients with amyotrophic lateral sclerosis (ALS) often suffer from salivation problems such as drooling and dry mouth. We examined resting salivation rate cross-sectionally in 66 advanced ALS patients with tracheostomy invasive ventilation using a cotton roll method, and investigated clinical factors associated with salivation rate. Resting salivation rate in the patients was well preserved (median value 0.6 g/min), and was significantly more increased in patients with impairment of jaw movement (P = 0.007) or mouth opening (P = 0.003) than in patients with less impairment, and in patients with the mouth being constantly open ≥ 10 mm in rostrocaudal length than in patients with < 10 mm. These data indicate that salivation rate was increased with progression of dysfunction of voluntary jaw movement. Appropriate oral care is required in advanced ALS patients to maintain their oral hygiene and to avoid penetration of saliva into the airway. PMID:27356730

  10. Non-invasive ventilation for sleep-disordered breathing in Smith-Magenis syndrome.

    PubMed

    Connor, Victoria; Zhao, Sizheng; Angus, Robert

    2016-01-01

    Smith-Magenis syndrome (SMS) is a rare genetic neurodevelopmental disorder characterised by behavioural disturbances, intellectual disability and early onset obesity. The physical features of this syndrome are well characterised; however, behavioural features, such as sleep disturbance, are less well understood and difficult to manage. Sleep issues in SMS are likely due to a combination of disturbed melatonin cycle, facial anatomy and obesity-related ventilatory problems. Sleep disorders can be very distressing to patients and their families, as exemplified by our patient's experience, and can worsen behavioural issues as well as general health. This case demonstrates the successful use of non-invasive ventilation in treating underlying obesity hypoventilation syndrome and obstructive sleep apnoea. As a consequence of addressing abnormalities in sleep patterns, some behavioural problems improved. PMID:27495174

  11. Fat embolism syndrome managed by non-invasive ventilation--a case report.

    PubMed

    Ashok, R; Kumar, R Vinoth; Saravanan, K; Kalaivani

    2012-02-01

    A 31-year-old male was struck by a motor cycle and diagnosed to have closed injury to the thigh involving right sided femur shaft fracture. Patient was operated on the next day by the orthopaedic surgeon. The patient did not have any signs of fat embolism syndrome before and after surgery. But the rare ECG change of S1Q3T3 (pulmonary embolism) was present before and after surgery. The presence of oedematous retina and cherry red spots in the macula was also present in the young patient. Patient developed all the classical signs of fat embolism syndrome 18 hours after surgery. The case had classic presentations of fat embolism syndrome managed by non-invasive ventilation. The role of steroids and albumin is also discussed as it was always a controversy in the management of fat embolism syndrome. PMID:23029849

  12. Effect of non-invasive ventilation on the measurement of ventilatory and metabolic variables.

    PubMed

    Dennis, C J; Menadue, C; Harmer, A R; Barnes, D J; Alison, J A

    2016-07-01

    The effect of non-invasive ventilation (NIV) on the accuracy of measurements of ventilation, oxygen consumption (V˙O2) and carbon dioxide production (V˙CO2) was examined using a simulator. Known gas volumes of oxygen and carbon dioxide were delivered to a metabolic system that measured tidal volume, respiratory rate, V˙O2 and V˙CO2, both with and without NIV. Bland-Altman analyses were used to compare between conditions. NIV at pressure support (PS) 20cm H2O compared to without NIV showed: VT, mean difference (MD) 0mL (limits of agreement (LOA) -21 to 21) mL; V˙O2 MD -413 (LOA -810 to 16) mL/min; and V˙CO2 MD 32 (LOA -32 to 97) mL/min. For V˙O2 measurements during NIV, a correction was applied to account for increased air density due to PS. After correction, V˙O2 measurement accuracy improved; MD -46 (LOA -108 to 17) mL/min. Tidal volume and metabolic variables can be measured with acceptable accuracy during NIV, providing V˙O2 is corrected for altered gas density. PMID:26932772

  13. Clinical review: Humidifiers during non-invasive ventilation - key topics and practical implications

    PubMed Central

    2012-01-01

    Inadequate gas conditioning during non-invasive ventilation (NIV) can impair the anatomy and function of nasal mucosa. The resulting symptoms may have a negative effect on patients' adherence to ventilatory treatment, especially for chronic use. Several parameters, mostly technical aspects of NIV, contribute to inefficient gas conditioning. Factors affecting airway humidity during NIV include inspiratory flow, inspiratory oxygen fraction, leaks, type of ventilator, interface used to deliver NIV, temperature and pressure of inhaled gas, and type of humidifier. The correct application of a humidification system may avoid the effects of NIV-induced drying of the airway. This brief review analyses the consequences of airway dryness in patients receiving NIV and the technical tools necessary to guarantee adequate gas conditioning during ventilatory treatment. Open questions remain about the timing of gas conditioning for acute or chronic settings, the choice and type of humidification device, the interaction between the humidifier and the underlying disease, and the effects of individual humidification systems on delivered humidity. PMID:22316078

  14. Flow transport and gas mixing during invasive high frequency oscillatory ventilation.

    PubMed

    Alzahrany, Mohammed; Banerjee, Arindam; Salzman, Gary

    2014-06-01

    A large Eddy simulation (LES) based computational fluid dynamics study was performed to investigate gas transport and mixing in patient specific human lung models during high frequency oscillatory ventilation. Different pressure-controlled waveforms (sinusoidal, exponential and square) and ventilator frequencies (15, 10 and 6Hz) were used (tidal volume=50mL). The waveforms were created by solving the equation of motion subjected to constant lung wall compliance and flow resistance. Simulations were conducted with and without endotracheal tube to understand the effect of invasive management device. Variation of pressure-controlled waveform and frequency exhibits significant differences on counter flow pattern, which could lead to a significant impact on the gas mixing efficiency. Pendelluft-like flow was present for the sinusoidal waveform at all frequencies but occurred only at early inspiration for the square waveform at highest frequency. The square waveform was most efficient for gas mixing, resulting in the least wall shear stress on the lung epithelium layer thereby reducing the risk of barotrauma to both airways and the alveoli for patients undergoing therapy. PMID:24656889

  15. Domiciliary Non-invasive Ventilation in COPD: An International Survey of Indications and Practices.

    PubMed

    Crimi, Claudia; Noto, Alberto; Princi, Pietro; Cuvelier, Antoine; Masa, Juan F; Simonds, Anita; Elliott, Mark W; Wijkstra, Peter; Windisch, Wolfram; Nava, Stefano

    2016-08-01

    Despite the fact that metanalyses and clinical guidelines do not recommend the routine use of domiciliary non-invasive ventilation (NIV) for patients diagnosed with severe stable Chronic Obstructive Pulmonary Disease (COPD) and with chronic respiratory failure, it is common practice in some countries. We conducted an international web-survey of physicians involved in provision of long-term NIV to examine patterns of domiciliary NIV use in patients diagnosed with COPD. The response rate was 41.6%. A reduction of hospital admissions, improvements in quality of life and dyspnea relief were considered as the main expected benefits for patients. Nocturnal oxygen saturation assessment was the principal procedure performed before NIV prescription. Recurrent exacerbations (>3) requiring NIV and failed weaning from in hospital NIV were the most important reasons for starting domiciliary NIV. Pressure support ventilation (PSV) was the most common mode, with "low" intensity settings (PSV-low) the most popular (44.4 ± 30.1%) compared with "high" intensity (PSV-high) strategies (26.9 ± 25.9%), with different geographical preferences. COPD is confirmed to be a common indication for domiciliary NIV. Recurrent exacerbations and failed weaning from in-hospital NIV were the main reasons for its prescription. PMID:26744042

  16. Closure mechanisms of ventilated supercavities under steady and unsteady flows

    NASA Astrophysics Data System (ADS)

    Karn, Ashish; De, Rohan; Hong, Jiarong; Arndt, Roger E. A.

    2015-12-01

    The present work reports some interesting experimental results for ventilated supercavitation in steady and unsteady flows. First, a variety of closure modes obtained as a result of systematic variation in Froude number and air entrainment, are reported. The closure mechanisms were found to differ from the standard criterion reported in the literature. Further, the occurrence of a variety of stable and unstable closure mechanisms were discovered that have not been reported in the literature. Next, a hypothesis is presented to explain the cause behind these different closure mechanisms. The proposed hypothesis is then validated by synchronized high-speed imaging and pressure measurements inside and outside of the supercavity. These measurements show that the supercavity closure is a function of instantaneous cavitation number under unsteady flow conditions. (Research sponsored by Office of Naval Research, USA)

  17. Critical Pertussis in a Young Infant Requiring Mechanical Ventilation

    PubMed Central

    Nataprawira, Heda Melinda; Somasetia, Dadang Hudaya; Sudarwati, Sri; Kadir, Minerva; Sekarwana, Nanan

    2013-01-01

    Pertussis may likely be misdiagnosed in its initial or catarrhal phase as a common respiratory infection. The earlier diagnosis of pertussis really depends on the capability of the medical professional especially in the first line public health services. The lack of awareness in diagnosis of severe pertussis as one of the causes of severe respiratory problems may likely misdiagnose pertussis as respiratory failure or even septic shock. In fact, pertussis may manifest as a critical pertussis which can be fatal due to the respiratory failure that require pediatric intensive care unit using mechanical ventilation. We reported a confirmed pertussis case of a 7-weeks-old female infant referred to our tertiary hospital with gasping leading to respiratory failure and septic shock requiring mechanical ventilation, aggressive fluid therapy, and antibiotics. Pertussis was diagnosed late during the course of illness when the patient was hospitalized. Improvement was noted after administering macrolide which gave a good response. Bordetella pertussis isolation from Bordet-Gengou media culture yielded positive result. PMID:23738154

  18. [Non-invasive and invasive out of hospital ventilation in chronic respiratory failure : Consensus report of the working group on ventilation and intensive care medicine of the Austrian Society of Pneumology].

    PubMed

    Schenk, Peter; Eber, Ernst; Funk, Georg-Christian; Fritz, Wilfried; Hartl, Sylvia; Heininger, Peter; Kink, Eveline; Kühteubl, Gernot; Oberwaldner, Beatrice; Pachernigg, Ulrike; Pfleger, Andreas; Schandl, Petra; Schmidt, Ingrid; Stein, Markus

    2016-02-01

    The current consensus report was compiled under the patronage of the Austrian Society of Pneumology (Österreichischen Gesellschaft für Pneumologie, ÖGP) with the intention of providing practical guidelines for out-of-hospital ventilation that are in accordance with specific Austrian framework parameters and legal foundations. The guidelines are oriented toward a 2004 consensus ÖGP recommendation concerning the setup of long-term ventilated patients and the 2010 German Respiratory Society S2 guidelines on noninvasive and invasive ventilation of chronic respiratory insufficiency, adapted to national experiences and updated according to recent literature. In 11 chapters, the initiation, adjustment, and monitoring of out-of-hospital ventilation is described, as is the technical equipment and airway access. Additionally, the different indications-such as chronic obstructive pulmonary diseases, thoracic restrictive and neuromuscular diseases, obesity hypoventilation syndrome, and pediatric diseases-are discussed. Furthermore, the respiratory physiotherapy of adults and children on invasive and noninvasive long-term ventilation is addressed in detail. PMID:26837865

  19. Automatic control of pressure support mechanical ventilation using fuzzy logic.

    PubMed

    Nemoto, T; Hatzakis, G E; Thorpe, C W; Olivenstein, R; Dial, S; Bates, J H

    1999-08-01

    There is currently no universally accepted approach to weaning patients from mechanical ventilation, but there is clearly a feeling within the medical community that it may be possible to formulate the weaning process algorithmically in some manner. Fuzzy logic seems suited this task because of the way it so naturally represents the subjective human notions employed in much of medical decision-making. The purpose of the present study was to develop a fuzzy logic algorithm for controlling pressure support ventilation in patients in the intensive care unit, utilizing measurements of heart rate, tidal volume, breathing frequency, and arterial oxygen saturation. In this report we describe the fuzzy logic algorithm, and demonstrate its use retrospectively in 13 patients with severe chronic obstructive pulmonary disease, by comparing the decisions made by the algorithm with what actually transpired. The fuzzy logic recommendations agreed with the status quo to within 2 cm H(2)O an average of 76% of the time, and to within 4 cm H(2)O an average of 88% of the time (although in most of these instances no medical decisions were taken as to whether or not to change the level of ventilatory support). We also compared the predictions of our algorithm with those cases in which changes in pressure support level were actually made by an attending physician, and found that the physicians tended to reduce the support level somewhat more aggressively than the algorithm did. We conclude that our fuzzy algorithm has the potential to control the level of pressure support ventilation from ongoing measurements of a patient's vital signs. PMID:10430727

  20. Indoor Environmental Quality in Mechanically Ventilated, Energy-Efficient Buildings vs. Conventional Buildings

    PubMed Central

    Wallner, Peter; Munoz, Ute; Tappler, Peter; Wanka, Anna; Kundi, Michael; Shelton, Janie F.; Hutter, Hans-Peter

    2015-01-01

    Energy-efficient buildings need mechanical ventilation. However, there are concerns that inadequate mechanical ventilation may lead to impaired indoor air quality. Using a semi-experimental field study, we investigated if exposure of occupants of two types of buildings (mechanical vs. natural ventilation) differs with regard to indoor air pollutants and climate factors. We investigated living and bedrooms in 123 buildings (62 highly energy-efficient and 61 conventional buildings) built in the years 2010 to 2012 in Austria (mainly Vienna and Lower Austria). Measurements of indoor parameters (climate, chemical pollutants and biological contaminants) were conducted twice. In total, more than 3000 measurements were performed. Almost all indoor air quality and room climate parameters showed significantly better results in mechanically ventilated homes compared to those relying on ventilation from open windows and/or doors. This study does not support the hypothesis that occupants in mechanically ventilated low energy houses are exposed to lower indoor air quality. PMID:26561823

  1. The optimum timing to wean invasive ventilation for patients with AECOPD or COPD with pulmonary infection

    PubMed Central

    Song, Yuanlin; Chen, Rongchang; Zhan, Qingyuan; Chen, Shujing; Luo, Zujin; Ou, Jiaxian; Wang, Chen

    2016-01-01

    COPD is characterized by a progressive decline in lung function and mental and physical comorbidities. It is a significant burden worldwide due to its growing prevalence, comorbidities, and mortality. Complication by bronchial-pulmonary infection causes 50%–90% of acute exacerbations of COPD (AECOPD), which may lead to the aggregation of COPD symptoms and the development of acute respiratory failure. Non-invasive or invasive ventilation (IV) is usually implemented to treat acute respiratory failure. However, ventilatory support (mainly IV) should be discarded as soon as possible to prevent the onset of time-dependent complications. To withdraw IV, an optimum timing has to be selected based on weaning assessment and spontaneous breathing trial or replacement of IV by non-IV at pulmonary infection control window. The former method is more suitable for patients with AECOPD without significant bronchial-pulmonary infection while the latter method is more suitable for patients with AECOPD with acute significant bronchial-pulmonary infection. PMID:27042042

  2. Weaning from mechanical ventilation: why are we still looking for alternative methods?

    PubMed

    Frutos-Vivar, F; Esteban, A

    2013-12-01

    Most patients who require mechanical ventilation for longer than 24 hours, and who improve the condition leading to the indication of ventilatory support, can be weaned after passing a first spontaneous breathing test. The challenge is to improve the weaning of patients who fail that first test. We have methods that can be referred to as traditional, such as the T-tube, pressure support or synchronized intermittent mandatory ventilation (SIMV). In recent years, however, new applications of usual techniques as noninvasive ventilation, new ventilation methods such as automatic tube compensation (ATC), mandatory minute ventilation (MMV), adaptive support ventilation or automatic weaning systems based on pressure support have been described. Their possible role in weaning from mechanical ventilation among patients with difficult or prolonged weaning remains to be established. PMID:23084120

  3. Control of Breathing During Mechanical Ventilation: Who Is the Boss?

    PubMed Central

    Williams, Kathleen; Hinojosa-Kurtzberg, Marina; Parthasarathy, Sairam

    2011-01-01

    Over the past decade, concepts of control of breathing have increasingly moved from being theoretical concepts to “real world” applied science. The purpose of this review is to examine the basics of control of breathing, discuss the bidirectional relationship between control of breathing and mechanical ventilation, and critically assess the application of this knowledge at the patient’s bedside. The principles of control of breathing remain under-represented in the training curriculum of respiratory therapists and pulmonologists, whereas the day-to-day bedside application of the principles of control of breathing continues to suffer from a lack of outcomes-based research in the intensive care unit. In contrast, the bedside application of the principles of control of breathing to ambulatory subjects with sleep-disordered breathing has out-stripped that in critically ill patients. The evolution of newer technologies, faster real-time computing abilities, and miniaturization of ventilator technology can bring the concepts of control of breathing to the bedside and benefit the critically ill patient. However, market forces, lack of scientific data, lack of research funding, and regulatory obstacles need to be surmounted. PMID:21333174

  4. Noninvasive Mechanical Ventilation Improves Breathing-Swallowing Interaction of Ventilator Dependent Neuromuscular Patients: A Prospective Crossover Study

    PubMed Central

    Garguilo, Marine; Lejaille, Michèle; Vaugier, Isabelle; Orlikowski, David; Terzi, Nicolas; Lofaso, Frédéric; Prigent, Hélène

    2016-01-01

    Background Respiratory involvement in neuromuscular disorders may contribute to impaired breathing-swallowing interactions, swallowing disorders and malnutrition. We investigated whether the use of non-invasive ventilation (NIV) controlled by the patient could improve swallowing performances in a population of neuromuscular patients requiring daytime NIV. Methods Ten neuromuscular patients with severe respiratory failure requiring extensive NIV use were studied while swallowing without and with NIV (while ventilated with a modified ventilator allowing the patient to withhold ventilation as desired). Breathing-swallowing interactions were investigated by chin electromyography, cervical piezoelectric sensor, nasal flow recording and inductive plethysmography. Two water-bolus sizes (5 and 10ml) and a textured yogurt bolus were tested in a random order. Results NIV use significantly improved swallowing fragmentation (defined as the number of respiratory interruption of the swallowing of a single bolus) (p = 0.003) and breathing-swallowing synchronization (with a significant increase of swallows followed by an expiration) (p <0.0001). Patient exhibited piecemeal swallowing which was not influenced by NIV use (p = 0.07). NIV use also significantly reduced dyspnea during swallowing (p = 0.04) while preserving swallowing comfort, regardless of bolus type. Conclusion The use of patient controlled NIV improves swallowing parameters in patients with severe neuromuscular respiratory failure requiring daytime NIV, without impairing swallowing comfort. Trial Registration ClinicalTrials.gov NCT01519388 PMID:26938617

  5. Development and implementation of explicit computerized protocols for mechanical ventilation in children

    PubMed Central

    2011-01-01

    Mechanical ventilation can be perceived as a treatment with a very narrow therapeutic window, i.e., highly efficient but with considerable side effects if not used properly and in a timely manner. Protocols and guidelines have been designed to make mechanical ventilation safer and protective for the lung. However, variable effects and low compliance with use of written protocols have been reported repeatedly. Use of explicit computerized protocols for mechanical ventilation might very soon become a "must." Several closed loop systems are already on the market, and preliminary studies are showing promising results in providing patients with good quality ventilation and eventually weaning them faster from the ventilator. The present paper defines explicit computerized protocols for mechanical ventilation, describes how these protocols are designed, and reports the ones that are available on the market for children. PMID:22189095

  6. Fluid flow and particle transport in mechanically ventilated airways. Part II: particle transport.

    PubMed

    Alzahrany, Mohammed; Van Rhein, Timothy; Banerjee, Arindam; Salzman, Gary

    2016-07-01

    The flow mechanisms that play a role on aerosol deposition were identified and presented in a companion paper (Timothy et al. in Med Biol Eng Comput. doi: 10.1007/s11517-015-1407-3 , 2015). In the current paper, the effects of invasive conventional mechanical ventilation waveforms and endotracheal tube (ETT) on the aerosol transport were investigated. In addition to the enhanced deposition seen at the carinas of the airway bifurcations, enhanced deposition was also seen in the right main bronchus due to impaction and turbulent dispersion resulting from the fluid structures created by jet caused by the ETT. The orientation of the ETT toward right bronchus resulted in a substantial deposition inside right lung compared to left lung. The deposition inside right lung was ~12-fold higher than left lung for all considered cases, except for the case of using pressure-controlled sinusoidal waveform where a reduction of this ratio by ~50 % was found. The total deposition during pressure constant, volume ramp, and ascending ramp waveforms was similar and ~1.44 times higher than deposition fraction when using pressure sinusoidal waveform. Varying respiratory waveform demonstrated a significant role on the deposition enhancement factors and give evidence of drug aerosol concentrations in key deposition sites, which may be significant for drugs with negative side effects in high concentrations. These observations are thought to be important for ventilation treatment strategy. PMID:26541600

  7. Successful use of nasal BiPAP in three patients previously requiring intubation and mechanical ventilation.

    PubMed

    Poponick, J M; Renston, J P; Emerman, C L

    1997-01-01

    Noninvasive mask ventilation may be used to treat patients with impending respiratory failure. In this case series, three patients with severe chronic obstructive pulmonary disease, who required mechanical ventilation in the past, were successfully treated with nasal bi-level positive airway pressure (BiPAP). All patients tolerated BiPAP well without complications. Therefore, nasal BiPAP may be considered a treatment option for patients with severe COPD who have previously required intubation and mechanical ventilation. PMID:9404794

  8. Mechanical ventilation: past lessons and the near future.

    PubMed

    Marini, John J

    2013-01-01

    The ability to compensate for life-threatening failure of respiratory function is perhaps the signature technology of intensive care medicine. Unchanging needs for providing effective life-support with minimized risk and optimized comfort have been, are now, and will be the principal objectives of providing mechanical ventilation. Important lessons acquired over nearly half-a-century of ICU care have brought us closer to meeting them, as technological advances in instrumentation now effectively put this hard-won knowledge into action. Rising demand in the face of economic constraints is likely to drive future innovations focused on reducing the need for user input, automating multi-element protocols, and carefully monitoring the patient for progress and complications. PMID:23514222

  9. Outcome at school-age after neonatal mechanical ventilation.

    PubMed

    Gunn, T R; Lepore, E; Outerbridge, E W

    1983-06-01

    103 school-age children (5 to 12 years) who survived mechanical ventilation for neonatal respiratory failure were evaluated for growth, neurological, intellectual, psychological and school function in order to determine those children most at risk for handicap. A major handicap occurred in seven children, preventing attendance at normal school or normal classes. Neurological sequelae were significantly associated with perinatal asphyxia and with birthweights of 1500g or less, and neurological sequelae and socio-economic factors were the major determinants of ability. The effects of the Neonatal Intensive Care Unit (NICU) experience on parents and subsequent parent-child relationships were also investigated: 67 per cent of the mothers were very upset by the experience and many continue to worry excessively about the health of their child. Parents who visited their child in the NICU frequently were significantly more anxious and overprotective, restricting many activities even when the child was of school age. PMID:6873492

  10. The Extent of Ventilator-Induced Lung Injury in Mice Partly Depends on Duration of Mechanical Ventilation

    PubMed Central

    Hegeman, Maria A.; Hemmes, Sabrine N. T.; Kuipers, Maria T.; Bos, Lieuwe D. J.; Jongsma, Geartsje; Roelofs, Joris J. T. H.; van der Sluijs, Koenraad F.; Juffermans, Nicole P.; Vroom, Margreeth B.; Schultz, Marcus J.

    2013-01-01

    Background. Mechanical ventilation (MV) has the potential to initiate ventilator-induced lung injury (VILI). The pathogenesis of VILI has been primarily studied in animal models using more or less injurious ventilator settings. However, we speculate that duration of MV also influences severity and character of VILI. Methods. Sixty-four healthy C57Bl/6 mice were mechanically ventilated for 5 or 12 hours, using lower tidal volumes with positive end-expiratory pressure (PEEP) or higher tidal volumes without PEEP. Fifteen nonventilated mice served as controls. Results. All animals remained hemodynamically stable and survived MV protocols. In both MV groups, PaO2 to FiO2 ratios were lower and alveolar cell counts were higher after 12 hours of MV compared to 5 hours. Alveolar-capillary permeability was increased after 12 hours compared to 5 hours, although differences did not reach statistical significance. Lung levels of inflammatory mediators did not further increase over time. Only in mice ventilated with increased strain, lung compliance declined and wet to dry ratio increased after 12 hours of MV compared to 5 hours. Conclusions. Deleterious effects of MV are partly dependent on its duration. Even lower tidal volumes with PEEP may initiate aspects of VILI after 12 hours of MV. PMID:23691294

  11. The extent of ventilator-induced lung injury in mice partly depends on duration of mechanical ventilation.

    PubMed

    Hegeman, Maria A; Hemmes, Sabrine N T; Kuipers, Maria T; Bos, Lieuwe D J; Jongsma, Geartsje; Roelofs, Joris J T H; van der Sluijs, Koenraad F; Juffermans, Nicole P; Vroom, Margreeth B; Schultz, Marcus J

    2013-01-01

    Background. Mechanical ventilation (MV) has the potential to initiate ventilator-induced lung injury (VILI). The pathogenesis of VILI has been primarily studied in animal models using more or less injurious ventilator settings. However, we speculate that duration of MV also influences severity and character of VILI. Methods. Sixty-four healthy C57Bl/6 mice were mechanically ventilated for 5 or 12 hours, using lower tidal volumes with positive end-expiratory pressure (PEEP) or higher tidal volumes without PEEP. Fifteen nonventilated mice served as controls. Results. All animals remained hemodynamically stable and survived MV protocols. In both MV groups, PaO2 to FiO2 ratios were lower and alveolar cell counts were higher after 12 hours of MV compared to 5 hours. Alveolar-capillary permeability was increased after 12 hours compared to 5 hours, although differences did not reach statistical significance. Lung levels of inflammatory mediators did not further increase over time. Only in mice ventilated with increased strain, lung compliance declined and wet to dry ratio increased after 12 hours of MV compared to 5 hours. Conclusions. Deleterious effects of MV are partly dependent on its duration. Even lower tidal volumes with PEEP may initiate aspects of VILI after 12 hours of MV. PMID:23691294

  12. Compensation for increase in respiratory workload during mechanical ventilation. Pressure-support versus proportional-assist ventilation.

    PubMed

    Grasso, S; Puntillo, F; Mascia, L; Ancona, G; Fiore, T; Bruno, F; Slutsky, A S; Ranieri, V M

    2000-03-01

    Variation in respiratory impedance may occur in mechanically ventilated patients. During pressure-targeted ventilatory support, this may lead to patient-ventilator asynchrony. We assessed the hypothesis that during pressure-support ventilation (PSV), preservation of minute ventilation (V E) consequent to added mechanical loads would result in an increase in respiratory rate (RR) due to the large reduction in tidal volume (VT). WITH proportional-assist ventilation (PAV), preservation of V E would occur through the preservation of VT, with a smaller effect on RR. We anticipated that this compensatory strategy would result in greater patient comfort and a reduce work of breathing. An increase in respiratory impedance was obtained by chest and abdominal binding in 10 patients during weaning from mechanical ventilation. V E remained constant in both ventilatory modes after chest and abdominal compression. During PSV, this maintenance of VE was obtained through a 58 +/- 3% increase in RR that compensated for a 29 +/- 2% reduction in VT. The magnitudes of the reduction in VT (10 +/- 3%) and of the increase in RR (14 +/- 2%) were smaller (p < 0. 001) during PAV. During both PSV and PAV, chest and abdominal compression caused increases in both the pressure-time product (PTP) of the diaphragm per minute (142.9 +/- 26.9 cm H(2)O. s/min, PSV, and 117.6 +/- 16.4 cm H(2)O. s/min, PAV) and per liter (13.4 +/- 2.5 cm H(2)O. s/L, PSV, and 9.6 +/- 0.7 cm H(2)O. s/L, PAV). These increments were greater (p < 0.001) during PSV than during PAV. The capability of keeping VT and V E constant through increases in inspiratory effort after increases in mechanical loads is relatively preserved only during PAV. The ventilatory response to an added respiratory load during PSV required greater muscle effort than during PAV. PMID:10712328

  13. Quantitative investigation of alveolar structures with OCT using total liquid ventilation during mechanical ventilation

    NASA Astrophysics Data System (ADS)

    Schnabel, Christian; Gaertner, Maria; Meissner, Sven; Koch, Edmund

    2012-02-01

    To develop new treatment possibilities for patients with severe lung diseases it is crucial to understand the lung function on an alveolar level. Optical coherence tomography (OCT) in combination with intravital microscopy (IVM) are used for imaging subpleural alveoli in animal models to gain information about dynamic and morphological changes of lung tissue during mechanical ventilation. The image content suitable for further analysis is influenced by image artifacts caused by scattering, refraction, reflection, and absorbance. Because the refractive index varies with each air-tissue interface in lung tissue, these effects decrease OCT image quality exceedingly. The quality of OCT images can be increased when the refractive index inside the alveoli is matched to the one of tissue via liquid-filling. Thereby, scattering loss can be decreased and higher penetration depth and tissue contrast can be achieved. To use the advantages of liquid-filling for in vivo imaging of small rodent lungs, a suitable breathing fluid (perfluorodecalin) and a special liquid respirator are necessary. Here we show the effect of liquid-filling on OCT and IVM image quality of subpleural alveoli in a mouse model.

  14. Palliative care and circumstances of dying in German ALS patients using non-invasive ventilation.

    PubMed

    Kühnlein, Peter; Kübler, Andrea; Raubold, Sabine; Worrell, Marcia; Kurt, Anja; Gdynia, Hans-Jürgen; Sperfeld, Anne-Dorte; Ludolph, Albert Christian

    2008-04-01

    Non-invasive ventilation (NIV) is known to improve quality of life and to prolong survival in amyotrophic lateral sclerosis (ALS) patients. However, little is known about the circumstances of dying in ventilated ALS patients. In the light of the debate on legalizing euthanasia it is important to provide empirical data about the process of dying in these patients. In a structured interview, 29 family caregivers of deceased ALS patients were asked about their own and the patient's attitude toward physician-assisted suicide (PAS) and euthanasia, circumstances of dying, and the use of palliative medication. Quantitative and qualitative content analysis was performed on the data. Non-recurring suicidal thoughts were reported by five patients. Three patients and seven relatives had thought about PAS. Seventeen caregivers described the patients' death as "peaceful", while choking was reported in six bulbar patients. In final stages of dying, the general practitioner (GP) was involved in the treatment of 10 patients, with palliative medication including sedatives and opiates being administered in eight cases. In conclusion, in contrast to the Netherlands, where 20% of terminal ALS patients die from PAS or euthanasia, only a small minority of our patients seems to have thought about PAS. The legal situation in Germany (where euthanasia is illegal), a bias due to the selection of NIV patients as well as a high percentage of religious patients and those with good levels of social support from family and friends, might account for this. Most of our patients died peacefully at home from carbon dioxide narcosis, but choking was described in some bulbar patients. Thus, palliative care, especially the use of opiates, anxiolytics and sedatives should be optimized, and the involvement of GP should be strongly encouraged, especially in bulbar patients. PMID:18428001

  15. Influence of inertance on respiratory mechanics measurements in mechanically ventilated puppies.

    PubMed

    Lanteri, C J; Petak, F; Gurrin, L; Sly, P D

    1999-08-01

    The complete equation of motion for a single compartment model (SCM) includes an inertance term to describe pressure changes in phase with acceleration, as well as terms for resistance and elastance. Inertance has traditionally been excluded from the model when measuring respiratory mechanics at conventional ventilatory frequencies in mature respiratory systems. However, this omission has been questioned recently for measurements of respiratory mechanics in intubated infants where higher ventilation frequencies and smaller tracheal tubes are the norm. We investigated 1) the significance of inertance in an immature respiratory system during mechanical ventilation, and 2) the effect of omitting it from the model on estimates of respiratory mechanics. Six anesthetised, paralysed and mechanically ventilated puppies (2.6-3.9 kg) were studied. A SCM, including an inertance term was fitted to measurements of flow and airway opening (P(AO)) or transpulmonary (P(TP)) pressure using multiple linear regression to estimate respiratory system and lung resistance (R(RS), R(L)), elastance (E(RS), E(L)) and inertance (I(RS), I(L)) respectively, at various ventilation frequencies (0.2-2 Hz). Data obtained at each ventilation frequency were also fitted with a similar model without the inertance term. Inertance contributed significantly to the model at frequencies greater than approximately 0.3-0.5 Hz (20-30 breaths per minute), with I(RS) dominated by the lung. The importance of including the inertance term in the model increased as ventilation frequency increased. Exclusion of inertance from the model led to underestimation of E(RS) and E(L), but no errors in estimates of R(RS) or R(L). The errors increased with ventilation frequency to approximately 10-20% for E(RS) and approximately 10-40% for E(L) at 2 Hz. While inertance contributed significantly to the SCM at ventilation frequencies typically required to maintain normal gas exchange in puppies, the errors from excluding this

  16. Tracheomegaly and tracheosephagial fistula following mechanical ventilation: A case report and review of the literature

    PubMed Central

    Kucuk, Canan; Arda, Kemal; Ata, Naim; Turkkani, Mustafa Hamidullah; Yildiz, Özgür Ömer

    2016-01-01

    Postintubation Tracheoesophageal fistula (TEF) is a rare complication. Acquired TEF most commonly occurred following prolonged mechanical ventilation with an endotracheal or tracheostomy tube, cuff-related tracheal injury, post-intubation injury. We present a case of both tracheomegaly and tracheosephagial fistula following mechanical ventilation for 15 days, in the light of the literature. PMID:27222792

  17. Model-based advice for mechanical ventilation: From research (INVENT) to product (Beacon Caresystem).

    PubMed

    Rees, Stephen E; Karbing, Dan S

    2015-01-01

    This paper describes the structure and functionality of a physiological model-based system for providing advice on the settings of mechanical ventilation. Use of the system is presented with examples of patients on support and control modes of mechanical ventilation. PMID:26737495

  18. The comparison of manual and LabVIEW-based fuzzy control on mechanical ventilation.

    PubMed

    Guler, Hasan; Ata, Fikret

    2014-09-01

    The aim of this article is to develop a knowledge-based therapy for management of rats with respiratory distress. A mechanical ventilator was designed to achieve this aim. The designed ventilator is called an intelligent mechanical ventilator since fuzzy logic was used to control the pneumatic equipment according to the rat's status. LabVIEW software was used to control all equipments in the ventilator prototype and to monitor respiratory variables in the experiment. The designed ventilator can be controlled both manually and by fuzzy logic. Eight female Wistar-Albino rats were used to test the designed ventilator and to show the effectiveness of fuzzy control over manual control on pressure control ventilation mode. The anesthetized rats were first ventilated for 20 min manually. After that time, they were ventilated for 20 min by fuzzy logic. Student's t-test for p < 0.05 was applied to the measured minimum, maximum and mean peak inspiration pressures to analyze the obtained results. The results show that there is no statistical difference in the rat's lung parameters before and after the experiments. It can be said that the designed ventilator and developed knowledge-based therapy support artificial respiration of living things successfully. PMID:25205667

  19. Long-term non-invasive ventilation therapies in children: a scoping review protocol

    PubMed Central

    Castro Codesal, Maria L; Featherstone, Robin; Martinez Carrasco, Carmen; Katz, Sherri L; Chan, Elaine Y; Bendiak, Glenda N; Almeida, Fernanda R; Young, Rochelle; Olmstead, Deborah; Waters, Karen A; Sullivan, Collin; Woolf, Vicki; Hartling, Lisa; MacLean, Joanna E

    2015-01-01

    Introduction Non-invasive ventilation (NIV) in children has become an increasingly common modality of breathing support where pressure support is delivered through a mask interface or less commonly through other non-invasive interfaces. At this time, NIV is considered a first-line option for ventilatory support of chronic respiratory insufficiency associated with a range of respiratory and sleep disorders. Previous reviews on the effectiveness, complications and adherence to NIV treatment have lacked systematic methods. The purpose of this scoping review is to provide an overview of the evidence for the use of long-term NIV in children. Methods and analysis We will use previously established scoping methodology. Ten electronic databases will be searched to identify studies in children using NIV for longer than 3 months outside an intensive care setting. Grey literature search will include conference proceedings, thesis and dissertations, unpublished trials, reports from regulatory agencies and manufacturers. Two reviewers will independently screen titles and abstracts for inclusion, followed by full-text screening of potentially relevant articles to determine final inclusion. Data synthesis will be performed at three levels: (1) an analysis of the number, publication type, publication year, and country of publication of the studies; (2) a summary of the study designs, outcomes measures used; (3) a thematic analysis of included studies by subgroups. Ethics and dissemination This study will provide a wide and rigorous overview of the evidence on the use of long-term NIV in children and provide critical information for healthcare professionals and policymakers to better care for this group of children. We will disseminate our findings through conference proceedings and publications, and evaluate the results for further systematic reviews and meta-analyses. PMID:26270951

  20. Upright position mechanical ventilation: an alternative strategy for ALI/ARDS patients?

    PubMed

    Zhu, Min; Zhang, Wei; Wang, Jia-Ning; Yan, Hua; Li, Yang-Kai; Ai, Bo; Fu, Sheng-Lin; Fu, Xiang-Ning

    2009-11-01

    Use of body positioning to improve oxygenation in mechanically ventilated patients with acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) has been well documented. However, neither prone position ventilation nor side lying ventilation has been reported to improve the survival. Whether there is a body position superior to routine supine position or other positions as therapeutic adjunct for ventilated patients with ALI and ARDS? We propose the hypothesis that upright position ventilation may be helpful to improve oxygenation and benefit patients with ALI/ARDS. According to the existing physiologic and pathophysiologic data of upright position investigation, we suppose that improvement of V/Q matching, increased functional residual capacity, alveolar recruitment, accelerated diaphragm recovery, early gastric emptying and enteric feeding may be a potential protect mechanism of upright position ventilation. Whether this can be translated into improvement in patient outcome should be further tested in clinical trial. PMID:19683402

  1. Lung Injury After One-Lung Ventilation: A Review of the Pathophysiologic Mechanisms Affecting the Ventilated and the Collapsed Lung.

    PubMed

    Lohser, Jens; Slinger, Peter

    2015-08-01

    Lung injury is the leading cause of death after thoracic surgery. Initially recognized after pneumonectomy, it has since been described after any period of 1-lung ventilation (OLV), even in the absence of lung resection. Overhydration and high tidal volumes were thought to be responsible at various points; however, it is now recognized that the pathophysiology is more complex and multifactorial. All causative mechanisms known to trigger ventilator-induced lung injury have been described in the OLV setting. The ventilated lung is exposed to high strain secondary to large, nonphysiologic tidal volumes and loss of the normal functional residual capacity. In addition, the ventilated lung experiences oxidative stress, as well as capillary shear stress because of hyperperfusion. Surgical manipulation and/or resection of the collapsed lung may induce lung injury. Re-expansion of the collapsed lung at the conclusion of OLV invariably induces duration-dependent, ischemia-reperfusion injury. Inflammatory cytokines are released in response to localized injury and may promote local and contralateral lung injury. Protective ventilation and volatile anesthesia lessen the degree of injury; however, increases in biochemical and histologic markers of lung injury appear unavoidable. The endothelial glycocalyx may represent a common pathway for lung injury creation during OLV, because it is damaged by most of the recognized lung injurious mechanisms. Experimental therapies to stabilize the endothelial glycocalyx may afford the ability to reduce lung injury in the future. In the interim, protective ventilation with tidal volumes of 4 to 5 mL/kg predicted body weight, positive end-expiratory pressure of 5 to 10 cm H2O, and routine lung recruitment should be used during OLV in an attempt to minimize harmful lung stress and strain. Additional strategies to reduce lung injury include routine volatile anesthesia and efforts to minimize OLV duration and hyperoxia. PMID:26197368

  2. Anaesthesia ventilators

    PubMed Central

    Jain, Rajnish K; Swaminathan, Srinivasan

    2013-01-01

    Anaesthesia ventilators are an integral part of all modern anaesthesia workstations. Automatic ventilators in the operating rooms, which were very simple with few modes of ventilation when introduced, have become very sophisticated with many advanced ventilation modes. Several systems of classification of anaesthesia ventilators exist based upon various parameters. Modern anaesthesia ventilators have either a double circuit, bellow design or a single circuit piston configuration. In the bellows ventilators, ascending bellows design is safer than descending bellows. Piston ventilators have the advantage of delivering accurate tidal volume. They work with electricity as their driving force and do not require a driving gas. To enable improved patient safety, several modifications were done in circle system with the different types of anaesthesia ventilators. Fresh gas decoupling is a modification done in piston ventilators and in descending bellows ventilator to reduce th incidence of ventilator induced volutrauma. In addition to the conventional volume control mode, modern anaesthesia ventilators also provide newer modes of ventilation such as synchronised intermittent mandatory ventilation, pressure-control ventilation and pressure-support ventilation (PSV). PSV mode is particularly useful for patients maintained on spontaneous respiration with laryngeal mask airway. Along with the innumerable benefits provided by these machines, there are various inherent hazards associated with the use of the ventilators in the operating room. To use these workstations safely, it is important for every Anaesthesiologist to have a basic understanding of the mechanics of these ventilators and breathing circuits. PMID:24249886

  3. Predictors of impaired communication in amyotrophic lateral sclerosis patients with tracheostomy-invasive ventilation.

    PubMed

    Nakayama, Yuki; Shimizu, Toshio; Mochizuki, Yoko; Hayashi, Kentaro; Matsuda, Chiharu; Nagao, Masahiro; Watabe, Kazuhiko; Kawata, Akihiro; Oyanagi, Kiyomitsu; Isozaki, Eiji; Nakano, Imaharu

    2015-01-01

    Predictors of communication impairment in patients with amyotrophic lateral sclerosis (ALS) using tracheostomy-invasive ventilation (TIV) were investigated. Seventy-six ALS patients using TIV were enrolled and classified into three subgroups of communication ability: patients who could communicate with communication devices (Stage I), patients who had difficulty with communication (Stage II, III, or IV), and patients who could not communicate by any means (Stage V). Predictors of communication impairment were analysed by the Cox proportional hazard model. Results demonstrated that there were no significant differences in disease duration between subgroups. Within 24 months after disease onset, patients who needed TIV and tube feeding, developed oculomotor impairment or became totally quadriplegic and progressed from Stage I to II and V significantly earlier. Multivariate analyses revealed that within 24 months from onset, the need for TIV and progression to total quadriplegia were significant events in patients who progressed to Stage II, whereas the development of oculomotor limitation was significant in patients who progressed to Stage V. In conclusion, TIV, impaired oculomotor movement and total quadriplegia are predictors of severe communication impairment. Rapid disease progression might indicate future communication impairment after the use of TIV. We highly recommend early detection of impaired communication and identification of the best methods of communication. PMID:26121169

  4. Accepting or declining non-invasive ventilation or gastrostomy in amyotrophic lateral sclerosis: patients' perspectives.

    PubMed

    Greenaway, L P; Martin, N H; Lawrence, V; Janssen, A; Al-Chalabi, A; Leigh, P N; Goldstein, L H

    2015-01-01

    The objective was to identify factors associated with decisions made by patients with amyotrophic lateral sclerosis (ALS) to accept or decline non-invasive ventilation (NIV) and/or gastrostomy in a prospective population-based study. Twenty-one people with ALS, recruited from the South-East ALS Register who made an intervention decision during the study timeframe underwent a face-to-face in-depth interview, with or without their informal caregiver present. Sixteen had accepted an intervention (11 accepted gastrostomy, four accepted NIV and one accepted both interventions). Five patients had declined gastrostomy. Thematic analysis revealed three main themes: (1) patient-centric factors (including perceptions of control, acceptance and need, and aspects of fear); (2) external factors (including roles played by healthcare professionals, family, and information provision); and (3) the concept of time (including living in the moment and the notion of 'right thing, right time'). Many aspects of these factors were inter-related. Decision-making processes for the patients were found to be complex and multifaceted and reinforce arguments for individualised (rather than 'algorithm-based') approaches to facilitating decision-making by people with ALS who require palliative interventions. PMID:25683760

  5. [The effectiveness of music therapy in reducing physiological and psychological anxiety in mechanically ventilated patients].

    PubMed

    Wu, Shiau-Jiun; Chou, Fan-Hao

    2008-10-01

    Anxiety, a common reaction in patients receiving ventilation therapy, often impacts negatively on patient recovery. Music therapy, a non-invasion intervention, is readily accepted by patients and has been used to relieve patient anxiety with encouraging results. The purpose of this study was to investigate the effectiveness of music therapy on reducing anxiety in patients on mechanical ventilators. An experimental design was used and all cases were collected from a medical center in southern Taiwan. While the experimental group patients took a 30-minute music therapy session, control group patients were asked to rest. Both facility anxiety and anxiety visual scales were used as research tools, with other non-invasive medical instruments employed to measure heartbeat and breathing, blood pressure and blood oxygen saturation in both patient groups. When compared with the control group, patients in the experimental group showed significant improvement in sense of anxiety (Brief Anxiety Scale, BAS, t(29) = -4.80, p < .001; Visual Analogue Anxiety Scales, VAAS, t(29) = -3.38, p = .002), diastolic pressure (t(29) = -2.74, p = .002), mean arterial pressure(t(29) = -2.26, p = .031) and breathing rate (t(29) = -4.84, p < .001). In analyzing data from the two groups, we found that the sense of anxiety (BAS, t(58) = -3.21, p = .002; VAAS, t(58) = -2.90, p = .005) and breathing rate (t(58) = -3.20, p = .002) in the experimental group decreased significantly following music therapy. Study results are hoped to serve as an important reference for clinical nursing staff. Also, it is hoped that the music therapy method may help facilitate achievement of broader humanized nursing goals. PMID:18836973

  6. Anesthetic management in atrial fibrillation ablation procedure: Adding non-invasive ventilation to deep sedation.

    PubMed

    Sbrana, Francesco; Ripoli, Andrea; Formichi, Bruno

    2015-01-01

    Anesthetic management of patients undergoing pulmonary vein isolation for atrial fibrillation has specific requirements. The feasibility of non-invasive ventilation (NIV) added to deep sedation procedure was evaluated. Seventy-two patients who underwent ablation procedure were retrospectively revised, performed with (57%) or without (43%) application of NIV (Respironic(®) latex-free total face mask connected to Garbin ventilator-Linde Inc.) during deep sedation (Midazolam 0.01-0.02 mg/kg, fentanyl 2.5-5 μg/kg and propofol: bolus dose 1-1.5 mg/kg, maintenance 2-4 mg/kg/h). In the two groups (NIV vs deep sedation), differences were detected in intraprocedural (pH 7.37 ± 0.05 vs 7.32 ± 0.05, p = 0.001; PaO2 117.10 ± 27.25 vs 148.17 ± 45.29, p = 0.004; PaCO2 43.37 ± 6.91 vs 49.33 ± 7.34, p = 0.002) and in percentage variation with respect to basal values (pH -0.52 ± 0.83 vs -1.44 ± 0.87, p = 0.002; PaCO2 7.21 ± 15.55 vs 34.91 ± 25.76, p = 0.001) of arterial blood gas parameters. Two episodes of respiratory complications, treated with application of NIV, were reported in deep sedation procedure. Endotracheal intubation was not necessary in any case. Adverse events related to electrophysiological procedures and recurrence of atrial fibrillation were recorded, respectively, in 36% and 29% of cases. NIV proved to be feasible in this context and maintained better respiratory homeostasis and better arterial blood gas balance when added to deep sedation. PMID:26937093

  7. Numerical investigation of aerosolized drug delivery in the human lungs under mechanical ventilator conditions

    NASA Astrophysics Data System (ADS)

    Vanrhein, Timothy; Banerjee, Arindam

    2010-11-01

    Particle deposition for aerosolized drug delivery in the human airways is heavily dependent upon flow conditions. Numerical modeling techniques have proven valuable for determining particle deposition characteristics under steady flow conditions. For the case of patients under mechanical ventilation, however, flow conditions change drastically and there is an increased importance to understand particle deposition characteristics. This study focuses on mechanically ventilated conditions in the upper trachea-bronchial (TB) region of the human airways. Solution of the continuous phase flow is done under ventilator waveform conditions with a suitable turbulence model in conjunction with a realistic model of upper TB airways. A discrete phase Euler-Lagrange approach is applied to solve for particle deposition characteristics with a focus on the effect of the ventilator inlet waveform. The purpose of this study is to accurately model flow conditions in the upper TB airways under mechanically ventilated conditions with a focus on real-time patient specific targeted aerosolized drug delivery.

  8. Brachial artery peak velocity variation to predict fluid responsiveness in mechanically ventilated patients

    PubMed Central

    2009-01-01

    Introduction Although several parameters have been proposed to predict the hemodynamic response to fluid expansion in critically ill patients, most of them are invasive or require the use of special monitoring devices. The aim of this study is to determine whether noninvasive evaluation of respiratory variation of brachial artery peak velocity flow measured using Doppler ultrasound could predict fluid responsiveness in mechanically ventilated patients. Methods We conducted a prospective clinical research in a 17-bed multidisciplinary ICU and included 38 mechanically ventilated patients for whom fluid administration was planned due to the presence of acute circulatory failure. Volume expansion (VE) was performed with 500 mL of a synthetic colloid. Patients were classified as responders if stroke volume index (SVi) increased ≥ 15% after VE. The respiratory variation in Vpeakbrach (ΔVpeakbrach) was calculated as the difference between maximum and minimum values of Vpeakbrach over a single respiratory cycle, divided by the mean of the two values and expressed as a percentage. Radial arterial pressure variation (ΔPPrad) and stroke volume variation measured using the FloTrac/Vigileo system (ΔSVVigileo), were also calculated. Results VE increased SVi by ≥ 15% in 19 patients (responders). At baseline, ΔVpeakbrach, ΔPPrad and ΔSVVigileo were significantly higher in responder than nonresponder patients [14 vs 8%; 18 vs. 5%; 13 vs 8%; P < 0.0001, respectively). A ΔVpeakbrach value >10% predicted fluid responsiveness with a sensitivity of 74% and a specificity of 95%. A ΔPPrad value >10% and a ΔSVVigileo >11% predicted volume responsiveness with a sensitivity of 95% and 79%, and a specificity of 95% and 89%, respectively. Conclusions Respiratory variations in brachial artery peak velocity could be a feasible tool for the noninvasive assessment of fluid responsiveness in patients with mechanical ventilatory support and acute circulatory failure. Trial Registration

  9. Clinical Outcomes Associated with Home Mechanical Ventilation: A Systematic Review

    PubMed Central

    MacIntyre, Erika J.; Asadi, Leyla; Mckim, Doug A.; Bagshaw, Sean M.

    2016-01-01

    Background. The prevalence of patients supported with home mechanical ventilation (HMV) for chronic respiratory failure has increased. However, the clinical outcomes associated with HMV are largely unknown. Methods. We performed a systematic review of studies evaluating patients receiving HMV for indications other than obstructive lung disease, reporting at least one clinically relevant outcome including health-related quality of life (HRQL) measured by validated tools; hospitalization requirements; caregiver burden; and health service utilization. We searched MEDLINE, EMBASE, CINAHL, the Cochrane library, clinical trial registries, proceedings from selected scientific meetings, and bibliographies of retrieved citations. Results. We included 1 randomized control trial (RCT) and 25 observational studies of mixed methodological quality involving 4425 patients; neuromuscular disorders (NMD) (n = 1687); restrictive thoracic diseases (RTD) (n = 481); obesity hypoventilation syndrome (OHS) (n = 293); and others (n = 748). HRQL was generally described as good for HMV users. Mental rather than physical HRQL domains were rated higher, particularly where physical assessment was limited. Hospitalization rates and days in hospital appear to decrease with implementation of HMV. Caregiver burden associated with HMV was generally high; however, it is poorly described. Conclusion. HRQL and need for hospitalization may improve after establishment of HMV. These inferences are based on relatively few studies of marked heterogeneity and variable quality. PMID:27445559

  10. Clinical Outcomes Associated with Home Mechanical Ventilation: A Systematic Review.

    PubMed

    MacIntyre, Erika J; Asadi, Leyla; Mckim, Doug A; Bagshaw, Sean M

    2016-01-01

    Background. The prevalence of patients supported with home mechanical ventilation (HMV) for chronic respiratory failure has increased. However, the clinical outcomes associated with HMV are largely unknown. Methods. We performed a systematic review of studies evaluating patients receiving HMV for indications other than obstructive lung disease, reporting at least one clinically relevant outcome including health-related quality of life (HRQL) measured by validated tools; hospitalization requirements; caregiver burden; and health service utilization. We searched MEDLINE, EMBASE, CINAHL, the Cochrane library, clinical trial registries, proceedings from selected scientific meetings, and bibliographies of retrieved citations. Results. We included 1 randomized control trial (RCT) and 25 observational studies of mixed methodological quality involving 4425 patients; neuromuscular disorders (NMD) (n = 1687); restrictive thoracic diseases (RTD) (n = 481); obesity hypoventilation syndrome (OHS) (n = 293); and others (n = 748). HRQL was generally described as good for HMV users. Mental rather than physical HRQL domains were rated higher, particularly where physical assessment was limited. Hospitalization rates and days in hospital appear to decrease with implementation of HMV. Caregiver burden associated with HMV was generally high; however, it is poorly described. Conclusion. HRQL and need for hospitalization may improve after establishment of HMV. These inferences are based on relatively few studies of marked heterogeneity and variable quality. PMID:27445559

  11. Evaluation of Pain Assessment Tools in Patients Receiving Mechanical Ventilation.

    PubMed

    Al Darwish, Zainab Q; Hamdi, Radwa; Fallatah, Summayah

    2016-01-01

    Pain assessment poses a great challenge for clinicians in intensive care units. This descriptive study aimed to find the most reliable, sensitive, and valid tool for assessing pain. The researcher and a nurse simultaneously assessed 47 nonverbal patients receiving mechanical ventilation in the intensive care unit by using 3 tools: the Behavioral Pain Scale (BPS), the Critical-Care Pain Observation Tool (CPOT), and the adult Nonverbal Pain Scale (NVPS) before, during, and after turning and suctioning. All tools were found to be reliable and valid (Cronbach α = 0.95 for both the BPS and the CPOT, α = 0.86 for the NVPS), and all subscales of both the BPS and CPOT were highly sensitive for assessing pain (P < .001). The NVPS physiology (P = .21) and respiratory (P = .16) subscales were not sensitive for assessing pain. The BPS was the most reliable, valid, and sensitive tool, with the CPOT considered an appropriate alternative tool for assessing pain. The NVPS is not recommended because of its inconsistent psychometric properties. PMID:27153305

  12. Respiratory muscle dysfunction: a multicausal entity in the critically ill patient undergoing mechanical ventilation.

    PubMed

    Díaz, Magda C; Ospina-Tascón, Gustavo A; Salazar C, Blanca C

    2014-02-01

    Respiratory muscle dysfunction, particularly of the diaphragm, may play a key role in the pathophysiological mechanisms that lead to difficulty in weaning patients from mechanical ventilation. The limited mobility of critically ill patients, and of the diaphragm in particular when prolonged mechanical ventilation support is required, promotes the early onset of respiratory muscle dysfunction, but this can also be caused or exacerbated by other factors that are common in these patients, such as sepsis, malnutrition, advanced age, duration and type of ventilation, and use of certain medications, such as steroids and neuromuscular blocking agents. In this review we will study in depth this multicausal origin, in which a common mechanism is altered protein metabolism, according to the findings reported in various models. The understanding of this multicausality produced by the same pathophysiological mechanism could facilitate the management and monitoring of patients undergoing mechanical ventilation. PMID:23669061

  13. Effect of Pressure Controlled Waveforms on Flow Transport and Gas mixing in a Patient Specific Lung Model during Invasive High Frequency Oscillatory Ventilation

    NASA Astrophysics Data System (ADS)

    Alzahrany, Mohammed; Banerjee, Arindam

    2012-11-01

    A computational fluid dynamic study is carried out to investigate gas transport in patient specific human lung models (based on CT scans) during high frequency oscillatory ventilation (HFOV). Different pressure-controlled waveforms and various ventilator frequencies are studied to understand the effect of flow transport and gas mixing during these processes. Three different pressure waveforms are created by solving the equation of motion subjected to constant lung wall compliance and flow resistance. Sinusoidal, exponential and constant waveforms shapes are considered with three different frequencies 6, 10 and 15 Hz and constant tidal volume 50 ml. The velocities are calculated from the obtained flow rate and imposed as inlet flow conditions to represent the mechanical ventilation waveforms. An endotracheal tube ETT is joined to the model to account for the effect of the invasive management device with the peak Reynolds number (Re) for all the cases ranging from 6960 to 24694. All simulations are performed using high order LES turbulent model. The gas transport near the flow reversal will be discussed at different cycle phases for all the cases and a comparison of the secondary flow structures between different cases will be presented.

  14. Non-invasive Positive Pressure Ventilation during Sleep at 3800m: relationship to Acute Mountain Sickness and sleeping oxyhemoglobin saturation

    PubMed Central

    Johnson, PL; Popa, DA; Prisk, GK; Sullivan, CE; Edwards, N

    2014-01-01

    Background and objectives Ascent to high altitude results in hypobaric hypoxia and some individuals will develop Acute Mountain Sickness, which has been shown to be associated with low oxyhemoglobin saturation during sleep. Previous research has shown that positive end-expiratory pressure by use of expiratory valves in a face mask while awake, results in a reduction in AMS symptoms and higher oxyhemoglobin saturation. We aimed to test whether pressure ventilation during sleep would prevent AMS by keeping oxyhaemoglobin higher during sleep. Methods We compared sleeping oxyhemoglobin saturation and the incidence and severity of Acute Mountain Sickness in seven subjects sleeping for two consecutive nights at 3800m above sea level using either non-invasive positive pressure ventilation that delivered positive inspiratory and expiratory airway pressure via a face mask, or sleeping without assisted ventilation. The presence and severity of Acute Mountain Sickness was assessed by administration of the Lake Louise questionnaire. Results We found significant increases in the mean and minimum sleeping oxyhemoglobin saturation and decreases in AMS symptoms in subjects who used positive pressure ventilation during sleep. Mean and minimum sleeping SaO2 was lower in subjects who developed AMS after the night spent without positive pressure ventilation. Conclusion The use of positive pressure ventilation during sleep at 3800m significantly increased the sleeping oxygen saturation; we suggest that the marked reduction in symptoms of AMS is due to this higher sleeping SaO2. We agree with the findings from previous studies that the development of AMS is associated with a lower sleeping oxygen saturation. PMID:20051046

  15. Mortality Prediction in Patients Undergoing Non-Invasive Ventilation in Intermediate Care

    PubMed Central

    Martinez-Urbistondo, Diego; Alegre, Félix; Carmona-Torre, Francisco; Huerta, Ana; Fernandez-Ros, Nerea; Landecho, Manuel Fortún; García-Mouriz, Alberto; Núñez-Córdoba, Jorge M.; García, Nicolás; Quiroga, Jorge; Lucena, Juan Felipe

    2015-01-01

    Background Intermediate Care Units (ImCU) have become an alternative scenario to perform Non-Invasive Ventilation (NIV). The limited number of prognostic studies in this population support the need of mortality prediction evaluation in this context. Objective The objective of this study is to analyze the performance of Simplified Acute Physiology Score (SAPS) II and 3 in patients undergoing NIV in an ImCU. Additionally, we searched for new variables that could be useful to customize these scores, in order to improve mortality prediction. Design Cohort study with prospectively collected data from all patients admitted to a single center ImCU who received NIV. The SAPS II and 3 scores with their respective predicted mortality rates were calculated. Discrimination and calibration were evaluated by calculating the area under the receiver operating characteristic curve (AUC) and with the Hosmer-Lemeshow goodness of fit test for the models, respectively. Binary logistic regression was used to identify new variables to customize the scores for mortality prediction in this setting. Patients The study included 241 patients consecutively admitted to an ImCU staffed by hospitalists from April 2006 to December 2013. Key Results The observed in-hospital mortality was 32.4% resulting in a Standardized Mortality Ratio (SMR) of 1.35 for SAPS II and 0.68 for SAPS 3. Mortality discrimination based on the AUC was 0.73 for SAPS II and 0.69 for SAPS 3. Customized models including immunosuppression, chronic obstructive pulmonary disease (COPD), acute pulmonary edema (APE), lactic acid, pCO2 and haemoglobin levels showed better discrimination than old scores with similar calibration power. Conclusions These results suggest that SAPS II and 3 should be customized with additional patient-risk factors to improve mortality prediction in patients undergoing NIV in intermediate care. PMID:26436420

  16. Update: Non-Invasive Positive Pressure Ventilation in Chronic Respiratory Failure Due to COPD.

    PubMed

    Altintas, Nejat

    2016-01-01

    Long-term non-invasive positive pressure ventilation (NPPV) has widely been accepted to treat chronic hypercapnic respiratory failure arising from different etiologies. Although the survival benefits provided by long-term NPPV in individuals with restrictive thoracic disorders or stable, slowly-progressing neuromuscular disorders are overwhelming, the benefits provided by long-term NPPV in patients with chronic obstructive pulmonary disease (COPD) remain under question, due to a lack of convincing evidence in the literature. In addition, long-term NPPV reportedly failed in the classic trials to improve important physiological parameters such as arterial blood gases, which might serve as an explanation as to why long-term NPPV has not been shown to substantially impact on survival. However, high intensity NPPV (HI-NPPV) using controlled NPPV with the highest possible inspiratory pressures tolerated by the patient has recently been described as a new and promising approach that is well-tolerated and is also capable of improving important physiological parameters such as arterial blood gases and lung function. This clearly contrasts with the conventional approach of low-intensity NPPV (LI-NPPV) that uses considerably lower inspiratory pressures with assisted forms of NPPV. Importantly, HI-NPPV was very recently shown to be superior to LI-NPPV in terms of improved overnight blood gases, and was also better tolerated than LI-NPPV. Furthermore, HI-NPPV, but not LI-NPPV, improved dyspnea, lung function and disease-specific aspects of health-related quality of life. A recent study showed that long-term treatment with NPPV with increased ventilatory pressures that reduced hypercapnia was associated with significant and sustained improvements in overall mortality. Thus, long-term NPPV seems to offer important benefits in this patient group, but the treatment success might be dependent on effective ventilatory strategies. PMID:26418151

  17. The Effect of Pressure-Controlled Ventilation and Volume-Controlled Ventilation in Prone Position on Pulmonary Mechanics and Inflammatory Markers.

    PubMed

    Şenay, Hasan; Sıvacı, Remziye; Kokulu, Serdar; Koca, Buğra; Bakı, Elif Doğan; Ela, Yüksel

    2016-08-01

    The aim of this present study is to compare the effect of pressure-controlled ventilation and volume-controlled ventilation on pulmonary mechanics and inflammatory markers in prone position. The study included 41 patients undergoing to vertebrae surgery. The patients were randomized into two groups: Group 1 received volume-controlled ventilation, while group 2 received pressure-controlled ventilation. The demographic data, pulmonary mechanics, the inflammatory marker levels just after the induction of anesthetics, at the 6th and 12th hours, and gas analysis from arterial blood samples taken at the beginning and the 30th minute were recorded. The inflammatory marker levels increased in both groups, without any significant difference among groups. Peak inspiratory pressure level was higher in the volume-controlled ventilation group. This study revealed that there is no difference regarding inflammatory marker levels between volume- and pressure-controlled ventilation. PMID:27221140

  18. An Overview of the Predictor Standard Tools for Patient Weaning from Mechanical Ventilation

    PubMed Central

    Dehghani, Acieh; Abdeyazdan, Gholamhossein; Davaridolatabadi, Elham

    2016-01-01

    Most patients staying in the intensive care unit (ICU) require respiratory support through a ventilator. Since prolonged mechanical ventilation and weaning from the ventilator without criteria or at the inappropriate time can result in many complications, it is required that patients be weaned off the ventilator as soon as possible. This study was conducted to investigate a few standard tools that predict successful and timely weaning of patients from the ventilator. In the literature, SOFA and APACHE II scores, along with various tools, including Burn, Morganroth, and Corgian, have been used in weaning patients from the ventilator. In most of these studies, the increase or decrease in the APACHE II score was correlated with the patient’s weaning time, and this score could be used as a criterion for weaning. Several authors have expressed their belief that the SOFA score in the ICU is a good indicator of the prognosis of patient’s weaning from the ventilator, length of stay, mortality, and rate of recovery. Several studies have compared SOFA and APACHE II scores and have shown that there is a positive correlation between the SOFA and APACHE II scores and that both mortality and dependence on the ventilator are related to these two scores. Another tool is Burn’s weaning program. A higher Burn score indicates successful weaning off of the ventilator, successful extubation, lower length of mechanical ventilation, and shorter stay in the hospital. However, the capabilities of the Morganroth scale and the Gluck and Corgian scoring systems were evaluated only for successful weaning off of the ventilator, and a decrease in the Morganroth and Gluck scores indicated successful weaning. PMID:27054004

  19. An Overview of the Predictor Standard Tools for Patient Weaning from Mechanical Ventilation.

    PubMed

    Dehghani, Acieh; Abdeyazdan, Gholamhossein; Davaridolatabadi, Elham

    2016-02-01

    Most patients staying in the intensive care unit (ICU) require respiratory support through a ventilator. Since prolonged mechanical ventilation and weaning from the ventilator without criteria or at the inappropriate time can result in many complications, it is required that patients be weaned off the ventilator as soon as possible. This study was conducted to investigate a few standard tools that predict successful and timely weaning of patients from the ventilator. In the literature, SOFA and APACHE II scores, along with various tools, including Burn, Morganroth, and Corgian, have been used in weaning patients from the ventilator. In most of these studies, the increase or decrease in the APACHE II score was correlated with the patient's weaning time, and this score could be used as a criterion for weaning. Several authors have expressed their belief that the SOFA score in the ICU is a good indicator of the prognosis of patient's weaning from the ventilator, length of stay, mortality, and rate of recovery. Several studies have compared SOFA and APACHE II scores and have shown that there is a positive correlation between the SOFA and APACHE II scores and that both mortality and dependence on the ventilator are related to these two scores. Another tool is Burn's weaning program. A higher Burn score indicates successful weaning off of the ventilator, successful extubation, lower length of mechanical ventilation, and shorter stay in the hospital. However, the capabilities of the Morganroth scale and the Gluck and Corgian scoring systems were evaluated only for successful weaning off of the ventilator, and a decrease in the Morganroth and Gluck scores indicated successful weaning. PMID:27054004

  20. [High frequency jet ventilation combined with conventional mechanical ventilation in the treatment of adult respiratory distress syndrome].

    PubMed

    Roustan, J P

    1995-01-01

    Better understanding of the physiopathology of ventilatory mechanisms associated with ARDS and the recent re-evaluation of the iatrogenic potential of mechanical ventilation (MV) brings us closer to the best suited ventilatory mode for these patients. In severely ill ARDS patients, only a small lung volume is ventilated, and remains available for the totality of the gas exchanges (baby lung concept). The goal of MV is to restore and maintain an optimal exchange volume while limiting mechanical agression of the lung tissue. Analysis of the ARDS related pressure-volume relationship (P/V) is helpful in specifying the tolerable limits of the ventilatory pressure regimen. The lower limit (end expiratory pressure) must be kept above the lower inflexion point of the curve, in order to increase the ventilated lung volume and avoid distal airway collapse. Under this limit, gas exchanges are altered by the shunt effect, and shear stress lesions result from the repeated opening and closing of the distal airways. The upper limit (end inspiratory pressure) must be situated below the upper inflexion point of the curve, in order to avoid lesions resulting from surdistension of the alveolocapillary membranes and barotraumatisms. The only way to position MV in such a narrow pressure window, is to greatly reduce the tidal volume (VT). Though CO2 retention would inevitably occur under conventional MV conditions, high frequency ventilation (HFV) seems better adapted to these theoreotical objectives; small VT's are injected under a limited amplitude pressure regimen and a satisfactory CO2 clearance is maintained. This ventilatory mode, existing since more than 15 years, has recently benefited from many technical improvements as well as the concept of oscillating the ventilation around a selected mean pressure in the central region of the P/V curve. In the past, HFV was applied using low pressure regimens, situated below the lower inflexion point of the curve. The resulting failures are

  1. MEASUREMENT OF AMMONIA EMISSIONS FROM MECHANICALLY VENTILATED POULTRY HOUSES USING MULTIPATH TUNABLE DIODE LASER SPECTROSCOPY

    EPA Science Inventory

    Ammonia emissions from mechanically ventilated poultry operations are an important environmental concern. Open Path Tunable Diode Laser Absorption Spectroscopy has emerged as a robust real-time method for gas phase measurement of ammonia concentrations in agricultural settings. ...

  2. Mechanical ventilation and sepsis impair protein metabolism in the diaphragm of neonatal pigs

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Mechanical ventilation (MV) impairs diaphragmatic function and diminishes the ability to wean from ventilatory support in adult humans. In normal neonatal pigs, animals that are highly anabolic, endotoxin (LPS) infusion induces sepsis, reduces peripheral skeletal muscle protein synthesis rates, but ...

  3. Myocardial perfusion as assessed by thallium-201 scintigraphy during the discontinuation of mechanical ventilation in ventilator-dependent patients

    SciTech Connect

    Hurford, W.E.; Lynch, K.E.; Strauss, H.W.; Lowenstein, E.; Zapol, W.M. )

    1991-06-01

    Patients who cannot be separated from mechanical ventilation (MV) after an episode of acute respiratory failure often have coexisting coronary artery disease. The authors hypothesized that increased left ventricular (LV) wall stress during periods of spontaneous ventilation (SV) could alter myocardial perfusion in these patients. Using thallium-201 (201TI) myocardial scintigraphy, the authors studied the occurrence of myocardial perfusion abnormalities during periods of SV in 15 MV-dependent patients (nine women, six men; aged 71 {plus minus} 7 yr, mean {plus minus} SD). Fourteen of these patients were studied once with 201TI myocardial scintigraphy during intermittent mechanical ventilation (IMV) and again on another day, after at least 10 min of SV through a T-piece. One patient was studied during SV only. Thirteen of 14 of the patients (93%) studied during MV had abnormal patterns of initial myocardial 201TI uptake, but only 1 patient demonstrated redistribution of 201TI on delayed images. The remainder of the abnormalities observed during MV were fixed defects. SV produced significant alterations of myocardial 201TI distribution or transient LV dilation, or both, in 7 of the 15 patients (47%). Four patients demonstrated new regional decreases of LV myocardial thallium concentration with redistribution of the isotope on delayed images. The patient studied only during SV also had myocardial 201TI defects with redistribution. Five patients (3 also having areas of 201TI redistribution) had transient LV dilation during SV.

  4. Impact of Residential Mechanical Ventilation on Energy Cost and Humidity Control

    SciTech Connect

    Martin, Eric

    2014-01-01

    Optimizing whole house mechanical ventilation as part of the Building Ameerica program's systems engineered approach to constructing housing has been an important subject of the program's research. Ventilation in residential buildings is one component of an effective, comprehensive strategy for creation and maintenance of a comfortable and healthy indoor air environment. The study described in this report is based on building energy modeling with an important focus on the indoor humidity impacts of ventilation. The modeling tools used were EnergyPlus version 7.1 (E+) and EnergyGauge USA (EGUSA). Twelve U.S. cities and five climate zones were represented. A total of 864 simulations (2*2*3*3*12= 864) were run using two building archetypes, two building leakage rates, two building orientations, three ventilation systems, three ventilation rates, and twelve climates.

  5. Impact of Residential Mechanical Ventilation on Energy Cost and Humidity Control

    SciTech Connect

    Martin, E.

    2014-01-01

    The DOE Building America program has been conducting research leading to cost effective high performance homes since the early 1990's. Optimizing whole house mechanical ventilation as part of the program's systems engineered approach to constructing housing has been an important subject of the program's research. Ventilation in residential buildings is one component of an effective, comprehensive strategy for creation and maintenance of a comfortable and healthy indoor air environment. The study described in this white paper is based on building energy modeling with an important focus on the indoor humidity impacts of ventilation. The modeling tools used were EnergyPlus version 7.1 (E+) and EnergyGauge USA (EGUSA). Twelve U.S. cities and five climate zones were represented. A total of 864 simulations (2*2*3*3*12= 864) were run using two building archetypes, two building leakage rates, two building orientations, three ventilation systems, three ventilation rates, and twelve climates.

  6. Assisted Ventilation.

    PubMed

    Dries, David J

    2016-01-01

    Controlled Mechanical Ventilation may be essential in the setting of severe respiratory failure but consequences to the patient including increased use of sedation and neuromuscular blockade may contribute to delirium, atelectasis, and diaphragm dysfunction. Assisted ventilation allows spontaneous breathing activity to restore physiological displacement of the diaphragm and recruit better perfused lung regions. Pressure Support Ventilation is the most frequently used mode of assisted mechanical ventilation. However, this mode continues to provide a monotonous pattern of support for respiration which is normally a dynamic process. Noisy Pressure Support Ventilation where tidal volume is varied randomly by the ventilator may improve ventilation and perfusion matching but the degree of support is still determined by the ventilator. Two more recent modes of ventilation, Proportional Assist Ventilation and Neurally Adjusted Ventilatory Assist (NAVA), allow patient determination of the pattern and depth of ventilation. Proposed advantages of Proportional Assist Ventilation and NAVA include decrease in patient ventilator asynchrony and improved adaptation of ventilator support to changing patient demand. Work of breathing can be normalized with these modes as well. To date, however, a clear pattern of clinical benefit has not been demonstrated. Existing challenges for both of the newer assist modes include monitoring patients with dynamic hyperinflation (auto-positive end expiratory pressure), obstructive lung disease, and air leaks in the ventilator system. NAVA is dependent on consistent transduction of diaphragm activity by an electrode system placed in the esophagus. Longevity of effective support with this technique is unclear. PMID:25501776

  7. Mechanics of ventilation in swellsharks, Cephaloscyllium ventriosum (Scyliorhinidae).

    PubMed

    Ferry-Graham, L A

    1999-06-01

    A simple two-pump model has served to describe the mechanics of ventilation in cartilaginous and bony fishes since the pioneering work of G. M. Hughes. A hallmark of this model is that water flow over the gills is continuous. Studies of feeding kinematics in the swellshark Cephaloscyllium ventriosum, however, suggested that a flow reversal occurred during prey capture and transport. Given that feeding is often considered to be simply an exaggeration of the kinematic events performed during respiration, I investigated whether flow reversals are potentially present during respiration. Pressure and impedance data were coupled with kinematic data from high-speed video footage and dye studies and used to infer patterns of water flow through the heads of respiring swellsharks. Swellsharks were implanted with pressure transducers to determine the pattern and magnitude of pressures generated within the buccal and parabranchial (gill) cavities during respiration. Pressure traces revealed extended periods of pressure reversal during the respiratory cycle. Further, impedance data suggested that pressures within the buccal and parabranchial cavities were not generated by the cyclic opening and closing of the jaws and gills in the manner previously suggested by Hughes. Thus, the classic model needs to be re-evaluated to determine its general applicability. Two alternative models for pressure patterns and their mechanism of generation during respiration are provided. The first depicts a double-reversal scenario common in the swellshark whereby pressures are reversed following both of the pump stages (the suction pump and the pressure pump) rather than after the pressure-pump stage only. The second model describes a scenario in which the suction pump is insufficient for generating a positive pressure differential across the gills; thus, a pressure reversal persists throughout this phase of respiration. Kinematic analysis based on high-speed video footage and dye studies, however

  8. Effect of early mobilization on discharge disposition of mechanically ventilated patients

    PubMed Central

    Ota, Hideki; Kawai, Hideki; Sato, Makoto; Ito, Kazuaki; Fujishima, Satoshi; Suzuki, Hiroko

    2015-01-01

    [Purpose] The purpose of this study was to clarify the benefits of early mobilization for mechanically ventilated patients for their survival to discharge to home from the hospital. [Subjects and Methods] Medical records were retrospectively analyzed of patients who satisfied the following criteria: age ≥ 18 years; performance status 0–2 and independent living at their home before admission; mechanical ventilation for more than 48 h; and survival after mechanical ventilation. Mechanically ventilated patients in the early mobilization (EM) group (n = 48) received mobilization therapy, limb exercise and chest physiotherapy, whereas those in the control group (n = 60) received bed rest alone. Univariate and multivariate logistic regression analyses were performed to identify clinical variables associated with discharge disposition. [Results] Early mobilization was a positive independent factor and the presence of neurological deficits was a negative factor contributing to discharge to home. Among patients surviving mechanical ventilation without neurological deficits, the rate of discharge to home was significantly higher among patients in the EM group that in the control group (76% vs. 40%). [Conclusion] Early mobilization can improve the rate of discharge to home of patients requiring mechanical ventilation because of non-neurological deficits. PMID:25931747

  9. Infiltration Effects on Residential Pollutant Concentrations for Continuous and Intermittent Mechanical Ventilation Approaches

    SciTech Connect

    Sherman, Max; Logue, Jennifer; Singer, Brett

    2010-06-01

    The prevailing residential ventilation standard in North America, American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE) Standard 62.2, specifies volumetric airflow requirements as a function of the overall size of the home and the number of bedrooms, assumes a fixed, minimal amount of infiltration, and requires mechanical ventilation to achieve the remainder. The standard allows for infiltration credits and intermittent ventilation patterns that can be shown to provide comparable performance. Whole-house ventilation methods have a substantial effect on time-varying indoor pollutant concentrations. If alternatives specified by Standard 62.2, such as intermittent ventilation, are used, short-term pollutant concentrations could exceed acute health standards even if chronic health standards are met.The authors present a methodology for comparing ASHRAE- and non-ASHRAE-specified ventilation scenarios on relative indoor pollutant concentrations. We use numerical modeling to compare the maximum time-averaged concentrations for acute exposure relevant (1-hour, 8-hour, 24-hour ) and chronic exposure relevant (1-year) time periods for four different ventilation scenarios in six climates with a range of normalized leakage values. The results suggest that long-term concentrations are the most important metric for assessing the effectiveness of whole-house ventilation systems in meeting exposure standards and that, if chronic health exposure standards are met, acute standards will also be met.

  10. [Long-term effects of home mechanical ventilation with positive pressure using a nasal mask].

    PubMed

    Escarrabill, J; Estopà, R; Robert, D; Casolivé, V; Manresa, F

    1991-10-01

    Home mechanical ventilation (HMV) is an efficient alternative in the treatment of patients with chronic respiratory failure secondary to restrictive mechanical disorders (neuromuscular disease, such as Duchenne's disease, thorax deformities due to kyphoscoliosis or tuberculosis sequelae). The case of a patient with severe kyphoscoliosis in the phase of chronic respiratory failure (PaO2 34 mmHg and PaCO2 61 mmHg, breathing ambient air) is presented in which, following the failure of negative pressure mechanical ventilation ("poncho"), positive pressure ventilation was tested with a silicon made-to-measure nasal mask as the access via. Adaptation to HMV was good with the patient using the ventilation nightly. Following 12 months of treatment the patient is able to carry out everyday activities and arterial gasometry breathing ambient air is PaO2 77 mmHg and PaCO2 43 mmHg. PMID:1961049

  11. Measured Air Distribution Effectiveness for Residential Mechanical Ventilation Systems

    SciTech Connect

    Sherman, Max; Sherman, Max H.; Walker, Iain S.

    2008-05-01

    The purpose of ventilation is dilute or remove indoor contaminants that an occupant is exposed to. In a multi-zone environment such as a house, there will be different dilution rates and different source strengths in every zone. Most US homes have central HVAC systems, which tend to mix the air thus the indoor conditions between zones. Different types of ventilation systems will provide different amounts of exposure depending on the effectiveness of their air distribution systems and the location of sources and occupants. This paper will report on field measurements using a unique multi-tracer measurement system that has the capacity to measure not only the flow of outdoor air to each zone, but zone-to-zone transport. The paper will derive seven different metrics for the evaluation of air distribution. Measured data from two homes with different levels of natural infiltration will be used to evaluate these metrics for three different ASHRAE Standard 62.2 compliant ventilation systems. Such information can be used to determine the effectiveness of different systems so that appropriate adjustments can be made in residential ventilation standards such as ASHRAE Standard 62.2.

  12. Particle Size Concentration Distribution and Influences on Exhaled Breath Particles in Mechanically Ventilated Patients

    PubMed Central

    Chen, Yi-Fang; Huang, Sheng-Hsiu; Wang, Yu-Ling; Chen, Chun-Wan

    2014-01-01

    Humans produce exhaled breath particles (EBPs) during various breath activities, such as normal breathing, coughing, talking, and sneezing. Airborne transmission risk exists when EBPs have attached pathogens. Until recently, few investigations had evaluated the size and concentration distributions of EBPs from mechanically ventilated patients with different ventilation mode settings. This study thus broke new ground by not only evaluating the size concentration distributions of EBPs in mechanically ventilated patients, but also investigating the relationship between EBP level and positive expiratory end airway pressure (PEEP), tidal volume, and pneumonia. This investigation recruited mechanically ventilated patients, with and without pneumonia, aged 20 years old and above, from the respiratory intensive care unit of a medical center. Concentration distributions of EBPs from mechanically ventilated patients were analyzed with an optical particle analyzer. This study finds that EBP concentrations from mechanically ventilated patients during normal breathing were in the range 0.47–2,554.04 particles/breath (0.001–4.644 particles/mL). EBP concentrations did not differ significantly between the volume control and pressure control modes of the ventilation settings in the mechanically ventilated patients. The patient EBPs were sized below 5 µm, and 80% of them ranged from 0.3 to 1.0 µm. The EBPs concentrations in patients with high PEEP (> 5 cmH2O) clearly exceeded those in patients with low PEEP (≤ 5 cmH2O). Additionally, a significant negative association existed between pneumonia duration and EBPs concentration. However, tidal volume was not related to EBPs concentration. PMID:24475230

  13. Early mechanical ventilation is deleterious after aspiration-induced lung injury in rabbits.

    PubMed

    Hermon, Michael M; Wassermann, Esther; Pfeiler, Claudia; Pollak, Arnold; Redl, Heinz; Strohmaier, Wolfgang

    2005-01-01

    We investigated whether mechanical ventilation after aspiration is deleterious when started before surfactant therapy. Gas exchange and lung mechanics were measured in rabbits after aspiration either mechanically ventilated before or after lavage with diluted surfactant or Ringer's solution. Lung injury was induced by intratracheal instillation of 2 mL/kg of a betain/HCl pepsin mixture. After 30 min of spontaneous breathing, ventilation was started in 12 rabbits, which were then treated by lavage with diluted surfactant (15 mL/kg body weight; 5.3 mg/mL, group MVpre S) or with Ringer's solution (1 mL/kg; group MVpre R). Another 12 rabbits were treated by lavage while spontaneously breathing and were then connected to the ventilator (MVpost S and MVpost R). Sham control rabbits were mechanically ventilated for 4 h. At the end of experiment, PaO2/FiO2 ratio in MVpost S was five times higher than in MVpre S (P=0.0043). Lung mechanics measurements showed significant difference between MVpre S and MVpost S (P=0.0072). There was histopathologic evidence of decreased lung injury in MVpost S. Immediate initiation of ventilation is harmful when lung injury is induced by aspiration. Further investigations are needed to clarify whether the timing of lavage with diluted surfactant has an impact on the treatment of patients with aspiration or comparable types of direct lung injury. PMID:15614133

  14. Total Liquid Ventilation Provides Superior Respiratory Support to Conventional Mechanical Ventilation in a Large Animal Model of Severe Respiratory Failure

    PubMed Central

    Pohlmann, Joshua R; Brant, David O; Daul, Morgan A; Reoma, Junewai L; Kim, Anne C; Osterholzer, Kathryn R; Johnson, Kent J; Bartlett, Robert H; Cook, Keith E; Hirschl, Ronald B

    2011-01-01

    Total liquid ventilation (TLV) has the potential to provide respiratory support superior to conventional mechanical ventilation (CMV) in the acute respiratory distress syndrome (ARDS). However, laboratory studies are limited to trials in small animals for no longer than 4 hours. The objective of this study was to compare TLV and CMV in a large animal model of ARDS for 24 hours. Ten sheep weighing 53 ± 4 (SD) kg were anesthetized and ventilated with 100% oxygen. Oleic acid was injected into the pulmonary circulation until PaO2:FiO2 ≥ 60 mmHg, followed by transition to a protective CMV protocol (n=5) or TLV (n=5) for 24 hours. Pathophysiology was recorded and the lungs were harvested for histological analysis. Animals treated with CMV became progressively hypoxic and hypercarbic despite maximum ventilatory support. Sheep treated with TLV maintained normal blood gases with statistically greater PO2 (p<10−9) and lower PCO2 (p < 10−3) than the CMV group. Survival at 24 hours in the TLV and CMV groups were 100% and 40% respectively (p< 0.05). Thus, TLV provided gas exchange superior to CMV in this laboratory model of severe ARDS. PMID:21084968

  15. Efficiency and outcome of non-invasive versus invasive positive pressure ventilation therapy in respiratory failure due to chronic obstructive pulmonary disease.

    PubMed Central

    Amri Maleh, Valiollah; Monadi, Mahmood; Heidari, Behzad; Maleh, Parviz Amri; Bijani, Ali

    2016-01-01

    Background: Application noninvasive ventilation in the patients with exacerbation of chronic obstructive pulmonary disease (COPD) reduced mortality. This case-control study was designed to compare efficiency and outcome of non-invasive (NIV) versus invasive positive pressure ventilation (IPPV) in respiratory failure due to COPD. Methods: The patients were assigned to NIV or IPPV intermittantly.The clinical parameters, including RR (respiratory rate), BP (blood pressure), HR (heart rate) and PH, PaCO2, PaO2 before and 1, 4 and 24 h after treatment were measured. Demographic information such as age, sex, severity of disease based on APACHE score, length of stay and outcome were recorded. Results: Fifty patients were enrolled in the NIV group and 50 patients in IPPV. The mean age was 70.5 in NIV and 63.9 in invasive ventilation group (p>0.05). In IPPV group, the average values of PH: PCO2: and PO2, were 7.22±0.11, 69.64 + 24.25: and 68.86±24.41 .In NIV, the respective values were 7.30±0.07, 83.94±18.95, and 60.60±19.88. In NIV group, after 1, 4 and 24 h treatment, the clinical and ventilation parameters were stable. The mean APACHE score in was IPPV, 26.46±5.45 and in NIV was 12.26±5.54 (p<0.05). The average length of hospital stay in IPPV was 15.90±10 and in NIV 8.12±6.49 days (p<0.05). The total mortality in the NIV was 4 (8%) and in IPPV, 27 patients (54%) (p<0.05). Conclusion: This study indicates that using NIPPV is a useful therapeutic mode of treatment for respiratory failure with acceptable success rate and lower mortality. The application of NIPPV reduces hospital stay, intubation and its consequent complications.

  16. Initial mechanical ventilator settings for pediatric patients: clinical judgement in selection of tidal volume.

    PubMed

    Kanter, R K; Blatt, S D; Zimmerman, J J

    1987-03-01

    Guidelines for selection of initial mechanical ventilator settings for pediatric patients were evaluated. Protocols specifying tidal volume or peak inspiratory pressure are difficult to apply for infants and children because of leaks at uncuffed endotracheal tubes, compression loss in ventilators, and inaccuracy of settings for intended tidal volume. To avoid these difficulties, the selection of tidal volume was based on subjective clinical observations: visible chest excursion and audible air entry at least simulating normal breathing. In 76 consecutive patients, use of the guidelines resulted in satisfactory PaCO2 for 97% and PaO2 for 89% of infants and children with a wide variety of respiratory disorders. Adequacy of gas exchange was not related to the patient's age, type of ventilator, tightness of fit of the endotracheal tube, or presence of spontaneous breathing. These results support a simple, versatile method of teaching selection of initial mechanical ventilator settings, relying on clinical judgment for regulation of tidal volume. PMID:3470010

  17. Effect of Alterations in Mechanical Ventilator Settings on Pulmonary Gas Exchange in Hyaline Membrane Disease

    PubMed Central

    Reynolds, E. O. R.

    1971-01-01

    The effect of altering peak airway pressure, respiratory frequency, and inspiration: expiration ratio on arterial blood gas tensions, blood pressure, and calculated right-to-left shunt was investigated in 6 infants undergoing mechanical ventilation for hyaline membrane disease with a Bennet ventilator. The use of a very long inspiratory phase resulted in a large increase in Pao2 and fall in right-to-left shunt without affecting mean arterial blood pressure. ImagesFIG. 1FIG. 4 PMID:5576023

  18. The rapid shallow breathing index as a predictor of successful mechanical ventilation weaning: clinical utility when calculated from ventilator data

    PubMed Central

    de Souza, Leonardo Cordeiro; Lugon, Jocemir Ronaldo

    2015-01-01

    ABSTRACT OBJECTIVE: The use of the rapid shallow breathing index (RSBI) is recommended in ICUs, where it is used as a predictor of mechanical ventilation (MV) weaning success. The aim of this study was to compare the performance of the RSBI calculated by the traditional method (described in 1991) with that of the RSBI calculated directly from MV parameters. METHODS: This was a prospective observational study involving patients who had been on MV for more than 24 h and were candidates for weaning. The RSBI was obtained by the same examiner using the two different methods (employing a spirometer and the parameters from the ventilator display) at random. In comparing the values obtained with the two methods, we used the Mann-Whitney test, Pearson's linear correlation test, and Bland-Altman plots. The performance of the methods was compared by evaluation of the areas under the ROC curves. RESULTS: Of the 109 selected patients (60 males; mean age, 62 ± 20 years), 65 were successfully weaned, and 36 died. There were statistically significant differences between the two methods for respiratory rate, tidal volume, and RSBI (p < 0.001 for all). However, when the two methods were compared, the concordance and the intra-observer variation coefficient were 0.94 (0.92-0.96) and 11.16%, respectively. The area under the ROC curve was similar for both methods (0.81 ± 0.04 vs. 0.82 ± 0.04; p = 0.935), which is relevant in the context of this study. CONCLUSIONS: The satisfactory performance of the RSBI as a predictor of weaning success, regardless of the method employed, demonstrates the utility of the method using the mechanical ventilator. PMID:26785962

  19. The use of 2% chlorhexidine gel and toothbrushing for oral hygiene of patients receiving mechanical ventilation: effects on ventilator-associated pneumonia

    PubMed Central

    Meinberg, Maria Cristina de Avila; Cheade, Maria de Fátima Meinberg; Miranda, Amanda Lucia Dias; Fachini, Marcela Mascaro; Lobo, Suzana Margareth

    2012-01-01

    Objective To evaluate the effects of oral chlorhexidine hygiene with toothbrushing on the rate of ventilator-associated pneumonia in a mixed population of critically ill patients under prolonged mechanical ventilation. Methods Prospective, randomized, and placebo-controlled pilot study. Patients who were receiving mechanical ventilation, had been admitted less than 24 hours prior, and were anticipated to require mechanical ventilation for more than 72 hours were included in the study. The patients were randomly divided into one of the following groups: chlorhexidine hygiene with toothbrushing or a placebo group (gel with the same color and consistency and toothbrushing). Results The planned interim analysis was conducted using 52 patients, and the study was terminated prematurely. In total, 28 patients were included in the chlorhexidine / toothbrushing group, and 24 patients were included in the placebo group. Ventilator-associated pneumonia occurred in 45.8% of the placebo group and in 64.3% of the chlorhexidine hygiene with toothbrushing group (RR=1.4; 95% CI=0.83-2.34; p=0.29). Conclusion Because the study was terminated due to futility, it was not possible to evaluate the impact of oral hygiene using 2% chlorhexidine and toothbrushing on the incidence of ventilator-associated pneumonia in this heterogeneous population of critical patients receiving long-term mechanical ventilation, and no beneficial effect was observed for this intervention. PMID:23917935

  20. Pulmonary blood flow distribution in sheep: effects of anesthesia, mechanical ventilation, and change in posture

    NASA Technical Reports Server (NTRS)

    Walther, S. M.; Domino, K. B.; Glenny, R. W.; Hlastala, M. P.

    1997-01-01

    BACKGROUND: Recent studies providing high-resolution images of pulmonary perfusion have questioned the classical zone model of pulmonary perfusion. Hence the present work was undertaken to provide detailed maps of regional pulmonary perfusion to examine the influence of anesthesia, mechanical ventilation, and posture. METHODS: Pulmonary perfusion was analyzed with intravenous fluorescent microspheres (15 microm) in six sheep studied in four conditions: prone and awake, prone with pentobarbital-anesthesia and breathing spontaneously, prone with anesthesia and mechanical ventilation, and supine with anesthesia and mechanical ventilation. Lungs were air dried at total lung capacity and sectioned into approximately 1,100 pieces (about 2 cm3) per animal. The pieces were weighed and assigned spatial coordinates. Fluorescence was read on a spectrophotometer, and signals were corrected for piece weight and normalized to mean flow. Pulmonary blood flow heterogeneity was assessed using the coefficient of variation of flow data. RESULTS: Pentobarbital anesthesia and mechanical ventilation did not influence perfusion heterogeneity, but heterogeneity increased when the animals were in the supine posture (P < 0.01). Gravitational flow gradients were absent in the prone position but present in the supine (P < 0.001 compared with zero). Pulmonary perfusion was distributed with a hilar-to-peripheral gradient in animals breathing spontaneously (P < 0.05). CONCLUSIONS: The influence of pentobarbital anesthesia and mechanical ventilation on pulmonary perfusion heterogeneity is small compared with the effect of changes in posture. Analysis of flow gradients indicate that gravity plays a small role in determining pulmonary blood flow distribution.

  1. Assessment of Indoor Air Quality Benefits and Energy Costs of Mechanical Ventilation

    SciTech Connect

    Logue, J.M.; Price, P.N.; Sherman, M.H.; Singer, B.C.

    2011-07-01

    Intake of chemical air pollutants in residences represents an important and substantial health hazard. Sealing homes to reduce air infiltration can save space conditioning energy, but can also increase indoor pollutant concentrations. Mechanical ventilation ensures a minimum amount of outdoor airflow that helps reduce concentrations of indoor emitted pollutants while requiring some energy for fan(s) and thermal conditioning of the added airflow. This work demonstrates a physics based, data driven modeling framework for comparing the costs and benefits of whole-house mechanical ventilation and applied the framework to new California homes. The results indicate that, on a population basis, the health benefits from reduced exposure to indoor pollutants in New California homes are worth the energy costs of adding mechanical ventilation as specified by ASHRAE Standard 62.2.This study determines the health burden for a subset of pollutants in indoor air and the costs and benefits of ASHRAE's mechanical ventilation standard (62.2) for new California homes. Results indicate that, on a population basis, the health benefits of new home mechanical ventilation justify the energy costs.

  2. Pulmonary Drug Delivery System for inhalation therapy in mechanically ventilated patients.

    PubMed

    Dhand, Rajiv; Sohal, Harjyot

    2008-01-01

    The Pulmonary Drug Delivery System (PDDS) Clinical represents a newer generation of electronic nebulizers that employ a vibrating mesh or aperture plate to generate an aerosol. The PDDS Clinical is designed for aerosol therapy in patients receiving mechanical ventilation. The components of the device include a control module that is connected to the nebulizer/reservoir unit by a cable. The nebulizer contains Aerogen's OnQ aerosol generator. A pressure sensor monitors the pressure in the inspiratory limb of the ventilator circuit and provides feedback to the control module. Based on the feedback from the pressure sensor, aerosol generation occurs only during a specific part of the respiratory cycle. In bench models, the PDDS Clinical has high efficiency for aerosol delivery both on and off the ventilator, with a lower respiratory tract delivery of 50-70% of the nominal dose. Currently, the PDDS Clinical is being evaluated for the treatment of ventilator-associated pneumonia with aerosolized amikacin, an aminoglycoside antibiotic. Preliminary studies in patients with ventilator-associated pneumonia found that the administration of amikacin via PDDS reduced the need for concomitant intravenous antibiotics; however, more definitive clinical studies are needed. The PDDS Clinical delivers a high percentage of the nominal dose to the lower respiratory tract, and is well suited for inhalation therapy in mechanically ventilated patients. PMID:18095891

  3. Changes in respiratory mechanics during respiratory physiotherapy in mechanically ventilated patients

    PubMed Central

    Moreira, Fernanda Callefe; Teixeira, Cassiano; Savi, Augusto; Xavier, Rogério

    2015-01-01

    Objective To evaluate the changes in ventilatory mechanics and hemodynamics that occur in patients dependent on mechanical ventilation who are subjected to a standard respiratory therapy protocol. Methods This experimental and prospective study was performed in two intensive care units, in which patients dependent on mechanical ventilation for more than 48 hours were consecutively enrolled and subjected to an established respiratory physiotherapy protocol. Ventilatory variables (dynamic lung compliance, respiratory system resistance, tidal volume, peak inspiratory pressure, respiratory rate, and oxygen saturation) and hemodynamic variables (heart rate) were measured one hour before (T-1), immediately after (T0) and one hour after (T+1) applying the respiratory physiotherapy protocol. Results During the period of data collection, 104 patients were included in the study. Regarding the ventilatory variables, an increase in dynamic lung compliance (T-1 = 52.3 ± 16.1mL/cmH2O versus T0 = 65.1 ± 19.1mL/cmH2O; p < 0.001), tidal volume (T-1 = 550 ± 134mL versus T0 = 698 ± 155mL; p < 0.001), and peripheral oxygen saturation (T-1 = 96.5 ± 2.29% versus T0 = 98.2 ± 1.62%; p < 0.001) were observed, in addition to a reduction of respiratory system resistance (T-1 = 14.2 ± 4.63cmH2O/L/s versus T0 = 11.0 ± 3.43cmH2O/L/s; p < 0.001), after applying the respiratory physiotherapy protocol. All changes were present in the assessment performed one hour (T+1) after the application of the respiratory physiotherapy protocol. Regarding the hemodynamic variables, an immediate increase in the heart rate after application of the protocol was observed, but that increase was not maintained (T-1 = 88.9 ± 18.7 bpm versus T0 = 93.7 ± 19.2bpm versus T+1 = 88.5 ± 17.1bpm; p < 0.001). Conclusion Respiratory therapy leads to immediate changes in the lung mechanics and hemodynamics of mechanical ventilation-dependent patients, and ventilatory changes are likely to remain for at least one hour

  4. Protocolized Sedation versus Usual Care in Pediatric Patients Mechanically Ventilated for Acute Respiratory Failure: A Randomized Clinical Trial

    PubMed Central

    Curley, Martha A.Q.; Wypij, David; Watson, R. Scott; Grant, Mary Jo C.; Asaro, Lisa A.; Cheifetz, Ira M.; Dodson, Brenda; Franck, Linda S.; Gedeit, Rainer G.; Angus, Derek C.; Matthay, Michael A.

    2016-01-01

    Importance Protocolized sedation improves clinical outcomes in critically-ill adults, but its effect in children is unknown. Objective To determine whether critically-ill children managed with a nurse-implemented, goal-directed sedation protocol (RESTORE) would experience fewer days of mechanical ventilation than patients receiving usual care. Design, Setting, and Participants Cluster-randomized trial conducted in 31 U.S. Pediatric Intensive Care Units (PICUs). Children (n=2449; mean age 4.7 years, range 2 weeks to 17 years) mechanically ventilated for acute respiratory failure were enrolled 2009–2013 and followed until 72 hours after opioids were discontinued, 28 days, or hospital discharge. Interventions Intervention PICUs (17 sites, n=1225 patients) managed sedation using a protocol that included targeted sedation, arousal assessments, extubation readiness testing, sedation adjustment every 8 hours, and sedation weaning. Control PICUs (14 sites, n=1224 patients) managed sedation per usual care without a protocol. Main Outcome and Measures The primary outcome was duration of mechanical ventilation. Secondary outcomes included time to recovery from acute respiratory failure, duration of weaning from mechanical ventilation, neurological testing, PICU and hospital lengths of stay, in-hospital mortality, sedation-related adverse events, sedative exposure including measures of wakefulness, pain, and agitation, and occurrence of iatrogenic withdrawal. Results Duration of mechanical ventilation was not statistically significantly different between the two groups (median; interquartile range: intervention: 6.5 days; 4.1–11.2 vs. control: 6.5; 3.7–12.1). Sedation-related adverse events including inadequate pain and sedation management, clinically significant iatrogenic withdrawal, and unplanned endotracheal tube/invasive line removal were not statistically significantly different between the two groups. Intervention patients experienced more post-extubation stridor

  5. Unrecognized suffering in the ICU: Addressing dyspnea in mechanically ventilated patients

    PubMed Central

    Schmidt, Matthieu; Banzett, Robert B.; Raux, Mathieu; Morélot-Panzini, Capucine; Dangers, Laurence; Similowski, Thomas; Demoule, Alexandre

    2014-01-01

    Background Intensive care unit (ICU) patients are exposed to many sources of discomfort. Although growing attention has been given to the detection and treatment of pain, very little has been given to the detection and treatment of dyspnea (defined as ‘breathing discomfort’). Discussion In this article, we review the published information on prevalence, mechanisms and potential negative impacts of dyspnea in mechanically ventilated patients. In addition, we review the most appropriate tools to detect and quantify dyspnea in ICU patients. Conclusions Growing evidence suggests that dyspnea is a frequent issue in mechanically ventilated ICU patients, is highly associated with anxiety and pain, and is improved in many patients by altering ventilator settings. Future studies are needed to better delineate the impact of dyspnea in the ICU, and to define diagnostic, monitoring and therapeutic protocols. PMID:24132382

  6. Music preferences of mechanically ventilated patients participating in a randomized controlled trial

    PubMed Central

    Heiderscheit, Annie; Breckenridge, Stephanie J.; Chlan, Linda L.; Savik, Kay

    2014-01-01

    Mechanical ventilation (MV) is a life-saving measure and supportive modality utilized to treat patients experiencing respiratory failure. Patients experience pain, discomfort, and anxiety as a result of being mechanically ventilated. Music listening is a non-pharmacological intervention used to manage these psychophysiological symptoms associated with mechanical ventilation. The purpose of this secondary analysis was to examine music preferences of 107 MV patients enrolled in a randomized clinical trial that implemented a patient-directed music listening protocol to help manage the psychophysiological symptom of anxiety. Music data presented includes the music genres and instrumentation patients identified as their preferred music. Genres preferred include: classical, jazz, rock, country, and oldies. Instrumentation preferred include: piano, voice, guitar, music with nature sounds, and orchestral music. Analysis of three patients’ preferred music received throughout the course of the study is illustrated to demonstrate the complexity of assessing MV patients and the need for an ongoing assessment process. PMID:25574992

  7. Linkages of plant-soil feedbacks and underlying invasion mechanisms.

    PubMed

    Inderjit; Cahill, James F

    2015-01-01

    Soil microbial communities and processes have repeatedly been shown to impact plant community assembly and population growth. Soil-driven effects may be particularly pronounced with the introduction of plants to non-native ranges, as introduced plants are not typically accompanied by transference of local soil communities. Here we describe how the mechanisms by which soil community processes influence plant growth overlap with several known and well-described mechanisms of plant invasion. Critically, a given soil community process may either facilitate or limit invasion, depending upon local conditions and the specific mechanisms of soil processes involved. Additionally, as soil communities typically consist of species with short generation times, the net consequences of plant-soil feedbacks for invasion trajectories are likely to change over time, as ecological and evolutionary adjustments occur. Here we provide an overview of the ecological linkages of plant-soil feedbacks and underlying mechanisms of invasion. PMID:25784668

  8. Chest compression with a higher level of pressure support ventilation: effects on secretion removal, hemodynamics, and respiratory mechanics in patients on mechanical ventilation*

    PubMed Central

    Naue, Wagner da Silva; Forgiarini, Luiz Alberto; Dias, Alexandre Simões; Vieira, Silvia Regina Rios

    2014-01-01

    OBJECTIVE: To determine the efficacy of chest compression accompanied by a 10-cmH2O increase in baseline inspiratory pressure on pressure support ventilation, in comparison with that of aspiration alone, in removing secretions, normalizing hemodynamics, and improving respiratory mechanics in patients on mechanical ventilation. METHODS: This was a randomized crossover clinical trial involving patients on mechanical ventilation for more than 48 h in the ICU of the Porto Alegre Hospital de Clínicas, in the city of Porto Alegre, Brazil. Patients were randomized to receive aspiration alone (control group) or compression accompanied by a 10-cmH2O increase in baseline inspiratory pressure on pressure support ventilation (intervention group). We measured hemodynamic parameters, respiratory mechanics parameters, and the amount of secretions collected. RESULTS: We included 34 patients. The mean age was 64.2 ± 14.6 years. In comparison with the control group, the intervention group showed a higher median amount of secretions collected (1.9 g vs. 2.3 g; p = 0.004), a greater increase in mean expiratory tidal volume (16 ± 69 mL vs. 56 ± 69 mL; p = 0.018), and a greater increase in mean dynamic compliance (0.1 ± 4.9 cmH2O vs. 2.8 ± 4.5 cmH2O; p = 0.005). CONCLUSIONS: In this sample, chest compression accompanied by an increase in pressure support significantly increased the amount of secretions removed, the expiratory tidal volume, and dynamic compliance. (ClinicalTrials.gov Identifier:NCT01155648 [http://www.clinicaltrials.gov/]) PMID:24626270

  9. Hyperpolarized 3He magnetic resonance imaging ventilation defects in asthma: relationship to airway mechanics.

    PubMed

    Leary, Del; Svenningsen, Sarah; Guo, Fumin; Bhatawadekar, Swati; Parraga, Grace; Maksym, Geoffrey N

    2016-04-01

    In patients with asthma, magnetic resonance imaging (MRI) provides direct measurements of regional ventilation heterogeneity, the etiology of which is not well-understood, nor is the relationship of ventilation abnormalities with lung mechanics. In addition, respiratory resistance and reactance are often abnormal in asthmatics and the frequency dependence of respiratory resistance is thought to reflect ventilation heterogeneity. We acquiredMRIventilation defect maps, forced expiratory volume in one-second (FEV1), and airways resistance (Raw) measurements, and used a computational airway model to explore the relationship of ventilation defect percent (VDP) with simulated measurements of respiratory system resistance (Rrs) and reactance (Xrs).MRIventilation defect maps were experimentally acquired in 25 asthmatics before, during, and after methacholine challenge and these were nonrigidly coregistered to the airway tree model. Using the model coregistered to ventilation defect maps, we narrowed proximal (9th) and distal (14th) generation airways that were spatially related to theMRIventilation defects. The relationships forVDPwith Raw measured using plethysmography (r = 0.79), and model predictions of Rrs>14(r = 0.91,P < 0.0001) and Rrs>9(r = 0.88,P < 0.0001) were significantly stronger (P = 0.005;P = 0.03, respectively) than withFEV1(r = -0.68,P = 0.0001). The slopes for the relationship ofVDPwith simulated lung mechanics measurements were different (P < 0.0001); among these, the slope for theVDP-Xrs0.2relationship was largest, suggesting thatVDPwas dominated by peripheral airway heterogeneity in these patients. In conclusion, as a first step toward understanding potential links between lung mechanics and ventilation defects, impedance predictions were made using a computational airway tree model with simulated constriction of airways related to ventilation defects measured in mild-moderate asthmatics. PMID:27053294

  10. Intracuff alkalized lidocaine reduces sedative/analgesic requirements for mechanically ventilated patients

    PubMed Central

    Basuni, Ahmed Sobhy

    2014-01-01

    Background: The objective of this study is to investigate the effect of intracuff alkalized lidocaine on sedative/analgesic requirements for mechanically ventilated patients and its consequence on patient-ventilator interaction. Materials and Methods: A total of 64 patients who expected to require ventilatory support for a period of more than 48 h were randomly assigned to groups S and L. In group S, the endotracheal tube (ETT) cuffs were inflated with normal saline. In group L, the ETT cuffs were inflated with lidocaine 2% and sodium bicarbonate 8.4%. The investigator and the surgical intensive care unit staff were blinded to the nature of cuff-filled solutions. Sedation was maintained with propofol and fentanyl infusions. The total requirements for propofol and fentanyl, frequency and severity of cough and number of ineffective triggering during the first 24 h of mechanical ventilation were recorded. Results: There was a significant reduction (about 30%) in the requirements for propofol and fentanyl in patients who received intracuff alkalinized lidocaine; P < 0.001. The frequency and severity of cough were significantly lower in group L compared with group S and the frequency of ineffective triggering was significantly lower in group L; P < 0.001 for both comparisons. Conclusion: Intracuff alkalized lidocaine increases ETT tolerance and hence, decreases sedatives/analgesics requirements for mechanically ventilated patients. This results in improved patient-ventilator synchronization. PMID:25422600