Sample records for mechanical ventilator care

  1. Care of a cardiac pt on mechanical ventilation

    E-print Network

    Kay, Mark A.

    Care of a cardiac pt on mechanical ventilation CVICU New Hires Orientation Day 2 Winnie Yung, RN, MN #12;Outline · Physiology of breathing · Terminology · Intubation · Mode of mechanical ventilation· Mode of mechanical ventilation · Nursing care of a vented pt · Nursing care of a vented single

  2. Year in review 2005: Critical Care Respirology: mechanical ventilation, infection, monitoring, and education

    Microsoft Academic Search

    Jack J Haitsma; Jess Villar; Arthur S Slutsky

    2006-01-01

    We summarize all original research in the field of respiratory intensive care medicine published in 2005 in Critical Care. Twenty-seven articles were grouped into the following categories and subcategories to facilitate rapid overview: mechanical ventilation (physiology, spontaneous breathing during mechanical ventilation, high frequency oscillatory ventilation, side effects of mechanical ventilation, sedation, and prone positioning); infection (pneumonia and sepsis); monitoring (ventilatory

  3. How Is Mechanical Ventilation Employed in the Intensive Care Unit? An International Utilization Review

    Microsoft Academic Search

    ANDRS ESTEBAN; ANTONIO ANZUETO; FEDERICO GORDO; DAVID CIDE; ROSANNE GOLDWASER; GUILLERMO BUGEDO; CARLOS RODRIGO; JORGE PIMENTEL; GUILLERMO RAIMONDI; MARTIN J. TOBIN; Fraga Filho; Asociacin Espaola

    A 1-d point-prevalence study was performed with the aim of de- scribing the characteristics of conventional mechanical ventilation in intensive care units ICUs from North America, South America, Spain, and Portugal. The study involved 412 medical-surgical ICUs and 1,638 patients receiving mechanical ventilation at the mo- ment of the study. The main outcome measures were characteriza- tion of the indications

  4. Can and should level II nurseries care for newborns who require mechanical ventilation?

    PubMed

    Meadow, W; Mendez, D; Makela, J; Malin, A; Gray, C; Lantos, J D

    1996-09-01

    Perinatal regionalization was conceived roughly 25 years ago to provide centralized care for critically ill newborn infants. As for many 25-year-old concepts, the obligatory centripetal design of many regionalization policies may need to be modified. This article presents the outcomes of 408 surviving patients who required mechanical ventilation (136 born in one community hospital and 272 birthweight-matched infants born in our tertiary center), and were cared for in our perinatal network. Mechanical ventilation of a resident population of newborns at a community NICU appeared to be as effective as ventilatory care at a regionalized tertiary neonatal intensive care unit, when assessed by comparing birthweight-matched populations for length of hospital stay, days on ventilator, and the need for home O2. Some may still claim that every baby who requires mechanical ventilation must be transferred to a tertiary care center. In an era of heightened interest in health services, health outcomes, and cost-effectiveness analysis, however, the authors believe that such claims will be subjected to increasing scrutiny. Our study represents a first attempt at determining the shape such scrutiny might take, and the sort of data analyses that may be required to reformat a perinatal network. PMID:8884126

  5. Swallowing rehabilitation of dysphagic tracheostomized patients under mechanical ventilation in intensive care units: a feasibility study

    PubMed Central

    Rodrigues, Katia Alonso; Machado, Flvia Ribeiro; Chiari, Braslia Maria; Rosseti, Helosa Baccaro; Lorenzon, Paula; Gonalves, Maria Ins Rebelo

    2015-01-01

    Objective The aim of the present study was to assess the feasibility of the early implementation of a swallowing rehabilitation program in tracheostomized patients under mechanical ventilation with dysphagia. Methods This prospective study was conducted in the intensive care units of a university hospital. We included hemodynamically stable patients under mechanical ventilation for at least 48 hours following 48 hours of tracheostomy and with an appropriate level of consciousness. The exclusion criteria were previous surgery in the oral cavity, pharynx, larynx and/or esophagus, the presence of degenerative diseases or a past history of oropharyngeal dysphagia. All patients were submitted to a swallowing rehabilitation program. An oropharyngeal structural score, a swallowing functional score and an otorhinolaryngological structural and functional score were determined before and after swallowing therapy. Results We included 14 patients. The mean duration of the rehabilitation program was 12.4 9.4 days, with 5.0 5.2 days under mechanical ventilation. Eleven patients could receive oral feeding while still in the intensive care unit after 4 (2 - 13) days of therapy. All scores significantly improved after therapy. Conclusion In this small group of patients, we demonstrated that the early implementation of a swallowing rehabilitation program is feasible even in patients under mechanical ventilation.

  6. Sedation and memories of patients subjected to mechanical ventilation in an intensive care unit

    PubMed Central

    da Costa, Jaquilene Barreto; Marcon, Sonia Silva; de Macedo, Claudia Rejane Lima; Jorge, Amaury Cesar; Duarte, Pricles Almeida Delfino

    2014-01-01

    Objective To investigate the relationship between sedation and the memories reported by patients subjected to mechanical ventilation following discharge from the intensive care unit. Methods This prospective, observational, cohort study was conducted with individuals subjected to mechanical ventilation who remained in the intensive care unit for more than 24 hours. Clinical statistics and sedation records were extracted from the participants' clinical records; the data relative to the participants' memories were collected using a specific validated instrument. Assessment was performed three months after discharge from the intensive care unit. Results A total of 128 individuals were assessed, most of whom (84.4%) reported recollections from their stay in the intensive care unit as predominantly a combination of real and illusory events. The participants subjected to sedation (67.2%) at deep levels (Richmond Agitation-Sedation Scale [RASS] -4 and -5) for more than two days and those with psychomotor agitation (33.6%) exhibited greater susceptibility to occurrence of illusory memories (p>0.001). Conclusion The probability of the occurrence of illusory memories was greater among the participants who were subjected to deep sedation. Sedation seems to be an additional factor that contributed to the occurrence of illusory memories in severely ill individuals subjected to mechanical ventilation. PMID:25028945

  7. Noninvasive ventilation after intubation and mechanical ventilation

    Microsoft Academic Search

    M. Ferrer; O. Bernadich; S. Nava; A. Torres

    2002-01-01

    Noninvasive ventilation after intubation and mechanical ventilation. M. Ferrer, O. Bernadich, S. Nava, A. Torres. #ERS Journals Ltd 2002. ABSTRACT: Patients with chronic airflow obstruction who are difficult to wean from mechanical ventilation are at increased risk of intubation-associated complications and mortality because of prolonged invasive mechanical ventilation. Noninvasive positive pressure ventilation may revert most of the pathophysiological mechanisms associated

  8. Pulmonary complications of mechanical ventilation.

    PubMed

    Sandur, S; Stoller, J K

    1999-06-01

    Although life-saving, mechanical ventilation may be associated with many complications, including consequences of positive intrathoracic pressure, the many aspects of volutrauma, and adverse effects of intubation and tracheostomy. Optimal ventilatory care requires implementing mechanical ventilation with attention to minimizing adverse hemodynamic effects, averting volutrauma, and effecting freedom from mechanical ventilation as quickly as possible so as to minimize the risk of airway complications. PMID:10386254

  9. [Mechanical ventilation in children

    PubMed

    Carvalho, W B

    1998-07-01

    OBJECTIVE: To make a brief review about mechanical ventilation in Pediatrics.METHODS: Review of the classification of types of mechanical ventilation, characteristics of pression and flow waves and indications for its installation. In a sequential way we discuss the various modes of ventilation (control ventilation, assisted-control ventilation, assisted ventilation, intermittent mandatory ventilation, synchronized intermittent mandatory ventilation, pressure-support ventilation) showing some advantages and disadvantages of using these modes. RESULTS: General rules for mechanical ventilation are presented, considering some specific pathologies in Pediatrics (acute respiratory distress syndrome, bronchopleural fistulae, cranial trauma, cardiac failure, neuromuscular pathology, acute asthma and in patients with acute descompensation of a cronic respiratory failure). CONCLUSIONS: Some limitations of mechanical ventilation and the possible advances in a short period are presented. PMID:14685580

  10. [Assessment of Wiki technology: a tool for accessing information on mechanical ventilation in intensive care].

    PubMed

    Barra, Daniela Couto Carvalho; Dal Sasso, Grace Teresinha Marcon; Martins, Cleusa Rios; Barbosa, Sayonara de Ftima Faria

    2012-01-01

    The development and application of information technology influence all areas of knowledge, enabling new ways of learning. The Wiki is a tool of information and communication technology provided by the Web 2.0 that can be exploited and used in teaching, learning, care and research in nursing education. Thus, this quantitative study is a descriptive and exploratory objective was to evaluate the nursing students with the criteria of Ergonomics and Usability of the tool Wiki as a technology to access information on nursing care in mechanical ventilation in the Intensive Care Unit. The tool was evaluated as "excellent" in the criteria for Ergonomics and Usability, and is considered a new emerging technology suitable for educational use. PMID:23032338

  11. Mechanical Ventilation

    MedlinePLUS

    ... in a regular unit of a hospital, a rehabilitation facility, or cared for at home. respiratory therapists) ... service of the American Thoracic Society and its journal, the AJRCCM. The information appearing in this series ...

  12. Paid carers' experiences of caring for mechanically ventilated children at home: implications for services and training.

    PubMed

    Maddox, Christina; Pontin, David

    2013-06-01

    UK survival rates for long-term mechanically ventilated children have increased and paid carers are trained to care for them at home, however there is limited literature on carers' training needs and experience of sharing care. Using a qualitative abductive design, we purposively sampled experienced carers to generate data via diaries, semi-structured interviews, and researcher reflexive notes. Research ethics approval was granted from NHS and University committees. Five analytical themes emerged - Parent as expert; Role definition tensions; Training and Continuing Learning Needs; Mixed Emotions; Support Mechanisms highlighting the challenges of working in family homes for carers and their associated learning needs. Further work on preparing carers to share feelings with parents, using burnout prevention techniques, and building confidence is suggested. Carers highlight the lack of clinical supervision during their night-working hours. One solution may be to provide access to registered nurse support when working out-of-office hours. PMID:23711491

  13. Prognostic Factors of Patients Requiring Prolonged Mechanical Ventilation in a Medical Intensive Care Unit of Korea

    PubMed Central

    Kim, Mi Hyun; Cho, Woo Hyun; Kim, Ki Uk; Jeon, Doo Soo; Park, Hye-Kyung; Kim, Yun Seong; Lee, Min Ki; Park, Soon Kew

    2012-01-01

    Background We evaluated the clinical outcomes and prognostic factors of patients requiring prolonged mechanical ventilation (PMV), defined as ventilator care for ?21 days, who were admitted to the medical intensive care unit (ICU) of a university hospital in Korea. Methods During the study period, a total of 2,644 patients were admitted to the medical ICU, and 136 patients (5.1%) were enrolled between 2005 and 2010. Results The mean age of the patients was 61.314.5 years, and 94 (69.1%) were male. The ICU and six-month cumulative mortality rates were 45.6 and 58.8%, respectively. There were 96 patients with tracheostomy placement after admission and their mean period from admission to the day of tracheostomy was 21.38.4 days. Sixty-three patients (46.3%) were successfully weaned from ventilator care. Of the ICU survivors (n=74), 34 patients (45.9%) were transferred to other hospitals (not university hospitals). Two variables (thrombocytopenia [hazard ratio (HR), 1.964; 95% confidence interval (CI), 1.225~3.148; p=0.005] and the requirement for vasopressors [HR, 1.822; 95% CI, 1.111~2.986; p=0.017] on day 21) were found to be independent factors of survival on based on the Cox proportional hazard model. Conclusion We found that patients requiring PMV had high six-month cumulative mortality rates, and that two clinical variables (measured on day 21), thrombocytopenia and requirement for vasopressors, may be associated with prognostic indicators. PMID:23166558

  14. One-year trajectories of care and resource utilization for recipients of prolonged mechanical ventilation: a cohort study

    PubMed Central

    Unroe, Mark; Kahn, Jeremy M.; Carson, Shannon S.; Govert, Joseph A.; Martinu, Tereza; Sathy, Shailaja J.; Clay, Alison S.; Chia, Jessica; Gray, Alice; Tulsky, James A.; Cox, Christopher E.

    2010-01-01

    Background Growing numbers of critically ill patients receive prolonged mechanical ventilation. Little is known about their patterns of care as they transition from the acute hospital to post-acute care facilities or the associated resource utilization. Objectives To describe one-year trajectories of care and resource utilization for prolonged mechanical ventilation patients. Design One-year prospective cohort study. Setting 5 ICUs at Duke University Medical Center. Participants 126 prolonged mechanical ventilation patients as well as their 126 surrogates and 54 ICU physicians were enrolled consecutively during one year. Prolonged mechanical ventilation was defined as ventilation for ?4 days with tracheostomy placement or ventilation for ?21 days without tracheostomy. Measurements Patients and surrogates were interviewed in hospital, as well as 3 and 12 months later to determine patient survival, functional status, and facility type and duration of post-discharge care. Physicians were interviewed in-hospital to elicit prognoses. Institutional billing records were used to assign costs for acute care, outpatient care, and inter-facility transportation. We used Medicare claims data to assign costs for post-acute care. Results 103 (82%) hospital survivors experienced 457 separate transitions in post-discharge care location (median 4 [interquartile range 3, 5]), including 68 (67%) patients who were readmitted at least once. Patients spent an average of 74% (CI, 68% to 80%) of all days alive in a hospital, post-acute care facility, or receiving home health care. At one year, 11 (9%) patients had a good outcome (alive with no functional dependency), 33 (26%) had a fair outcome (alive with moderate dependency), and 82 (65%) had a poor outcome (either alive with complete functional dependency (n=4, 21%) or dead (n=56, 44%). Patients experiencing a poor outcome were older, had more comorbidities, and were more frequently discharged to a post-acute care facility than patients with either fair or good outcomes (all p <0.05). Costs per patient were $306,135 (SD $285,467) and total cohort costs totaled $38.1 million, for an estimated $3.5 million per one-year independently functioning survivor. Limitations The results of this single center study may not be applicable to other centers. Conclusions Prolonged mechanical ventilation patients experience multiple transitions of care, resulting in extraordinary health care costs and persistent, profound disability. The optimism of surrogate decision makers should be balanced by discussions of these outcomes when considering a course of prolonged life support. PMID:20679561

  15. Mechanical ventilation with the esophageal tracheal combitube (ETC) in the intensive care unit.

    PubMed Central

    Frass, M; Frenzer, R; Mayer, G; Popovic, R; Leithner, C

    1987-01-01

    Mechanical ventilation in critically ill patients is usually performed with the conventional endotracheal airway. The esophageal tracheal combitube (ETC) is a new device for cardiopulmonary resuscitation, conceived to bridge the gap between hospital and prehospital phases. The ETC may be used in esophageal and endotracheal positions. The authors report six patients who were ventilated with the ETC in the esophageal obturator position for 2-8 h after emergency ventilation. Blood gas data showed adequate ventilation with the ETC during the observation period. Data suggest that mechanical ventilation with the ETC is possible for several hours after cardiopulmonary resuscitation. This might be helpful during the initial post-arrest period, when replacement of the ETC by a conventional endotracheal airway might destabilize a vulnerable patient. PMID:3440049

  16. Clinical review: Liberation from mechanical ventilation

    Microsoft Academic Search

    Mohamad F El-Khatib; Pierre Bou-Khalil

    2008-01-01

    Mechanical ventilation is the defining event of intensive care unit (ICU) management. Although it is a life saving intervention in patients with acute respiratory failure and other disease entities, a major goal of critical care clinicians should be to liberate patients from mechanical ventilation as early as possible to avoid the multitude of complications and risks associated with prolonged unnecessary

  17. Mechanical Ventilation in Children - Problems and Issues.

    PubMed

    Zieli?ska, Marzena; Zieli?ski, Stanis?aw; Sniatkowska-Bartkowska, Alicja

    2014-01-01

    Respiratory failure is the leading reason for the admission of children to intensive care units, and the ventilator is the main therapeutic tool used during the treatment of these patients. Acompetently used ventilator and adequate knowledge of the anatomy, histology and physiology of the respiratory system in particular age groups of children (especially among neonates and infants) are crucial for successful treatment. Both non-invasive and invasive ventilation modes can be used for respiratory treatment in children. Invasive ventilation modes can be divided into two groups: conventional ones such as pressure-controlled or volume-controlled ventilation, or non-conventional modes such as oscillatory ventilation. Mechanical ventilation can involve ahigh risk of serious complications, such as pressure injury (barotrauma), volume injury (volutrauma) and biotrauma. Adhering to the principles of lung-protective ventilation can reduce the risk of side effects of mechanical ventilation. PMID:25491702

  18. Equipment needs for noninvasive mechanical ventilation

    Microsoft Academic Search

    B. Schonhofer; S. Sortor-Leger

    2002-01-01

    ABSTRACT: Noninvasive mechanical,ventilation (NIV) has a long tradition for the treatment of chronic respiratory failure and more recently has also been applied in acute respiratory failure. Based on this experience both critical care ventilators and portable ventilators are used to perform,NIV. The individual choice of ventilator type should depend on the patient9s condition and also on the expertise of attending

  19. Mechanical ventilation after injury.

    PubMed

    Maung, Adrian A; Kaplan, Lewis J

    2014-01-01

    Injury is a major cause of critical illness worldwide. Severely injured patients often require mechanical ventilation not only to manage primary respiratory failure but also as adjunct to manage other conditions. Injury induces fundamental changes in multiple organ systems which directly impact ventilator management; these changes are not shared by patients without concomitant tissue injury. In this article, we review the physiologic changes after injury and discuss the impact of injury on ventilator strategies and management. We also explore the special considerations in patients with traumatic brain injury, thermal injury, blast injury or bronchopleural fistula. PMID:22956744

  20. Survival pattern in patients with acute organophosphate poisoning on mechanical ventilation: A retrospective intensive care unit-based study in a tertiary care teaching hospital

    PubMed Central

    Ahmed, Syed M; Das, Bikramjit; Nadeem, Abu; Samal, Rajiv K

    2014-01-01

    Background and Aims: Organophosphorus (OP) compound poisoning is one of the most common poisonings in India. The aim of the study was to study the outcomes and predictors of mortality in patients with acute OP poisoning requiring mechanical ventilation. Methods: A retrospective study was conducted in the intensive care unit and 117 patients were included. Diagnosis was performed from the history taken either from the patient or from the patient's relatives. Demographic data, month of the year, mode of poisoning, common age group, duration of mechanical ventilation, time of starting pralidoxime (PAM), and mortality were recorded. Chi square test, Pearson correlation test, and multivariate binary logistic regression analysis was used. Data are presented as mean SD. Results: 91.86% (79/86) of cases were suicidal and remaining cases were accidental. Duration of mechanical ventilation varied from less than 48 hours to more than 7 days. Mortality rate was 33.3%, 7.2%, and 100% in those who required mechanical ventilation for more than 7 days, 5 to 7 days, and 2 to 4 days, respectively. Lag time was less than 6 hrs in 13 patients and all of them survived. 17.1% and 28.1% patients died in whom PAM was started 6 to 12 hrs and 13 to 24 hrs after poisoning, respectively. There was statistically significant positive correlation between lag time of starting of PAM with duration of mechanical ventilation and total dose of PAM (P < 0.0001). None of the predictors age, lag time, severity of poisoning, and duration of ventilation were independent predictors of death. Overall mortality rate was 18.6%. Conclusion: Mortality from OP compound poisoning is directly proportionate to the severity of poisoning, delay in starting PAM, and duration of mechanical ventilation. Death is not dependent on a single factor, rather contributory to these factors working simultaneously. PMID:24700893

  1. Humidification policies for mechanically ventilated intensive care patients and prevention of ventilator-associated pneumonia: a systematic review of randomized controlled trials.

    PubMed

    Nil-Weise, B S; Wille, J C; van den Broek, P J

    2007-04-01

    The Dutch Working Party on Infection Prevention (WIP) aimed to determine whether certain humidification policies are better than others in terms of prevention of ventilator-associated pneumonia (VAP) in mechanically ventilated intensive care unit (ICU) patients. Publications were retrieved by a systematic search of Medline and the Cochrane Library up to February 2006. All (quasi-) randomized trials and systematic reviews/meta-analyses comparing humidification methods in ventilated ICU patients were selected. Two reviewers independently assessed trial quality and extracted data. If the data was incomplete, clarification was sought from original authors and used to calculate the relative risk of VAP. Data for VAP were combined in the analysis, where appropriate, using a random-effects model. Ten trials were included in the review. In general, the quality of the trials and the way they were reported were unsatisfactory. The results did not show any benefit from specific humidification techniques in terms of reducing VAP. WIP do not recommend either passive or active humidifiers to prevent VAP, nor the type of passive humidifiers to be used. Regarding active humidification, WIP recommends using heated wire circuits. This is due to the theoretical consideration that less condensate reduces colonization and subsequent risk of spread throughout an ICU when condensate is removed. PMID:17320243

  2. Establishment of a prospective cohort of mechanically ventilated patients in five intensive care units in Lima, Peru: protocol and organisational characteristics of participating centres

    PubMed Central

    Denney, Joshua A; Capanni, Francesca; Herrera, Phabiola; Dulanto, Augusto; Roldan, Rollin; Paz, Enrique; Jaymez, Amador A; Chirinos, Eduardo E; Portugal, Jose; Quispe, Rocio; Brower, Roy G; Checkley, William

    2015-01-01

    Introduction Mechanical ventilation is a cornerstone in the management of critically ill patients worldwide; however, less is known about the clinical management of mechanically ventilated patients in low and middle income countries where limitation of resources including equipment, staff and access to medical information may play an important role in defining patient-centred outcomes. We present the design of a prospective, longitudinal study of mechanically ventilated patients in Peru that aims to describe a large cohort of mechanically ventilated patients and identify practices that, if modified, could result in improved patient-centred outcomes and lower costs. Methods and analysis Five Peruvian intensive care units (ICUs) and the Medical ICU at the Johns Hopkins Hospital were selected for this study. Eligible patients were those who underwent at least 24?h of invasive mechanical ventilation within the first 48?h of admission into the ICU. Information on ventilator settings, clinical management and treatment were collected daily for up to 28?days or until the patient was discharged from the unit. Vital status was assessed at 90?days post enrolment. A subset of participants who survived until hospital discharge were asked to participate in an ancillary study to assess vital status, and physical and mental health at 6, 12, 24 and 60?months after hospitalisation, Primary outcomes include 90-day mortality, time on mechanical ventilation, hospital and ICU lengths of stay, and prevalence of acute respiratory distress syndrome. In subsequent analyses, we aim to identify interventions and standardised care strategies that can be tailored to resource-limited settings and that result in improved patient-centred outcomes and lower costs. Ethics and dissemination We obtained ethics approval from each of the four participating hospitals in Lima, Peru, and at the Johns Hopkins School of Medicine, Baltimore, USA. Results will be disseminated as several separate publications in different international journals. PMID:25596196

  3. Low mechanical ventilation times and reintubation rates associated with a specific weaning protocol in an intensive care unit setting: a retrospective study

    PubMed Central

    de Medeiros Silva, Cilene Saghabi; Timenetsky, Karina T.; Taniguchi, Corinne; Calegaro, Sedila; Azevedo, Carolina Sant'Anna A.; Stus, Ricardo; de Matos, Gustavo Faissol Janot; Eid, Raquel A.C.; Barbas, Carmen Silvia Valente

    2012-01-01

    OBJECTIVES: A number of complications exist with invasive mechanical ventilation and with the use of and withdrawal from prolonged ventilator support. The use of protocols that enable the systematic identification of patients eligible for an interruption in mechanical ventilation can significantly reduce the number of complications. This study describes the application of a weaning protocol and its results. METHODS: Patients who required invasive mechanical ventilation for more than 24 hours were included and assessed daily to identify individuals who were ready to begin the weaning process. RESULTS: We studied 252 patients with a median mechanical ventilation time of 3.7 days (interquartile range of 1 to 23 days), a rapid shallow breathing index value of 48 (median), a maximum inspiratory pressure of 40 cmH2O, and a maximum expiratory pressure of 40 cm H2O (median). Of these 252 patients, 32 (12.7%) had to be reintubated, which represented weaning failure. Noninvasive ventilation was used postextubation in 170 (73%) patients, and 15% of these patients were reintubated, which also represented weaning failure. The mortality rate of the 252 patients studied was 8.73% (22), and there was no significant difference in the age, gender, mechanical ventilation time, and maximum inspiratory pressure between the survivors and nonsurvivors. CONCLUSIONS: The use of a specific weaning protocol resulted in a lower mechanical ventilation time and an acceptable reintubation rate. This protocol can be used as a comparative index in hospitals to improve the weaning system, its monitoring and the informative reporting of patient outcomes and may represent a future tool and source of quality markers for patient care. PMID:23018293

  4. Air Distribution Effectiveness for Different Mechanical Ventilation

    E-print Network

    LBNL-62700 Air Distribution Effectiveness for Different Mechanical Ventilation Systems Max H Effectiveness for Different Mechanical Ventilation Systems Max H. Sherman and Iain S. Walker Lawrence Berkeley National Laboratory, USA ABSTRACT The purpose of ventilation is to dilute indoor contaminants

  5. Secretion management in the mechanically ventilated patient.

    PubMed

    Branson, Richard D

    2007-10-01

    Secretion management in the mechanically ventilated patient includes routine methods for maintaining mucociliary function, as well as techniques for secretion removal. Humidification, mobilization of the patient, and airway suctioning are all routine procedures for managing secretions in the ventilated patient. Early ambulation of the post-surgical patient and routine turning of the ventilated patient are common secretion-management techniques that have little supporting evidence of efficacy. Humidification is a standard of care and a requisite for secretion management. Both active and passive humidification can be used. The humidifier selected and the level of humidification required depend on the patient's condition and the expected duration of intubation. In patients with thick, copious secretions, heated humidification is superior to a heat and moisture exchanger. Airway suctioning is the most important secretion removal technique. Open-circuit and closed-circuit suctioning have similar efficacy. Instilling saline prior to suctioning, to thin the secretions or stimulate a cough, is not supported by the literature. Adequate humidification and as-needed suctioning are the foundation of secretion management in the mechanically ventilated patient. Intermittent therapy for secretion removal includes techniques either to simulate a cough, to mechanically loosen secretions, or both. Patient positioning for secretion drainage is also widely used. Percussion and postural drainage have been widely employed for mechanically ventilated patients but have not been shown to reduce ventilator-associated pneumonia or atelectasis. Manual hyperinflation and insufflation-exsufflation, which attempt to improve secretion removal by simulating a cough, have been described in mechanically ventilated patients, but neither has been studied sufficiently to support routine use. Continuous lateral rotation with a specialized bed reduces atelectasis in some patients, but has not been shown to improve secretion removal. Intrapulmonary percussive ventilation combines percussion with hyperinflation and a simulated cough, but the evidence for intrapulmonary percussive ventilation in mechanically ventilated patients is insufficient to support routine use. Secretion management in the mechanically ventilated patient consists of appropriate humidification and as-needed airway suctioning. Intermittent techniques may play a role when secretion retention persists despite adequate humidification and suctioning. The technique selected should remedy the suspected etiology of the secretion retention (eg, insufflation-exsufflation for impaired cough). Further research into secretion management in the mechanically ventilated patient is needed. PMID:17894902

  6. Music therapya complementary treatment for mechanically ventilated intensive care patients

    Microsoft Academic Search

    Sofia Almerud; Kerstin Petersson

    2003-01-01

    The aim of this study was to ascertain whether music therapy had a measurable relaxing effect on patients who were temporarily on a respirator in an intensive care unit (ICU) and after completion of respirator treatment investigate those patients experiences of the music therapy. In the study both quantitative and qualitative measurements were applied. Twenty patients were included using consecutive

  7. 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 patients 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

  8. Home mechanical ventilation: What are all the options ?

    Microsoft Academic Search

    Wendy L. Votroubek

    1995-01-01

    Children requiring mechanical ventilation are increasingly cared for in the home setting. The goals for these children at home include ensure medical safety of the child, optimize the child's quality of life, use respiratory equipment safely and properly, and prevent or minimize compli cations. Although positive pressure ventilation with a tracheostomy is the technique most com monly used in the

  9. Capnography/Capnometry during mechanical ventilation: 2011.

    PubMed

    Walsh, Brian K; Crotwell, David N; Restrepo, Ruben D

    2011-04-01

    We searched the MEDLINE, CINAHL, and Cochrane Library databases for articles published between January 1990 and November 2010. The update of this clinical practice guideline is based on 234 clinical studies and systematic reviews, 19 review articles that investigated capnography/capnometry during mechanical ventilation, and the 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. The following recommendations are made following the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) scoring system: (1) Continuous-waveform capnography is recommended, in addition to clinical assessment to confirm and monitor correct placement of an endotracheal tube. (2) If waveform capnography is not available, a non-waveform exhaled CO(2) monitor, in addition to clinical assessment, is suggested as the initial method for confirming correct tube placement in a patient in cardiac arrest. (3) End-tidal CO(2) (P(ETCO(2))) is suggested to guide ventilator management. (4) Continuous capnometry during transport of the mechanically ventilated patients is suggested. (5) Capnography is suggested to identify abnormalities of exhaled air flow. (6) Volumetric capnography is suggested to assess CO(2) elimination and the ratio of dead-space volume to tidal volume (V(D)/V(T)) to optimize mechanical ventilation. (7) Quantitative waveform capnography is suggested in intubated patients to monitor cardiopulmonary quality, optimize chest compressions, and detect return of spontaneous circulation during chest compressions or when rhythm check reveals an organized rhythm. PMID:21255512

  10. STATE OF CALIFORNIA MECHANICAL VENTILATION AND REHEAT

    E-print Network

    STATE OF CALIFORNIA MECHANICAL VENTILATION AND REHEAT CEC-MECH-3C (Revised 08/09) CALIFORNIA ENERGY COMMISSION MECHANICAL VENTILATION AND REHEAT MECH-3C PROJECT NAME DATE MECHANICAL VENTILATION §121(b)2 REHEAT'D V.A. Max of D or G Design Ventilation Air cfm 50% of Design Zone Supply cfm B x 0.4 cfm/ft² Max

  11. 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

  12. Humidification during mechanical ventilation in the adult patient.

    PubMed

    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

  13. Telemedicine enabled remote critical care ventilator

    Microsoft Academic Search

    Gregory J. Seifert; Daniel S. Hedin; Robert J. Dahlstrom; Gary D. Havey

    2010-01-01

    Following a critical illness, technology-dependent children on chronic ventilator support require specialized care to facilitate recovery and rehabilitation that minimally impedes social and psychological development. Intervention strategies have been confounded by the need for frequent assessment via physical exam in a relatively immobile patient population. The availability of technology that enables effective, timely, and reliable information transfer between the homecare

  14. Therapeutic suggestion helps to cut back on drug intake for mechanically ventilated patients in intensive care unit

    PubMed Central

    Fritz, Gbor; Varga, Katalin

    2013-01-01

    Research was conducted on ventilated patients treated in an intensive care unit (ICU) under identical circumstances; patients were divided into two groups (subsequently proved statistically identical as to age and Simplified Acute Physiology Score II [SAPS II]). One group was treated with positive suggestions for 1520 min a day based on a predetermined scheme, but tailored to the individual patient, while the control group received no auxiliary psychological treatment. Our goal was to test the effects of positive communication in this special clinical situation. In this section of the research, the subsequent data collection was aimed to reveal whether any change in drug need could be demonstrated upon the influence of suggestions as compared to the control group. Owing to the strict recruitment criteria, a relatively small sample (suggestion group n = 15, control group n = 10) was available during the approximately nine-month period of research. As an outcome of suggestions, there was a significant drop in benzodiazepine (p < 0.005), opioid (p < 0.001), and the ?2-agonist (p < 0.05) intake. All this justifies the presence of therapeutic suggestions among the therapies used in ICUs. However, repeating the trial on a larger sample of patients would be recommended. PMID:24381732

  15. Tracheal colonization with Sphingomonas paucimobilis in mechanically ventilated neonates due to contaminated ventilator temperature probes

    Microsoft Academic Search

    D. Lemaitre; A. Elaichouni; M. Hundhausen; G. Claeys; P. Vanhaesebrouck; M. Vaneechoutte; G. Verschraegen

    1996-01-01

    Sphingomonas paucimobilis was isolated from tracheal secretions of a total of 85 mechanically ventilated babies in a neonatal intensive-care unit (NICU) during a two-year-period. None of the neonates developed pneumonia or sepsis. After each increase in the fluctuating number of S. paucimobilis isolates, extra attention was paid to hand hygiene and to the maintenance of the ventilation equipment. This resulted

  16. A comparison of gradual sedation levels using the Comfort-B scale and bispectral index in children on mechanical ventilation in the pediatric intensive care unit

    PubMed Central

    Silva, Cludia da Costa; Alves, Marta Maria Osrio; El Halal, Michel Georges dos Santos; Pinheiro, Sabrina dos Santos; Carvalho, Paulo Roberto Antonacci

    2013-01-01

    Objective Compare the scores resulting from the Comfort-B scale with the bispectral index in children in an intensive care unit. Methods Eleven children between the ages of 1 month and 16 years requiring mechanical ventilation and sedation were simultaneously classified based on the bispectral index and the Comfort-B scale. Their behavior was recorded using digital photography, and the record was later evaluated by three independent evaluators. Agreement tests (Bland-Altman and Kappa) were then performed. The correlation between the two methods (Pearson correlation) was tested. Results In total, 35 observations were performed on 11 patients. Based on the Kappa coefficient, the agreement among evaluators ranged from 0.56 to 0.75 (p<0.001). There was a positive and consistent association between the bispectral index and the Comfort-B scale [r=0.424 (p=0.011) to r=0.498 (p=0.002)]. Conclusion Due to the strong correlation between the independent evaluators and the consistent correlation between the two methods, the results suggest that the Comfort-B scale is reproducible and useful in classifying the level of sedation in children requiring mechanical ventilation. PMID:24553512

  17. Delirium in the Intensive Care Unit and Subsequent Long-term Disability Among Survivors of Mechanical Ventilation

    PubMed Central

    Brummel, Nathan E.; Jackson, James C.; Pandharipande, Pratik P.; Thompson, Jennifer L.; Shintani, Ayumi K.; Dittus, Robert S.; Gill, Thomas M.; Bernard, Gordon R.; Ely, E. Wesley; Girard, Timothy D.

    2013-01-01

    Objective Survivors of critical illness are frequently left with long-lasting disability. The association between delirium and disability in critically ill patients has not been described. We hypothesized that the duration of delirium in the ICU would be associated with subsequent disability and worse physical health status following a critical illness. Design Prospective cohort study nested within a randomized controlled trial of a paired sedation and ventilator weaning strategy. Setting A single-center tertiary-care hospital Patients One hundred twenty-six survivors of a critical illness Measurements Confusion assessment method for the ICU (CAM-ICU), Katz activities of daily living (ADL), Functional Activities Questionnaire (FAQ, measuring instrumental activities of daily living), Medical Outcomes Study 36-item Short Form General Health Survey Physical Components Score (SF-36 PCS) and Awareness Questionnaire (AQ). Associations between delirium duration and outcomes were determined via proportional odds models with generalized estimating equations (GEE) (for ADL and FAQ scores) or via nonlinear mixed effects models (for SF-36 PCS and AQ scores). Main Results Excluding patients who died prior to follow-up but including those who withdrew or were lost to follow-up, we assessed 80/99 patients (81%) at 3-months and 63/87 (72%) at 12-months. After adjusting for covariates, delirium duration was associated with worse ADL scores (p=0.002) over the course of the 12-month study period but was not associated with worse IADL scores (p=0.15) or worse SF-36 PCS scores (p=0.58). Duration of delirium was also associated with lower AQ motor-sensory function scores (p=0.02). Conclusion In the setting of critical illness, longer delirium duration is independently associated with disability in ADLs and worse motor-sensory function in the following year. These data point to a need for further study into the determinants of functional outcomes in ICU survivors. PMID:24158172

  18. Tracheostomy and mechanical ventilation weaning in children affected by respiratory virus according to a weaning protocol in a pediatric intensive care unit in Argentina: an observational restrospective trial

    PubMed Central

    2011-01-01

    We describe difficult weaning after prolonged mechanical ventilation in three tracheostomized children affected by respiratory virus infection. Although the spontaneous breathing trials were successful, the patients failed all extubations. Therefore a tracheostomy was performed and the weaning plan was begun. The strategy for weaning was the decrease of ventilation support combining pressure control ventilation (PCV) with increasing periods of continuous positive airway pressure + pressure support ventilation (CPAP + PSV) and then CPAP + PSV with increasing intervals of T-piece. They presented acute respiratory distress syndrome on admission with high requirements of mechanical ventilation (MV). Intervening factors in the capabilities and loads of the respiratory system were considered and optimized. The average MV time was 69 days and weaning time 31 days. We report satisfactory results within the context of a directed weaning protocol. PMID:21244710

  19. The reality of patients requiring prolonged mechanical ventilation: a multicenter study

    PubMed Central

    Loss, Srgio Henrique; de Oliveira, Roselaine Pinheiro; Maccari, Juara Gasparetto; Savi, Augusto; Boniatti, Marcio Manozzo; Hetzel, Mrcio Pereira; Dallegrave, Daniele Munaretto; Balzano, Patrcia de Campos; Oliveira, Eubrando Silvestre; Hher, Jorge Amilton; Torelly, Andr Peretti; Teixeira, Cassiano

    2015-01-01

    Objective The number of patients who require prolonged mechanical ventilation increased during the last decade, which generated a large population of chronically ill patients. This study established the incidence of prolonged mechanical ventilation in four intensive care units and reported different characteristics, hospital outcomes, and the impact of costs and services of prolonged mechanical ventilation patients (mechanical ventilation dependency ? 21 days) compared with non-prolonged mechanical ventilation patients (mechanical ventilation dependency < 21 days). Methods This study was a multicenter cohort study of all patients who were admitted to four intensive care units. The main outcome measures were length of stay in the intensive care unit, hospital, complications during intensive care unit stay, and intensive care unit and hospital mortality. Results There were 5,287 admissions to the intensive care units during study period. Some of these patients (41.5%) needed ventilatory support (n = 2,197), and 218 of the patients met criteria for prolonged mechanical ventilation (9.9%). Some complications developed during intensive care unit stay, such as muscle weakness, pressure ulcers, bacterial nosocomial sepsis, candidemia, pulmonary embolism, and hyperactive delirium, were associated with a significantly higher risk of prolonged mechanical ventilation. Prolonged mechanical ventilation patients had a significant increase in intensive care unit mortality (absolute difference = 14.2%, p < 0.001) and hospital mortality (absolute difference = 19.1%, p < 0.001). The prolonged mechanical ventilation group spent more days in the hospital after intensive care unit discharge (26.9 29.3 versus 10.3 20.4 days, p < 0.001) with higher costs. Conclusion The classification of chronically critically ill patients according to the definition of prolonged mechanical ventilation adopted by our study (mechanical ventilation dependency ? 21 days) identified patients with a high risk for complications during intensive care unit stay, longer intensive care unit and hospital stays, high death rates, and higher costs.

  20. Mechanical Ventilation and the Kidney

    PubMed Central

    Koyner, Jay L.; Murray, Patrick T.

    2010-01-01

    Acute lung injury (ALI) and acute kidney injury (AKI) are complications often encountered in the setting of critical illness. Both forms of end-organ injury commonly occur in similar settings of systemic inflammatory response syndrome, shock, and evolving multiple organ dysfunction. Recent elucidation of the pathobiology of critical illness has led to a more basic mechanistic understanding of the complex interplay between injured organs in patients with multiple organ dysfunction syndrome; this has been aptly called the slippery slope of critical illness [Kidney Int Suppl 1998;66:S25S33]. Distant organ effects of apparently isolated injuries to the lungs, gut, and kidneys have all been discovered in recent years. In this article, we will review the harmful bidirectional interaction between ALI and AKI, which appears to be a common clinical syndrome with routine clinical implications. We will review the current understanding of lung-kidney interactions from both perspectives, including the renal effects of ALI and mechanical ventilation, and the pulmonary sequelae of AKI. In this review of the emerging evidence of deleterious bidirectional organ cross talk between lung and kidney, we will focus on the role of ventilator-induced kidney injury in the pathogenesis of AKI in patients with ALI. PMID:19923815

  1. [Ventilation in special situations. Mechanical ventilation in status asthmaticus].

    PubMed

    Molini Menchn, N; Ibiza Palacios, E; Modesto i Alapont, V

    2003-10-01

    The indications for mechanical ventilation in status asthmaticus are cardiopulmonary arrest, significant alteration of consciousness, respiratory exhaustion, and progressive respiratory insufficiency despite aggressive bronchodilator treatment. In mechanical ventilation for status asthmaticus, a specific strategy directed at reducing dynamic hyperinflation must be used, with low tidal volumes and long expiratory times, achieved by diminishing respiratory frequency. This ventilatory pattern produces permissive hypercapnia, which is generally well tolerated with suitable sedation. The best methods for detecting and/or controlling dynamic hyperinflation in ventilated patients with status asthmaticus are the flow/time and flow/volume respiratory curves, pulmonary volume at the end of inspiration, and the pressure plateau. In addition to mechanical ventilation the child must receive sedation with or without a muscle relaxant to prevent barotrauma and accidental extubation. Bronchodilator treatment with beta-adrenergic agonists, methyl-prednisolone, and intravenous aminophylline are also required. A combination of inhaled salbutamol and nebulized ipratropium in the inspiratory branch of the ventilator should be used in patients in whom this treatment is effective. Currently there is insufficient evidence on the efficiency of other treatments in status asthmaticus and these should be used as rescue treatments. PMID:14519306

  2. Care of the ventilator circuit and its relation to ventilator-associated pneumonia.

    PubMed

    Hess, Dean R; Kallstrom, Thomas J; Mottram, Carl D; Myers, Timothy R; Sorenson, Helen M; Vines, David L

    2003-09-01

    Ventilator circuits should not be changed routinely for infection control purposes. The maximum duration of time that circuits can be used safely is unknown. Evidence is lacking related to ventilator-associated pneumonia (VAP) and issues of heated versus unheated circuits, type of heated humidifier, method for filling the humidifier, and technique for clearing condensate from the ventilator circuit. Although the available evidence suggests a lower VAP rate with passive humidification than with active humidification, other issues related to the use of passive humidifiers (resistance, dead space volume, airway occlusion risk) preclude a recommendation for the general use of passive humidifiers. Passive humidifiers do not need to be changed daily for reasons on infection control or technical performance. They can be safely used for at least 48 hours, and with some patient populations some devices may be able to be used for periods of up to 1 week. The use of closed suction catheters should be considered part of VAP prevention strategy, and they do not need to be changed daily for infection control purposes. The maximum duration of time that closed suction catheters can be used safely is unknown. Clinicians caring for mechanically ventilated patients should be aware of risk factors for VAP (eg, nebulizer therapy, manual ventilation, and patient transport). PMID:14513820

  3. 46 CFR 154.1200 - Mechanical ventilation system: General.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...2012-10-01 2012-10-01 false Mechanical ventilation system: General. 154.1200 Section...and Equipment Cargo Area: Mechanical Ventilation System 154.1200 Mechanical ventilation system: General. (a) Each...

  4. 46 CFR 154.1205 - Mechanical ventilation system: Standards.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...2011-10-01 2011-10-01 false Mechanical ventilation system: Standards. 154.1205 Section...and Equipment Cargo Area: Mechanical Ventilation System 154.1205 Mechanical ventilation system: Standards. (a) Each...

  5. 46 CFR 154.1200 - Mechanical ventilation system: General.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...2011-10-01 2011-10-01 false Mechanical ventilation system: General. 154.1200 Section...and Equipment Cargo Area: Mechanical Ventilation System 154.1200 Mechanical ventilation system: General. (a) Each...

  6. 46 CFR 154.1205 - Mechanical ventilation system: Standards.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...2014-10-01 2014-10-01 false Mechanical ventilation system: Standards. 154.1205 Section...and Equipment Cargo Area: Mechanical Ventilation System 154.1205 Mechanical ventilation system: Standards. (a) Each...

  7. 46 CFR 154.1205 - Mechanical ventilation system: Standards.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...2013-10-01 2013-10-01 false Mechanical ventilation system: Standards. 154.1205 Section...and Equipment Cargo Area: Mechanical Ventilation System 154.1205 Mechanical ventilation system: Standards. (a) Each...

  8. 46 CFR 154.1200 - Mechanical ventilation system: General.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...2014-10-01 2014-10-01 false Mechanical ventilation system: General. 154.1200 Section...and Equipment Cargo Area: Mechanical Ventilation System 154.1200 Mechanical ventilation system: General. (a) Each...

  9. 46 CFR 154.1200 - Mechanical ventilation system: General.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...2013-10-01 2013-10-01 false Mechanical ventilation system: General. 154.1200 Section...and Equipment Cargo Area: Mechanical Ventilation System 154.1200 Mechanical ventilation system: General. (a) Each...

  10. 46 CFR 154.1205 - Mechanical ventilation system: Standards.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...2012-10-01 2012-10-01 false Mechanical ventilation system: Standards. 154.1205 Section...and Equipment Cargo Area: Mechanical Ventilation System 154.1205 Mechanical ventilation system: Standards. (a) Each...

  11. 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

  12. JAMA Patient Page: Mechanical Ventilation

    MedlinePLUS

    ... ventilators , is used routinely when persons have general anesthesia (unconsciousness) for operations, for critically ill individuals who ... sedative medications, or, in the case of general anesthesia, after medications are given to produce unconsciousness to ...

  13. Optimizing Communication in Mechanically Ventilated Patients

    PubMed Central

    Pandian, Vinciya; Smith, Christine P.; Cole, Therese Kling; Bhatti, Nasir I.; Mirski, Marek A.; Yarmus, Lonny B.; Feller-Kopman, David J.

    2014-01-01

    Purpose To describe the types of talking tracheostomy tubes available, present four case studies of critically ill patients who used a specialized tracheostomy tube to improve speech, discuss their advantages and disadvantages, propose patient selection criteria, and provide practical recommendations for medical care providers. Methods Retrospective chart review of patients who underwent tracheostomy in 2010. Results Of the 220 patients who received a tracheostomy in 2010, 164 (74.55%) received a percutaneous tracheostomy and 56 (25.45%) received an open tracheostomy. Among the percutaneous tracheostomy patients, speech-language pathologists were consulted on 113 patients, 74 of whom were on a ventilator. Four of these 74 patients received a talking tracheostomy tube, and all four were able to speak successfully while on the mechanical ventilator even though they were unable to tolerate cuff deflation. Conclusions Talking tracheostomy tubes allow patients who are unable to tolerate-cuff deflation to achieve phonation. Our experience with talking tracheostomy tubes suggests that clinicians should consider their use for patients who cannot tolerate cuff deflation. PMID:25429193

  14. 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

  15. Humidification of inspired gases during mechanical ventilation.

    PubMed

    Gross, J L; Park, G R

    2012-04-01

    Humidification of inspired gas is mandatory for all mechanically ventilated patients to prevent secretion retention, tracheal tube blockage and adverse changes occurring to the respiratory tract epithelium. However, the debate over "ideal" humidification continues. Several devices are available that include active and passive heat and moisture exchangers and hot water humidifiers Each have their advantages and disadvantages in mechanically ventilated patients. This review explores each device in turn and defines their role in clinical practice. PMID:22269929

  16. 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 (Associao 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 So 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

  17. Brazilian recommendations of mechanical ventilation 2013. Part 2

    PubMed Central

    Barbas, Carmen Slvia Valente; sola, Alexandre Marini; Farias, Augusto Manoel de Carvalho; Cavalcanti, Alexandre Biasi; Gama, Ana Maria Casati; Duarte, Antonio Carlos Magalhes; Vianna, Arthur; Serpa Neto, Ary; Bravim, Bruno de Arruda; Pinheiro, Bruno do Valle; Mazza, Bruno Franco; de Carvalho, Carlos Roberto Ribeiro; Toufen Jnior, Carlos; David, Cid Marcos Nascimento; Taniguchi, Corine; Mazza, Dbora 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, Joo Claudio; Valiatti, Jorge Luis dos Santos; Teles, Jos Mario Meira; Victorino, Josu Almeida; Ferreira, Juliana Carvalho; Prodomo, Luciana Passuello do Vale; Hajjar, Ludhmila Abraho; Martins, Luiz Claudio; Malbouisson, Luis Marcelo S; Vargas, Mara Ambrosina de Oliveira; Reis, Marco Antonio Soares; Amato, Marcelo Brito Passos; Holanda, Marcelo Alcntara; Park, Marcelo; Jacomelli, Marcia; Tavares, Marcos; Damasceno, Marta Cristina Paulette; Assuno, Murillo Santucci Csar; Damasceno, Moyzes Pinto Coelho Duarte; Youssef, Nazah Cherif Mohamed; Teixeira, Paulo Jos Zimmermann; Caruso, Pedro; Duarte, Pricles 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, Vernica 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 (Associao 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 So 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 (Associao 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 So 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 I

    PubMed Central

    Barbas, Carmen Slvia Valente; sola, Alexandre Marini; Farias, Augusto Manoel de Carvalho; Cavalcanti, Alexandre Biasi; Gama, Ana Maria Casati; Duarte, Antonio Carlos Magalhes; 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, Dbora 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, Joo Claudio; Valiatti, Jorge Luis dos Santos; Teles, Jos Mario Meira; Victorino, Josu Almeida; Ferreira, Juliana Carvalho; Prodomo, Luciana Passuello do Vale; Hajjar, Ludhmila Abraho; Martins, Luiz Cludio; Malbouisson, Luiz Marcelo S; Vargas, Mara Ambrosina de Oliveira; Reis, Marco Antonio Soares; Amato, Marcelo Brito Passos; Holanda, Marcelo Alcntara; Park, Marcelo; Jacomelli, Marcia; Tavares, Marcos; Damasceno, Marta Cristina Paulette; Assuno, Murillo Santucci Csar; Damasceno, Moyzes Pinto Coelho Duarte; Youssef, Nazah Cherif Mohamad; Teixeira, Paulo Jos Zimmermann; Caruso, Pedro; Duarte, Pricles Almeida Delfino; Messeder, Octavio; Eid, Raquel Caserta; Rodrigues, Ricardo Goulart; de Jesus, Rodrigo Francisco; Kairalla, Ronaldo Adib; Justino, Sandra; Nemer, Srgio Nogueira; Romero, Simone Barbosa; Amado, Vernica 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 (Associao 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 So 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

  20. Indications of BAL, lung biopsy, or both in mechanically ventilated patients with unexplained infiltrations

    Microsoft Academic Search

    L. Papazian; M. Gainnier

    2003-01-01

    12 The diagnosis of unexplained infiltrations in mechanically ventilated patients is a major problem in intensive care unit (ICU) patients. In this issue of the European Respiratory Journal ,B ULPA et al. (1) report the results of 38 mechanically ventilated patients who underwent bronchoalveolar lavage (BAL) combined with transbronchial biopsy (TBB) for the diagnosis of lung infiltrates. They obtained a

  1. Home Mechanical Ventilation in South Korea

    PubMed Central

    Kim, Dong Hyun; Choi, Won Ah

    2014-01-01

    Purpose To survey the use of invasive and noninvasive home mechanical ventilation (HMV) methods in South Korea from the perspective of physical medicine and rehabilitation (PM&R). Materials and Methods For 413 users of HMV, retrospective reviews of PM&R interventions and survey of HMV methods employed from Mar 2000 to Dec 2009. Results Of the 413 users, the majority of whom with progressive neuromuscular disorders (NMDs) (n=358), 284 patients initially used noninvasive mechanical ventilation (NIV), while 63 others who were using tracheostomy mechanical ventilation switched to NIV as part of their rehabilitation. The NMD patients began HMV at an earlier age (34.920.3 yrs), and used for longer (14.77.5) hours than patients with non-neuromuscular causes of respiratory impairment. Conclusion Noninvasive management was preferred over invasive ones, and transition to the former was a result of PM&R interventions. PMID:25323913

  2. Frequency of hypoxic events in patients on a mechanical ventilator

    PubMed Central

    Mahmood, Nader A.; Chaudry, Fawad A.; Azam, Hamad; Ali, M. Imran; Khan, M. Anees

    2013-01-01

    Background: Mechanical ventilation is an important tool in the management of respiratory failure in the critically ill patient. Although mechanical ventilation can be a life-saving intervention, it is also known to carry several side-effects and risks. Adequate oxygenation is one of the primary goals of mechanical ventilation. However, while on mechanical ventilation, patients frequently experience hypoxic events resulting from various causes, which need to be properly evaluated and treated. Materials and Methods: Data were obtained by prospectively reviewing all intensive care admissions during the period from March 2009 to March 2010 at a 651-bed urban medical center. Patients who developed hypoxemia (oxygen saturation ?88% and a PaO2?60 torrs) while on mechanical ventilation were investigated for the cause of hypoxic event. Results: During the study period, 955 patients required mechanical ventilation from which 79 developed acute hypoxia. The causes of acute hypoxia in decreasing order of occurrences were pulmonary edema, atelectasis, pneumothorax, pneumonia, ARDS, endotracheal tube malfunction, airway bleeding, and pulmonary embolism. Conclusions: Appropriate evaluation of all hypoxic events must begin at the bedside. A step-by-step approach must include a thorough physical examination. Evaluation of the endotracheal tube can immediately reveal dislodgement, bleeding, and secretions. Correlation of physical examination findings with those on chest radiograph is essential. Each hypoxic event requires a different intervention depending on its etiology. Instead of simply increasing the fraction of oxygen in the inspired air to overcome hypoxia, a concerted effort in appropriate problem solving can reduce the likelihood of an incorrect diagnosis and management response. PMID:23961457

  3. THE MECHANICS OF LUNG TISSUE UNDER HIGH-FREQUENCY VENTILATION

    E-print Network

    THE MECHANICS OF LUNG TISSUE UNDER HIGH-FREQUENCY VENTILATION MARKUS R. OWEN AND MARK A. LEWIS Abstract. High frequency ventilation is a radical departure from conventional lung ventilation question concerns ventilator induced damage to the lung tissue, and a clear protocol for the most effective

  4. THE MECHANICS OF LUNG TISSUE UNDER HIGH-FREQUENCY VENTILATION

    E-print Network

    Lewis, Mark

    THE MECHANICS OF LUNG TISSUE UNDER HIGH-FREQUENCY VENTILATION MARKUS R. OWEN AND MARK A. LEWIS SIAM­1761 Abstract. High-frequency ventilation is a radical departure from conventional lung ventilation question concerns ventilator-induced damage to the lung tissue, and a clear protocol for the most effective

  5. The Impact of a Simple, Low-cost Oral Care Protocol on Ventilator-associated Pneumonia Rates in a Surgical Intensive Care Unit

    Microsoft Academic Search

    Carrie S. Sona; Jeanne E. Zack; Marilyn E. Schallom; Maryellen McSweeney; Kathleen McMullen; James Thomas; Craig M. Coopersmith; Walter A. Boyle; Timothy G. Buchman; John E. Mazuski; Douglas J. E. Schuerer

    2009-01-01

    Objective: The purpose of this study was to determine the effects of a simple low-cost oral care protocol on ventilator-associated pneumonia rates in a surgical intensive care unit. Design: Preintervention and postintervention observational study. Setting: Twenty-four bed surgical\\/trauma\\/burn intensive care units in an urban university hospital. Patients: All mechanically ventilated patients that were admitted to the intensive care unit between

  6. GUIDELINE FOR THE WITHDRAWAL OF MECHANICAL VENTILATION/LIFE SUPPORT

    E-print Network

    Acton, Scott

    GUIDELINE FOR THE WITHDRAWAL OF MECHANICAL VENTILATION/LIFE SUPPORT OF ADULTS USING TERMINAL when the decision has been made to withdraw mechanical ventilation/life support. For more information see policy #191 ­ Forgoing Treatment. CONTENT: 1. The decision to withdraw mechanical ventilation

  7. 42 CFR 440.185 - Respiratory care for ventilator-dependent individuals.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...2010-10-01 2010-10-01 false Respiratory care for ventilator-dependent individuals...PROVISIONS Definitions 440.185 Respiratory care for ventilator-dependent individuals. (a) Respiratory care for...

  8. 46 CFR 154.1205 - Mechanical ventilation system: Standards.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...CARRYING BULK LIQUEFIED GASES Design, Construction and Equipment Cargo Area: Mechanical Ventilation...control station, and other gas-safe spaces. ...ventilation system for a gas-safe cargo control station in the cargo area must change the air...

  9. Injurious mechanical ventilation affects neuronal activation in ventilated rats

    PubMed Central

    2011-01-01

    Introduction Survivors of critical illness often have significant long-term brain dysfunction, and routine clinical procedures like mechanical ventilation (MV) may affect long-term brain outcome. We aimed to investigate the effect of the increase of tidal volume (Vt) on brain activation in a rat model. Methods Male Sprague Dawley rats were randomized to three groups: 1) Basal: anesthetized unventilated animals, 2) low Vt (LVt): MV for three hours with Vt 8 ml/kg and zero positive end-expiratory pressure (ZEEP), and 3) high Vt (HVt) MV for three hours with Vt 30 ml/kg and ZEEP. We measured lung mechanics, mean arterial pressure (MAP), arterial blood gases, and plasma and lung levels of cytokines. We used immunohistochemistry to examine c-fos as a marker of neuronal activation. An additional group of spontaneously breathing rats was added to discriminate the effect of surgical procedure and anesthesia in the brain. Results After three hours on LVt, PaO2 decreased and PaCO2 increased significantly. MAP and compliance remained stable in MV groups. Systemic and pulmonary inflammation was higher in MV rats than in unventilated rats. Plasma TNF? was significantly higher in HVt than in LVt. Immunopositive cells to c-fos in the retrosplenial cortex and thalamus increased significantly in HVt rats but not in LVt or unventilated rats. Conclusions MV promoted brain activation. The intensity of the response was higher in HVt animals, suggesting an iatrogenic effect of MV on the brain. These findings suggest that this novel cross-talking mechanism between the lung and the brain should be explored in patients undergoing MV. PMID:21569477

  10. Preventing Airborne Disease Transmission: Review of Methods for Ventilation Design in Health Care Facilities

    PubMed Central

    Aliabadi, Amir A.; Rogak, Steven N.; Bartlett, Karen H.; Green, Sheldon I.

    2011-01-01

    Health care facility ventilation design greatly affects disease transmission by aerosols. The desire to control infection in hospitals and at the same time to reduce their carbon footprint motivates the use of unconventional solutions for building design and associated control measures. This paper considers indoor sources and types of infectious aerosols, and pathogen viability and infectivity behaviors in response to environmental conditions. Aerosol dispersion, heat and mass transfer, deposition in the respiratory tract, and infection mechanisms are discussed, with an emphasis on experimental and modeling approaches. Key building design parameters are described that include types of ventilation systems (mixing, displacement, natural and hybrid), air exchange rate, temperature and relative humidity, air flow distribution structure, occupancy, engineered disinfection of air (filtration and UV radiation), and architectural programming (source and activity management) for health care facilities. The paper describes major findings and suggests future research needs in methods for ventilation design of health care facilities to prevent airborne infection risk. PMID:22162813

  11. STATE OF CALIFORNIA INDOOR AIR QUALITY AND MECHANICAL VENTILATION

    E-print Network

    STATE OF CALIFORNIA INDOOR AIR QUALITY AND MECHANICAL VENTILATION CEC- CF-6R-MECH-05 (Revised 08 Ventilation (Page 1 of 7) Site Address: Enforcement Agency: Permit Number: 2008 Residential Compliance Forms August 2009 Ventilation for Indoor Air Quality (IAQ): All dwelling units shall meet the requirements

  12. [The application of n-acetylcysteine as an antioxidant and mucolytic in mechanical ventilation in intensive care patients. A prospective, randomized, placebo-controlled, double-blind study].

    PubMed

    Konrad, F; Schoenberg, M H; Wiedmann, H; Kilian, J; Georgieff, M

    1995-09-01

    Oxygen radicals and oxygen radial mediators are thought to be important components in the development of acute lung injury, sepsis, and multiple organ failure. Injured patients, patients with pulmonary diseases, and multiple trauma patients also showed an elevated lipid peroxidation, indicating increased oxidant stress. N-Acetylcysteine (NAC) has been used as an antioxidant in a wide variety of experiments. NAC has been suggested to act by raising concentrations of cysteine, and hence glutathione, and by scavenging of oxidant species [1, 11, 17, 29]. The present study was designed to investigate whether the application of NAC in intubated patients has an effect on concentrations of reduced glutathione in plasma and bronchoalveolar lavage fluid (BAL) and on the lipid peroxidation products malondialdehyde and conjugated dienes. Because NAC has been widely used as a mucolytic drug for the treatment of lung diseases, the influence on tracheobronchial mucus was studied, too. METHODS. In a randomized, double-blind, placebo-controlled study, a total of 38 long-term ventilated patients of a surgical intensive care unit were investigated. Patients were treated for 5 days with either 3 g NAC/day or placebo. The plasma concentration of reduced glutathione, malondialdehyde, and conjugated dienes were measured on admission and on the 3rd and 5th days of treatment [8, 34, 48]. Additionally, the numbers of tracheobronchial suctionings were registered and chest radiographs were evaluated. A fibre-bronchoscopy was performed on admission and on the 3rd day of treatment. The amount and viscidity of tracheobronchial secretions were examined semiquantitatively, and glutathione levels were measured in the unconcentrated BAL. The study was approved by the ethics committee of the University of Ulm. RESULTS. The two groups were comparable with respect to age, sex, APACHE II score and diagnosis (Table 1). We found no significant differences in reduced glutathione levels in the plasma or in the BAL (Figs. 1, 2). Plasma concentrations of malondialdehyde were similar (Fig. 3). Only the levels of conjugated dienes were significantly higher on the 5th treatment day in the placebo group (Fig. 4). The organ function of the lung (FiO2, PEEP, PaO2), liver (SGOT, bilirubin), and kidney (creatinine) and coagulation parameters (PTT, prothrombin time, platelet count) were similar in the two groups during the time of investigation. We observed no clinically relevant differences in the tracheobronchial mucus (Table 2). CONCLUSION. The present data do not support routine use of NAC in ventilated patients, either as an antioxidant or as a mucolytic agent. Intravenous administration of 3 g NAC/day had no clinically relevant effect on glutathione levels, lipid peroxidation products, tracheobronchial mucus, and clinical condition. PMID:7485927

  13. 42 CFR 440.185 - Respiratory care for ventilator-dependent individuals.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...ventilator-dependent individuals. (a) Respiratory care for ventilator-dependent...in the beneficiary's home by a respiratory therapist or other health care professional trained in respiratory therapy (as determined by the State)...

  14. 42 CFR 440.185 - Respiratory care for ventilator-dependent individuals.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...ventilator-dependent individuals. (a) Respiratory care for ventilator-dependent...in the beneficiary's home by a respiratory therapist or other health care professional trained in respiratory therapy (as determined by the State)...

  15. 42 CFR 440.185 - Respiratory care for ventilator-dependent individuals.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...ventilator-dependent individuals. (a) Respiratory care for ventilator-dependent...basis in the recipient's home by a respiratory therapist or other health care professional trained in respiratory therapy (as determined by the State)...

  16. 42 CFR 440.185 - Respiratory care for ventilator-dependent individuals.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...ventilator-dependent individuals. (a) Respiratory care for ventilator-dependent...in the beneficiary's home by a respiratory therapist or other health care professional trained in respiratory therapy (as determined by the State)...

  17. Carbon Dioxide and Oxygen Levels in Disposable Individually Ventilated Cages after Removal from Mechanical Ventilation

    PubMed Central

    Nagamine, Claude M; Long, C Tyler; McKeon, Gabriel P; Felt, Stephen A

    2012-01-01

    Disposable individually ventilated cages have lids that restrict air exchange when the cage is not mechanically ventilated. This design feature may cause intracage CO2 to increase and O2 to decrease (hypercapnic and hypoxic conditions, respectively) when the electrical supply to the ventilated rack fails, the ventilated rack malfunctions, cages are docked in the rack incorrectly, or cages are removed from the ventilated rack for extended periods of time. We investigated how quickly hypercapnic and hypoxic conditions developed within disposable individually ventilated cages after removal from mechanical ventilation and compared the data with nondisposable static cages, disposable static cages, and unventilated nondisposable individually ventilated cages. When disposable individually ventilated cages with 5 adult mice per cage were removed from mechanical ventilation, CO2 concentrations increased from less than 1% at 0 h to approximately 5% at 3 h and O2 levels dropped from more than 20% at 0 h to 11.7% at 6 h. The breathing pattern of the mice showed a prominent abdominal component (hyperventilation). Changes were similar for 4 adult mice per cage, reaching at least 5% CO2 at 4 h and 13.0% O2 at 6 h. For 3 or 2 mice per cage, values were 4.6% CO2 and 14.7% O2 and 3.04% CO2 and 17.1% O2, respectively, at 6 h. These results document that within disposable individually ventilated cages, a hypercapnic and hypoxic microenvironment develops within hours in the absence of mechanical ventilation. PMID:22776114

  18. Diagnosing ventilator-associated pneumonia in pediatric intensive care.

    PubMed

    Iosifidis, Elias; Stabouli, Stella; Tsolaki, Anastasia; Sigounas, Vaios; Panagiotidou, Emilia-Barbara; Sdougka, Maria; Roilides, Emmanuel

    2015-04-01

    The Centers for Disease Control and Prevention's criteria were applied by independent investigators for ventilator-associated pneumonia (VAP) diagnosis in critically ill children and compared with tracheal aspirate cultures (TACs). In addition, correlation between antibiotic use, VAP incidence, and epidemiology of TACs was investigated. A modest agreement (?=0.41) was found on radiologic findings between 2 investigators. VAP incidence was 7.7 episodes per 1,000 ventilator days, but positive TACs were the most significant factor for driving high antimicrobial usage in the pediatric intensive care unit. PMID:25704257

  19. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial

    Microsoft Academic Search

    William D Schweickert; Mark C Pohlman; Anne S Pohlman; Celerina Nigos; Amy J Pawlik; Cheryl L Esbrook; Linda Spears; Megan Miller; Mietka Franczyk; Deanna Deprizio; Gregory A Schmidt; Amy Bowman; Rhonda Barr; Kathryn E McCallister; Jesse B Hall; John P Kress

    2009-01-01

    Summary Background Long-term complications of critical illness include intensive care unit (ICU)-acquired weakness and neuropsychiatric disease. Immobilisation secondary to sedation might potentiate these problems. We assessed the effi cacy of combining daily interruption of sedation with physical and occupational therapy on functional outcomes in patients receiving mechanical ventilation in intensive care. Methods Sedated adults (?18 years of age) in the

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

    Microsoft Academic Search

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

    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

  1. 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

  2. The fluid mechanics of natural ventilation

    Microsoft Academic Search

    Paul Linden

    1999-01-01

    Natural ventilation of buildings is the flow generated by temperature differences and by the wind. Modern buildings have extreme designs with large, tall open plan spaces and large cooling requirements. Natural ventilation offers a means of cooling these buildings and providing good indoor air quality. The essential feature of ventilation is an exchange between an interior space and the external

  3. A randomized trial of chlorhexidine gluconate on oral bacterial pathogens in mechanically ventilated patients

    Microsoft Academic Search

    Frank A Scannapieco; Jihnhee Yu; Krishnan Raghavendran; Angela Vacanti; Susan I Owens; Kenneth Wood; Joseph M Mylotte

    2009-01-01

    INTRODUCTION: Dental plaque biofilms are colonized by respiratory pathogens in mechanically-ventilated intensive care unit patients. Thus, improvements in oral hygiene in these patients may prevent ventilator-associated pneumonia. The goal of this study was to determine the minimum frequency (once or twice a day) for 0.12% chlorhexidine gluconate application necessary to reduce oral colonization by pathogens in 175 intubated patients in

  4. Humidification during invasive and noninvasive mechanical ventilation: 2012.

    PubMed

    Restrepo, Ruben D; Walsh, Brian K

    2012-05-01

    We searched the MEDLINE, CINAHL, and Cochrane Library databases for articles published between January 1990 and December 2011. The update of this clinical practice guideline is based on 184 clinical trials and systematic reviews, and 10 articles investigating humidification during invasive and noninvasive mechanical ventilation. The following recommendations are made following the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) scoring system: 1. Humidification is recommended on every patient receiving invasive mechanical ventilation. 2. Active humidification is suggested for noninvasive mechanical ventilation, as it may improve adherence and comfort. 3. When providing active humidification to patients who are invasively ventilated, it is suggested that the device provide a humidity level between 33 mg H(2)O/L and 44 mg H(2)O/L and gas temperature between 34C and 41C at the circuit Y-piece, with a relative humidity of 100%. 4. When providing passive humidification to patients undergoing invasive mechanical ventilation, it is suggested that the HME provide a minimum of 30 mg H(2)O/L. 5. Passive humidification is not recommended for noninvasive mechanical ventilation. 6. When providing humidification to patients with low tidal volumes, such as when lung-protective ventilation strategies are used, HMEs are not recommended because they contribute additional dead space, which can increase the ventilation requirement and P(aCO(2)). 7. It is suggested that HMEs are not used as a prevention strategy for ventilator-associated pneumonia. PMID:22546299

  5. Determinants of tracheobronchial histologic alterations during conventional mechanical ventilation.

    PubMed

    Wiswell, T E; Turner, B S; Bley, J A; Fritz, D L; Hunt, R E

    1989-08-01

    It was hypothesized that diverse mechanisms may influence upper airway injury during mechanical ventilation. To assess the roles of several factors in the propagation of such injury, the tracheobronchial histologic changes in 53 newborn piglets were compared following conventional positive pressure ventilation. Eight animals were assigned to each of four positive pressure ventilation groups at "low" settings (an FiO2 of 0.25, a frequency of 10 breaths per minute, a peak inspiratory pressure of 20 cm H2O, a positive end-expiratory pressure of 4 cm H2O, a flow rate of 10 L/min, and an inspiratory time to expiratory time ratio of 1:2): (1) positive pressure ventilation with no hypotension or hypoxemia; (2) positive pressure ventilation with hypotension; (3) positive pressure ventilation with hypoxemia; and (4) positive pressure ventilation with both hypotension and hypoxemia. In addition, eight piglets were assigned to each of two positive pressure ventilation groups at "high" settings (greater frequency [40 breaths per minute], higher peak inspiratory pressure [40 cm H2O], and greater flow rate [17 L/min]): (1) positive pressure ventilation with no hypotension or hypoxemia; and (2) positive pressure ventilation with both hypotension and hypoxemia. The changes were mild and similar among the first three positive pressure groups at low settings. However, the injury scores of the combined hypotension and hypoxemia group (group 4) were greater than those of the former three positive pressure ventilation groups (P less than .004). The piglets receiving positive pressure ventilation at high settings with no hypotension or hypoxemia (group 5) had no more injury than those in the first three groups receiving positive pressure ventilation.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2748259

  6. Mechanical ventilation strategies: what's new and what's worth keeping?

    PubMed

    Hess, Dean R

    2002-09-01

    Many technologic and management strategies related to mechanical ventilation have been introduced in recent years. Strategies that avoid intubation and get patients extubated sooner decrease costs related to mechanical ventilation. In general, "people" solutions such as weaning protocols are preferable to "technology" solutions such as new ventilator modes. It must be remembered that mechanical ventilation is supportive-it is not curative-and has the potential to do harm if applied incorrectly. There is an increasing list of examples in which short-term physiologic outcomes such as improvements in blood gas values are not related to patient-important outcomes such as survival. When new mechanical ventilation technology and strategies are introduced, a question we need to ask ourselves is whether these are solutions for problems or whether these are simply solutions in search of problems. PMID:12188936

  7. FAMILY PRESENCE AND SURVEILLANCE DURING WEANING FROM PROLONGED MECHANICAL VENTILATION

    PubMed Central

    Happ, Mary Beth; Swigart, Valerie A.; Tate, Judith A.; Arnold, Robert A.; Sereika, Susan M.; Hoffman, Leslie A.

    2007-01-01

    Objectives The research was designed to describe the care and communication processes during weaning from long-term mechanical ventilation (LTMV). A portion of those findings, specifically, how family members interact with the patient and respond to the ventilator and associated ICU bedside equipment during LTMV weaning, are reported here. Methods Ethnography conducted in a medical intensive care unit (MICU) and step-down MICU following 30 adults who were weaning from LTMV (> 4 days). Data collection involved field observations conducted from November 2001 to July 2003, interviews with patients, family members, and MICU clinicians, and clinical record review. Results Family members were present at the LTMV patients bedside during 46% of weaning trials and interacted with patients through touch, talking, and surveillance. Families bedside surveillance activities were interpretive of numerical monitor displays and laboratory values, protective of patient safety and comfort, and often focused exclusively on weaning. Interpretive language and surveillance were learned from and imitative of clinician behaviors. Clinicians characterized the familys presence as helpful, a hindrance, or having no effect on the weaning process. Quantitative analysis using random coefficient modeling examining the effect of family presence on length of weaning trials showed significantly longer daily weaning trials when families were present (p < .0001). Conclusion Critical care clinicians influence families acquisition of interpretive surveillance skills at the bedside of patients who are weaning from LTMV. This study provides a potentially useful conceptual framework of family behaviors with long-term critically ill patients that could enhance the dialogue about family-centered care and guide future research on family presence in the ICU. PMID:17234477

  8. Ketamine for continuous sedation of mechanically ventilated patients

    PubMed Central

    Umunna, Ben-Paul; Tekwani, Karis; Barounis, Dave; Kettaneh, Nick; Kulstad, Erik

    2015-01-01

    Context: Long-term sedation with midazolam or propofol has been demonstrated to have serious adverse side effects, such as toxic accumulation or propofol infusion syndrome. Ketamine remains a viable alternative for continuous sedation as it is inexpensive and widely available, however, there are few analyses regarding its safety in this clinical setting. Objective: To review the data related to safety and efficacy of ketamine as a potential sedative agent in mechanically ventilated patients admitted to the intensive care unit (ICU). Materials and Methods: This was a single-center retrospective study from September 2011 to March 2012 of patients who required sedation for greater than 24 hours, in whom ketamine was selected as the primary sedative agent. All patients greater than 18 years of age, regardless of admitting diagnosis, were eligible for inclusion. Patients that received ketamine for continuous infusion but died prior to receiving it for 24 hours were not included. Results: Thirty patients received ketamine for continuous sedation. In four patients, ketamine was switched to another sedative agent due to possible adverse side effects. Of these, two patients had tachydysrhythmias, both with new onset atrial fibrillation and two patients had agitation believed to be caused by ketamine. The adverse event rate in our patient population was 13% (4/30). Conclusions: Among ICU patients receiving prolonged mechanical ventilation, the use of ketamine appeared to have a frequency of adverse events similar to more common sedative agents, like propofol and benzodiazepines. PMID:25709246

  9. Predictors of extubation failure and reintubation in newborn infants subjected to mechanical ventilation

    PubMed Central

    Costa, Ana Cristina de Oliveira; Schettino, Renata de Carvalho; Ferreira, Sandra Clecncio

    2014-01-01

    Objective To identify risk factors for extubation failure and reintubation in newborn infants subjected to mechanical ventilation and to establish whether ventilation parameters and blood gas analysis behave as predictors of those outcomes. Methods Prospective study conducted at a neonatal intensive care unit from May to November 2011. A total of 176 infants of both genders subjected to mechanical ventilation were assessed after extubation. Extubation failure was defined as the need to resume mechanical ventilation within less than 72 hours. Reintubation was defined as the need to reintubate the infants any time after the first 72 hours. Results Based on the univariate analysis, the variables gestational age <28 weeks, birth weight <1,000g and low Apgar scores were associated with extubation failure and reintubation. Based on the multivariate analysis, the variables length of mechanical ventilation (days), potential of hydrogen (pH) and partial pressure of oxygen (pO2) remained associated with extubation failure, and the five-minute Apgar score and age at extubation were associated with reintubation. Conclusion Low five-minute Apgar scores, age at extubation, length of mechanical ventilation, acid-base disorders and hyperoxia exhibited associations with the investigated outcomes of extubation failure and reintubation. PMID:24770689

  10. Mechanical ventilation for a child with quadriplegia.

    PubMed

    Novotny, William E; Perkin, Ronald M; Mukherjee, Debjani; Lantos, John D

    2014-09-01

    Parents generally have the right to make medical decisions for their children. This right can be challenged when the parents' decision seems to go against the child's interests. The toughest such decisions are for a child who will survive with physical and neurocognitive impairments. We discuss a case of a 5-year-old boy who suffered a spinal injury as a result of a motor vehicle accident and whose father requests discontinuation of life support. Many experts recommend a "trial of therapy" to clarify both prognosis and quality of life. The key ethical question, then, is not whether to postpone a decision to forego mechanical ventilation. Instead, the key question is how long to wait. Parents should be allowed time to see what life will be like for themselves and for their child. Most of the time, life turns out better than they might have imagined. Comments are provided by 2 pediatric intensivists, Drs William Novotny and Ronald Perkin of East Carolina University, and by a specialist in rehabilitation, Dr Debjani Mukherjee of the Rehabilitation Institute of Chicago. PMID:25136041

  11. 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-? and IL-1?. 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

  12. 46 CFR 154.1200 - Mechanical ventilation system: General.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...VESSELS CARRYING BULK LIQUEFIED GASES Design, Construction and Equipment Cargo Area: Mechanical Ventilation System...control station in the cargo area. (3) Each gas-safe space in the cargo area. (4) Each space...

  13. Dopamine increases lung liquid clearance during mechanical ventilation.

    PubMed

    Saldas, F J; Comellas, A P; Pesce, L; Lecuona, E; Sznajder, J I

    2002-07-01

    Short-term mechanical ventilation with high tidal volume (HVT) causes mild to moderate lung injury and impairs active Na+ transport and lung liquid clearance in rats. Dopamine (DA) enhances active Na+ transport in normal rat lungs by increasing Na+-K+-ATPase activity in the alveolar epithelium. We examined whether DA would increase alveolar fluid reabsorption in rats ventilated with HVT for 40 min compared with those ventilated with low tidal volume (LVT) and with nonventilated rats. Similar to previous reports, HVT ventilation decreased alveolar fluid reabsorption by ~50% (P < 0.001). DA increased alveolar fluid reabsorption in nonventilated control rats (by ~60%), LVT ventilated rats (by approximately 55%), and HVT ventilated rats (by ~200%). In parallel studies, DA increased Na+-K+-ATPase activity in cultured rat alveolar epithelial type II cells (ATII). Depolymerization of cellular microtubules by colchicine inhibited the effect of DA on HVT ventilated rats as well as on Na+-K+-ATPase activity in ATII cells. Neither DA nor colchicine affected the short-term Na+-K+-ATPase alpha1- and beta1-subunit mRNA steady-state levels or total alpha1- and beta1-subunit protein abundance in ATII cells. Thus we reason that DA improved alveolar fluid reabsorption in rats ventilated with HVT by upregulating the Na+-K+-ATPase function in alveolar epithelial cells. PMID:12060570

  14. Actual performance of mechanical ventilators in ICU: a multicentric quality control study

    PubMed Central

    Govoni, Leonardo; Dellaca, Raffaele L; Peuelas, Oscar; Bellani, Giacomo; Artigas, Antonio; Ferrer, Miquel; Navajas, Daniel; Pedotti, Antonio; Farr, Ramon

    2012-01-01

    Even if the performance of a given ventilator has been evaluated in the laboratory under very well controlled conditions, inappropriate maintenance and lack of long-term stability and accuracy of the ventilator sensors may lead to ventilation errors in actual clinical practice. The aim of this study was to evaluate the actual performances of ventilators during clinical routines. A resistance (7.69 cmH2O/L/s) elastance (100 mL/cmH2O) test lung equipped with pressure, flow, and oxygen concentration sensors was connected to the Y-piece of all the mechanical ventilators available for patients in four intensive care units (ICUs; n = 66). Ventilators were set to volume-controlled ventilation with tidal volume = 600 mL, respiratory rate = 20 breaths/minute, positive end-expiratory pressure (PEEP) = 8 cmH2O, and oxygen fraction = 0.5. The signals from the sensors were recorded to compute the ventilation parameters. The average standard deviation and range (minmax) of the ventilatory parameters were the following: inspired tidal volume = 607 36 (530723) mL, expired tidal volume = 608 36 (530728) mL, peak pressure = 20.8 2.3 (17.225.9) cmH2O, respiratory rate = 20.09 0.35 (19.521.6) breaths/minute, PEEP = 8.43 0.57 (7.2610.8) cmH2O, oxygen fraction = 0.49 0.014 (0.410.53). The more error-prone parameters were the ones related to the measure of flow. In several cases, the actual delivered mechanical ventilation was considerably different from the set one, suggesting the need for improving quality control procedures for these machines. PMID:23293543

  15. Newly identified precipitating factors in mechanical ventilation-induced brain damage: implications for treating ICU delirium.

    PubMed

    Gonzlez-Lpez, Adrin; Albaiceta, Guillermo M; Talbot, Konrad

    2014-06-01

    Delirium is 1.5 to 4.1 times as likely in intensive care unit patients when they are mechanically ventilated. While progress in treatment has occurred, delirium is still a major problem in mechanically ventilated patients. Based on studies of a murine mechanical ventilation model, we summarize evidence here for a novel mechanism by which such ventilation can quickly initiate brain damage likely to cause cognitive deficits expressed as delirium. That mechanism consists of aberrant vagal sensory input driving sustained dopamine D2 receptor (D2R) signaling in the hippocampal formation, which induces apoptosis in that brain area within 90 min without causing hypoxia, oxidative stress, or inflammatory responses. This argues for minimizing the duration and tidal volumes of mechanical ventilation and for more effectively reducing sustained D2R signaling than achieved with haloperidol alone. The latter might be accomplished by reducing D2R cell surface expression and D2R-mediated Akt inhibition by elevating protein expression of dysbindin-1C. PMID:24852225

  16. Oceanic ventilation and biogeochemical cycling: Understanding the physical mechanisms that produce realistic distributions of tracers and

    E-print Network

    Matsumoto, Katsumi

    Oceanic ventilation and biogeochemical cycling: Understanding the physical mechanisms that produce circulation support different rates of ventilation, which in turn produce different distributions. Matsumoto, J. L. Sarmiento, R. D. Slater, and P. S. Swathi (2004), Oceanic ventilation and biogeochemical

  17. ENERGY IMPACTS OF VARIOUS RESIDENTIAL MECHANICAL VENTILATION STRATEGIES

    E-print Network

    Vieira, R.; Parker, D.; Lixing, G.; Wichers, M.

    ENERGY IMPACTS OF VARIOUS RESIDENTIAL MECHANICAL VENTILATION STRATEGIES Robin K. Vieira, Buildings. Research Division Director Danny S. Parker Principal Research Scientist Lixing Gu Principal Research Engineer Michael Wichers... into the homes. Many of these strategies utilize the central air handler fan from the HVAC system to ventilate when the system runs. Controllers can be purchased to force the air to enter for minimum periods of time or to shut off outside air dampers after...

  18. Education alone is not enough in ventilator associated pneumonia care bundle compliance

    PubMed Central

    Hamishehkar, Hadi; Vahidinezhad, Mahdi; Mashayekhi, Simin Ozar; Asgharian, Parina; Hassankhani, Hadi; Mahmoodpoor, Ata

    2014-01-01

    Objective: Ventilator-associated pneumonia (VAP) described as a secondary and preventable consequence in mechanically ventilated patients, emerges 48 h or more after patients intubation. Considering the high morbidity and mortality rate of VAP and the fact that VAP is preventable, it seemed necessary to evaluate care bundle compliance rate and effect of education on its improvement. Methods: This observational study was conducted on 10 Intensive Care Units (ICUs) of four university affiliated hospitals in three steps. In the first step, VAP care bundle compliance including head of bed (HOB) elevation, endotracheal cuff pressure (ETCP), mouthwash time, utilizing close suction systems, subglottic secretion drainage, type of suction package, and hand wash before suctioning was evaluated. In the second and third steps, ICU staffs were trained and its effect on VAP care bundle compliance was investigated. Finally, an inquiry from nurses was conducted to evaluate the obtained results. Findings: A total of 552 checklists consisting of 294 observations in the pre-education group and 258 observations in the posteducation group were filled. Mean VAP care bundle compliance in pre-education and posteducation stages was 36.5% and 41.2%, respectively (P > 0.05). Except for patients' mouth washing, there were no improvement in HOB elevation (>30), hand washing and ETCP after education. Based on the results of questionnaire received from nurses at the end of study, more than 90% of nurses believed that lack of rigid monitoring of VAP care bundle is a main reason of low adherence for VAP care bundle compliance. Conclusion: The adherence to VAP care bundle was inappropriate. Education seems to be ineffective on improving VAP care bundle compliance. Frequent recall of the necessity of the VAP care bundle and the continuous supervision of ICU staffs is highly recommended. PMID:25114937

  19. MECHANICAL VENTILATION WEANING AND EXTUBATION AFTER SPINAL CORD INJURY: A WESTERN TRAUMA ASSOCIATION MULTICENTER STUDY

    PubMed Central

    Kornblith, LZ; Kutcher, ME; Callcut, RA; Redick, BJ; Hu, CK; Cogbill, TH; Baker, CC; Shapiro, ML; Burlew, CC; Kaups, KL; DeMoya, MA; Haan, JM; Koontz, CH; Zolin, SJ; Gordy, SD; Shatz, DV; Paul, DB; Cohen, MJ

    2013-01-01

    BACKGROUND Respiratory failure after acute spinal cord injury (SCI) is well recognized, but data defining which patients need long-term ventilator support, and criteria for weaning and extubation are lacking. We hypothesized that many patients with SCI, even those with cervical SCI, can be successfully managed without long-term mechanical ventilation and its associated morbidity. METHODS Under the auspices of the Western Trauma Association Multi-Center Trials Group, a retrospective study of patients with SCI at 14 major trauma centers was conducted. Comprehensive injury, demographic, and outcome data on patients with acute SCI was compiled. The primary outcome variable was the need for mechanical ventilation at discharge. Secondary outcomes included the use of tracheostomy, and development of acute lung injury (ALI) and ventilator-associated pneumonia (VAP). RESULTS 360 patients had SCI requiring mechanical ventilation. Sixteen patients were excluded for death within the first 2 days of hospitalization. Of the 344 patients included, 222 (64.5%) had cervical SCI. Notably, 62.6% of patients with cervical SCI were ventilator-free by discharge. 149 patients (43.3%) underwent tracheostomy and 53.7% of them were successfully weaned from the ventilator, compared to an 85.6% success rate among those with no tracheostomy (p<0.05). Patients who underwent tracheostomy had significantly higher rates of VAP (61.1% vs 20.5%, p<0.05) and ALI (12.8% vs 3.6%, p<0.05), and fewer ventilator free days (1 vs. 24 p<0.05). When controlled for injury severity, thoracic injury, and respiratory comorbidities, tracheostomy after cervical SCI was an independent predictor of ventilator dependence with an associated 14-fold higher likelihood of prolonged mechanical ventilation (OR 14.1, CI 2.7871.67, p<0.05). DISCUSSION While many patients with SCI require short-term mechanical ventilation, the majority can be successfully weaned prior to discharge. In patients with SCI tracheostomy is associated with major morbidity and its use, especially among patients with cervical SCI, deserves further study. LEVEL OF EVIDENCE Level III, care-management/prognostic PMID:24256682

  20. The use of the bispectral index in the detection of pain in mechanically ventilated adults in the intensive care unit: A review of the literature

    PubMed Central

    Coleman, Robin Marie; Tousignant-Laflamme, Yannick; Ouellet, Paul; Parenteau-Goudreault, lizabeth; Cogan, Jennifer; Bourgault, Patricia

    2015-01-01

    BACKGROUND: Pain assessment is an immense challenge for clinicians, especially in the context of the intensive care unit, where the patient is often unable to communicate verbally. Several methods of pain assessment have been proposed to assess pain in this environment. These include both behavioural observation scales and evaluation of physiological measurements such as heart rate and blood pressure. Although numerous validation studies pertaining to behavioural observation scales have been published, several limitations associated with using these measures for pain assessment remain. Over the past few years, researchers have been interested in the use of the bispectral index monitoring system as a proxy for the evaluation of encephalography readings to assess the level of anesthesia and, potentially, analgesia. OBJECTIVES: To synthesize the main studies exploring the use of the bispectral index monitoring system for pain assessment, to guide future research in adults under sedation in the intensive care unit. METHOD: The EMBASE, Medline, CINAHL and PsycINFO databases were searched for studies published between 1996 and 2013 that evaluated the use of the bispectral index in assessing pain. RESULTS: Most studies conclude that nociceptive stimulation causes a significant increase in the bispectral index and revealed the importance of controlling certain confounding variables such as the level of sedation. DISCUSSION: Further studies are needed to clearly demonstrate the relationship between nociceptive stimuli and the bispectral index, as well as the specificity of the bispectral index in detecting pain. PMID:25050877

  1. Mechanical Ventilation for Comatose Patients with Inoperative Acute Intracerebral Hemorrhage: Possible Futility of Treatment

    PubMed Central

    Fukuhara, Toru; Aoi, Mizuho; Namba, Yoichiro

    2014-01-01

    Background Comatose patients with acute intracerebral hemorrhage (ICH) diagnosed as inoperative due to their severe comorbidity will be treated differently between countries. In certain countries including Japan, aggressive medical care may be performed according to the patients' family requests although the effects on the outcome are obscure. For respiratory distress in comatose patients with inoperative acute ICH, the role of mechanical ventilation on the outcome is unknown. We speculated that the efficacy of a ventilator in such a specific condition is limited and possibly futile. Methods We retrospectively evaluated the in-hospital mortality and further outcome of 65 comatose patients with inoperative ICH. Among the patients, 56 manifested respiratory distress, and the effect of the ventilator was evaluated by comparing the patients treated with and without the ventilator. Results The in-hospital mortality was calculated as 80%. A statistically significant parameter affecting the mortality independently was the motor subset on the Glasgow Coma Scale (P?=?0.015). Among the patients who manifested respiratory distress, 7.7% of patients treated with a ventilator and 14.0% of patients not treated with a ventilator survived; an outcome is not significantly different. The mean survival duration of patients treated with a ventilator was significantly longer than the mean survival duration of patients not treated with a ventilator (P?=?0.021). Among the surviving 13 patients, 7 patients died 5 to 29 months after onset without significant consciousness recovery. Another 6 patients suffered continuous disablement due to prolonged severe consciousness disturbances. Conclusion The current results indicate that treating comatose patients resulting from inoperative acute ICH may be futile. In particular, treating these patients with a ventilator only has the effect of prolonging unresponsive life, and the treatment may be criticized from the perspective of the appropriate use of public medical resources. PMID:25062014

  2. [Mechanical ventilation of newborn infants in Punta Arenas].

    PubMed

    Montt, J

    1991-01-01

    A retrospective evaluation of 136 newborns treated with mechanical ventilation between 1983 and 1989 at the chilean's southernmost regional hospital of Punta Arenas is presented. Seventy five percent of neonates had birthweights under 2,500 g and 39% of them were under 1,500 g. Lethality was higher in infants less than 1,500 g birthweight (43.4%). The most frequent cause of death was periventricular and or intraventricular hemorrhage, occurring in 20 among 26 deaths. Lethality was lower among patients with birthweights 1,500 g throughout 2,499 g (16.7%). The most frequent disease requiring mechanical ventilation was hyaline membrane disease (62.5%): lethality for these patients was 25.9%. Complications developed in 43.4% of mechanically ventilated newborns, the most frequent being obstruction of the endotracheal tube and atelectasis. PMID:1844525

  3. Noninvasive Positive Pressure Ventilation or Conventional Mechanical Ventilation for Neonatal Continuous Positive Airway Pressure Failure

    PubMed Central

    Badiee, Zohreh; Nekooie, Babak; Mohammadizadeh, Majid

    2014-01-01

    Background: The aim of this study was to assess the success rate of nasal intermittent positive pressure ventilation (NIPPV) for treatment of continuous positive airway pressure (CPAP) failure and prevention of conventional ventilation (CV) in preterm neonates. Methods: Since November 2012 to April 2013, a total number of 55 consecutive newborns with gestational ages of 26-35 weeks who had CPAP failure were randomly assigned to one of the two groups. The NIPPV group received NIPPV with the initial peak inspiratory pressure (PIP) of 16-20 cmH2O and frequency of 40-60 breaths/min. The CV group received PIP of 12-20 cmH2O and frequency of 40-60 breaths/min. Results: About 74% of newborns who received NIPPV for management of CPAP failure responded to NIPPV and did not need intubation and mechanical ventilation. Newborns with lower postnatal age at entry to the study and lower 5 min Apgar score more likely had NIPPV failure. In addition, treatment failure was higher in newborns who needed more frequent doses of surfactant. Duration of oxygen therapy was 9.28 days in CV group and 7.77 days in NIPPV group (P = 0.050). Length of hospital stay in CV group and NIPPV groups were 48.7 and 41.7 days, respectively (P = 0.097). Conclusions: NIPPV could decrease the need for intubation and mechanical ventilation in preterm infants with CPAP failure. PMID:25489454

  4. 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

  5. Exhaled Breath Condensate Collection in the Mechanically Ventilated Patient

    PubMed Central

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

    2012-01-01

    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 ten minutes. 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

  6. Effectiveness and safety of a protocolized mechanical ventilation and weaning strategy of COPD patients by respiratory therapists

    PubMed Central

    Ediboglu, Ozlem; Naz, Ilknur; Cimen, Pinar; Tatar, Dursun

    2014-01-01

    Introduction Prior researches have showed that weaning protocols may decrease the duration of mechanical ventilation. The effect of these protocols on chronic obstructive pulmonary disease (COPD) patients is unknown. The purpose of this study was to evaluate the impact of an extensive mechanical ventilation protocol including weaning applied by a respiratory therapist (RT) on the duration of mechanical ventilation and intensive care unit (ICU) stay in COPD patients. Materials and methods A novel mechanical ventilation protocol including weaning was developed and initiated for all intubated COPD patients by a respiratory therapist. Outcomes of patients treated using this protocol during a 6-month period were compared to those of patients treated by physicians without a protocol during the preceding 6 months. Results A total of 170 patients were enrolled. Extubation success was significantly higher (98% vs. 78%, P=0.014) and median durations of weaning, mechanical ventilation and ICU stay compared with time to event analysis were significantly shorter in the protocol based group (2 vs. 26 hours, log rank P<0.001, 3.1 vs. 5 days, log rank P<0.001 and 6 vs. 12 days, log rank P<0.001, respectively). Patients who were successfully extubated and patients in the protocol based group were more likely to have shorter ventilation duration [HR: 1.87, 95% confidence intervals (CI): 1.13-3.08, P=0.015 and HR: 2.08, 95% CI: 1.40-3.10, P<0.001 respectively]. Conclusions In our center, a protocolized mechanical ventilation and weaning strategy improved weaning success and shortened the total duration of mechanical ventilation and ICU stay in COPD patients requiring mechanical ventilation. PMID:25276358

  7. Noninvasive ventilation: application to the cancer patient admitted in the intensive care unit.

    PubMed

    Meert, A P; Close, L; Hardy, M; Berghmans, T; Markiewicz, E; Sculier, J P

    2003-01-01

    The objective of this retrospective study of prospectively registered patients was to determine the usefulness and efficacy of noninvasive ventilation (NIV) in cancer patients admitted to the medical intensive care unit of an European cancer hospital for a medical complication, as reflected in discharges from the intensive care unit (ICU) and from hospital. The subjects were a total of 40 consecutive cancer patients (28 with solid tumours and 12 with haematological malignancies) who required immediate or delayed NIV. Variables relating to demographic parameters, severity scores, cancer characteristics, intensive care data and hospital discharge were recorded. The complications making NIV necessary were hypoxaemic pneumonia in 32.5%, hypercapnic ventilatory failure in 30%, multifactorial respiratory failure in 17.5%, acute haemodynamic oedema in 10%, acute respiratory distress syndrome in 2.5%, alveolar haemorrhage in 2.5%, pulmonary embolism in 2.5% and lysis pneumopathy in 2.5%. Most of the patients, 57.5% and 42.5%, respectively, were discharged from the ICU and from the hospital. Among the 10 patients (25%) who required salvage invasive mechanical ventilation, only 1 was discharged from hospital. Sixty-four per cent of the solid tumour patients and 42% of those with haematological malignancies were discharged from the ICU and 50% and 25%, respectively, from the hospital. NIV thus appears to be an effective form of ventilatory support for cancer patients, including those with solid tumours. PMID:12527955

  8. LBNL-XXXXX | Logue et al., Evaluation of an Incremental Ventilation Energy Model for Estimating Impacts of Air Sealing and Mechanical Ventilation

    E-print Network

    LBNL-XXXXX | Logue et al., Evaluation of an Incremental Ventilation Energy Model for Estimating Impacts of Air Sealing and Mechanical Ventilation 1 Evaluation of an Incremental Ventilation Energy Model for Estimating Impacts of Air Sealing and Mechanical Ventilation Jennifer M. Logue, William J. N

  9. Previous antibiotic exposure and evolution of antibiotic resistance in mechanically ventilated patients with

    E-print Network

    Cochran-Stafira, D. Liane

    Previous antibiotic exposure and evolution of antibiotic resistance in mechanically ventilated, Taichung, Taiwan Keywords: Antibiotic resistance; Antibiotic exposure; Antibiotic selection pressure of antibiotic-resistant infections. Methods: We retrospectively analyzed 167 mechanically ventilated patients

  10. Prevention of ventilator-associated pneumonia in the intensive care unit: A review of the clinically relevant recent advancements

    PubMed Central

    Keyt, Holly; Faverio, Paola; Restrepo, Marcos I.

    2014-01-01

    Ventilator-associated pneumonia (VAP) is one of the most commonly encountered hospital-acquired infections in intensive care units and is associated with significant morbidity and high costs of care. The pathophysiology, epidemiology, treatment and prevention of VAP have been extensively studied for decades, but a clear prevention strategy has not yet emerged. In this article we will review recent literature pertaining to evidence-based VAP-prevention strategies that have resulted in clinically relevant outcomes. A multidisciplinary strategy for prevention of VAP is recommended. Those interventions that have been shown to have a clinical impact include the following: (i) Non-invasive positive pressure ventilation for able patients, especially in immunocompromised patients, with acute exacerbation of chronic obstructive pulmonary disease or pulmonary oedema, (ii) Sedation and weaning protocols for those patients who do require mechanical ventilation, (iii) Mechanical ventilation protocols including head of bed elevation above 30 degrees and oral care, and (iv) Removal of subglottic secretions. Other interventions, such as selective digestive tract decontamination, selective oropharyngeal decontamination and antimicrobial-coated endotracheal tubes, have been tested in different studies. However, the evidence for the efficacy of these measures to reduce VAP rates is not strong enough to recommend their use in clinical practice. In numerous studies, the implementation of VAP prevention bundles to clinical practice was associated with a significant reduction in VAP rates. Future research that considers clinical outcomes as primary endpoints will hopefully result in more detailed prevention strategies. PMID:25109715

  11. An evidence-based recommendation on bed head elevation for mechanically ventilated patients

    PubMed Central

    2011-01-01

    Introduction A semi-upright position in ventilated patients is recommended to prevent ventilator-associated pneumonia (VAP) and is one of the components in the Ventilator Bundle of the Institute for Health Care Improvement. This recommendation, however, is not an evidence-based one. Methods A systematic review on the benefits and disadvantages of semi-upright position in ventilated patients was done according to PRISMA guidelines. Then a European expert panel developed a recommendation based on the results of the systematic review and considerations beyond the scientific evidence in a three-round electronic Delphi procedure. Results Three trials (337 patients) were included in the review. The results showed that it was uncertain whether a 45 bed head elevation was effective or harmful with regard to the occurrence of clinically suspected VAP, microbiologically confirmed VAP, decubitus and mortality, and that it was unknown whether 45 elevation for 24 hours a day increased the risk for thromboembolism or hemodynamic instability. A group of 22 experts recommended elevating the head of the bed of mechanically ventilated patients to a 20 to 45 position and preferably to a ?30 position as long as it does not pose risks or conflicts with other nursing tasks, medical interventions or patients' wishes. Conclusions Although the review failed to prove clinical benefits of bed head elevation, experts prefer this position in ventilated patients. They made clear that the position of a ventilated patient in bed depended on many determinants. Therefore, given the scientific uncertainty about the benefits and harms of a semi-upright position, this position could only be recommended as the preferred position with the necessary restrictions. PMID:21481251

  12. Tilt Table Practice Improved Ventilation in a Patient with Prolonged Artificial Ventilation Support in Intensive Care Unit

    PubMed Central

    Hashim, Asiah M; Joseph, Leonard H; Embong, Juleida; Kasim, Zalila; Mohan, Vikram

    2012-01-01

    Patients who are on prolonged ventilator support in critical care unit present wide variety of complications, which range from reduction in oxygen uptake to various musculoskeletal impairments. Early mobilization and rehabilitation are encouraged to manage these complications effectively. Use of tilt table to motivate early mobilization in the intensive care unit for ventilator practices is not a usual practice. However, this new technique has attracted involvements of clinicians and therapists for its therapeutic benefits to the patient. Herein we describe a case of a seventy eight-year-old male patient who suffered Motor car accident, and was on ventilator support in intensive care unit for more than one month. He underwent treatment using a tilt table protocol with other routine treatment, which benefited him based on clinical as well as physiological variables. For practitioners in intensive care units, this report may offer perceptivity into the alternate practice of early mobilization using tilt table, and for investigators it may promote interest for further studies. PMID:23115431

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

    PubMed

    Chiner, Eusebi; Sancho-Chust, Jos N; Landete, Pedro; Senent, Cristina; Gmez-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

  14. 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.

  15. 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. (Cornell Univ. Medical College, Manhasset, NY (USA))

    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.

  16. Impact of acetazolamide use in severe exacerbation of chronic obstructive pulmonary disease requiring invasive mechanical ventilation

    PubMed Central

    Bahloul, Mabrouk; Chaari, Anis; Tounsi, Ahmed; Turki, Olfa; Chtara, Kamilia; Hamida, Chokri Ben; Ghadhoune, Hatem; Dammak, Hassen; Chelly, Hedi; Bouaziz, Mounir

    2015-01-01

    Purpose: To analyse the impact of acetazolamide (ACET) use in severe acute decompensation of chronic obstructive pulmonary disease requiring mechanical ventilation and intensive care unit (ICU) admission. Patients and Methods: Retrospective pair-wise, case-control study with 1:1 matching. Patients were defined as cases when they had received acetazolamide (500 mg per day) and as controls when they did not received it. Patients were matched according to age, severity on admission (pH, PaO2/FiO2 ratio) and SAPSII score. Our primary endpoint was the effect of ACET (500 mg per day) on the duration of mechanical ventilation. Our secondary endpoints were the effect of ACET on arterial blood gas parameters, ICU length of stay (LOS) and ICU mortality. Results: Seventy-two patients were included and equally distributed between the two studied groups. There were 66 males (92%). The mean age ( SD) was 69.7 7.4 years ranging from 53 to 81 years. There were no differences between baseline characteristics of the two groups. Concomitant drugs used were also not significantly different between two groups. Mean duration of mechanical ventilation was not significantly different between ACET(+) and ACET(-) patients (10.67.8 days and 9.67.6 days, respectively; P = 0.61). Cases had a significantly decreased serum bicarbonate, arterial blood pH, and PaCO2 levels. We did not found any significant difference between the two studied groups in terms of ICU LOS. ICU mortality was also comparable between ACET(+) and ACET(-) groups (38% and 52%, respectively; P = 0.23). Conclusion: Although our study some limitations, it suggests that the use of insufficient acetazolamide dosage (500 mg/d) ACET (500 mg per day) has no significant effect on the duration of mechanical ventilation in critically ill COPD patients requiring invasive mechanical ventilation. Our results should be confirmed or infirmed by further studies.

  17. Does Etomidate Increase Vasopressor Requirements in Patients Needing Mechanical Ventilation?

    PubMed Central

    Elliot, Mary; Brown, Glen; Kuo, I fan

    2012-01-01

    Background: Single-dose etomidate is used as an induction agent for rapid-sequence intubation and is associated with transient adrenal insufficiency. There is ongoing debate as to the clinical consequences of this transient adrenal insufficiency for critically ill patients. Objective: To determine if the use of etomidate is associated with higher requirements for a vasopressor, relative to other induction agents, at a single time point (24 h after administration of the induction agent) in patients needing mechanical ventilation. Methods: In this retrospective observational study utilizing electronic health records, a convenience sample of 50 patients who had undergone intubation in the emergency department with etomidate were matched (1:1) with patients who had received other induction agents. Matching was based on primary admitting diagnosis relating to the cause of shock, APACHE II (Acute Physiology and Chronic Health Evaluation II) score, age, and sex. All patients were subsequently admitted to critical care areas for management. As a surrogate marker of hemodynamic instability, the vasopressor dose was recorded 24 h after intubation. Vasopressor doses were converted to norepinephrine equivalents for comparison. Results: The mean dose of vasopressors, in norepinephrine equivalents, was 4 ?g/min?1 for patients receiving etomidate and 3 ?g/min?1 for the control group (mean difference 0.7 ?g min?1, 95% confidence interval [CI] ?1.9 to 3.2 ?g min?1, p = 0.61). Twelve of the patients in the etomidate group and 16 of those in the control group required the use of vasopressors at 24 h following intubation (odds ratio 2.3, 95% CI 0.53 to 13.99, p = 0.34). Conclusions: Single-dose etomidate does not adversely affect hemodynamic stability, as measured by the dose of vasopressors required at 24 h after administration. PMID:22919104

  18. 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 while milled ITZ NanoClusters maintained the crystalline character. Overall, NanoClusters prepared by various processes represent a potential engineered drug particle approach for inhalation therapy since they provide effective aerosol properties and stability due to the crystalline state of the drug powders. Future work will continue to explore formulation and delivery performance in vitro and in vivo..

  19. 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

  20. Wash and Wean: Bathing Patients Undergoing Weaning Trials During Prolonged Mechanical Ventilation

    PubMed Central

    Happ, Mary Beth; Tate, Judith A.; Swigart, Valerie A.; DiVirgilio-Thomas, Dana; Hoffman, Leslie A.

    2010-01-01

    BACKGROUND Bathing is a fundamental nursing care activity performed for or with the self-assistance of critically ill patients. Few studies address caregiver and/or patient-family perspectives about bathing activity during weaning from prolonged mechanical ventilation. OBJECTIVE To describe practices and beliefs about bathing patients during weaning from prolonged mechanical ventilation (PMV). METHODS Secondary analysis of qualitative data (observational field notes, interviews, and clinical record review) from a larger ethnographic study involving 30 patients weaning from PMV and the clinicians who cared for them using basic qualitative description. RESULTS Bathing, hygiene, and personal care were highly valued and equated with good nursing care by families and nurses. Nurses and respiratory therapists reported working around bath time and promoted conducting weaning trials before or after bathing. Patients were nevertheless bathed during weaning trials despite clinicians expressed concerns for energy conservation. Clinicians recognized individual patient response to bathing during PMV weaning trials. CONCLUSION Bathing is a central care activity for PMV patients and a component of daily work processes in the ICU. Bathing requires assessment of patient condition and activity tolerance and nurse-respiratory therapist negotiation and accommodation with respect to the initiation and/or continuation of PMV weaning trials during bathing. Further study is needed to validate the impact (or lack of impact) of various timing strategies for bathing PMV patients. PMID:20561877

  1. Flexible bronchoscopy during mechanical ventilation in the prone position to treat acute lung injury.

    PubMed

    Guarracino, F; Bertini, P; Bortolotti, U; Stefani, M; Ambrosino, N

    2013-01-01

    In patients with severe acute lung injury (ALI) or acute respiratory distress syndrome (ARDS) the prone position has been shown to improve survival of patients who are severely hypoxemic with an arterial oxygen tension to inspiratory oxygen fraction ratio (PaO(2)/FiO(2))<100. In those patients tracheobronchial toilette is crucial in preventing or treating airways obstructed by secretions and deterioration of oxygenation. Flexible fiberoptic bronchoscopy is widely recognized as an effective technique to perform bronchial toilette in the intensive care unit (ICU). Flexible bronchoscopy performed during prone mechanical ventilation in two cardiosurgical patients who developed ALI after complex surgery, proved feasible and safe and helped to avoid undesirable earlier cessation of prone mechanical ventilation. However decision making about bronchoscopy in severe hypoxia should be even more cautious than in the supine patient, as dangerous delay in resuscitation manoeuvres due to postponed switching the patient to the supine position should always be prevented. PMID:22868006

  2. Airway humidification with aheat and moisture exchanger in mechanically ventilated neonates

    Microsoft Academic Search

    Mikala Fassassi; Fabrice Michel; Laurent Thomachot; Claire Nicaise; Renaud Vialet; Yves Jammes; Pierre Lagier; Claude Martin

    2007-01-01

    ObjectiveWe set out to evaluate the efficacy of passive inspiratory gas conditioning in mechanically ventilated neonates and compared\\u000a it with that of aheated humidifier (HH).\\u000a \\u000a \\u000a \\u000a DesignProspective, randomized, controlled study.\\u000a \\u000a \\u000a \\u000a SettingNeonatal and pediatric intensive care unit.\\u000a \\u000a \\u000a \\u000a PatientsFourteen mechanically ventilated neonates nursed in incubators.\\u000a \\u000a \\u000a \\u000a InterventionsThe HH was set to deliver atemperature of 37?C and an absolute humidity of 40?mgH2O\\/l at the incubator

  3. Mechanical ventilation induces inflammation, lung injury, and extra-pulmonary organ dysfunction in experimental pneumonia

    Microsoft Academic Search

    Shireesha Dhanireddy; William A Altemeier; Gustavo Matute-Bello; D Shane O'Mahony; Robb W Glenny; Thomas R Martin; W Conrad Liles

    2006-01-01

    Mechanical ventilation (MV) is frequently employed for the management of critically ill patients with respiratory failure. A major complication of mechanical ventilation (MV) is the development of ventilator-associated pneumonia (VAP), in which Staphylococcus aureus is a prominent pathogen. Moreover, previous studies suggest that MV may be an important cofactor in the development of acute lung injury (ALI) and the acute

  4. Copyright 2006 Mosby, Inc., an affiliate of Elsevier Inc. Pilbeam: Mechanical Ventilation, 4th

    E-print Network

    Kay, Mark A.

    Copyright © 2006 Mosby, Inc., an affiliate of Elsevier Inc. Pilbeam: Mechanical Ventilation, 4th Edition Special Techniques in Mechanical Ventilation SECTION IV: Nitric Oxide OUTLINE PROPERTIES SYSTEMS FOR DELIVERING INHALED NO I-NOvent Delivery System Continuous-Flow Ventilator System Premixed

  5. A multicenter randomized trial of computer-driven protocolized weaning from mechanical ventilation

    E-print Network

    Dojat, Michel

    A multicenter randomized trial of computer-driven protocolized weaning from mechanical ventilation; Fax: 33 1 42 07 99 43 E-mail: laurent.brochard@hmn.aphp.fr Descriptor: 6. Mechanical ventilation Copyright (C) 2006 by the American Thoracic Society. #12;Running title: Automated ventilation Word count

  6. Mechanical Ventilation Jairo I. Santanilla, MDa,b,*, Brian Daniel, RRTc

    E-print Network

    Mechanical Ventilation Jairo I. Santanilla, MDa,b,*, Brian Daniel, RRTc , Mei-Ean Yeow, MDa leads to a delay in transfer and ventilator management falls upon the emergency medicine (EM) physician to troubleshoot or stabilize mechanically ventilated patients in the ICU. This article reviews the common modes

  7. Lung ventilation in vertebrates is accomplished by diverse respiratory pump mechanisms. Amniotes use an aspiration

    E-print Network

    Brainerd, Elizabeth

    Lung ventilation in vertebrates is accomplished by diverse respiratory pump mechanisms. Amniotes primitive body form, and a recent study of lung ventilation in Necturus maculosus has suggested that studies). The mechanism of lung ventilation in N. maculosus is similar to the buccal pump used by lepidosirenid lungfishes

  8. Design and prototyping of a low-cost portable mechanical ventilator

    E-print Network

    Powelson, Stephen K. (Stephen Kirby)

    2010-01-01

    This paper describes the design and prototyping of a low-cost portable mechanical ventilator for use in mass casualty cases and resource-poor environments. The ventilator delivers breaths by compressing a conventional ...

  9. Patients' statements and experiences concerning receiving mechanical ventilation: a prospective video-recorded study.

    PubMed

    Karlsson, Veronika; Lindahl, Berit; Bergbom, Ingegerd

    2012-09-01

    Prospective studies using video-recordings of patients during mechanical ventilator treatment (MVT) while conscious have not previously been published. The aim was to describe patients' statements, communication and facial expressions during a video-recorded interview while undergoing MVT. Content analysis and hermeneutics inspired by the philosophy of Gadamer were used. The patients experienced almost constant difficulties in breathing and lost their voice. The most common types of communication techniques patients used were nodding or shaking the head. Their expressions were interpreted as stiffened facial expression, tense body position and feelings of sadness and sorrow. Nursing care for patients' conscious during MVT is challenging as it creates new demands regarding the content of the care provided. In caring for patients undergoing MVT while conscious, establishing a caring relationship, making patients feel safe and helping them to communicate seem to be most important for alleviating discomfort and instilling hope. PMID:22882507

  10. Adjunct therapies during mechanical ventilation: airway clearance techniques, therapeutic aerosols, and gases.

    PubMed

    Kallet, Richard H

    2013-06-01

    Mechanically ventilated patients in respiratory failure often require adjunct therapies to address special needs such as inhaled drug delivery to alleviate airway obstruction, treat pulmonary infection, or stabilize gas exchange, or therapies that enhance pulmonary hygiene. These therapies generally are supportive in nature rather than curative. Currently, most lack high-level evidence supporting their routine use. This overview describes the rationale and examines the evidence supporting adjunctive therapies during mechanical ventilation. Both mechanistic and clinical research suggests that intrapulmonary percussive ventilation may enhance pulmonary secretion mobilization and might reverse atelectasis. However, its impact on outcomes such ICU stay is uncertain. The most crucial issue is whether aerosolized antibiotics should be used to treat ventilator-associated pneumonia, particularly when caused by multi-drug resistant pathogens. There is encouraging evidence from several studies supporting its use, at least in individual cases of pneumonia non-responsive to systemic antibiotic therapy. Inhaled pulmonary vasodilators provide at least short-term improvement in oxygenation and may be useful in stabilizing pulmonary gas exchange in complex management situations. Small uncontrolled studies suggest aerosolized heparin with N-acetylcysteine might break down pulmonary casts and relieve airway obstruction in patients with severe inhalation injury. Similar low-level evidence suggests that heliox is effective in reducing airway pressure and improving ventilation in various forms of lower airway obstruction. These therapies generally are supportive and may facilitate patient management. However, because they have not been shown to improve patient outcomes, it behooves clinicians to use these therapies parsimoniously and to monitor their effectiveness carefully. PMID:23709200

  11. 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

  12. Mechanical Ventilation for Imaging the Small Animal Lung Laurence W. Hedlund and G. Allan Johnson

    E-print Network

    Mechanical Ventilation for Imaging the Small Animal Lung Laurence W. Hedlund and G. Allan Johnson lung. Because me- chanical ventilation plays a key role in high-quality, high- resolution imaging of the small animal lung, the article focuses particularly on the problems of ventilation support, control

  13. Noninvasive mechanical ventilation in high-risk pulmonary infections: a clinical review.

    PubMed

    Esquinas, Antonio M; Egbert Pravinkumar, S; Scala, Raffaele; Gay, Peter; Soroksky, Arie; Girault, Christophe; Han, Fang; Hui, David S; Papadakos, Peter J; Ambrosino, Nicolino

    2014-12-01

    The aim of this article was to review the role of noninvasive ventilation (NIV) in acute pulmonary infectious diseases, such as severe acute respiratory syndrome (SARS), H1N1 and tuberculosis, and to assess the risk of disease transmission with the use of NIV from patients to healthcare workers. We performed a clinical review by searching Medline and EMBASE. These databases were searched for articles on "clinical trials" and "randomised controlled trials". The keywords selected were non-invasive ventilation pulmonary infections, influenza-A (H1N1), SARS and tuberculosis. These terms were cross-referenced with the following keywords: health care workers, airborne infections, complications, intensive care unit and pandemic. The members of the International NIV Network examined the major results regarding NIV applications and SARS, H1N1 and tuberculosis. Cross-referencing mechanical ventilation with SARS yielded 76 studies, of which 10 studies involved the use of NIV and five were ultimately selected for inclusion in this review. Cross-referencing with H1N1 yielded 275 studies, of which 27 involved NIV. Of these, 22 were selected for review. Cross-referencing with tuberculosis yielded 285 studies, of which 15 involved NIV and from these seven were selected. In total 34 studies were selected for this review. NIV, when applied early in selected patients with SARS, H1N1 and acute pulmonary tuberculosis infections, can reverse respiratory failure. There are only a few reports of infectious disease transmission among healthcare workers. PMID:25445941

  14. Friday night ventilation: a safety starting tool kit for mechanically ventilated patients.

    PubMed

    Gattinoni, L; Carlesso, E; Brazzi, L; Cressoni, M; Rosseau, S; Kluge, S; Kalenka, A; Bachmann, M; Toepfer, L; Wrigge, H; Redaelli, F; Vetter, C; Wysocki, M

    2014-09-01

    We wish to report here a practical approach to an acute respiratory distress syndrome (ARDS) patient as devised by a group of intensivists with different expertise. The referral scenario is an intensive care unit of a Community Hospital with limited technology, where a young doctor, alone, must deal with this complicate syndrome during the night. The knowledge of pulse oximetry at room air and at 100% oxygen allows to estimate the PaO2 and the cause of hypoxemia, shunt vs. VA/Q maldistribution. The ARDS severity (mild [200ventilation should be attempted in mild ARDS only. Possible errors due to inappropriate premature intubation are preferable to a delayed intubation. In moderate and severe ARDS tracheal intubation associated with heavy sedation/muscle relaxation allows to fully characterize the patient. A tidal volume of 6 mL/kg predicted body weight is recommended, either in pressure or volume control ventilation. Tailoring tidal volume on residual functional capacity, however, is preferable. Plateau pressure greater than 30 cmH2O is acceptable only if chest wall compliance is decreased. In this case maximal attention must be devoted to the hemodynamics. PEEP from 5 to 10, from 10 to 15 and greater than 15 cmH2O should be set in mild, moderate and severe ARDS, respectively. Prone position should be applied in severe ARDS, if experience is available. In case of unchanged conditions or increased ARDS severity a referral center should be contacted. PMID:24847737

  15. Optimal tracheal tube cuff inflation in infants: implications for mechanical ventilation and respiratory mechanics.

    PubMed

    Habib, R H

    2001-11-01

    Uncuffed tracheal tubes (TT) are used to intubate infants and children to avoid laryngotracheal tissue injury. The geometric mismatch resulting from such intubation limits the efficacy of mechanical ventilation, and reliability of derived respiratory mechanical properties. This study tested the hypotheses that (1) normal stresses applied to the cuff surface by leak flows during ventilation result in intracuff pressure (Pcuff) fluctuations proportionate to leak magnitudes, and (2) these fluctuations reach a steady minimum when cuff volume reaches a critical value (Vcrit) at which the TT-airway mismatch is removed. Physical model and piglet measurements showed that, during simultaneous cuff inflation and mechanical ventilation, Pcuff consisted of a leak-dependent (Pcuff,l) component that cycles with the ventilator superimposed on a ramp rise due to cuff inflation. The breath-to-breath peak Pcuff,l (max Pcuff,l) decreased as leak flows are reduced, and these were relatively greater for higher ventilator flows and when the load impedance is increased such as by disease. These results describe a reproducible method of TT cuff inflation that removes leaks without increased risk of laryngotracheal tissue injury. Moreover, inflation of the TT cuff more securely improved ventilation efficacy and allowed for accurate respiratory mechanics. PMID:11791682

  16. Prevention of ventilator-associated pneumonia, mortality and all intensive care unit acquired infections by topically applied antimicrobial or antiseptic agents: a meta-analysis of randomized controlled trials in intensive care units

    Microsoft Academic Search

    Claudia Pileggi; Aida Bianco; Domenico Flotta; Carmelo GA Nobile; Maria Pavia

    2011-01-01

    IntroductionGiven the high morbidity and mortality attributable to ventilator-associated pneumonia (VAP) in intensive care unit (ICU)\\u000a patients, prevention plays a key role in the management of patients undergoing mechanical ventilation. One of the candidate\\u000a preventive interventions is the selective decontamination of the digestive or respiratory tract (SDRD) by topical antiseptic\\u000a or antimicrobial agents. We performed a meta-analysis to investigate the

  17. 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., Kinoshita, T., Kinsella, T. M. Inhibition of Janus kinase signaling during controlled mechanical ventilation prevents ventilation-induced diaphragm dysfunction. PMID:24671708

  18. Measurement of lung function using Electrical Impedance Tomography (EIT) during mechanical ventilation

    NASA Astrophysics Data System (ADS)

    Nebuya, Satoru; Koike, Tomotaka; Imai, Hiroshi; Noshiro, Makoto; Brown, Brian H.; Soma, Kazui

    2010-04-01

    The consistency of regional lung density measurements as estimated by Electrical Impedance Tomography (EIT), in eleven patients supported by a mechanical ventilator, was validated to verify the feasibility of its use in intensive care medicine. There were significant differences in regional lung densities between the normal lung and diseased lungs associated with pneumonia, atelectasis and pleural effusion (Steel-Dwass test, p < 0.05). Temporal changes in regional lung density of patients with atelectasis were observed to be in good agreement with the results of clinical diagnosis. These results indicate that it is feasible to obtain a quantitative value for regional lung density using EIT.

  19. EGF RECEPTOR REGULATES MECHANICAL VENTILATION INDUCED LUNG INJURY IN MICE

    PubMed Central

    Bierman, Alexis; Yerrapureddy, Adi; Reddy, Narsa M.; Hassoun, Paul M; Reddy, Sekhar P.

    2008-01-01

    SUMMARY Mechanical ventilation (MV) is used as therapy to support critically ill patients, however the mechanisms by which MV induces lung injury and inflammation remain unclear. EGFR mediated signaling plays a key role in various physiologic and pathologic processes, including those modulated by mechanical and shear forces, in various cell types. We hypothesized that EGFR-activated signaling plays a key role in ventilator induced lung injury and inflammation (VILI). To test this hypothesis, we assessed lung vascular and alveolar permeability, as well as inflammation, which are cardinal features of VILI, in mice treated with the EGFR inhibitor, AG1478. Inhibition of EGFR activity greatly diminished MV-induced lung alveolar permeability and neutrophil accumulation in the bronchoalveolar lavage (BAL) fluid, as compared to vehicle-treated controls. Similarly, AG1478 inhibition diminished lung vascular leak (as assessed by Evans blue extravasation), but did not affect interstitial neutrophil accumulation. Inhibition of the EGFR pathway also blocked expression of genes induced by MV. However, intratracheal instillation of EGF alone failed to induce lung injury. Collectively, our findings suggest that EGFR-activated signaling is necessary but not sufficient to produce ALI in mice. PMID:19059161

  20. Thenar oxygen saturation during weaning from mechanical ventilation: an observational study.

    PubMed

    Gruartmoner, Guillem; Mesquida, Jaume; Masip, Jordi; Martnez, Maria L; Villagra, Ana; Baigorri, Francisco; Pinsky, Michael R; Artigas, Antonio

    2014-01-01

    Our aim was to determine whether thenar tissue oxygen saturation (S(tO2)), measured by noninvasive near-infrared spectroscopy, and its changes derived from an ischaemic challenge are associated with weaning outcome. Our study comprised a prospective observational study in a 26-bed medical-surgical intensive care unit. Patients receiving mechanical ventilation for >48 h, and considered ready to wean by their physicians underwent a 30-min weaning trial. S(tO2) was measured continuously on the thenar eminence. A transient vascular occlusion test was performed prior to and at the end of the 30-min weaning trial, in order to obtain S(tO2) deoxygenation and reoxygenation rates, and estimated local oxygen consumption. 37 patients were studied. Patients were classified as weaning success (n=24) or weaning failure (n=13). No significant demographic, respiratory or haemodynamic differences were observed between the groups at inclusion. Patients who failed the overall weaning process showed a significant increase in deoxygenation and in local oxygen consumption from baseline to 30 min of weaning trial, whereas no significant changes were observed in the weaning success group. Failure to wean from mechanical ventilation was associated with higher relative increases in deoxygenation after 30 min of spontaneous ventilation. PMID:23314894

  1. Impact of tongue biofilm removal on mechanically ventilated patients

    PubMed Central

    Santos, Paulo Srgio 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

  2. Survival and quality of life outcome after mechanical ventilation in elderly stroke patients

    PubMed Central

    Foerch, C; Kessler, K; Steckel, D; Steinmetz, H; Sitzer, M

    2004-01-01

    Objectives: Mortality is high and functional outcome poor in mechanically ventilated stroke patients. In addition, age >65 years is an independent predictor of death at 2 months among these patients. Our objective was to determine survival rates, functional outcome, and quality of life (QoL) in stroke patients older than 65 years requiring mechanical ventilation. Methods: A prospective cohort study with an additional cross-sectional survey in 65 patients aged 65 years and older (mean age (SD): 75.6 (6.0) years) with ischaemic or haemorrhagic stroke who underwent mechanical ventilation. Main outcome measures were survival rate at 6 months, and Barthel Index (BI), modified Rankin Scale, and QoL at 15.8 (SD 8.0) months. Results: Survival rate at 6 months was 40%. Elective intubation (odds ratio (OR) 13.6; p = 0.002) was the only independent positive predictor for survival, while age >77.5 years (OR 0.1; p = 0.004) and white blood count >10/nl at admission (OR 0.31; p = 0.032) were independent negative predictors for survival at 6 months. At the time of the cross-sectional survey, BI was >70 in five out of 22 patients, 3570 in three and <35 in the remaining 14 patients. QoL was impaired primarily in the physical domain, whereas the psychosocial domain was less affected. Conclusions: Although only 40% of elderly patients intubated in the acute phase of stroke survived at least 6 months, one in four survivors recovered to a good functional outcome with a reasonable QoL. Elderly stroke patients need to be selected carefully for intensive care treatment, but elective intubation to allow diagnostic procedures should not be withheld primarily based on their age. PMID:15201356

  3. Liquid ventilation

    PubMed Central

    Sarkar, Suman; Paswan, Anil; Prakas, S.

    2014-01-01

    Human have lungs to breathe air and they have no gills to breath liquids like fish. When the surface tension at the air-liquid interface of the lung increases as in acute lung injury, scientists started to think about filling the lung with fluid instead of air to reduce the surface tension and facilitate ventilation. Liquid ventilation (LV) is a technique of mechanical ventilation in which the lungs are insufflated with an oxygenated perfluorochemical liquid rather than an oxygen-containing gas mixture. The use of perfluorochemicals, rather than nitrogen as the inert carrier of oxygen and carbon dioxide offers a number of advantages for the treatment of acute lung injury. In addition, there are non-respiratory applications with expanding potential including pulmonary drug delivery and radiographic imaging. It is well-known that respiratory diseases are one of the most common causes of morbidity and mortality in intensive care unit. During the past few years several new modalities of treatment have been introduced. One of them and probably the most fascinating, is of LV. Partial LV, on which much of the existing research has concentrated, requires partial filling of lungs with perfluorocarbons (PFC's) and ventilation with gas tidal volumes using conventional mechanical ventilators. Various physico-chemical properties of PFC's make them the ideal media. It results in a dramatic improvement in lung compliance and oxygenation and decline in mean airway pressure and oxygen requirements. No long-term side-effect reported.

  4. 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 motivation of the patient, and the support of the family. PMID:22663966

  5. Epidemiology of noninvasive mechanical ventilation in acute respiratory failure - a retrospective population-based study

    PubMed Central

    2013-01-01

    Background Noninvasive mechanical ventilation (NIV) is a front-line therapy for the management of acute respiratory failure (ARF) in the intensive care units. However, the data on factors and outcomes associated with the use of NIV in ARF patients is lacking. Therefore, we aimed to determine the utilization of NIV for ARF in a population-based study. Methods We conducted a populated-based retrospective cohort study, where in all consecutively admitted adults (?18?years) with ARF from Olmsted County, Rochester, MN, at the Mayo Clinic medical and surgical ICUs, during 2006 were included. Patients without research authorization or on chronic NIV use for sleep apnea were excluded. Results Out of 1461 Olmsted County adult residents admitted to the ICUs in 2006, 364 patients developed ARF, of which 146 patients were initiated on NIV. The median age in years was 75 (interquartile range, 6084), 48% females and 88.7% Caucasians. Eighteen patients (12%) were on Continuous Positive Airway Pressure (CPAP) mode and 128 (88%) were on noninvasive intermittent positive-pressure ventilation (NIPPV) mode. Forty-six (10%) ARF patients were put on NIV for palliative strategy to alleviate dyspnea. Seventy-six ARF patients without treatment limitation were given a trial of NIV and 49 patients succeeded, while 27 had to be intubated. Mortality was similar between the patients initially supported with NIV versus invasive mechanical ventilation (33% vs 22%, P=0.289). In the multivariate analysis, the development of acute respiratory distress syndrome (ARDS) and higher APACHE III scores were associated with the failure of initial NIV treatment. Conclusions Our results have important implications for a future planning of NIV in a suburban US community with high access to critical care services. The higher APACHE III scores and the development of ARDS are associated with the failure of initial NIV treatment. PMID:23570601

  6. Stable Small Animal Mechanical Ventilation for Dynamic Lung Imaging to Support Computational Fluid Dynamics Models

    SciTech Connect

    Jacob, Rick E.; Lamm, W. J.

    2011-11-08

    Pulmonary computational fluid dynamics models require 3D images to be acquired over multiple points in the dynamic breathing cycle, with no breath holds or changes in ventilatory mechanics. With small animals, these requirements result in long imaging times ({approx}90 minutes), over which lung mechanics, such as compliance, can gradually change if not carefully monitored and controlled. These changes, caused by derecruitment of parenchymal tissue, are manifested as an upward drift in peak inspiratory pressure or by changes in the pressure waveform and/or lung volume over the course of the experiment. We demonstrate highly repeatable mechanical ventilation in anesthetized rats over a long duration for pulmonary CT imaging throughout the dynamic breathing cycle. We describe significant updates to a basic commercial ventilator that was acquired for these experiments. Key to achieving consistent results was the implementation of periodic deep breaths, or sighs, of extended duration to maintain lung recruitment. In addition, continuous monitoring of breath-to-breath pressure and volume waveforms and long-term trends in peak inspiratory pressure and flow provide diagnostics of changes in breathing mechanics.

  7. [The management of patients receiving home respiratory care with tracheostomy and positive-pressure ventilation].

    PubMed

    Aoki, Masashi

    2013-01-01

    On March 11, 2011, the Great East Japan Earthquake occurred and a massive tsunami hit the northeastern coast of Japan. In Miyagi prefecture in Tokoku district, 49 patients with amyotrophic lateral sclerosis were supported by home respiratory care with tracheostomy and positive-pressure ventilation at that time. Among them, two patients were died in the tsunami and 25 patients were forced to evacuate to hospitals. We should hurry to submit a guideline for medical transportation for patients with neuromuscular diseases requiring artificial ventilation. We also should research the disaster medicine in the field of neurology. PMID:24291911

  8. 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.

  9. Effects of prolonged mechanical ventilation on respiratory muscle ultrastructure and mitochondrial respiration in rabbits

    Microsoft Academic Search

    Nathalie Bernard; Stefan Matecki; Guillaume Py; Sandrine Lopez; Jacques Mercier; Xavier Capdevila

    2003-01-01

    Objective. To investigate in rabbits whether prolonged mechanical ventilation (PMV) leads to ultrastructural changes in respiratory muscles and alters diaphragm mitochondrial respiration. Design and setting. Experimental prospective study in a university laboratory. Animals and interventions. We studied respiratory muscles of seven rabbits after 49ǃ h of controlled mechanical ventilation. Ten nonventilated rabbits were used as a control group. Measurements and

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

    PubMed

    Mirambeaux Villalona, Rosa; Mayoralas Alises, Sagrario; Daz 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

  11. Critical care nurses' knowledge of measures to prevent ventilator-associated pneumonia.

    PubMed

    Lin, Hsin-Lan; Lai, Chih-Cheng; Yang, Li-Yu

    2014-08-01

    We queried critical care nurses at a hospital about their level of knowledge of interventions designed to prevent ventilator-associated pneumonia (VAP). The mean score was 7.87 1.36 (65.6%) among 133 questionnaires. Multivariate analysis revealed that intensive care unit (ICU) license (P = .03) and ranking of registered nurses (RNs) (P = .041) were significantly associated with higher knowledge level (?8 correct answers of 12 items) of respondents. This surveillance study revealed that non-ICU-licensed nurses and junior RNs lack the knowledge necessary to prevent VAP in critical care settings. PMID:25087147

  12. Shortening the length of stay and mechanical ventilation time by using positive suggestions via MP3 players for ventilated patients

    PubMed Central

    Diszeghy, Csaba; Fritz, Gbor; Gl, Jnos; Varga, Katalin

    2014-01-01

    Long stay in intensive care unit (ICU) and prolonged ventilation are deleterious for subsequent quality of life and surcharge financial capacity. We have already demonstrated the beneficial effects of using suggestive communication on recovery time during intensive care. The aim of our present study was to prove the same effects with standardized positive suggestive message delivered by an MP3 player. Patients ventilated in ICU were randomized into a control group receiving standard ICU treatment and two groups with a standardized pre-recorded material delivered via headphones: a suggestive message about safety, self-control, and recovery for the study group and a relaxing music for the music group. Groups were similar in terms of age, gender, and mortality, but the SAPS II scores were higher in the study group than that in the controls (57.8 23.6 vs. 30.1 15.5 and 33.7 17.4). Our post-hoc analysis results showed that the length of ICU stay (134.2 73.3 vs. 314.2 178.4 h) and the time spent on ventilator (85.2 34.9 vs. 232.0 165.6 h) were significantly shorter in the study group compared to the unified control. The advantage of the structured positive suggestive message was proven against both music and control groups. PMID:24672669

  13. Implementing early mobilization interventions in mechanically ventilated patients in the ICU.

    PubMed

    Schweickert, William D; Kress, John P

    2011-12-01

    As ICU survival continues to improve, clinicians are faced with short- and long-term consequences of critical illness. Deconditioning and weakness have become common problems in survivors of critical illness requiring mechanical ventilation. Recent literature, mostly from a medical population of patients in the ICU, has challenged the patient care model of prolonged bed rest. Instead, the feasibility, safety, and benefits of early mobilization of mechanically ventilated ICU patients have been reported in recent publications. The benefits of early mobilization include reductions in length of stay in the ICU and hospital as well as improvements in strength and functional status. Such benefits can be accomplished with a remarkably acceptable patient safety profile. The importance of interactions between mind and body are highlighted by these studies, with improvements in patient awareness and reductions in ICU delirium being noted. Future research to address the benefits of early mobilization in other patient populations is needed. In addition, the potential for early mobilization to impact long-term outcomes in ICU survivors requires further study. PMID:22147819

  14. Heat stress protects against mechanical ventilation-induced diaphragmatic atrophy.

    PubMed

    Ichinoseki-Sekine, Noriko; Yoshihara, Toshinori; Kakigi, Ryo; Sugiura, Takao; Powers, Scott K; Naito, Hisashi

    2014-09-01

    Mechanical ventilation (MV) is a life-saving intervention in patients who are incapable of maintaining adequate pulmonary gas exchange due to respiratory failure or other disorders. However, prolonged MV is associated with the development of respiratory muscle weakness. We hypothesized that a single exposure to whole body heat stress would increase diaphragm expression of heat shock protein 72 (HSP72) and that this treatment would protect against MV-induced diaphragmatic atrophy. Adult male Wistar rats (n = 38) were randomly assigned to one of four groups: an acutely anesthetized control group (CON) with no MV; 12-h controlled MV group (CMV); 1-h whole body heat stress (HS); or 1-h whole body heat stress 24 h prior to 12-h controlled MV (HSMV). Compared with CON animals, diaphragmatic HSP72 expression increased significantly in the HS and HSMV groups (P < 0.05). Prolonged MV resulted in significant atrophy of type I, type IIa, and type IIx fibers in the costal diaphragm (P < 0.05). Whole body heat stress attenuated this effect. In contrast, heat stress did not protect against MV-induced diaphragm contractile dysfunction. The mechanisms responsible for this heat stress-induced protection remain unclear but may be linked to increased expression of HSP72 in the diaphragm. PMID:25059237

  15. Energy and exergy performance of residential heating systems with separate mechanical ventilation

    Microsoft Academic Search

    Radu Zmeureanu; Xin Yu Wu

    2007-01-01

    The paper brings new evidence on the impact of separate mechanical ventilation system on the annual energy and exergy performance of several design alternatives of residential heating systems, when they are designed for a house in Montreal. Mathematical models of residential heating, ventilation and domestic hot water (HVACDHW) systems, which are needed for this purpose, are developed and furthermore implemented

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

    PubMed

    Daz, Magda C; Ospina-Tascn, 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

  17. Commissioning Trial for Mechanical Ventilation System Installed in Houses

    E-print Network

    Ohta, I.; Fukushima, A.

    2004-01-01

    OK OK OK OK NO NO NO NO NO OK OK OK NO NO NO Exchange parts having excessive pressure drop OK Air flow rate measurement Air flow rate measurement Cleaning of filter and insect prevention net Air flow rate measurement Air flow rate measurement... Cleaning of filter and insect prevention net End Add local ventilation unit Increase air intake parts Ventilation rate measurement Add local ventilation unit OK OK OK OK NO NO NO NO NO OK OK OK NO NO NO Exchange parts having excessive pressure drop OK Air...

  18. High-frequency ventilation and conventional mechanical ventilation in newborn babies with respiratory distress syndrome: A prospective, randomized trial

    Microsoft Academic Search

    A. Pardou; D. Vermeylen; M. F. Muller; D. Detemmerman

    1993-01-01

    Objective. Morbidity and mortality remain high amongst babies ventilated for a respiratory distress syndrome (RDS). Whether newly developed ventilators allowing high frequency ventilation such as high frequen- cy flow interrupted ventilation (HFFIV) could decrease the morbidity and the mortality was investigated in a ran- domized study. Design: Preterm babies weighing < 1800 g suffering from RDS and ventilated by conventional

  19. Predictors of Prolonged Mechanical Ventilation after Open Heart Surgery

    PubMed Central

    Totonchi, Ziae; Baazm, Farah; Chitsazan, Mitra; Seifi, Somayeh; Chitsazan, Mandana

    2014-01-01

    Introduction: Due to the importance of prolonged mechanical ventilation (PMV) as a postoperative complication, predicting "high-risk" patients by identifying predisposing risk factors is of important issue. The present study was aimed to identify perioperative variables associated with PMV in patients undergoing open heart surgery. Methods: A total of 743 consecutive patients, American Society of Anesthesiologists (ASA) physical status class III, who were scheduled to undergo open heart surgery using cardiopulmonary bypass were included in this observational study. Perioperative variables were compared between the patients with and without PMV, as defined by an extubation time of >48 h. Results: PMV occurred in 45 (6.1%) patients. On univariate analysis, pre-operative variables; including gender, history of chronic obstructive pulmonary disease (COPD); chronic kidney disease and endocarditis, intra-operative variables; including type of surgery, operation time, pump time, transfusion in operating room and postoperative variables; including bleeding and inotrope-dependency were significantly different between patients with and without PMV (all P<0.001, except for COPD and transfusion in operating room; P=0.004 and P=0.017, respectively). Conclusion: Our findings reinforce that risk stratification for predicting delayed extubation should be an important aspect of preoperative clinical evaluation in all anesthesiology settings. PMID:25610551

  20. Effect of non-invasive mechanical ventilation on sleep and nocturnal ventilation in patients with chronic respiratory failure

    PubMed Central

    Schonhofer, B.; Kohler, D.

    2000-01-01

    BACKGROUNDChronic respiratory failure (CRF) is associated with nocturnal hypoventilation. Due to the interaction of sleep and breathing, sleep quality is reduced during nocturnal hypoventilation. Non-invasive mechanical ventilation (NMV), usually performed overnight, relieves symptoms of hypoventilation and improves daytime blood gas tensions in patients with CRF. The time course of the long term effect of NMV on sleep and breathing during both spontaneous ventilation (withdrawing the intervention) and NMV was investigated in patients with CRF due to thoracic restriction.?METHODSFifteen consecutive patients (13 women) of mean (SD) age 57.9 (12.0) years with CRF due to thoracic restriction were included in the study. During the one year observation period four polysomnographic studies were performed: three during spontaneous breathing without NMVbefore initiation of NMV (T0) and after withdrawing NMV for one night at six months (T6) and 12 months (T12-)and the fourth during NMV after 12 months (T12+). Daytime blood gas tensions and lung function were also measured.?RESULTSSpontaneous ventilation (in terms of mean oxygen saturation) progressively improved (from T0 to T12-) during both REM sleep (24.8%, 95% CI 12.9 to 36.9) and NREM sleep (21.5%, 95% CI 12.4to 30.6). Sleep quality during spontaneous ventilation also improved in terms of increased total sleep time (26.8%, 95% CI 11.6 to 42.0) and sleep efficiency (17.5%, 95% CI 5.4 to 29.6) and decreased awakenings (54.0%, 95% CI 70.3 to 37.7). Accordingly, REM and NREM sleep stages 3 and 4 significantly improved. However, the most significant improvements in both nocturnal ventilation and sleep quality were seen during NMV at 12months.?CONCLUSIONSAfter long term NMV both spontaneous ventilation during sleep and sleep quality in patients with CRF due to thoracic restriction showed evidence of progressive improvement compared with baseline after withdrawal of NMV for a single night at six and 12 months. However, the greatest improvements in nocturnal ventilation and sleep were achieved during NMV at 12months.?? PMID:10722771

  1. Outcome of invasive mechanical ventilation after pediatric allogeneic hematopoietic SCT: results from a prospective, multicenter registry.

    PubMed

    van Gestel, J P J; Bierings, M B; Dauger, S; Dalle, J-H; Pavl?ek, P; Sedl?ek, P; Monteiro, L M; Lankester, A; Bollen, C W

    2014-10-01

    Exact data on prognosis of children receiving invasive mechanical ventilation (IMV) after allogeneic hematopoietic SCT (HSCT) is lacking. We therefore started a prospective registry in four European university HSCT centers (Leiden, Paris, Prague and Utrecht) and their pediatric intensive care units (PICUs). The registry started in January 2009. In January 2013, the four centers together had treated a total of 83 admissions with IMV. The case fatality rate in these patients was 52%. Mortality 6 months after PICU discharge was 45%. There were significant differences between centers in the proportion of children who received IMV after HSCT (6-23%, P<0.01), in severity of disease on admission to PICU (predicted mortality 14-37%, P<0.01), in applying noninvasive ventilation before IMV (3-75% of admissions, P<0.01) and in the use of renal replacement therapy (RRT) (8-58% of admissions, P<0.01). Severe impairment in oxygenation, use of RRT and CMV viremia were independent predictors of mortality. Our study shows that mortality in children receiving IMV after HSCT remains high, but has clearly improved compared with older studies. Patient selection and treatment in PICU differed significantly between centers, which underscores the need to standardize and optimize the PICU admission criteria, ventilatory strategies and therapies applied in PICU. PMID:25068426

  2. Perioperative risk factors for prolonged mechanical ventilation after liver transplantation due to acute liver failure

    PubMed Central

    Lee, Serin; Jung, Hyun Sik; Choi, Jong Ho; Lee, Jaemin; Hong, Sang Hyun; Lee, Sung Hyun

    2013-01-01

    Background Acute liver failure (ALF) is a rapidly progressing and fatal disease for which liver transplantation (LT) is the only treatment. Posttransplant mechanical ventilation tends to be more prolonged in patients with ALF than in other LT patients. The present study examined the clinical effects of prolonged posttransplant mechanical ventilation (PMV), and identified risk factors for PMV following LT for ALF. Methods We reviewed data of patients undergoing LT for ALF between January 2005 and June 2011. After grouping patients according to administration of PMV (? 24 h), donor and recipient perioperative variables were compared between the groups with and without PMV. Potentially significant factors (P < 0.1) from the univariate intergroup comparison were entered into a multivariate logistic regression to establish a predictive model for PMV. Results Twenty-four (25.3%) of 95 patients with ALF who received PMV had a higher mortality rate (29.2% vs 11.3%, P = 0.038) and longer intensive care unit stay (12.9 10.4 vs 7.1 2.7 days, P = 0.012) than patients without PMV. The intergroup comparisons revealed worse preoperative hepatic conditions, more supportive therapy, and more intraoperative fluctuations in vital signs and less urine output in the with- compared with the without-PMV group. The multivariate analysis revealed that preoperative hepatic encephalopathy (? grade III), intraoperative blood pressure fluctuation, and oliguria (< 0.5 ml/kg/h) were independent risk factors for PMV. Conclusions PMV was associated with deleterious outcomes. Besides care for known risk factors including hepatic encephalopathy, meticulous attention to managing intraoperative hemodynamic circulatory status is required to avoid PMV and improve the posttransplant prognosis in ALF patients. PMID:24101957

  3. Nosocomial and ventilator-associated pneumonia in a community hospital intensive care unit: a retrospective review and analysis

    PubMed Central

    2014-01-01

    Background Nosocomial and ventilator-associated pneumonia (VAP) are causes of significant morbidity and mortality in hospitalized patients. We analyzed a) the incidence and the outcome of pneumonias caused by different pathogens in the intensive care unit (ICU) of a medium-sized twenty-four bed community hospital and b) the incidence of complications of such pneumonias requiring surgical intervention such as thoracotomy and decortication. Results We retrospectively reviewed the charts of patients diagnosed with nosocomial and ventilator-associated pneumonia in our ICU. Their bronchoalveolar lavage (BAL) and sputum cultures, antibiograms, and other clinical characteristics, including complications and need for tracheostomy, thoracotomy and decortication were studied. In a span of one year (201112), 43 patients were diagnosed with nosocomial pneumonia in our ICU. The median simplified acute physiology score (SAPS II) was 39. One or more gram negative organisms as the causative agents were present in 85% of microbiologic samples. The three most prevalent gram negatives were Stenotrophomonas maltophilia (34%), Pseudomonas aeurginosa (40%), and Acinetobacter baumannii (32%). Twenty eight percent of bronchoalveolar samples contained Staphylococcus aureus. Eight three percent of patients required mechanical ventilation postoperatively and 37% underwent tracheostony. Thirty five percent underwent thoracotomy and decortication because of further complications such as empyema and non-resolving parapneumonic effusions. A. baumannii, Klebsiella pneumonia extended spectrum beta lactam (ESBL) and P. aeurginosa had the highest prevalence of multi drug resistance (MDR). Fifteen patients required surgical intervention. Mortality from pneumonia was 37% and from surgery was 2%. Conclusion Nosocomial pneumonias, in particular the ones that were caused by gram negative drug resistant organisms and their ensuing complications which required thoracotomy and decortication, were the cause of significant morbidity in our intensive care unit. Preventative and more intensive and novel infection control interventions in reducing the incidence of nosocomial pneumonias are strongly emphasized. PMID:24725655

  4. 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 ...

  5. 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. ...

  6. Influence of Positive End-Expiratory Pressure on Myocardial Strain Assessed by Speckle Tracking Echocardiography in Mechanically Ventilated Patients

    PubMed Central

    Faltoni, Agnese; Cameli, Matteo; Muzzi, Luigi; Lisi, Matteo; Cubattoli, Lucia; Cecchini, Sofia; Mondillo, Sergio; Biagioli, Bonizella

    2013-01-01

    Purpose. The effects of mechanical ventilation (MV) on speckle tracking echocardiography- (STE-)derived variables are not elucidated. The aim of the study was to evaluate the effects of positive end-expiratory pressure (PEEP) ventilation on 4-chamber longitudinal strain (LS) analysis by STE. Methods. We studied 20 patients admitted to a mixed intensive care unit who required intubation for MV and PEEP titration due to hypoxia. STE was performed at three times: (T1) PEEP = 5?cmH2O; (T2) PEEP = 10?cmH2O; and (T3) PEEP = 15?cmH2O. STE analysis was performed offline using a dedicated software (XStrain MyLab 70 Xvision, Esaote). Results. Left peak atrial-longitudinal strain (LS) was significantly reduced from T1 to T2 and from T2 to T3 (P < 0.05). Right peak atrial-LS and right ventricular-LS showed a significant reduction only at T3 (P < 0.05). Left ventricular-LS did not change significantly during titration of PEEP. Cardiac chambers' volumes showed a significant reduction at higher levels of PEEP (P < 0.05). Conclusions. We demonstrated for the first time that incremental PEEP affects myocardial strain values obtained with STE in intubated critically ill patients. Whenever performing STE in mechanically ventilated patients, care must be taken when PEEP is higher than 10?cmH2O to avoid misinterpreting data and making erroneous decisions. PMID:24066303

  7. Comparison of jet and ultrasonic nebulizer pulmonary aerosol deposition during mechanical ventilation

    Microsoft Academic Search

    C. J. Harvey; M. J. O'Doherty; C. J. Page; S. H. L. Thomas; T. O. Nunan; D. F. Treacher

    Comparison of jet and ultrasonic nebulizer pulmonary aerosol deposition during mechan- ical ventilation. C.J. Harvey, M.J. O'Doherty, C.J. Page, S.H.L. Thomas, T.O. Nunan, D.F. Treacher. ERS Journals 1997. ABSTRACT: Increased delivery of aerosol to a model lung (attached to a mechan- ical ventilator) has been demonstrated with an ultrasonic nebulizer as compared to a jet nebulizer. This study examined whether

  8. 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.

  9. Mechanical ventilation in healthy mice induces reversible pulmonary and systemic cytokine elevation with preserved alveolar integrity: an in vivo model using clinical relevant ventilation settings

    Microsoft Academic Search

    Michiel Vaneker; Feico J. Halbertsma; Jan van Egmond; Mihai G. Netea; Henry B. Dijkman; Dirk G. Snijdelaar; Leo A. Joosten; Johannes G. van der Hoeven; Gert Jan Scheffer

    2007-01-01

    BACKGROUND: Mechanical ventilation (MV) may activate the innate immune system, causing the release of cytokines. The resulting proinflammatory state is a risk factor for ventilator-induced lung injury. Cytokine increase results from direct cellular injury but may also result from cyclic stretch alone as demonstrated in vitro: mechanotransduction. To study mechanotransduction in vivo, the authors used an animal MV model with

  10. 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.

  11. A dynamic Bayesian network for diagnosing ventilator-associated pneumonia in ICU patients q

    E-print Network

    Lucas, Peter

    A dynamic Bayesian network for diagnosing ventilator-associated pneumonia in ICU patients q Diagnosing ventilator-associated pneumonia in mechanically ventilated patients in intensive care units is seen as a clinical challenge. The difficulty in diagnosing ventilator-associated pneumonia stems from

  12. Effects of preserved spontaneous breathing activity during mechanical ventilation in experimental intra-abdominal hypertension

    Microsoft Academic Search

    Dietrich Henzler; Nadine Hochhausen; Ralf Bensberg; Alexander Schachtrupp; Sonja Biechele; Rolf Rossaint; Ralf Kuhlen

    2010-01-01

    PurposeVentilation problems are common in critically ill patients with intra-abdominal hypertension. The aim of this study was to\\u000a investigate the effects of preserved spontaneous breathing during mechanical ventilation on hemodynamics, gas exchange, respiratory\\u000a function and lung injury in experimental intra-abdominal hypertension.\\u000a \\u000a \\u000a \\u000a \\u000a MethodsTwenty anesthetized pigs were intubated and ventilated for 24h with biphasic positive airway pressure without (BIPAPPC) or with additional,

  13. 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.

  14. Low skeletal muscle area is a risk factor for mortality in mechanically ventilated critically ill patients

    PubMed Central

    2014-01-01

    Introduction Higher body mass index (BMI) is associated with lower mortality in mechanically ventilated critically ill patients. However, it is yet unclear which body component is responsible for this relationship. Methods This retrospective analysis in 240 mechanically ventilated critically ill patients included adult patients in whom a computed tomography (CT) scan of the abdomen was made on clinical indication between 1day before and 4days after admission to the intensive care unit. CT scans were analyzed at the L3 level for skeletal muscle area, expressed as square centimeters. Cutoff values were defined by receiver operating characteristic (ROC) curve analysis: 110cm2 for females and 170cm2 for males. Backward stepwise regression analysis was used to evaluate low-muscle area in relation to hospital mortality, with low-muscle area, sex, BMI, Acute Physiologic and Chronic Health Evaluation (APACHE) II score, and diagnosis category as independent variables. Results This study included 240 patients, 94 female and 146 male patients. Mean age was 57years; mean BMI, 25.6kg/m2. Muscle area for females was significantly lower than that for males (102??23cm2 versus 158??33cm2; P?mechanically ventilated critically ill patients, independent of sex and APACHE II score. Further analysis suggests muscle mass as primary predictor, not sex. BMI is not an independent predictor of mortality when muscle area is accounted for. PMID:24410863

  15. Does the Mean Arterial Pressure Influence Mortality Rate in Patients with Acute Hypoxemic Respiratory Failure under Mechanical Ventilation?

    PubMed Central

    Gjonbrataj, Juarda; Kim, Hyun Jung; Jung, Hye In

    2015-01-01

    Background In sepsis patients, target mean arterial pressures (MAPs) greater than 65 mm Hg are recommended. However, there is no such recommendation for patients receiving mechanical ventilation. We aimed to evaluate the influence of MAP over the first 24 hours after intensive care unit (ICU) admission on the mortality rate at 60 days post-admission in patients showing acute hypoxemic respiratory failure under mechanical ventilation. Methods This prospective, multicenter study included 22 ICUs and compared the mortality and clinical outcomes in patients showing acute hypoxemic respiratory failure with high (75-90 mm Hg) and low (65-74.9 mm Hg) MAPs over the first 24 hours of admission to the ICU. Results Of the 844 patients with acute hypoxemic respiratory failure, 338 had a sustained MAP of 65-90 mm Hg over the first 24 hours of admission to the ICU. At 60 days, the mortality rates in the low (26.2%) and high (24.5%) MAP groups were not significantly different. The ICU days, hospital days, and 60-day mortality rate did not differ between the groups. Conclusion In the first 24 hours of ICU admission, MAP range between 65 and 90 mm Hg in patients with acute hypoxemic respiratory failure under mechanical ventilation may not cause significantly differences in 60-day mortality. PMID:25861341

  16. Early sedation and clinical outcomes of mechanically ventilated patients: a prospective multicenter cohort study

    PubMed Central

    2014-01-01

    Introduction Sedation overuse is frequent and possibly associated with poor outcomes in the intensive care unit (ICU) patients. However, the association of early oversedation with clinical outcomes has not been thoroughly evaluated. The aim of this study was to assess the association of early sedation strategies with outcomes of critically ill adult patients under mechanical ventilation (MV). Methods A secondary analysis of a multicenter prospective cohort conducted in 45 Brazilian ICUs, including adult patients requiring ventilatory support and sedation in the first 48hours of ICU admissions, was performed. Sedation depth was evaluated after 48hours of MV. Multivariate analysis was used to identify variables associated with hospital mortality. Results A total of 322 patients were evaluated. Overall, ICU and hospital mortality rates were 30.4% and 38.8%, respectively. Deep sedation was observed in 113 patients (35.1%). Longer duration of ventilatory support was observed (7 (4 to 10) versus 5 (3 to 9) days, P?=?0.041) and more tracheostomies were performed in the deep sedation group (38.9% versus 22%, P?=?0.001) despite similar PaO2/FiO2 ratios and acute respiratory distress syndrome (ARDS) severity. In a multivariate analysis, age (Odds Ratio (OR) 1.02; 95% confidence interval (CI) 1.00 to 1.03), Charlson Comorbidity Index >2 (OR 2.06; 95% CI, 1.44 to 2.94), Simplified Acute Physiology Score 3 (SAPS 3) score (OR 1.02; CI 95%, 1.00 to 1.04), severe ARDS (OR 1.44; CI 95%, 1.09 to 1.91) and deep sedation (OR 2.36; CI 95%, 1.31 to 4.25) were independently associated with increased hospital mortality. Conclusions Early deep sedation is associated with adverse outcomes and constitutes an independent predictor of hospital mortality in mechanically ventilated patients. PMID:25047960

  17. Discrimination of True Lower Respiratory Tract Infection in the Mechanically Ventilated Patient

    Microsoft Academic Search

    Richard G. Wunderink; Grant W. Waterer

    \\u000a Pneumonia is a common complication in patients requiring mechanical ventilation, with prevalence estimates varying between\\u000a 6 and 52 cases per 100 patients, depending on the population studied (1). Far from a benign event, ventilator-associated pneumonia (VAP) is associated with a significant increase in mortality (24), with an attributable mortality exceeding 25% in one matched cohort study (5).

  18. Opioid Analgesia in Mechanically Ventilated Children: Results from the multicenter MOTIF study

    PubMed Central

    Anand, Kanwaljeet J. S.; Clark, Amy E.; Willson, Douglas F.; Berger, John; Meert, Kathleen L.; Zimmerman, Jerry J.; Harrison, Rick; Carcillo, Joseph A.; Newth, Christopher J. L.; Bisping, Stephanie; Holubkov, Richard; Dean, J. Michael; Nicholson, Carol E.

    2013-01-01

    Objective To examine the clinical factors associated with increased opioid dose among mechanically ventilated children in the Pediatric Intensive Care Unit (PICU). Design Prospective, observational study with 100% accrual of eligible patients. Setting Seven PICUs from tertiary-care childrens hospitals in the Collaborative Pediatric Critical Care Research Network. Patients 419 children treated with morphine or fentanyl infusions. Interventions None Measurements and Main Results Data on opioid use, concomitant therapy, demographic and explanatory variables were collected. Significant variability occurred in clinical practices, with up to 100-fold differences in baseline opioid doses, average daily or total doses, or peak infusion rates. Opioid exposure for 7 or 14 days required doubling of the daily opioid dose in 16% patients (95%CI: 1219%) and 20% patients (95%CI: 1624%) respectively. Among patients receiving opioids for longer than 3 days (n=225), this occurred in 28% (95%CI 2233%) and 35% (95%CI 2941%) by 7 or 14 days respectively. Doubling of the opioid dose was more likely to occur following opioid infusions for 7 days or longer (OR 7.9, 95%CI 4.314.3; p<0.001) or co-therapy with midazolam (OR 5.6, 95%CI 2.412.9; p<0.001), and it was less likely to occur if morphine was used as the primary opioid (vs. fentanyl) (OR 0.48, 95%CI 0.250.92; p=0.03), for patients receiving higher initial doses (OR 0.96, 95%CI 0.950.98; p<0.001), or if patients had prior PICU admissions (OR 0.37, 95%CI 0.150.89, p=0.03). Conclusions Mechanically ventilated children require increasing opioid doses, often associated with prolonged opioid exposure or the need for additional sedation. Efforts to reduce prolonged opioid exposure and clinical practice variation may prevent the complications of opioid therapy. PMID:23132396

  19. 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.

  20. 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.

  1. Experimental studies on the airflow characteristics of spaces with mechanical ventilation

    SciTech Connect

    Chow, W.K. [Hong Kong Polytechnic Univ., Hunghom (Hong Kong). Dept. of Building Services Engineering; Fung, W.Y. [Kowloon Canton Railway Corp., Fotan (Hong Kong)

    1997-12-31

    Ventilation in the occupied zone was studied experimentally in the waiting area of nine railway concourses in Hong Kong. The performance of the mechanical ventilation systems in those areas was also evaluated by studying the age of air, local air velocity, and carbon dioxide level. The results show that ventilation effectiveness may not necessarily be improved with increasing supply or extraction flow rate. The revised jet momentum numbers for those stations are also calculated and compared with the mean carbon dioxide concentration and the local age of air. It appears that this parameter can be used for evaluating the performance of the ventilation systems. A linear relation is fitted empirically to correlate the mean local age of air with the revised jet momentum number for the nine stations.

  2. Modeling airflow-related shear stress during heterogeneous constriction and mechanical ventilation

    E-print Network

    Lutchen, Kenneth

    Modeling airflow-related shear stress during heterogeneous constriction and mechanical ventilation, and Kenneth Lutchen. Modeling airflow-related shear stress during heterogeneous constriction and mechanical airflow-related shear stress to a dangerously high level that may be sufficient to cause injury

  3. 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

  4. Is there a benefit to multidisciplinary rounds in an open trauma intensive care unit regarding ventilator-associated pneumonia?

    PubMed

    Johnson, Van; Mangram, Alicia; Mitchell, Christopher; Lorenzo, Manuel; Howard, Dot; Dunn, Ernest

    2009-12-01

    Multidisciplinary rounds (MDRs) have been instituted for patient care since June 2005. Before June 2005, all care was provided by individual practitioners. MDRs include the surgical intensivist, surgical resident, patient's nurse, case manager, pharmacist, chaplain, nutritionist, and respiratory therapist. Our study examined the effect of MDRs on ventilator-associated pneumonia in trauma patients in open intensive care units (ICUs). Group 1 included patients from June 2003 to May 2005 before the implementation of MDRs, and Group 2 included patients after the institution of MDRs from June 2005 to May 2007. In Group 1, there were 83 ventilator-associated pneumonias (VAPs) during 2414 ventilator days. In Group 2, there were 49 VAPs during 2094 ventilator days. The ratio of VAPs per thousand ventilator days decreased from 34.4 to 23.4 between the two groups (P = 0.04). When comparing trauma patients in our open ICU with similar mean Injury Severity Score and mean Abbreviated Injury Score for chest and for head and neck, implementing MDRs significantly decreased our incidence of VAP. PMID:19999906

  5. Complex care: Ventilation management when brain injury and acute lung injury coexist.

    PubMed

    Modock, Jacqueline

    2014-04-01

    The purpose of this article is to explore the management of coexisting brain insult and acute lung injury to help guide clinicians in balancing what may appear to be competing goals. First, contemporary management of mechanically ventilated patients with either brain or lung injury diagnoses is reviewed, followed by a review of intracranial pressure and acute lung injury/acute respiratory distress syndrome. The article ends with a discussion of a literature review regarding possible treatment balance when the two conditions coexist. PMID:24556654

  6. 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 Simes; 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 Clnicas, 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

  7. Year in review 2008: Critical Care - respirology

    PubMed Central

    2009-01-01

    Original research contributions published in Critical Care in 2008 in the fields of respirology and critical care medicine are summarized. Eighteen articles were grouped into the following categories: acute lung injury and acute respiratory distress syndrome, mechanical ventilation, mechanisms of ventilator-induced lung injury, and tracheotomy decannulation and non-invasive ventilation. PMID:19863765

  8. Breath analysis for in vivo detection of pathogens related to ventilator-associated pneumonia in intensive care patients: a prospective pilot study.

    PubMed

    Filipiak, Wojciech; Beer, Ronny; Sponring, Andreas; Filipiak, Anna; Ager, Clemens; Schiefecker, Alois; Lanthaler, Simon; Helbok, Raimund; Nagl, Markus; Troppmair, Jakob; Amann, Anton

    2015-01-01

    Existing methods for the early detection of infections in mechanically ventilated (MV) patients at intensive care units (ICUs) are unsatisfactory. Here we present an exploratory study assessing the feasibility of breath VOC analyses for the non-invasive detection of pathogens in the lower respiratory tract of ventilated patients. An open uncontrolled clinical pilot study was performed by enrolling 28 mechanically ventilated (MV) patients with severe intracranial disease, being at risk for the development of or already with confirmed ventilation-associated pneumonia (VAP). The recently developed sampling technique enabled the collection of breath gas with a maximized contribution of alveolar air directly from the respiratory circuit under continuous capnography control, adsorptive preconcentration and final analysis by means of gas chromatography-mass spectrometry (GC-MS).VAP was confirmed in 22/28 preselected patients (78%). The most common microorganisms were Staphylococcus aureus (5/22 VAP patients), Escherichia coli (5/22 VAP patients) and Candida spp. (5/22 VAP patients). 12/32 metabolites released by S. aureus in our previous in vitro studies were also detected in the end-tidal air of VAP patients infected with this pathogen. A similar overlap was seen in Candida albicans infections (8/29 VOCs). Moreover, the concentration profile of selected compounds correlated with the course of the infection.This prospective pilot study provides proof of the concept that the appearance and the concentration profile of pathogen-derived metabolites (elucidated from in vitro experiments) in the breath of ventilated patients during clinically confirmed VAP correlates with the presence of a particular pathogen. PMID:25557917

  9. Predictors of Mortality in Mechanically Ventilated Critical Pertussis in a low Income Country

    PubMed Central

    Borgi, Aida; Menif, Khaled; Belhadj, Sarra; Ghali, Narjess; Salmen, Loukil; Hamdi, Asma; Khaldi, Ammar; Bouaffsoun, Aida; Kechaou, Sonia; Kechrid, Amel; Bouziri, Asma; Benjaballah, Nejla

    2014-01-01

    Background Critical pertussis is characterized by severe respiratory failure, important leukocytosis, pulmonary hypertension, septic shock and encephalopathy. Aim To describe the clinical course of critical pertussis, and identify predictors of death at the time of presentation for medical care. Methodology Retrospective study conducted in childrens hospital Tunisian PICU between 01 January and 31 October 2013. Patients with critical pertussis confirmed by RT-PCR and requiring mechanical ventilation were included. Predictors of death were studied. Results A total of 17 patients was studied. Median age was 50 days. Mortality was 23%. Predictors risk of mortality were : high PRISM score (Pediatric Risk of Mortality Score) (p=0,007), shock (p=0,002), tachycardia (p=0,005), seizures (p=0,006), altered mental status (p=0,006), elevated WBC count (p=0,003) and hemodynamic support (p=0022). However, the difference did not reach statistical significance in comorbidity, pneumoniae, high pulmonary hypertension or exchange transfusion. Concomitant viral or bacterial co-infection was not related to poor outcome. Conclusion Young infants are at high risk to have critical pertussis. Despite advances in life support and the treatment of organ failure in childhood critical illness, critical pertussis remains difficult to treat. PMID:25237472

  10. Determinants of plasma copeptin: a systematic investigation in a pediatric mechanical ventilation model.

    PubMed

    L'Abate, Pietro; Wiegert, Susanne; Struck, Joachim; Wellmann, Sven; Cannizzaro, Vincenzo

    2013-01-15

    Copeptin, the C-terminal part of the arginine vasopressin precursor peptide, holds promise as a diagnostic and prognostic plasma biomarker in various acute clinical conditions. Factors influencing copeptin response in the critical care setting are only partially established and have not been investigated systematically. Using an in vivo infant ventilation model (Wistar rats, 14 days old), we studied the influence of commonly occurring stressors in critically ill children. In unstressed ventilated rats basal median copeptin concentration was 22pmol/L. In response to respiratory alkalosis copeptin increased 5-fold, while exposure to hypoxemia, high PEEP, hemorrhage, and psycho-emotional stress produced a more than 10-fold increase. Additionally, we did not find a direct association between copeptin and acidosis, hypercapnia, and hyperthermia. Clinicians working in the acute critical care setting should be aware of factors influencing copeptin plasma concentrations. Moreover, our results do have implications for animal studies in the field of stress research. PMID:23123968

  11. Double impact of cigarette smoke and mechanical ventilation on the alveolar epithelial type II cell

    PubMed Central

    2014-01-01

    Introduction Ventilator-induced lung injury (VILI) impacts clinical outcomes in acute respiratory distress syndrome (ARDS), which is characterized by neutrophil-mediated inflammation and loss of alveolar barrier function. Recent epidemiological studies suggest that smoking may be a risk factor for the development of ARDS. Because alveolar type II cells are central to maintaining the alveolar epithelial barrier during oxidative stress, mediated in part by neutrophilic inflammation and mechanical ventilation, we hypothesized that exposure to cigarette smoke and mechanical strain have interactive effects leading to the activation of and damage to alveolar type II cells. Methods To determine if cigarette smoke increases susceptibility to VILI in vivo, a clinically relevant rat model was established. Rats were exposed to three research cigarettes per day for two weeks. After this period, some rats were mechanically ventilated for 4 hours. Bronchoalveolar lavage (BAL) and differential cell count was done and alveolar type II cells were isolated. Proteomic analysis was performed on the isolated alveolar type II cells to discover alterations in cellular pathways at the protein level that might contribute to injury. Effects on levels of proteins in pathways associated with innate immunity, oxidative stress and apoptosis were evaluated in alveolar type II cell lysates by enzyme-linked immunosorbent assay. Statistical comparisons were performed by t-tests, and the results were corrected for multiple comparisons using the false discovery rate. Results Tobacco smoke exposure increased airspace neutrophil influx in response to mechanical ventilation. The combined exposure to cigarette smoke and mechanical ventilation significantly increased BAL neutrophil count and protein content. Neutrophils were significantly higher after smoke exposure and ventilation than after ventilation alone. DNA fragments were significantly elevated in alveolar type II cells. Smoke exposure did not significantly alter other protein-level markers of cell activation, including Toll-like receptor 4; caspases 3, 8 and 9; and heat shock protein 70. Conclusions Cigarette smoke exposure may impact ventilator-associated alveolar epithelial injury by augmenting neutrophil influx. We found that cigarette smoke had less effect on other pathways previously associated with VILI, including innate immunity, oxidative stress and apoptosis. PMID:24666941

  12. Legal mechanisms supporting accountable care principles.

    PubMed

    Ramanathan, Tara

    2014-11-01

    Public health and private providers and facilities may shape the future of the US health system by engaging in new ways to deliver care to patients. "Accountable care" contracts allow private health care and public health providers and facilities to collaboratively serve defined populations. Accountable care frameworks emphasize health care quality and cost savings, among other goals. In this article, I explore the legal context for accountable care, including the mechanisms by which providers, facilities, and public health coordinate activities, avoid inefficiencies, and improve health outcomes. I highlight ongoing evaluations of the impact of accountable care on public health outcomes. PMID:25211740

  13. Impact of Ventilatory Modes on the Breathing Variability in Mechanically Ventilated Infants

    PubMed Central

    Baudin, Florent; Wu, Hau-Tieng; Bordessoule, Alice; Beck, Jennifer; Jouvet, Philippe; Frasch, Martin G.; Emeriaud, Guillaume

    2014-01-01

    Objectives: Reduction of breathing variability is associated with adverse outcome. During mechanical ventilation, the variability of ventilatory pressure is dependent on the ventilatory mode. During neurally adjusted ventilatory assist (NAVA), the support is proportional to electrical activity of the diaphragm (EAdi), which reflects the respiratory center output. The variability of EAdi is, therefore, translated into a similar variability in pressures. Contrastingly, conventional ventilatory modes deliver less variable pressures. The impact of the mode on the patients own respiratory drive is less clear. This study aims to compare the impact of NAVA, pressure-controlled ventilation (PCV), and pressure support ventilation (PSV) on the respiratory drive patterns in infants. We hypothesized that on NAVA, EAdi variability resembles most of the endogenous respiratory drive pattern seen in a control group. Methods: Electrical activity of the diaphragm was continuously recorded in 10 infants ventilated successively on NAVA (5?h), PCV (30?min), and PSV (30?min). During the last 10?min of each period, the EAdi variability pattern was assessed using non-rhythmic to rhythmic (NRR) index. These variability profiles were compared to the pattern of a control group of 11 spontaneously breathing and non-intubated infants. Results: In control infants, NRR was higher as compared to mechanically ventilated infants (p?Mechanical ventilation impacts the breathing variability in infants. NAVA produces EAdi pattern resembling most that of control infants. NRR can be used to characterize respiratory variability in infants. Larger prospective studies are necessary to understand the differential impact of the ventilatory modes on the cardio-respiratory variability and to study their impact on clinical outcomes. PMID:25505779

  14. Interplay between nuclear factor erythroid 2-related factor 2 and amphiregulin during mechanical ventilation.

    PubMed

    Reiss, Lucy Kathleen; Fragoulis, Athanassios; Siegl, Stephanie; Platen, Christopher; Kan, Yuet Wai; Nautiyal, Jaya; Parker, Malcom; Pufe, Thomas; Uhlig, Ulrike; Martin, Christian; Uhlig, Stefan; Wruck, Christoph Jan

    2014-11-01

    Mechanical ventilation (MV) elicits complex and clinically relevant cellular responses in the lungs. The current study was designed to define the role of the transcription factor nuclear factor erythroid 2-related factor 2 (Nrf2), a major regulator of the cellular antioxidant defense system, in the pulmonary response to MV. Nrf2 activity was quantified in ventilated isolated perfused mouse lungs (IPL). Regulation of amphiregulin (AREG) was investigated in BEAS-2B cells with inactivated Nrf2 or Keap1, the inhibitor of Nrf2, using a luciferase vector with AREG promoter. AREG-dependent Nrf2 activity was examined in BEAS-2B cells, murine precision-cut lung slices (PCLS), and IPL. Finally, Nrf2 knockout and wild-type mice were ventilated to investigate the interplay between Nrf2 and AREG during MV in vivo. Lung functions and inflammatory parameters were measured. Nrf2 was activated in a ventilation-dependent manner. The knockdown of Nrf2 and Keap1 via short hairpin RNA in BEAS-2B cells and an EMSA with lung tissue revealed that AREG is regulated by Nrf2. Conversely, AREG application induced a significant Nrf2 activation in BEAS-2B cells, PCLS, and IPL. The signal transduction of ventilation-induced Nrf2 activation was shown to be p38 MAP kinase-dependent. In vivo ventilation experiments indicated that AREG is regulated by Nrf2 during MV. We conclude that Areg expression is regulated by Nrf2. During high-pressure ventilation, Nrf2 becomes activated and induces AREG, leading to a positive feedback loop between Nrf2 and AREG, which involves the p38 MAPK and results in the expression of cytoprotective genes. PMID:24921206

  15. Mechanical ventilation and sepsis induce skeletal muscle catabolism in neonatal pigs

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Reduced rates of skeletal muscle accretion are a prominent feature of the metabolic response to sepsis in infants and children. Septic neonates often require medical support with mechanical ventilation (MV). The combined effects of MV and sepsis in muscle have not been examined in neonates, in whom ...

  16. Mechanical ventilation alone, and in the presence sepsis, induces peripheral skeletal muscle catabolism in neonatal pigs

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Reduced rates of skeletal muscle accretion are a prominent feature of the metabolic response to sepsis in infants and children. Septic neonates often require medical support with mechanical ventilation (MV). The combined effects of MV and sepsis in muscle have not been examined in neonates, in whom ...

  17. Mechanical ventilation induces myokine expression and catabolism in peripheral skeletal muscle in pigs

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Endotoxin (LPS)-induced sepsis increases circulating cytokines which have been associated with skeletal muscle catabolism. During critical illness, it has been postulated that muscle wasting associated with mechanical ventilation (MV) occurs due to inactivity. We hypothesize that MV and sepsis promo...

  18. Bronchial Microbial Patterns in Severe Exacerbations of Chronic Obstructive Pulmonary Disease (COPD) Requiring Mechanical Ventilation

    Microsoft Academic Search

    NSTOR SOLER; ANTONI TORRES; SANTIAGO EWIG; JULI GONZALEZ; ROSA CELIS; MUSTAFA EL-EBIARY; CARMEN HERNANDEZ; ROBERTO RODRIGUEZ-ROISIN

    1998-01-01

    We carried out a comprehensive microbiological study of the upper and lower airways in patients with severe exacerbations of chronic obstructive pulmonary disease (COPD) requiring mechanical ventilation in order to describe microbial patterns and analyze their clinical significance. Quantitative cultures of tracheobronchial aspirates (TBAs), bronchoscopically retrieved protected specimen brush (PSB) and bronchoalveolar lavage fluid (BALF) at admission to the ICU

  19. Evaluation of compliance with a computerized protocol: Weaning from mechanical ventilator support using pressure support

    Microsoft Academic Search

    Adrienne G Randolph; Terry P Clemmer; Thomas D East; Arvid T Kinder; James F Orme; C. Jane Wallace; Alan H Morris

    1998-01-01

    Study objectives: To use a computerized consultation system to evaluate the feasibility of a mechanical ventilator weaning protocol which used the rapid shallow breathing index to guide adjustments in pressure support. A program to monitor user compliance and reasons for noncompliance was built into the computerized consultation system. Methods: A total of nine critically ill patients (ten weaning episodes) were

  20. Biophysical determinants of alveolar epithelial plasma membrane wounding associated with mechanical ventilation

    PubMed Central

    Hussein, Omar; Walters, Bruce; Stroetz, Randolph; Valencia, Paul; McCall, Deborah

    2013-01-01

    Mechanical ventilation may cause harm by straining lungs at a time they are particularly prone to injury from deforming stress. The objective of this study was to define the relative contributions of alveolar overdistension and cyclic recruitment and collapse of unstable lung units to membrane wounding of alveolar epithelial cells. We measured the interactive effects of tidal volume (VT), transpulmonary pressure (PTP), and of airspace liquid on the number of alveolar epithelial cells with plasma membrane wounds in ex vivo mechanically ventilated rat lungs. Plasma membrane integrity was assessed by propidium iodide (PI) exclusion in confocal images of subpleural alveoli. Cyclic inflations of normal lungs from zero end-expiratory pressure to 40 cmH2O produced VT values of 56.9 3.1 ml/kg and were associated with 0.12 0.12 PI-positive cells/alveolus. A preceding tracheal instillation of normal saline (3 ml) reduced VT to 49.1 6 ml/kg but was associated with a significantly greater number of wounded alveolar epithelial cells (0.52 0.16 cells/alveolus; P < 0.01). Mechanical ventilation of completely saline-filled lungs with saline (VT = 52 ml/kg) to pressures between 10 and 15 cmH2O was associated with the least number of wounded epithelial cells (0.02 0.02 cells/alveolus; P < 0.01). In mechanically ventilated, partially saline-filled lungs, the number of wounded cells increased substantially with VT, but, once VT was accounted for, wounding was independent of maximal PTP. We found that interfacial stress associated with the generation and destruction of liquid bridges in airspaces is the primary biophysical cell injury mechanism in mechanically ventilated lungs. PMID:23997173

  1. Sustained Inflation at Birth Did Not Alter Lung Injury from Mechanical Ventilation in Surfactant-Treated Fetal Lambs

    PubMed Central

    Hillman, Noah H.; Kemp, Matthew W.; Miura, Yuichiro; Kallapur, Suhas G.; Jobe, Alan H.

    2014-01-01

    Background Sustained inflations (SI) are used with the initiation of ventilation at birth to rapidly recruit functional residual capacity and may decrease lung injury and the need for mechanical ventilation in preterm infants. However, a 20 second SI in surfactant-deficient preterm lambs caused an acute phase injury response without decreasing lung injury from subsequent mechanical ventilation. Hypothesis A 20 second SI at birth will decrease lung injury from mechanical ventilation in surfactant-treated preterm fetal lambs. Methods The head and chest of fetal sheep at 1261 day GA were exteriorized, with tracheostomy and removal of fetal lung fluid prior to treatment with surfactant (300 mg in 15 ml saline). Fetal lambs were randomized to one of four 15 minute interventions: 1) PEEP 8 cmH2O; 2) 20 sec SI at 40 cmH2O, then PEEP 8 cmH2O; 3) mechanical ventilation with 7 ml/kg tidal volume; or 4) 20 sec SI then mechanical ventilation at 7 ml/kg. Fetal lambs remained on placental support for the intervention and for 30 min after the intervention. Results SI recruited a mean volume of 6.80.8 mL/kg. SI did not alter respiratory physiology during mechanical ventilation. Heat shock protein (HSP) 70, HSP60, and total protein in lung fluid similarly increased in both ventilation groups. Modest pro-inflammatory cytokine and acute phase responses, with or without SI, were similar with ventilation. SI alone did not increase markers of injury. Conclusion In surfactant treated fetal lambs, a 20 sec SI did not alter ventilation physiology or markers of lung injury from mechanical ventilation. PMID:25419969

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

    PubMed

    Alfonso Megido, Joaqun; Gonzlez 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

  3. Nebulized heparin is associated with fewer days of mechanical ventilation in critically ill patients: a randomized controlled trial

    PubMed Central

    2010-01-01

    Introduction Prolonged mechanical ventilation has the potential to aggravate or initiate pulmonary inflammation and cause lung damage through fibrin deposition. Heparin may reduce pulmonary inflammation and fibrin deposition. We therefore assessed whether nebulized heparin improved lung function in patients expected to require prolonged mechanical ventilation. Methods Fifty patients expected to require mechanical ventilation for more than 48 hours were enrolled in a double-blind randomized placebo-controlled trial of nebulized heparin (25,000 U) or placebo (normal saline) 4 or 6 hourly, depending on patient height. The study drug was continued while the patient remained ventilated to a maximum of 14 days from randomization. Results Nebulized heparin was not associated with a significant improvement in the primary end-point, the average daily partial pressure of oxygen to inspired fraction of oxygen ratio while mechanically ventilated, but was associated with improvement in the secondary end-point, ventilator-free days amongst survivors at day 28 (22.6 4.0 versus 18.0 7.1, treatment difference 4.6 days, 95% CI 0.9 to 8.3, P = 0.02). Heparin administration was not associated with any increase in adverse events. Conclusions Nebulized heparin was associated with fewer days of mechanical ventilation in critically ill patients expected to require prolonged mechanical ventilation. Further trials are required to confirm these findings. Trial registration The Australian Clinical Trials Registry (ACTR-12608000121369). PMID:20937093

  4. Environmental and ventilation assessment in Child Day Care Centers in Porto: the ENVIRH Project.

    PubMed

    Mendes, Ana; Aelenei, Daniel; Papoila, Ana Lusa; Carreiro-Martins, Pedro; Aguiar, Lvia; Pereira, Cristiana; Neves, Paula; Azevedo, Susana; Cano, Manuela; Proena, Carmo; Viegas, Joo; Silva, Susana; Mendes, Diana; Neuparth, Nuno; Teixeira, Joo Paulo

    2014-01-01

    Children attending day care centers (CDCC) have been reported to be more prone to infectious diseases when compared with those cared for at home, and are exposed to conditions that may increase the risk of allergies and asthma. Several studies revealed that consequences of poor ventilation conditions include high levels of carbon dioxide (CO2) and many other indoor pollutants commonly detected in schools. Nine child day care centers were selected randomly to participate in this study. Fifty-two classrooms were assessed for chemical, biological, physical, and allergen parameters in spring and winter seasons in these nine CDCC located in Porto, Portugal. Outdoor measurements were also conducted for comparison. Our results indicated that (i) particulate matter (PM10) median levels were above the national reference levels, both by classroom type and by season; (ii) TVOC kindergarten peak values may raise some concern; (iii) CO2 was present at high median and maximum levels during spring and winter assessment in both nurseries and kindergartens classrooms; (iv) total bacteria concentrations were 57- and 52-fold higher in the nursery and kindergarten than outdoors, respectively, for the spring season; (v) winter and spring median predicted mean vote (PMV) indices were between "neutral" (0) and "slightly cool" (? -1) in the thermal sensation scale for comfort situations (-2 to 2) for both types of classrooms; (vi) there were significant differences for both PMV and predicted percentage of dissatisfied (PPD) indices by season; and (vii) CO2, total bacteria, and gram-negative bacteria were associated with low airflow rates. These data will help to evaluate the effectiveness of current building operation practices in child day care centers regarding indoor air quality and respiratory health. PMID:25072725

  5. Alterations in expression of elastogenic and angiogenic genes by different conditions of mechanical ventilation in newborn rat lung.

    PubMed

    Kroon, Andreas A; Wang, Jinxia; Post, Martin

    2015-04-01

    Mechanical ventilation is an important risk factor for development of bronchopulmonary dysplasia. Here we investigated the effects of different tidal volumes (VT) and duration of ventilation on expression of genes involved in alveolarization [tropoelastin (Eln), lysyloxidase-like 1 (Loxl1), fibulin5 (Fbln5), and tenascin-C (Tnc)] and angiogenesis [platelet derived growth factors (Pdgf) and vascular endothelial growth factors (Vegf) and their receptors] in 8-day-old rats. First, pups were ventilated for 8 h with low (LVT: 3.5 ml/kg), moderate (MVT: 8.5 ml/kg), or high (HVT: 25 ml/kg) tidal volumes. LVT and MVT decreased Tnc expression, whereas HVT increased expression of all three elastogenic genes and Tnc. PDGF ?-receptor mRNA was increased in all ventilation groups, while Pdgfb expression was decreased after MVT and HVT ventilation. Only HVT ventilation upregulated Vegf expression. Independent of VT, ventilation upregulated Vegfr1 expression, while MVT and HVT downregulated Vegfr2 expression. Next, we evaluated duration (0-24 h) of MVT ventilation on gene expression. Although expression of all elastogenic genes peaked at 12 h of ventilation, only Fbln5 was negatively affected at 24 h. Tnc expression decreased with duration of ventilation. Changes in expression of Pdgfr and Vegfr were maximal at 8 h of ventilation. Disturbed elastin fiber deposition and decrease in small vessel density was only observed after 24 h. Thus, an imbalance between Fbln5 and Eln expression may trigger dysregulated elastin fiber deposition during the first 24 h of mechanical ventilation. Furthermore, ventilation-induced alterations in Pdgf and Vegf receptor expression are tidal volume dependent and may affect pulmonary vessel formation. PMID:25617376

  6. Variable versus conventional lung protective mechanical ventilation during open abdominal surgery: study protocol for a randomized controlled trial

    PubMed Central

    2014-01-01

    Background General anesthesia usually requires mechanical ventilation, which is traditionally accomplished with constant tidal volumes in volume- or pressure-controlled modes. Experimental studies suggest that the use of variable tidal volumes (variable ventilation) recruits lung tissue, improves pulmonary function and reduces systemic inflammatory response. However, it is currently not known whether patients undergoing open abdominal surgery might benefit from intraoperative variable ventilation. Methods/Design The PROtective VARiable ventilation trial (PROVAR) is a single center, randomized controlled trial enrolling 50 patients who are planning for open abdominal surgery expected to last longer than 3hours. PROVAR compares conventional (non-variable) lung protective ventilation (CV) with variable lung protective ventilation (VV) regarding pulmonary function and inflammatory response. The primary endpoint of the study is the forced vital capacity on the first postoperative day. Secondary endpoints include further lung function tests, plasma cytokine levels, spatial distribution of ventilation assessed by means of electrical impedance tomography and postoperative pulmonary complications. Discussion We hypothesize that VV improves lung function and reduces systemic inflammatory response compared to CV in patients receiving mechanical ventilation during general anesthesia for open abdominal surgery longer than 3hours. PROVAR is the first randomized controlled trial aiming at intra- and postoperative effects of VV on lung function. This study may help to define the role of VV during general anesthesia requiring mechanical ventilation. Trial registration Clinicaltrials.gov NCT01683578 (registered on September 3 3012). PMID:24885921

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

    PubMed

    Khnlein, Peter; Kbler, Andrea; Raubold, Sabine; Worrell, Marcia; Kurt, Anja; Gdynia, Hans-Jrgen; 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

  8. Predictors and course of elective long-term mechanical ventilation: A prospective study of ALS patients.

    PubMed

    Rabkin, Judith G; Albert, Steven M; Tider, Toby; Del Bene, Maura L; O'Sullivan, Ita; Rowland, Lewis P; Mitsumoto, Hiroshi

    2006-06-01

    We sought to characterize ALS patients who opt for tracheostomy and long-term mechanical ventilation (LTMV) and compare them with respect to medical, psychiatric, and psychosocial measures to patients who declined tracheostomy and died. We studied 72 ALS patients who were identified as hospice-eligible. They were assessed monthly until the endpoint of death or tracheostomy. LTMV patients continued to be followed for up to 55 months. The spouse or other caregiver was similarly interviewed and followed. Medical and psychiatric evaluations were conducted, in addition to self-reported depressive symptoms, future orientation, attitudes about hastened death, religious beliefs, and quality of life. Global cognitive capacity was assessed by caregivers. Fourteen patients chose LTMV; 58 died without LTMV. At study entry, those who later chose LTMV were younger, more had young children, had more education, and higher household incomes on average. Although their physical conditions were similar, they reported higher levels of optimism including belief in imminent cure, and more positive appraisals of their ability to function in daily life, their physical health and overall life satisfaction. At study entry, none who later chose LTMV were clinically depressed, compared to 26% of those who later refused LTMV, and their mean scores on the Beck Depression Inventory were in the "not depressed" range while the mean for patients who later died was in the "probable depression" range. Fourteen percent of patients who later chose LTMV were reported by caregivers to have had at least mild cognitive problems, compared to 49% of those who later died. After an average of 33 months on LTMV, only about half retained high levels of optimism and enjoyment of daily life, independent of residence (home vs. facility). Two patients expressed interest in hastening death but none had asked to terminate ventilation despite disease progression. However, half identified future circumstances that would render life intolerable. At last contact with caregivers, only one LTMV patient was reported to have major cognitive impairment. While reporting substantial emotional burden after LTMV, most but not all spousal caregivers continued to express satisfaction with care-giving. Our findings suggest that the choice of LTMV was not about desperation (although it may involve unrealistic expectations of cure by some), ignorance, or inability to make wishes clear during a chaotic dying period. Rather, LTMV choice was consistent with a sustained sense that life was worth living in any way possible, at least for some time and within certain boundaries. ALS clinicians will need to recognize this motivation and provide appropriate clinical education to both patient and family. PMID:16753972

  9. Microbial Profile of Early and Late Onset Ventilator Associated Pneumonia in The Intensive Care Unit of A Tertiary Care Hospital in Bangalore, India

    PubMed Central

    Golia, Saroj; K.T., Sangeetha; C.L., Vasudha

    2013-01-01

    Introduction: Ventilator-associated pneumonia (VAP), an important form of hospital-acquired pneumonia (HAP), specifically refers to pneumonia developing in a patient on mechanical ventilator for more than 48 h after intubation or tracheostomy. Despite the advancements in antimicrobial regimes, VAP continues to be an important cause of morbidity and mortality. VAP requires a rapid diagnosis and initiation of appropriate antibiotic treatment, as there is adverse effect of inadequate antibiotic treatment on patients prognosis and the emergence of multidrug-resistant (MDR) pathogens. Aims: The present study was undertaken to assess the etiological agents of early-onset and late-onset VAP and to know their sensitivity pattern. Material and Methods: VAP data over a period of 12 months (February 2012 -February 2013) in a tertiary care ICU was retrospectively analysed. The patients were stratified by age, sex, duration of VAP (Early/Late onset) and the identified pathogens with their sensitivity pattern. Results: Incidence of VAP was found to be 35.14%, out of which 44.23% had early-onset (<4 days MV) VAP and 55.77% had late-onset (>4 days MV) VAP. The most common organisms isolated in early onset and late onset VAP was Pseudomonas aeruginosa, E.coli and Acinetobacter baumanii. All enterobacteriaceal isolates were extended spectrum beta lactamase (ESBL) producing organisms and all Staphylococcus aureus isolates except one were methicillin resistant. The incidence of Multidrug resistant (MDR) Pseudomonas aeruginosa and Acinetobacter were 40% and 37.5% respectively. Conclusion: Due to the increasing incidence of multidrug-resistant organisms in our ICU, early and correct diagnosis of VAP is an urgent challenge for an optimal antibiotic treatment and cure. Hence, knowing the local microbial flora causing VAP and effective infection control practices are essential to improve clinical outcomes. PMID:24392373

  10. Home Mechanical Ventilation in Childhood-Onset Hereditary Neuromuscular Diseases: 13 Years Experience at a Single Center in Korea

    PubMed Central

    Han, Young Joo; Park, June Dong; Lee, Bongjin; Choi, Yu Hyeon; Suh, Dong In; Lim, Byung Chan; Chae, Jong-Hee

    2015-01-01

    Introduction Children with hereditary neuromuscular diseases (NMDs) are at a high risk of morbidity and mortality related to respiratory failure. The use of home mechanical ventilation (HMV) has saved the lives of many children with NMD but, due to a lack of studies, dependable guidelines are not available. We drew upon our experience to compare the various underlying NMDs and to evaluate HMV with regard to respiratory morbidity, the proper indications and timing for its use, and to develop a policy to improve the quality of home noninvasive ventilation (NIV). Methods We retrospectively analyzed the medical records of 57 children with childhood-onset hereditary NMDs in whom HMV was initiated between January 2000 and May 2013 at Seoul National University Children's Hospital. The degree of respiratory morbidity was estimated by the frequency and duration of hospitalizations caused by respiratory distress. Results The most common NMD was spinal muscular atrophy (SMA, n = 33). Emergent mechanical ventilation was initiated in 44% of the patients before the confirmed diagnosis, and the indicators of pre-HMV respiratory morbidity (e.g., extubation trials, hypoxia, hospitalizations, and intensive care unit stay) were greater in these patients than in others. The proportion of post-HMV hospitalizations (range, 0.00?0.52; median, 0.01) was lower than that of pre-HMV hospitalizations (0.02?1.00; 0.99) (P < 0.001). Eight patients were able to maintain home NIV. The main causes of NIV failure were air leakage and a large amount of airway secretions. Conclusions The application of HMV helped reduce respiratory morbidity in children with childhood-onset hereditary NMD. Patients with SMA type I can benefit from an early diagnosis and the timely application of HMV. The choice between invasive and noninvasive HMV should be based on the patients age and NIV trial tolerance. Systematic follow-up guidelines provided by a multidisciplinary team are needed. PMID:25822836

  11. Prevention of ventilator-associated pneumonia in intensive care units: an international online survey

    PubMed Central

    2013-01-01

    Background On average 7% of patients admitted to intensive-care units (ICUs) suffer from a potentially preventable ventilator-associated pneumonia (VAP). Our objective was to survey attitudes and practices of ICUs doctors in the field of VAP prevention. Methods A questionnaire was made available online in 6 languages from April, 1st to September 1st, 2012 and disseminated through international and national ICU societies. We investigated reported practices as regards (1) established clinical guidelines for VAP prevention, and (2) measurement of process and outcomes, under the assumption if you cannot measure it, you cannot improve it; as well as attitudes towards the implementation of a measurement system. Weighted estimations for Europe were computed based on countries for which at least 10 completed replies were available, using total country population as a weight. Data from other countries were pooled together. Detailed country-specific results are presented in an online additional file. Results A total of 1730 replies were received from 77 countries; 1281 from 16 countries were used to compute weighted European estimates, as follows: care for intubated patients, combined with a measure of compliance to this guideline at least once a year, was reported by 57% of the respondents (95% CI: 5460) for hand hygiene, 28% (95% CI: 2433) for systematic daily interruption of sedation and weaning protocol, and 27% (95%: 2330) for oral care with chlorhexidine. Only 20% (95% CI: 1722) were able to provide an estimation of outcome data (VAP rate) in their ICU, still 93% (95% CI: 9194) agreed that Monitoring of VAP-related measures stimulates quality improvement. Results for 449 respondents from 61 countries not included in the European estimates are broadly comparable. Conclusions This study shows a low compliance with VAP prevention practices, as reported by ICU doctors in Europe and elsewhere, and identifies priorities for improvement. PMID:23531169

  12. Cisapride improves gastric emptying in mechanically ventilated, critically ill patients. A randomized, double-blind trial.

    PubMed

    Heyland, D K; Tougas, G; Cook, D J; Guyatt, G H

    1996-12-01

    We conducted a randomized, double-blind, placebo-controlled trial in mechanically ventilated intensive care unit (ICU) patients to evaluate the effect of cisapride on gastric emptying using an acetaminophen absorption model. We enrolled 72 patients expected to remain in the ICU for more than 48 h; 39% were female; the average age was 54.0 +/- 19.1 yr; 47% were postoperative, 83% were receiving narcotics, and the mean simplified acute physiology score (SAPS) was 9.5 +/- 3.0. Within 72 h of admission to ICU, 1.6 g of acetaminophen suspension was administered via a nasogastric tube into the stomach (Day 1). Blood samples were drawn at baseline, 30, 60, 90, 120, and 180 min for measurement of plasma acetaminophen levels. The following morning (Day 2), patients were randomized to receive 20 mg of cisapride or placebo and gastric emptying was again assessed. The difference (Day 2-Day 1) in the maximal plasma concentration was 49.1 mumol/L in the cisapride groups compared with 12.3 mumol/L in the placebo group (p = 0.005) and the time to reach maximal concentration was significantly shorter in the cisapride group (-40.8 min versus -4.2 min, p = 0.02). The difference in area under the time-acetaminophen concentration curve was also greater in the patients receiving cisapride (5,534 versus 2,832, p = 0.09). We conclude that cisapride enhances gastric emptying in critically ill patients. Studies to examine the effect of cisapride on tolerance to enteral nutrition, infectious morbidity, and other clinically important outcomes are warranted. PMID:8970354

  13. A Study of Utilization of Antimicrobial Agents in Patients on Ventilator in Intensive Care Unit (ICU) at Tertiary Care Teaching Hospital, India

    PubMed Central

    Gandhi, Anuradha M; Patel, Prakruti P

    2014-01-01

    Objective: To study the use of antimicrobial agents in patients on ventilator in ICU. Materials and Methods: Study was conducted at tertiary care teaching hospital Ahmedabad, India. Total 300 patients admitted in ICU and prescribed antimicrobial agents were included in the study. The data were recorded in preformed Case Record Form (CRF) and were analysed by Z and x2 Test. Results: Patients were divided into group A (patients on ventilator support) and group B (patients without ventilator support). In all the patients antimicrobial agents were prescribed empirically and more than two antimicrobial agents were prescribed in both groups. It was observed that above 60% antimicrobial agents were prescribed according to WHO, National and State Essential Medicine List (EML). Restricted antimicrobial agents (according to antimicrobial policy of tertiary care teaching hospital) were prescribed significantly (p<0.05) higher in group A as compared to group B. Resistance to antimicrobial agents by Pseudomonas aeruginosa and Kleibsella shown significantly (p<0.05) higher in group A as compared to group B. Change of antimicrobial therapy after Culture Sensitivity Test (CST) was significantly (p<0.05) higher in group A as compared to group B. Conclusion: Number of antimicrobial agents, antimicrobial resistance and change of antimicrobial therapy after CST were higher in patients on ventilator support. PMID:25584243

  14. Respiratory failure and mechanical ventilation: Pathophysiology and methods of promoting weaning

    Microsoft Academic Search

    Jill P. Karpel; Thomas K. Aldrich

    1986-01-01

    Respiratory failure may be manifested either by impaired gas exchange or by impaired ventilatory function. The latter results\\u000a in more severe problems in weaning patients from mechanical ventilation. Ventilatory failure may result from inadequate respiratory\\u000a drive, excessive respiratory workload, inadequate respiratory muscle endurance, or a combination of these factors.\\u000a \\u000a Simple bedside tests of ventilatory function are useful for evaluating the

  15. [Energy metabolism of ALS patients under mechanical ventilation and tube feeding].

    PubMed

    Shimizu, T; Hayashi, H; Tanabe, H

    1991-03-01

    We studied the energy metabolism of ALS patients under mechanical ventilation and tube feeding. Gas exchanges (O2 and CO2 content in expiratory and inspiratory gas) were measured all day long by DELTATRAC (Datex, Finland) in 11 ALS patients, and energy metabolism during 24 hours was calculated according to the next formula; 5.67 VO2 + 1.60 VCO2-2.17 UN (VO2; O2 consumption l/min, VCO2; CO2 production l/min, UN; urea nitrogen excretion in urine g/day). All patients were clinically stable under continuous mechanical ventilation and tube feeding, and did not have any infection such as pneumonia. The patients were 23-70 years old (mean 49.3), and had total clinical courses of 3-12 years (mean 7.1), and 2-8 year-long courses under mechanical ventilation (mean 4.6). They were classified into the next 3 groups: group I; totally locked-in state (2 patients), group II; complete tetraplegia (6 patients), group III; incomplete tetraparesis (3 patients). Basal metabolic rate (BMR) of each patient was also calculated from Harris-Benedict's formula; male = 66.47 + 13.75W + 5.0H - 6.76A, female = 665.10 + 0.567W + 1.85H - 4.68A (W; weight kg, H; height cm, A; body surface area m2). And the changes of the body weight by month were examined retrospectively in 26 ALS patients with at least 2 year-duration under mechanical ventilation, which include the previous 11 patients. The calorie consumption of 24 hours were 783.3 kcal (group I), 875.3 (group II), 974.9 (group III), which were all lower than BMR (I; -26.8%, II; -17.6%, III; -11.3%).(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1909943

  16. A Dynamic Bayesian Network for Diagnosing Ventilator-Associated Pneumonia in ICU Patients

    E-print Network

    Utrecht, Universiteit

    A Dynamic Bayesian Network for Diagnosing Ventilator-Associated Pneumonia in ICU Patients Theodore-associated pneumonia in mechanically ventilated patients in intensive care units is currently seen as a clinical challenge. The difficulty in diagnosing ventilator-associated pneumonia stems from the lack of a simple yet

  17. Mechanical ventilation alone, and in the presence of 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 ...

  18. Meeting Residential Ventilation Standards

    E-print Network

    LBNL 4591E Meeting Residential Ventilation Standards Through Dynamic Control of Ventilation Systems ventilation standards, including American Society of Heating, Refrigerating, and Air-conditioning Engineers (ASHRAE) Standard 62.2, specify continuous operation of a defined mechanical ventilation system to provide

  19. Respiratory Mechanics and Plasma Levels of Tumor Necrosis Factor Alpha and Interleukin 6 Are Affected by Gas Humidification during Mechanical Ventilation in Dogs

    PubMed Central

    Hernndez-Jimnez, Claudia; Garca-Torrentera, Rogelio; Olmos-Ziga, J. Ral; Jasso-Victoria, Rogelio; Gaxiola-Gaxiola, Miguel O.; Baltazares-Lipp, Matilde; Gutirrez-Gonzlez, Luis H.

    2014-01-01

    The use of dry gases during mechanical ventilation has been associated with the risk of serious airway complications. The goal of the present study was to quantify the plasma levels of TNF-alpha and IL-6 and to determine the radiological, hemodynamic, gasometric, and microscopic changes in lung mechanics in dogs subjected to short-term mechanical ventilation with and without humidification of the inhaled gas. The experiment was conducted for 24 hours in 10 dogs divided into two groups: Group I (n?=?5), mechanical ventilation with dry oxygen dispensation, and Group II (n?=?5), mechanical ventilation with oxygen dispensation using a moisture chamber. Variance analysis was used. No changes in physiological, hemodynamic, or gasometric, and radiographic constants were observed. Plasma TNF-alpha levels increased in group I, reaching a maximum 24 hours after mechanical ventilation was initiated (ANOVA p?=?0.77). This increase was correlated to changes in mechanical ventilation. Plasma IL-6 levels decreased at 12 hours and increased again towards the end of the study (ANOVA p>0.05). Both groups exhibited a decrease in lung compliance and functional residual capacity values, but this was more pronounced in group I. Pplat increased in group I (ANOVA p?=?0.02). Inhalation of dry gas caused histological lesions in the entire respiratory tract, including pulmonary parenchyma, to a greater extent than humidified gas. Humidification of inspired gases can attenuate damage associated with mechanical ventilation. PMID:25036811

  20. [Patient-ventilator interaction].

    PubMed

    Grsel, Gl; Aydo?du, Mge

    2009-01-01

    Mechanically ventilated patients interact with ventilator functions at different levels such as triggering of the ventilator, pressurization and cycling from inspiration to expiration. Patient ventilator asynchrony in any one of these phase results in fighting with ventilator, increase in work of breathing and respiratory muscle fatigue. Patient ventilator dyssynchrony occurs when gas delivery from the ventilator does not match with the neural output of the respiratory center. The clinical findings of patient-ventilator asynchrony are; use of accessory respiratory muscle, tachypnea, tachycardia, active expiration, diaphoresis and observation of asynchrony between patient respiratory effort and the ventilator waveforms. Among the patients with dynamic hyperinflation such as chronic obstructive pulmonary disease the most frequent causes of patient-ventilator asynchrony are trigger and expiratory asynchronies. In acute respiratory distress syndrome patient-ventilator asynchrony may develop due to problems in triggering or asynchrony in flow and inspiration-expiration cycle. Patient-ventilator interaction during noninvasive mechanical ventilation may be affected by the type of masks used, ventilator types, ventilation modes and parameters, humidification and sedation. Among the different patient groups it is important to know causes and solutions of patient-ventilator asynchrony problems. By this way patient will adapt ventilator and then dyspnea, ineffective respiratory effort and work of breathing may decrease subsequently. PMID:20037864

  1. Prospective Multicenter Study of Children With Bronchiolitis Requiring Mechanical Ventilation

    PubMed Central

    Piedra, Pedro A.; Stevenson, Michelle D.; Sullivan, Ashley F.; Forgey, Tate F.; Clark, Sunday; Espinola, Janice A.; Camargo, Carlos A.

    2012-01-01

    OBJECTIVE: To identify factors associated with continuous positive airway pressure (CPAP) and/or intubation for children with bronchiolitis. METHODS: We performed a 16-center, prospective cohort study of hospitalized children aged <2 years with bronchiolitis. For 3 consecutive years from November 1 until March 31, beginning in 2007, researchers collected clinical data and a nasopharyngeal aspirate from study participants. We oversampled children from the ICU. Samples of nasopharyngeal aspirate were tested by polymerase chain reaction for 18 pathogens. RESULTS: There were 161 children who required CPAP and/or intubation. The median age of the overall cohort was 4 months; 59% were male; 61% white, 24% black, and 36% Hispanic. In the multivariable model predicting CPAP/intubation, the significant factors were: age <2 months (odds ratio [OR] 4.3; 95% confidence interval [CI] 1.711.5), maternal smoking during pregnancy (OR 1.4; 95% CI 1.11.9), birth weight <5 pounds (OR 1.7; 95% CI 1.02.6), breathing difficulty began <1 day before admission (OR 1.6; 95% CI 1.22.1), presence of apnea (OR 4.8; 95% CI 2.58.5), inadequate oral intake (OR 2.5; 95% CI 1.34.3), severe retractions (OR 11.1; 95% CI 2.433.0), and room air oxygen saturation <85% (OR 3.3; 95% CI 2.04.8). The optimism-corrected c-statistic for the final model was 0.80. CONCLUSIONS: In this multicenter study of children hospitalized with bronchiolitis, we identified several demographic, historical, and clinical factors that predicted the use of CPAP and/or intubation, including children born to mothers who smoked during pregnancy. We also identified a novel subgroup of children who required mechanical respiratory support <1 day after respiratory symptoms began. PMID:22869823

  2. Mechanical ventilation and intra-abdominal hypertension: 'Beyond Good and Evil'

    PubMed Central

    2012-01-01

    Intra-abdominal hypertension is frequent in surgical and medical critically ill patients. Intra-abdominal hypertension has a serious impact on the function of respiratory as well as peripheral organs. In the presence of alveolar capillary damage, which occurs in acute respiratory distress syndrome (ARDS), intra-abdominal hypertension promotes lung injury as well as edema, impedes the pulmonary lymphatic drainage, and increases intra-thoracic pressures, leading to atelectasis, airway closure, and deterioration of respiratory mechanics and gas exchange. The optimal setting of mechanical ventilation and its impact on respiratory function and hemodynamics in ARDS associated with intra-abdominal hypertension are far from being assessed. We suggest that the optimal ventilator management of patients with ARDS and intra-abdominal hypertension would include the following: (a) intra-abdominal, esophageal pressure, and hemodynamic monitoring; (b) ventilation setting with protective tidal volume, recruitment maneuver, and level of positive end-expiratory pressure set according to the 'best' compliance of the respiratory system or the lung; (c) deep sedation with or without neuromuscular paralysis in severe ARDS; and (d) open abdomen in selected patients with severe abdominal compartment syndrome. PMID:23256904

  3. Individuality of breathing patterns in patients under noninvasive mechanical ventilation evidenced by chaotic global models

    NASA Astrophysics Data System (ADS)

    Letellier, Christophe; Rodrigues, Giovani G.; Muir, Jean-Franois; Aguirre, Luis A.

    2013-03-01

    Autonomous global models based on radial basis functions were obtained from data measured from patients under noninvasive mechanical ventilation. Some of these models, which are discussed in the paper, turn out to have chaotic or quasi-periodic solutions, thus providing a first piece of evidence that the underlying dynamics of the data used to estimate the global models are likely to be chaotic or, at least, have a chaotic component. It is explicitly shown that one of such global models produces attractors characterized by a Horseshoe map, two models produce toroidal chaos, and one model produces a quasi-periodic regime. These topologically inequivalent attractors evidence the individuality of breathing profiles observed in patient under noninvasive ventilation.

  4. Trend Analysis and Outcome Prediction in Mechanically Ventilated Patients: A Nationwide Population-Based Study in Taiwan

    PubMed Central

    Lee, Ming-Jang; Chen, Chao-Ju; Lee, King-Teh; Shi, Hon-Yi

    2015-01-01

    Objective To investigate the relationship between changes in patient attributes and hospital attributes over time and to explore predictors of medical utilization and mortality rates in mechanical ventilation (MV) patients in Taiwan. Background Providing effective medical care for MV patients is challenging and requires good planning and effective clinical decision making policies. Most studies of MV, however, have only analyzed a single regional ventilator weaning center or respiratory care unit, high-quality population-based studies of MV trends and outcomes are scarce. Methods This population-based cohort study retrospectively analyzed 213,945 MV patients treated during 2004-2009. Results During the study period, the percentages of MV patients with the following characteristics significantly increased: age ? 65 years, treatment at a medical center, and treatment by a high-volume physician. In contrast, the percentages of MV patients treated at local hospitals and by low-volume physicians significantly decreased (P<0.001). Age, gender, Deyo-Charlson co-morbidity index, teaching hospital, hospital level, hospital volume, and physician volume were significantly associated with MV outcome (P<0.001). Over the 6-year period analyzed in this study, the estimated mean hospital treatment cost increased 48.8% whereas mean length of stay decreased 13.9%. The estimated mean overall survival time for MV patients was 16.4 months (SD 0.4 months), and the overall in-hospital 1-, 3-, and 5-year survival rates were 61.0%, 36.7%, 17.3%, and 9.6%, respectively. Conclusions These population-based data revealed increases in the percentages of MV patients treated at medical centers and by high-volume physicians, especially in younger patients. Notably, although LOS for MV patients decreased, hospital treatment costs increased. Healthcare providers and patients should recognize that attributes of both the patient and the hospital may affect outcomes. PMID:25875442

  5. Ventilator Associated Pneumonia (VAP)

    E-print Network

    Connor, Ed

    Ventilator Associated Pneumonia (VAP) Prevention in a CVSICU ­ A CUSP based framework Ventilator Associated Pneumonia (VAP) is a serious hospital acquired condition that develops within 72 hours- associated pneumonia in intensive care: Impact of implementing a care bundle*. Critical Care Medicine, 39

  6. Being the parent of a ventilator-assisted child: perceptions of the family-health care provider relationship when care is offered in the family home.

    PubMed

    Lindahl, Berit; Lindblad, Britt-Marie

    2013-11-01

    The number of medically fragile children cared for at home is increasing; however, there are few studies about the professional support these families receive in their homes. The aim of the study was to understand the meanings that parents had about the support they received from health care professionals who offered care for their ventilator-assisted child in the family home. A phenomenological-hermeneutic method was used. Data included the narratives of five mother-father couples living in Sweden who were receiving professional support for their ventilator-assisted child. The findings indicate that receiving professional support meant being at risk of and/or exposed to the exercise of control over family privacy. The professional support system in the families' homes worked more by chance than by competent and sensible planning. In good cases, caring encounters were characterized by a mutual relationship where various occupational groups were embraced as a part of family life. The findings are discussed in light of compassionate care, exercise of power, and the importance of holistic educational programs. PMID:24122580

  7. Mechanical ventilation using non-injurious ventilation settings causes lung injury in the absence of pre-existing lung injury in healthy mice

    PubMed Central

    Wolthuis, Esther K; Vlaar, Alexander PJ; Choi, Goda; Roelofs, Joris JTH; Juffermans, Nicole P; Schultz, Marcus J

    2009-01-01

    Introduction Mechanical ventilation (MV) may cause ventilator-induced lung injury (VILI). Present models of VILI use exceptionally large tidal volumes, causing gross lung injury and haemodynamic shock. In addition, animals are ventilated for a relative short period of time and only after a 'priming' pulmonary insult. Finally, it is uncertain whether metabolic acidosis, which frequently develops in models of VILI, should be prevented. To study VILI in healthy mice, the authors used a MV model with clinically relevant ventilator settings, avoiding massive damage of lung structures and shock, and preventing metabolic acidosis. Methods Healthy C57Bl/6 mice (n = 66) or BALB/c mice (n = 66) were ventilated (tidal volume = 7.5 ml/kg or 15 ml/kg; positive end-expiratory pressure = 2 cmH2O; fraction of inspired oxygen = 0.5) for five hours. Normal saline or sodium bicarbonate were used to correct for hypovolaemia. Lung histopathology, lung wet-to-dry ratio, bronchoalveolar lavage fluid protein content, neutrophil influx and levels of proinflammatory cytokines and coagulation factors were measured. Results Animals remained haemodynamically stable throughout the whole experiment. Lung histopathological changes were minor, although significantly more histopathological changes were found after five hours of MV with a larger tidal volume. Lung histopathological changes were no different between the strains. In both strains and with both ventilator settings, MV caused higher wet-to-dry ratios, higher bronchoalveolar lavage fluid protein levels and more influx of neutrophils, and higher levels of proinflammatory cytokines and coagulation factors. Also, with MV higher systemic levels of cytokines were measured. All parameters were higher with larger tidal volumes. Correcting for metabolic acidosis did not alter endpoints. Conclusions MV induces VILI, in the absence of a priming pulmonary insult and even with use of relevant (least injurious) ventilator settings. This model offers opportunities to study the pathophysiological mechanisms behind VILI and the contribution of MV to lung injury in the absence of pre-existing lung injury. PMID:19152704

  8. Good ventilation is important

    E-print Network

    #12;Good ventilation is important Whether you're buying a new home or taking care of the one you're in now, good ventilation is important because it helps pro- tect your health and your home. Good ventilation is as critical to your comfort and safety as a reliable heating system, a smoke alarm, or a dry

  9. A micromechanical model for estimating alveolar wall strain in mechanically ventilated edematous lungs.

    PubMed

    Chen, Zheng-long; Chen, Ya-zhu; Hu, Zhao-yan

    2014-09-15

    To elucidate the micromechanics of pulmonary edema has been a significant medical concern, which is beneficial to better guide ventilator settings in clinical practice. In this paper, we present an adjoining two-alveoli model to quantitatively estimate strain and stress of alveolar walls in mechanically ventilated edematous lungs. The model takes into account the geometry of the alveolus, the effect of surface tension, the length-tension properties of parenchyma tissue, and the change in thickness of the alveolar wall. On the one hand, our model supports experimental findings (Perlman CE, Lederer DJ, Bhattacharya J. Am J Respir Cell Mol Biol 44: 34-39, 2011) that the presence of a liquid-filled alveolus protrudes into the neighboring air-filled alveolus with the shared septal strain amounting to a maximum value of 1.374 (corresponding to the maximum stress of 5.12 kPa) even at functional residual capacity; on the other hand, it further shows that the pattern of alveolar expansion appears heterogeneous or homogeneous, strongly depending on differences in air-liquid interface tension on alveolar segments. The proposed model is a preliminary step toward picturing a global topographical distribution of stress and strain on the scale of the lung as a whole to prevent ventilator-induced lung injury. PMID:24947025

  10. Finite element analysis of the mechanical behavior of preterm lamb tracheal bifurcation during total liquid ventilation.

    PubMed

    Bagnoli, Paola; Acocella, Fabio; Di Giancamillo, Mauro; Fumero, Roberto; Costantino, Maria Laura

    2013-02-01

    Knowledge of the mechanical behavior of immature airways is crucial to understand the effects exerted by ventilation treatments, namely by Total Liquid Ventilation (TLV). A computational approach was adopted to investigate preterm airways in the range of pressure applied during TLV. A 3D finite-element model of the tracheal bifurcation was developed. Structural analyses were performed using ABAQUS/Standard to evaluate airway deformation during TLV. The model consists of 7 rings, each composed of 3 tissues (cartilage, smooth muscle, connective tissue) modeled as hyperelastic materials. Biomechanical experimental tests were performed on lamb tracheae to obtain the stress-strain relationship for each tissue. Pressure load was applied on the internal surface of the model, reproducing the airway pressure tracing acquired during a TLV breath ending with a tracheal collapse phenomenon. Model reliability was verified by comparing the model outcomes to computer tomography scan images acquired during animal TLV trials. The simulations show progressive lumen narrowing during expiration, at increasing negative pressure until the occurrence of collapse; however not inducing complete airway occlusion. A reliable model was obtained to help setting ventilation parameters during TLV. PMID:23177086

  11. Temporal Disorganization of Circadian Rhythmicity and Sleep-Wake Regulation in Mechanically Ventilated Patients Receiving Continuous Intravenous Sedation

    PubMed Central

    Gehlbach, Brian K.; Chapotot, Florian; Leproult, Rachel; Whitmore, Harry; Poston, Jason; Pohlman, Mark; Miller, Annette; Pohlman, Anne S.; Nedeltcheva, Arlet; Jacobsen, John H.; Hall, Jesse B.; Van Cauter, Eve

    2012-01-01

    Objectives: Sleep is regulated by circadian and homeostatic processes and is highly organized temporally. Our study was designed to determine whether this organization is preserved in patients receiving mechanical ventilation (MV) and intravenous sedation. Design: Observational study. Setting: Academic medical intensive care unit. Patients: Critically ill patients receiving MV and intravenous sedation. Methods: Continuous polysomnography (PSG) was initiated an average of 2.0 (1.0, 3.0) days after ICU admission and continued ? 36 h or until the patient was extubated. Sleep staging and power spectral analysis were performed using standard approaches. We also calculated the electroencephalography spectral edge frequency 95% (SEF95), a parameter that is normally higher during wakefulness than during sleep. Circadian rhythmicity was assessed in 16 subjects through the measurement of aMT6s in urine samples collected hourly for 24-48 hours. Light intensity at the head of the bed was measured continuously. Measurements and Results: We analyzed 819.7 h of PSG recordings from 21 subjects. REM sleep was identified in only 2/21 subjects. Slow wave activity lacked the normal diurnal and ultradian periodicity and homeostatic decline found in healthy adults. In nearly all patients, SEF95 was consistently low without evidence of diurnal rhythmicity (median 6.3 [5.3, 7.8] Hz, n = 18). A circadian rhythm of aMT6s excretion was present in most (13/16, 81.3%) patients, but only 4 subjects had normal timing. Comparison of the SEF95 during the melatonin-based biological night and day revealed no difference between the 2 periods (P = 0.64). Conclusions: The circadian rhythms and PSG of patients receiving mechanical ventilation and intravenous sedation exhibit pronounced temporal disorganization. The finding that most subjects exhibited preserved, but phase delayed, excretion of aMT6s suggests that the circadian pacemaker of such patients may be free-running. Clinical Trial Information: Clinicaltrials.gov NCT01276652. Citation: Gehlbach BK; Chapotot F; Leproult R; Whitmore H; Poston J; Pohlman M; Miller A; Pohlman AS; Nedeltcheva A; Jacobsen JH; Hall JB; Van Cauter E. Temporal disorganization of circadian rhythmicity and sleep-wake regulation in mechanically ventilated patients receiving continuous intravenous sedation. SLEEP 2012;35(8):1105-1114. PMID:22851806

  12. Society of Critical Care Medicine

    MedlinePLUS

    ... Care Ultrasound Clinical Resources Current Concepts Adult Pediatric Pharmacology Ethics Acute Cardiac Care Mechanical Ventilation Nutrition ICU ... Pennsylvania Southeast Texas Sections Anesthesiology Clinical Pharmacy and Pharmacology Emergency Medicine Industry and Technology Internal Medicine In- ...

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

    PubMed Central

    Lopez-Campos, Jose Luis; Jara-Palomares, Luis; Muoz, Xavier; Bustamante, Vctor; 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.

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

    PubMed

    Lopez-Campos, Jose Luis; Jara-Palomares, Luis; Muoz, Xavier; Bustamante, Vctor; 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

  15. Heliox improves pulmonary mechanics in a pediatric porcine model of induced severe bronchospasm and independent lung mechanical ventilation

    Microsoft Academic Search

    Anthony J. Orsini; John L. Stefano; Kathleen H. Leef; Melinda Jasani; Andrew Ginn; Lisa Tice; Vinay M Nadkarni

    1999-01-01

    BACKGROUND: A helium-oxygen gas mixture (heliox) has low gas density and low\\u0009\\u0009\\u0009\\u0009turbulence and resistance through narrowed airways. The effects of heliox on\\u0009\\u0009\\u0009\\u0009pulmonary mechanics following severe methacholine-induced bronchospasm were\\u0009\\u0009\\u0009\\u0009investigated and compared to those of a nitrogen-oxygen gas mixture (nitrox) in\\u0009\\u0009\\u0009\\u0009an innovative pediatric porcine, independent lung, mechanical ventilation\\u0009\\u0009\\u0009\\u0009model. RESULTS: All of the lungs showed evidence of severe

  16. A Randomized Placebo-controlled Trial of Clonidine Impact on Sedation of Mechanically Ventilated ICU Patients

    PubMed Central

    Farasatinasab, Maryam; Kouchek, Mehran; Sistanizad, Mohammad; Goharani, Reza; Miri, Mirmohammad; Solouki, Mehrdad; Ghaeli, Padideh; Mokhtari, Majid

    2015-01-01

    Clonidine has sedative and analgesic properties. Randomized studies examining these properties in mechanically ventilated ICU patients are scarce. This study was designed to assess the impact of clonidine on sedative agent use in mechanically ventilated patients. In a prospective, randomized, double blind, placebo-controlled study in a general ICU of a university medical center in Tehran, Iran, 40 patients, over 18 years on mechanical ventilation for 3 days or more randomized into 2 equal groups of clonidine and placebo. Clonidine arm received usual sedation and enteral clonidine 0.1 mg TID and escalated to 0.2 mg TID on the second day if hemodynamics remained stable. Ramsay Sedation Score was used to assess sedation. Opioids and midazolam were used in all patients. 10 patients in clonidine and 3 in placebo arms had history of drug abuse (P = 0.018). The mean of sedatives used in the clonidine/placebo arms (mg/day) were; MED (Morphine Equivalent Dose) 91.4 97.9/112.1 98.8 P=0.39, midazolam 7.1 7.9/8.3 9.2 P=0.66 and propofol 535.8 866.7/139.1 359.9 P=0.125. After adjusting for addiction and propofol, clonidine reduced MED use by 79.6 mg/day (P=0.005) and midazolam by 5.41 mg/day (P = 0.05). Opioids and midazolam need reduced by clonidine co-administration regardless of history of drug abuse. Acceptable side effect profile and the lower cost of clonidine could make it an attractive adjunct to sedative agents in ICU. PMID:25561923

  17. A Randomized Placebo-controlled Trial of Clonidine Impact on Sedation of Mechanically Ventilated ICU Patients.

    PubMed

    Farasatinasab, Maryam; Kouchek, Mehran; Sistanizad, Mohammad; Goharani, Reza; Miri, Mirmohammad; Solouki, Mehrdad; Ghaeli, Padideh; Mokhtari, Majid

    2015-01-01

    Clonidine has sedative and analgesic properties. Randomized studies examining these properties in mechanically ventilated ICU patients are scarce. This study was designed to assess the impact of clonidine on sedative agent use in mechanically ventilated patients. In a prospective, randomized, double blind, placebo-controlled study in a general ICU of a university medical center in Tehran, Iran, 40 patients, over 18 years on mechanical ventilation for 3 days or more randomized into 2 equal groups of clonidine and placebo. Clonidine arm received usual sedation and enteral clonidine 0.1 mg TID and escalated to 0.2 mg TID on the second day if hemodynamics remained stable. Ramsay Sedation Score was used to assess sedation. Opioids and midazolam were used in all patients. 10 patients in clonidine and 3 in placebo arms had history of drug abuse (P = 0.018). The mean of sedatives used in the clonidine/placebo arms (mg/day) were; MED (Morphine Equivalent Dose) 91.4 97.9/112.1 98.8 P=0.39, midazolam 7.1 7.9/8.3 9.2 P=0.66 and propofol 535.8 866.7/139.1 359.9 P=0.125. After adjusting for addiction and propofol, clonidine reduced MED use by 79.6 mg/day (P=0.005) and midazolam by 5.41 mg/day (P = 0.05). Opioids and midazolam need reduced by clonidine co-administration regardless of history of drug abuse. Acceptable side effect profile and the lower cost of clonidine could make it an attractive adjunct to sedative agents in ICU. PMID:25561923

  18. Intravenous magnesium sulfate reduces rates of mechanical ventilation in pediatric asthma.

    PubMed

    Shedd, Glenn Clinton; Noe, Sarah M

    2014-01-01

    In this column, we examine an original research article by S. Torres et al. (2012) on the subject of magnesium sulfate use in pediatric patients with acute asthma. These researchers found that patients treated with 25 mg/kg of intravenous magnesium sulfate in addition to the conventional treatment options for acute asthma were less likely to require mechanical ventilation than patients in the control group. We review and critique this article and use a case study to illustrate the clinical implications of this research. We also examine some of the research and guidelines pertaining to the use of magnesium sulfate in acute asthma. PMID:24487258

  19. A prospective, randomized, double-blind, multicenter study comparing remifentanil with fentanyl in mechanically ventilated patients

    Microsoft Academic Search

    Claudia Spies; Martin MacGuill; Anja Heymann; Christina Ganea; Daniel Krahne; Angelika Assman; Heinrich-Rudolf Kosiek; Kathrin Scholtz; Klaus-Dieter Wernecke; Jrg Martin

    2011-01-01

    PurposeTo compare the quality of analgesia provided by a remifentanil-based analgesia regime with that provided by a fentanyl-based\\u000a regime in critically ill patients.\\u000a \\u000a \\u000a \\u000a \\u000a MethodsThis was a registered, prospective, two-center, randomized, triple-blind study involving adult medical and surgical patients\\u000a requiring mechanical ventilation (MV) for more than 24h. Patients were randomized to either remifentanil infusion or a fentanyl\\u000a infusion for a maximum

  20. Independent living with Duchenne muscular dystrophy and home mechanical ventilation in areas of Japan with insufficient national welfare services

    PubMed Central

    Yamaguchi, Miku; Suzuki, Machiko

    2013-01-01

    In Japan, there is no national 24-hour home care system for people with severe impairments. Despite this fact, a small number of people with Duchenne muscular dystrophy on home mechanical ventilation pursue independent living. Therefore, our aim was to better understand the process by which these individuals arrived at this goal for independence (i.e., choosing to live at home in Japan instead of in special sanatoriums that provide sufficient support and care). Twenty-one participants were interviewed in 2011 and 2013. The interviews were recorded, transcribed, and analysed following a grounded theory approach. These individuals placed particular emphasis on their personal choice regarding where and how they live as well as on whom they depend. Therefore, the core element underlying participants goals for independent living was self-reliant independency. To improve their social inclusion, the strategies used by the participants to retain their autonomy in an underdeveloped Japanese welfare system by establishing relationships with people in their communities can prevent them from experiencing social isolation. This could serve as an example to their counterparts in other countries. PMID:23981723

  1. Low-frequency assessment of airway and tissue mechanics in ventilated COPD patients.

    PubMed

    Lorx, Andrs; Szab, Barna; Hercsuth, Magdolna; Pnzes, Istvn; Hantos, Zoltn

    2009-12-01

    Low-frequency forced oscillations have increasingly been employed to characterize airway and tissue mechanics separately in the normal respiratory system and animal models of lung disease; however, few data are available on the use of this method in chronic obstructive pulmonary disease (COPD). We studied 30 intubated and mechanically ventilated patients (COPD, n = 9; acute exacerbation of COPD, n = 21) during short apneic intervals at different levels of positive end-expiratory pressure (PEEP), with small-amplitude forced oscillations between 0.4 and 4.8 Hz. In 16 patients, measurements were made before and after inhalation of fenoterol hydrobromide plus ipratropium bromide (Berodual). Newtonian resistance and coefficients of tissue resistance (G) and elastance (H) were estimated from the respiratory system impedance (Zrs) data by model fitting. Apart from some extremely high Zrs data obtained primarily at relatively low PEEP levels, the model yielded a reasonable partitioning of the airway and tissue parameters, and the inclusion of further parameters did not improve the model performance. With increasing PEEP, Newtonian resistance and the ratio G/H decreased, reflecting the volume dependence of the airway caliber and the improved homogeneity of the lungs, respectively. Bronchodilation after the administration of Berodual was also associated with simultaneous decreases in G and H, indicating recruitment of lung units. In conclusion, the measurement of low-frequency Zrs can be accomplished in ventilated COPD patients during short apneic periods and offers valuable information on the mechanical status of the airways and tissues. PMID:19833812

  2. Mitogen-activated Protein Kinase Phosphatase-1 Modulates Regional Effects of Injurious Mechanical Ventilation in Rodent Lungs

    PubMed Central

    Park, Moo Suk; Edwards, Michael G.; Sergew, Amen; Riches, David W. H.; Albert, Richard K.

    2012-01-01

    Rationale: Mechanical ventilation induces heterogeneous lung injury by mitogen-activated protein kinase (MAPK) and nuclear factor-?B. Mechanisms regulating regional injury and protective effects of prone positioning are unclear. Objectives: To determine the key regulators of the lung regional protective effects of prone positioning in rodent lungs exposed to injurious ventilation. Methods: Adult rats were ventilated with high (18 ml/kg, positive end-expiratory pressure [PEEP] 0) or low Vt (6 ml/kg; PEEP 3 cm H2O; 3 h) in supine or prone position. Dorsalcaudal lung mRNA was analyzed by microarray and MAPK phosphatases (MKP)-1 quantitative polymerase chain reaction. MKP-1?/? or wild-type mice were ventilated with very high (24 ml/kg; PEEP 0) or low Vt (67 ml/kg; PEEP 3 cm H2O). The MKP-1 regulator PG490-88 (MRx-108; 0.75 mg/kg) or phosphate-buffered saline was administered preventilation. Injury was assessed by lung mechanics, bronchioalveolar lavage cell counts, protein content, and lung injury scoring. Immunoblotting for MKP-1, and I?B? and cytokine ELISAs were performed on lung lysates. Measurements and Main Results: Prone positioning was protective against injurious ventilation in rats. Expression profiling demonstrated MKP-1 20-fold higher in rats ventilated prone rather than supine and regional reduction in p38 and c-jun N-terminal kinase activation. MKP-1?/? mice experienced amplified injury. PG490-88 improved static lung compliance and injury scores, reduced bronchioalveolar lavage cell counts and cytokine levels, and induced MKP-1 and I?B?. Conclusions: Injurious ventilation induces MAPK in an MKP-1dependent fashion. Prone positioning is protective and induces MKP-1. PG490-88 induced MKP-1 and was protective against high Vt in a nuclear factor-?Bdependent manner. MKP-1 is a potential target for modulating regional effects of injurious ventilation. PMID:22582160

  3. Development of trigger-based semi-automated surveillance of ventilator-associated pneumonia and central line-associated bloodstream infections in a Dutch intensive care

    PubMed Central

    2014-01-01

    Background Availability of a patient data management system (PDMS) has created the opportunity to develop trigger-based electronic surveillance systems (ESSs). The aim was to evaluate a semi-automated trigger-based ESS for the detection of ventilator-associated pneumonia (VAP) and central line-associated blood stream infections (CLABSIs) in the intensive care. Methods Prospective comparison of surveillance was based on a semi-automated ESS with and without trigger. Components of the VAP/CLABSI definition served as triggers. These included the use of VAP/CLABSI-related antibiotics, the presence of mechanical ventilation or an intravenous central line, and the presence of specific clinical symptoms. Triggers were automatically fired by the PDMS. Chest X-rays and microbiology culture results were checked only on patient days with a positive trigger signal from the ESS. In traditional screening, no triggers were used; therefore, chest X-rays and culture results had to be screened for all patient days of all included patients. Patients with pneumonia at admission were excluded. Results A total of 553 patients were screened for VAP and CLABSI. The incidence of VAP was 3.3/1,000 ventilation days (13 VAP/3,927 mechanical ventilation days), and the incidence of CLABSI was 1.7/1,000 central line days (24 CLABSI/13.887 central line days). For VAP, the trigger-based screening had a sensitivity of 92.3%, a specificity of 100%, and a negative predictive value of 99.8% compared to traditional screening of all patients. For CLABSI, sensitivity was 91.3%, specificity 100%, and negative predictive value 99.6%. Conclusions Pre-selection of patients to be checked for signs and symptoms of VAP and CLABSI by a computer-generated automated trigger system was time saving but slightly less accurate than conventional surveillance. However, this after-the-fact surveillance was mainly designed as a quality indicator over time rather than for precise determination of infection rates. Therefore, surveillance of VAP and CLABSI with a trigger-based ESS is feasible and effective. PMID:25646148

  4. Regional Lung Derecruitment and Inflammation during 16 Hours of Mechanical Ventilation in Supine Healthy Sheep

    PubMed Central

    Tucci, Mauro R.; Costa, Eduardo L.V.; Wellman, Tyler J.; Musch, Guido; Winkler, Tilo; Harris, R. Scott; Venegas, Jose G.; Amato, Marcelo B. P.; Vidal Melo, Marcos F.

    2014-01-01

    Background Lung derecruitment is common during general anesthesia. Mechanical ventilation with physiological tidal volumes could magnify derecruitment, and produce lung dysfunction and inflammation. We used Positron Emission Tomography to study the process of derecruitment in normal lungs ventilated for 16 h, and the corresponding changes in regional lung perfusion and inflammation. Methods Six anesthetized supine sheep were ventilated with VT = 8mL/kg and positive end-expiratory pressure = 0. Transmission scans were obtained at 2-h intervals to assess regional aeration. Emission scans were acquired at baseline and after 16 h for the tracers: (a) 18F-fluorodeoxyglucose to evaluate lung inflammation, and (b) 13NN to calculate regional perfusion and shunt fraction. Results Gas fraction decreased from baseline to 16 h in dorsal (0.31 0.13 to 0.14 0.12, P < 0.01) but not ventral regions (0.61 0.03 to 0.63 0.07, P = NS), with time constants of 1.5-44.6 h. Whereas the vertical distribution of relative perfusion did not change from baseline to 16 h, shunt increased in dorsal regions (0.34 0.23 to 0.63 0.35, P < 0.01). The average pulmonary net 18F-fluorodeoxyglucose uptake rate in six regions of interest along the ventral-dorsal direction increased from 3.4 1.410-3min-1 at baseline to 4.1 1.510-3min-1 after 16 h (P < 0.01), and the corresponding average regions of interest 18F-fluorodeoxyglucose phosphorylation rate increased from 2.0 0.210-2min-1 to 2.5 0.210-2min-1 (P < 0.01). Conclusions In normal lungs mechanically ventilated without positive end-expiratory pressure, loss of aeration occurs continuously for several hours and is preferentially localized to dorsal regions. Progressive lung derecruitment was associated with increased regional shunt, implying an insufficient hypoxic pulmonary vasoconstriction. The increased pulmonary net uptake and phosphorylation rates of 18F-fluorodeoxyglucose suggest incipient inflammation in these initially normal lungs. PMID:23535501

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

    PubMed

    Esquinas Rodriguez, Antonio M; Papadakos, Peter J; Carron, Michele; Cosentini, Roberto; Chiumello, Davide

    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 CO? 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

  6. 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

  7. Reliability of measured tidal volume in mechanically ventilated young pigs with normal lungs

    Microsoft Academic Search

    Mark J. Heulitt; Shirley J. Holt; Tracy L. Thurman; Rene A. Hall; Chan-Hee Jo; Pippa Simpson

    2005-01-01

    Objective: This study ex- amined whether volumes can be ac- curately measured at the expiratory valve of a conventional ventilator using pressure support ventilation and positive end expiratory pressure with software compensation for circuit compliance available in the Servo ? ventilator. Design and setting: Com- parison of two methods for measuring tidal volume in an animal laboratory. Subjects: Twenty healthy,

  8. In Vitro Performance of Spacers for Aerosol Delivery during Adult Mechanical Ventilation.

    PubMed

    Boukhettala, Nabile; Pore, Thierry; Diot, Patrice; Vecellio, Laurent

    2014-07-22

    Abstract Background: During mechanical ventilation, different aerosol generators are employed with various interfaces. The objective of this study was to evaluate the performance of a range of spacers, including a new device called Combihaler() designed for connection with both nebulizers and pressurized Metered-Dose Inhalers (pMDIs). Methods: To assess the spacers, we used a ventilator and the Dual Adult Training and Test Lung (model 5600i, Michigan Instruments). Ventilation parameters were measured with and without spacers in volume-controlled and pressure-controlled mode. A filter was placed at the end of the endotracheal tube to measure aerosol delivery. Amikacin (1?g/8?mL) and salbutamol (5?mg/5?mL) were nebulized with an Aeroneb Solo() connected to its T-adapter or the Combihaler() spacer. Salbutamol (100??g/actuation with 10 actuations) and beclomethasone (250??g/actuation with 10 actuations) were delivered with a pMDI connected to a Minispacer(), an ACE() spacer, or a Combihaler() spacer. Drug delivery measurements were performed in volume-controlled mode in dry and humidified conditions. Drug deposits on the filter were assayed. Results: The use of spacers and the T-adapter did not change the ventilation parameters (p>0.9). Aerosol delivery of salbutamol and Amikacin by nebulization increased up to three-fold with the Combihaler() compared with the T-adapter in humidified and nonhumidified conditions (p<0.05). Aerosol delivery of salbutamol and beclometasone by pMDI increased up to three-fold with the Combihaler() and the ACE() spacer compared with the Minispacer() in humidified and nonhumidified conditions (p<0.05). Aerosol delivery by pMDIs and vibrating mesh nebulizers using either a T-adapter or spacers was reduced by up to 62.5% in a humidified circuit compared with a nonhumidified circuit. Conclusion: Aerosol delivery via pMDIs and vibrating mesh nebulizers is greater with large spacers (Combihaler() and ACE()) than with smaller spacers (Minispacer()) or a T-adapter, in both humidified and nonhumidified conditions. In humidified conditions, the aerosol delivery decreased with all spacers. PMID:25050644

  9. Unmasking of tracheomalacia following short-term mechanical ventilation in a patient of adult respiratory distress syndrome

    PubMed Central

    Hegde, Harihar V; Bhat, Ravi L; Shanbag, Raghunath D; Bharat, MP; Rao, P Raghavendra

    2012-01-01

    Patients with chronic obstructive pulmonary disease (COPD) are susceptible to airway malacia, which may be unmasked following mechanical ventilation or tracheostomy decannulation. Dynamic imaging of central airways, a non-invasive test as effective as bronchoscopy to diagnose airway malacia, has increased the recognition of this disorder. We describe a 70-year-old woman admitted with adult respiratory distress syndrome. She had cardiorespiratory arrest on admission, from which she was successfully resuscitated. She had obesity, hypertension, diabetes mellitus, recurrent ventricular tachycardia, sarcoidosis with interstitial lung disease and COPD. She received short-term (18 days) mechanical ventilation with tracheostomy and developed respiratory distress following tracheostomy decannulation. PMID:22701211

  10. A novel preterm respiratory mechanics active simulator to test the performances of neonatal pulmonary ventilators

    NASA Astrophysics Data System (ADS)

    Cappa, Paolo; Sciuto, Salvatore Andrea; Silvestri, Sergio

    2002-06-01

    A patient active simulator is proposed which is capable of reproducing values of the parameters of pulmonary mechanics of healthy newborns and preterm pathological infants. The implemented prototype is able to: (a) let the operator choose the respiratory pattern, times of apnea, episodes of cough, sobs, etc., (b) continuously regulate and control the parameters characterizing the pulmonary system; and, finally, (c) reproduce the attempt of breathing of a preterm infant. Taking into account both the limitation due to the chosen application field and the preliminary autocalibration phase automatically carried out by the proposed device, accuracy and reliability on the order of 1% is estimated. The previously indicated value has to be considered satisfactory in light of the field of application and the small values of the simulated parameters. Finally, the achieved metrological characteristics allow the described neonatal simulator to be adopted as a reference device to test performances of neonatal ventilators and, more specifically, to measure the time elapsed between the occurrence of a potentially dangerous condition to the patient and the activation of the corresponding alarm of the tested ventilator.

  11. Use of High Frequency Oscillatory Ventilation (HFOV) in Neurocritical Care Patients

    Microsoft Academic Search

    Stacey S. Bennett; Carmelo Graffagnino; Cecil O. Borel; Michael L. James

    2007-01-01

    IntroductionAdult respiratory distress syndrome (ARDS) can be a common problem associated with the treatment of acute brain injury. High\\u000a frequency oscillatory ventilation (HFOV) is a developing therapy for the treatment of ARDS in adult patients that can be life\\u000a saving. However, often patients with acute, severe brain injury demonstrate intracranial hypertension (hICP) due to a variety\\u000a of injuries (e.g., traumatic

  12. Lipid metabolism disturbances and AMPK activation in prolonged propofol-sedated rabbits under mechanical ventilation

    PubMed Central

    Jiang, Wei; Yang, Zheng-bo; Zhou, Quan-hong; Huan, Xiang; Wang, Li

    2012-01-01

    Aim: To explore the mechanisms underlying the propofol infusion syndrome (PRIS), a potentially fatal complication during prolonged propofol infusion. Methods: Male rabbits under mechanical ventilation through endotracheal intubation were divided into 3 groups (n=6 for each) that were sedated with 1% propofol (Group P), isoflurane (Group I) or isoflurane while receiving 10% intralipid (Group II), respectively. Blood biochemical parameters were collected at 0, 6, 12, 18, 24 and 3036 h after the initiation of treatments. The hearts were removed out immediately after the experiments, and the level of tumor necrosis factor (TNF)-? in the hearts were studied using immunohistochemistry. AMP-activated protein kinase (AMPK) and phospho-AMPK in the hearts were assessed using Western blotting. Results: The mortality rate was 50% in Group P, and 0% in Groups I and II. The serum lipids and liver function indices in Group P were significantly increased, but moderately increased in Group II. Significant decreases in these indices were found in Groups I. All the groups showed dramatically increased release of creatine kinase (CK). Intense positive staining of TNF-? was found in all the heart samples in Group P, but only weak and neglectful staining was found in the hearts from Group II and Group I, respectively. AMPK phosphorylation was significantly increased in the hearts of Group P. Conclusion: Continuous infusion of large dose of propofol in rabbits undergoing prolonged mechanical ventilation causes hyperlipidemia, liver dysfunction, increased CK levels, AMPK activation and myocardial injury. The imbalance between energy demand and utilization may contribute to PRIS. PMID:22158109

  13. Ventilation and ventilators.

    PubMed

    Hayes, B

    1982-01-01

    The history of ventilation is reviewed briefly and recent developments in techniques of ventilation are discussed. Operating features of ventilators have changed in the past few years, partly as the result of clinical progress; yet, technology appears to have outstripped the clinician's ability to harness it most effectively. Clinical discipline and training of medical staff in the use of ventilators could be improved. The future is promising if clinician and designer can work together closely. Ergonomics of ventilators and their controls and the provision of alarms need special attention. Microprocessors are likely to feature prominently in the next generation of designs. PMID:6754938

  14. 76 FR 37307 - Rural Health Care Support Mechanism

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-27

    ...02-60; FCC 11-101] Rural Health Care Support Mechanism AGENCY: Federal...discounted services under the rural health care program. Grandfathered providers...but play a key role in delivering health care services to surrounding...

  15. 77 FR 42185 - Rural Health Care Support Mechanism

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-07-18

    ...02-60; FCC 12-74] Rural Health Care Support Mechanism AGENCY: Federal...responsible basis for specific Rural Health Care Pilot Program participants that...connectivity and the resulting health care benefits that patients...

  16. What happens to patients with COPD with long-term oxygen treatment who receive mechanical ventilation for COPD exacerbation? A 1-year retrospective follow-up study

    PubMed Central

    Hajizadeh, Negin; Goldfeld, Keith; Crothers, Kristina

    2015-01-01

    We performed a retrospective cohort study of patients with chronic obstructive lung disease (COPD) on long-term oxygen treatment (LTOT) who received invasive mechanical ventilation for COPD exacerbation. Of the 4791 patients, 23% died in the hospital, and 45% died in the subsequent 12?months. 67% of patients were readmitted at least once in the subsequent 12?months, and 26.8% were discharged to a nursing home or skilled nursing facility within 30?days. We conclude that these patients have high mortality rates, both in-hospital and in the 12?months postdischarge. If patients survive, many will be readmitted to the hospital and discharged to nursing home. These potential outcomes may support informed critical care decision making and more preference congruent care. PMID:24826845

  17. What happens to patients with COPD with long-term oxygen treatment who receive mechanical ventilation for COPD exacerbation? A 1-year retrospective follow-up study.

    PubMed

    Hajizadeh, Negin; Goldfeld, Keith; Crothers, Kristina

    2015-03-01

    We performed a retrospective cohort study of patients with chronic obstructive lung disease (COPD) on long-term oxygen treatment (LTOT) who received invasive mechanical ventilation for COPD exacerbation. Of the 4791 patients, 23% died in the hospital, and 45% died in the subsequent 12 months. 67% of patients were readmitted at least once in the subsequent 12 months, and 26.8% were discharged to a nursing home or skilled nursing facility within 30 days. We conclude that these patients have high mortality rates, both in-hospital and in the 12 months postdischarge. If patients survive, many will be readmitted to the hospital and discharged to nursing home. These potential outcomes may support informed critical care decision making and more preference congruent care. PMID:24826845

  18. Microbiology, resistance patterns, and risk factors of mortality in ventilator-associated bacterial pneumonia in a Northern Thai tertiary-care university based general surgical intensive care unit

    PubMed Central

    Chittawatanarat, Kaweesak; Jaipakdee, Wuttipong; Chotirosniramit, Narain; Chandacham, Kamtone; Jirapongcharoenlap, Tidarat

    2014-01-01

    Background Ventilator-associated pneumonia (VAP) occurrence, causative pathogens, and resistance patterns in surgical intensive care units (SICU) are different between Western and developing Asian countries. In Thailand, resistant organisms have progressively increased in the last decade. However, the evidence describing causes of VAP and its outcomes, especially secondary to resistant pathogens, in Asian developing countries SICUs is very limited. Therefore, the objective of this study was to describe the incidence, pathogen characteristics, and risk factors that impact mortality and patient survival following VAP in a tertiary Northern Thai SICU. Methods Between 2008 and 2012, VAP occurred in a total of 150 patients in Chiang Mai Universitys general SICUs (6.32.8 cases per 1,000 mechanical ventilator days). The following clinical data were collected from 46 patients who died and 104 patients who survived: microbiologic results, susceptible patterns, and survival status at hospital discharge. Antimicrobial susceptibility patterns were classified as susceptible, multidrug resistant (MDR), extensively drug resistant (XDR), and pan-drug resistant (PDR). The hazard ratio (HR) was calculated for risk factor analysis. Results Regarding the microbiology, gram negative organisms were the major pathogens (n=142, 94.7%). The first three most common organisms were Acinetobacter baumannii (38.7% of all organisms, mortality 41.4%), Klebsiella pneumoniae (17.3%, mortality 30.8%), and Pseudomonas aeruginosa (16.7%, mortality 16%) respectively. The most common gram positive organism was Staphylococcus aureus (4.0%, mortality 50%). The median day of VAP occurrence were significantly different between the three groups (P<0.01): susceptible (day 4), MDR (day 5), and XDR (day 6.5). Only half of all VAP cases were caused by susceptible organisms. Antibiotic resistance was demonstrated by 49.3% of the gram negative organisms and 62.5% of the gram positive organisms. Extensive drug resistance was evident only in Acinetobacter baumannii (30.6%) and Pseudomonas aeruginosa (1.3%). No pan-drug resistance was found during surveillance. The significant HR risk factors were age (P=0.03), resistant organisms (P=0.04), XDR (P=0.02), and acute physiology and chronic health evaluation II score (<0.01). Acinetobacter baumannii (P=0.06) and intubation due to severe sepsis (P=0.08) demonstrated a trend toward a significant increase in the HR. On the other hand, there were significantly decreased HRs in trauma patients (P=0.01). Initial administration of appropriate antibiotic therapy had a tendency toward a significant decrease in the HR (P=0.08). Conclusion Gram negative organisms were the primary cause of bacterial VAP in Chiang Mai Universitys general SICU. Resistant strains were present in half of all VAP cases and were associated with the day of VAP onset. Regarding risk factors, age, acute physiology, chronic health evaluation II score, resistant organisms (especially XDR), and being a non-trauma patient increased the risk of mortality. PMID:25152627

  19. [Helicopter transportation of a sedated, mechanically ventilated patient with cervical cord injury].

    PubMed

    Kato, Hideya; Nishiwaki, Yuko; Hosoi, Kunihiko; Shiomi, Naoto; Hirata, Masashi

    2013-09-01

    We report helicopter transportation of a sedated, mechanically ventilated patient with cervical cord injury. A 20-year-old male sustained traumatic injury to the cervical spinal cord during extracurricular activities in a college. On arrival at the hospital, a halo vest was placed on the patient and tracheostomy was performed. On the 38th hospital day, he was transported a distance of 520km by helicopter to a specialized hospital in Fukuoka for medical repatriation. Cabin space was narrow. Since power supply and carrying capacity were limited, battery-driven and portable medical devices were used. In consideration for patient's psychological stress, he was sedated with propofol. RSS (Ramsay sedation scale) scores were recorded to evaluate whether the patient was adequately sedated during helicopter transportation. Prior to transport, we rehearsed the sedation using bispectral index monitoring (BIS) in the hospital to further ensure the patient's safety during the transport. PMID:24063142

  20. [Search for early indications for reintubation after mechanical ventilation weaning of the newborn].

    PubMed

    Destuynder, R; Menget, A; Fromentin, C; Burguet, A

    1991-01-01

    Early predictive factors for successful extubation were investigated, in order to determine the best moment for respiratory weaning of the newborn, and the risk of subsequent reintubation. PaO2/FiO2 ratio, PCO2 and respiratory rate were measured 2 h after extubation in 100 newborn infants. There was no statistically significant difference for the PaO2/FiO2 ratio and PCO2 between infants who were successfully extubated (group 1) and those who required subsequent reintubation (group 2). By contrast, the respiratory rate 2 h after extubation was significantly higher in group 2, and a respiratory rate greater than 70/min appears to be the earliest ventilatory modification predictive of the need for further mechanical ventilation before the occurrence of hypoxemia and respiratory acidosis. PMID:1660124

  1. Determination of respiratory gas flow by electrical impedance tomography in an animal model of mechanical ventilation

    PubMed Central

    2014-01-01

    Background A recent method determines regional gas flow of the lung by electrical impedance tomography (EIT). The aim of this study is to show the applicability of this method in a porcine model of mechanical ventilation in healthy and diseased lungs. Our primary hypothesis is that global gas flow measured by EIT can be correlated with spirometry. Our secondary hypothesis is that regional analysis of respiratory gas flow delivers physiologically meaningful results. Methods In two sets of experiments n?=?7 healthy pigs and n?=?6 pigs before and after induction of lavage lung injury were investigated. EIT of the lung and spirometry were registered synchronously during ongoing mechanical ventilation. In-vivo aeration of the lung was analysed in four regions-of-interest (ROI) by EIT: 1) global, 2) ventral (non-dependent), 3) middle and 4) dorsal (dependent) ROI. Respiratory gas flow was calculated by the first derivative of the regional aeration curve. Four phases of the respiratory cycle were discriminated. They delivered peak and late inspiratory and expiratory gas flow (PIF, LIF, PEF, LEF) characterizing early or late inspiration or expiration. Results Linear regression analysis of EIT and spirometry in healthy pigs revealed a very good correlation measuring peak flow and a good correlation detecting late flow. PIFEIT?=?0.702??PIFspiro?+?117.4, r2?=?0.809; PEFEIT?=?0.690??PEFspiro-124.2, r2?=?0.760; LIFEIT?=?0.909??LIFspiro?+?27.32, r2?=?0.572 and LEFEIT?=?0.858??LEFspiro-10.94, r2?=?0.647. EIT derived absolute gas flow was generally smaller than data from spirometry. Regional gas flow was distributed heterogeneously during different phases of the respiratory cycle. But, the regional distribution of gas flow stayed stable during different ventilator settings. Moderate lung injury changed the regional pattern of gas flow. Conclusions We conclude that the presented method is able to determine global respiratory gas flow of the lung in different phases of the respiratory cycle. Additionally, it delivers meaningful insight into regional pulmonary characteristics, i.e. the regional ability of the lung to take up and to release air. PMID:24779960

  2. Bench-to-bedside review: Weaning failure should we rest the respiratory muscles with controlled mechanical ventilation?

    Microsoft Academic Search

    Theodoros Vassilakopoulos; Spyros Zakynthinos; Charis Roussos

    2005-01-01

    The use of controlled mechanical ventilation (CMV) in patients who experience weaning failure after a spontaneous breathing trial or after extubation is a strategy based on the premise that respiratory muscle fatigue (requiring rest to recover) is the cause of weaning failure. Recent evidence, however, does not support the existence of low frequency fatigue (the type of fatigue that is

  3. IEEE TRANSACTIONS ON BIOMEDICAL ENGINEERING, VOL. 60, NO. 6, JUNE 2013 1599 Optimization of Mechanical Ventilator Settings for

    E-print Network

    Davies, Christopher

    in the ITU and potentially resulting in pneumonia, permanent pulmonary fibrosis, and fatality due to multiple of Mechanical Ventilator Settings for Pulmonary Disease States Anup Das, Prathyush P. Menon, Jonathan G. Hardman. By combining val- idated computational models of pulmonary pathophysiology with global optimization algorithms

  4. Air Flow Distribution in a Mechanically-Ventilated High-Rise Residential Building* Richard C. Diamond and Helmut E. Feustel

    E-print Network

    Diamond, Richard

    additional exhaust fans located on the roof. The supply air system for the building is provided by a fanAir Flow Distribution in a Mechanically-Ventilated High-Rise Residential Building* Richard C. Diamond and Helmut E. Feustel Lawrence Berkeley National Laboratory Synopsis: Air flow measurements

  5. PET(CO2) measurement and feature extraction of capnogram signals for extubation outcomes from mechanical ventilation.

    PubMed

    Rasera, Carmen C; Gewehr, Pedro M; Domingues, Adriana Maria T

    2015-02-01

    Capnography is a continuous and noninvasive method for carbon dioxide (CO2) measurement, and it has become the standard of care for basic respiratory monitoring for intubated patients in the intensive care unit. In addition, it has been used to adjust ventilatory parameters during mechanical ventilation (MV). However, a substantial debate remains as to whether capnography is useful during the process of weaning and extubation from MV during the postoperative period. Thus, the main objective of this study was to present a new use for time-based capnography data by measuring the end-tidal CO2 pressure ([Formula: see text]), partial pressure of arterial CO2 ([Formula: see text]) and feature extraction of capnogram signals before extubation from MV to evaluate the capnography as a predictor of outcome extubation in infants after cardiac surgery. Altogether, 82 measurements were analysed, 71.9% patients were successfully extubated, and 28.1% met the criteria for extubation failure within 48?h. The ROC-AUC analysis for quantitative measure of the capnogram showed significant differences (p < 0.001) for: expiratory time (0.873), slope of phase III (0.866), slope ratio (0.923) and ascending angle (0.897). In addition, the analysis of [Formula: see text] (0.895) and [Formula: see text] (0.924) obtained 30?min before extubation showed significant differences between groups. The [Formula: see text] mean value for success and failure extubation group was 39.04?mmHg and 46.27?mmHg, respectively. It was also observed that high CO2 values in patients who had returned MV was 82.8? ?21?mmHg at the time of extubation failure. Thus, [Formula: see text] measurements and analysis of features extracted from a capnogram can differentiate extubation outcomes in infant patients under MV, thereby reducing the physiologic instability caused by failure in this process. PMID:25582400

  6. Ventilation therapy for patients suffering from obstructive lung diseases.

    PubMed

    Jungblut, Sven A; Heidelmann, Lena M; Westerfeld, Andreas; Frickmann, Hagen; Krber, Mareike K; Zautner, Andreas E

    2014-01-01

    Severe bronchial obstruction due to one of the major pulmonary diseases: asthma, COPD, or emphysema often requires mechanical ventilation support. Otherwise, patients are at risk of severe hypooxygenation with consecutive overloading and dilatation of the right cardiac ventricle with subsequent failure. This review focuses on how to manage a calculated ventilation therapy of patients suffering from bronchial obstruction and relevant patents. Options and pitfalls of invasive and non-invasive ventilation in the intensive care setting regarding clinical improvement and final outcome are discussed. The non-invasive ventilation is very efficient in treating acute or chronic respiratory failure in COPD patients and is capable of shortening the duration of hospitalization. Further non-invasive ventilation can successfully support the weaning after a long-lasting ventilation therapy and improve the prognosis of COPD patients. "Permissive hypercapnia" is unequivocally established in invasive ventilation therapy of severe bronchial obstruction in situations of limited ventilation. When intrinsic positive end-expiratory pressure (PEEP) and elevated airways resistance are present PEEP may be useful although external-PEEP application relieves over-inflation only in selected patients with airway obstruction during controlled mechanical ventilation. Upper limit of airways peak pressure used in "protective ventilation" of adult respiratory distress syndrome (ARDS) patients can be exceeded under certain circumstances. PMID:24383437

  7. Ventilation for humidity control: Measurements in a ventilation test house

    Microsoft Academic Search

    S. L. Palin; D. A. McIntyre; R. E. Edwards

    1996-01-01

    Three ventilation systems were installed in a recently refurbished test house: full house mechanical ventilation with heat recovery (MHVR), passive stack ventilation (PSV) and extract fans in kitchen and bathroom. Humidifiers were installed to simulate normal occupancy and behaviour of the ventilation was monitored over the winter of 1993\\/94. The test house has a low leakage rate of 3 ac

  8. JAMA Patient Page: Ventilator-Associated Pneumonia

    MedlinePLUS

    ... a person who is being assisted by mechanical ventilation (a breathing machine), is a serious and life- ... associated pneumonia are already critically ill (requiring mechanical ventilation), the death rate from ventilator-associated pneumonia is ...

  9. Clinical review: Long-term noninvasive ventilation

    PubMed Central

    Robert, Dominique; Argaud, Laurent

    2007-01-01

    Noninvasive positive ventilation has undergone a remarkable evolution over the past decades and is assuming an important role in the management of both acute and chronic respiratory failure. Long-term ventilatory support should be considered a standard of care to treat selected patients following an intensive care unit (ICU) stay. In this setting, appropriate use of noninvasive ventilation can be expected to improve patient outcomes, reduce ICU admission, enhance patient comfort, and increase the efficiency of health care resource utilization. Current literature indicates that noninvasive ventilation improves and stabilizes the clinical course of many patients with chronic ventilatory failure. Noninvasive ventilation also permits long-term mechanical ventilation to be an acceptable option for patients who otherwise would not have been treated if tracheostomy were the only alternative. Nevertheless, these results appear to be better in patients with neuromuscular/-parietal disorders than in chronic obstructive pulmonary disease. This clinical review will address the use of noninvasive ventilation (not including continuous positive airway pressure) mainly in diseases responsible for chronic hypoventilation (that is, restrictive disorders, including neuromuscular disease and lung disease) and incidentally in others such as obstructive sleep apnea or problems of central drive. PMID:17419882

  10. Dojat et al. International Journal of Clinical Monitoring and Computing. 1992;9:239-250. A KNOWLEDGE-BASED SYSTEM FOR ASSISTED VENTILATION OF

    E-print Network

    Paris-Sud XI, Université de

    ;9:239-250. A KNOWLEDGE-BASED SYSTEM FOR ASSISTED VENTILATION OF PATIENTS IN INTENSIVE CARE UNITS. Michel DOJAT, Laurent with respiratory insufficiency from mechanical ventilation may be complex and requires expertise obtained by long respiratory activity is assisted by a Hamilton Veolar ventilator delivering a positive pressure plateau during

  11. Costs and risk factors for ventilator-associated pneumonia in a Turkish University Hospital's Intensive Care Unit: A case-control study

    Microsoft Academic Search

    Riza Hakan Erbay; Ata Nevzat Yalcin; Mehmet Zencir; Simay Serin; Habip Atalay

    2004-01-01

    BACKGROUND: Ventilator-associated pneumonia (VAP) which is an important part of all nosocomial infections in intensive care unit (ICU) is a serious illness with substantial morbidity and mortality, and increases costs of hospital care. We aimed to evaluate costs and risk factors for VAP in adult ICU. METHODS: This is a-three year retrospective case-control study. The data were collected between 01

  12. The Impact of Acute Brain Dysfunction in the Outcomes of Mechanically Ventilated Cancer Patients

    PubMed Central

    Almeida, Isabel C. T.; Soares, Mrcio; Bozza, Fernando A.; Shinotsuka, Cassia Righy; Bujokas, Renata; Souza-Dantas, Vicente Cs; Ely, E. Wesley; Salluh, Jorge I. F.

    2014-01-01

    Introduction Delirium and coma are a frequent source of morbidity for ICU patients. Several factors are associated with the prognosis of mechanically ventilated (MV) cancer patients, but no studies evaluated delirium and coma (acute brain dysfunction). The present study evaluated the frequency and impact of acute brain dysfunction on mortality. Methods The study was performed at National Cancer Institute, Rio de Janeiro, Brazil. We prospectively enrolled patients ventilated >48 h with a diagnosis of cancer. Acute brain dysfunction was assessed during the first 14 days of ICU using RASS/CAM-ICU. Patients were followed until hospital discharge. Univariate and multivariable analysis were performed to evaluate factors associated with hospital mortality. Results 170 patients were included. 73% had solid tumors, age 65 [5372 (median, IQR 25%75%)] years. SAPS II score was 54[4663] points and SOFA score was (7 [6][9]) points. Median duration of MV was 13 (621) days and ICU stay was 14 (7.522) days. ICU mortality was 54% and hospital mortality was 66%. Acute brain dysfunction was diagnosed in 161 patients (95%). Survivors had more delirium/coma-free days [4(1,56) vs 1(02), p<0.001]. In multivariable analysis the number of days of delirium/coma-free days were associated with better outcomes as they were independent predictors of lower hospital mortality [0.771 (0.681 to 0.873), p<0.001]. Conclusions Acute brain dysfunction in MV cancer patients is frequent and independently associated with increased hospital mortality. Future studies should investigate means of preventing or mitigating acute brain dysfunction as they may have a significant impact on clinical outcomes. PMID:24465538

  13. Influence of mechanical ventilation and sepsis on redox balance in diaphragm, myocardium, limb muscles, and lungs.

    PubMed

    Chacon-Cabrera, Alba; Rojas, Yeny; Martnez-Caro, Leticia; Vila-Ubach, Monica; Nin, Nicolas; Ferruelo, Antonio; Esteban, Andrs; Lorente, Jos A; Barreiro, Esther

    2014-12-01

    Mechanical ventilation (MV), using high tidal volumes (V(T)), causes lung (ventilator-induced lung injury [VILI]) and distant organ injury. Additionally, sepsis is characterized by increased oxidative stress. We tested whether MV is associated with enhanced oxidative stress in sepsis, the commonest underlying condition in clinical acute lung injury. Protein carbonylation and nitration, antioxidants, and inflammation (immunoblotting) were evaluated in diaphragm, gastrocnemius, soleus, myocardium, and lungs of nonseptic and septic (cecal ligation and puncture 24 hours before MV) rats undergoing MV (n = 7 per group) for 150 minutes using 3 different strategies (low V(T) [V(T) = 9 mL/kg], moderate V(T) [V(T) = 15 mL/kg], and high V(T) [V(T) = 25 mL/kg]) and in nonventilated control animals. Compared with nonventilated control animals, in septic and nonseptic rodents (1) diaphragms, limb muscles, and myocardium of high-V(T) rats exhibited a decrease in protein oxidation and nitration levels, (2) antioxidant levels followed a specific fiber-type distribution in slow- and fast-twitch muscles, (3) tumor necrosis factor ? (TNF-?) levels were higher in respiratory and limb muscles, whereas no differences were observed in myocardium, and (4) in lungs, protein oxidation was increased, antioxidants were rather decreased, and TNF-? remained unmodified. In this model of VILI, oxidative stress does not occur in distant organs or skeletal muscles of rodents after several hours of MV with moderate-to-high V(T), whereas protein oxidation levels were increased in the lungs of the animals. Inflammatory events were moderately expressed in skeletal muscles and lungs of the MV rats. Concomitant sepsis did not strongly affect the MV-induced effects on muscles, myocardium, or lungs in the rodents. PMID:25168016

  14. A Patient-Specific Airway Branching Model for Mechanically Ventilated Patients

    PubMed Central

    Docherty, Paul D.; van Drunen, Erwin J.; Desaive, Thomas; Chase, J. Geoffrey

    2014-01-01

    Background. Respiratory mechanics models have the potential to guide mechanical ventilation. Airway branching models (ABMs) were developed from classical fluid mechanics models but do not provide accurate models of in vivo behaviour. Hence, the ABM was improved to include patient-specific parameters and better model observed behaviour (ABMps). Methods. The airway pressure drop of the ABMps was compared with the well-accepted dynostatic algorithm (DSA) in patients diagnosed with acute respiratory distress syndrome (ARDS). A scaling factor (?) was used to equate the area under the pressure curve (AUC) from the ABMps to the AUC of the DSA and was linked to patient state. Results. The ABMps recorded a median ? value of 0.58 (IQR: 0.540.63; range: 0.450.66) for these ARDS patients. Significantly lower ? values were found for individuals with chronic obstructive pulmonary disease (P < 0.001). Conclusion. The ABMps model allows the estimation of airway pressure drop at each bronchial generation with patient-specific physiological measurements and can be generated from data measured at the bedside. The distribution of patient-specific ? values indicates that the overall ABM can be readily improved to better match observed data and capture patient condition. PMID:25214888

  15. An air flow sensor for neonatal mechanical ventilation applications based on a novel fiber-optic sensing technique

    SciTech Connect

    Battista, L.; Sciuto, S. A.; Scorza, A. [Department of Engineering, ROMA TRE University, via della Vasca Navale 79/81, Rome (Italy)

    2013-03-15

    In this work, a simple and low-cost air flow sensor, based on a novel fiber-optic sensing technique has been developed for monitoring air flows rates supplied by a neonatal ventilator to support infants in intensive care units. The device is based on a fiber optic sensing technique allowing (a) the immunity to light intensity variations independent by measurand and (b) the reduction of typical shortcomings affecting all biomedical fields (electromagnetic interference and patient electrical safety). The sensing principle is based on the measurement of transversal displacement of an emitting fiber-optic cantilever due to action of air flow acting on it; the fiber tip displacement is measured by means of a photodiode linear array, placed in front of the entrance face of the emitting optical fiber in order to detect its light intensity profile. As the measurement system is based on a detection of the illumination pattern, and not on an intensity modulation technique, it results less sensitive to light intensity fluctuation independent by measurand than intensity-based sensors. The considered technique is here adopted in order to develop two different configurations for an air flow sensor suitable for the measurement of air flow rates typically occurring during mechanical ventilation of newborns: a mono-directional and a bi-directional transducer have been proposed. A mathematical model for the air flow sensor is here proposed and a static calibration of two different arrangements has been performed: a measurement range up to 3.00 Multiplication-Sign 10{sup -4} m{sup 3}/s (18.0 l/min) for the mono-directional sensor and a measurement range of {+-}3.00 Multiplication-Sign 10{sup -4} m{sup 3}/s ({+-}18.0 l/min) for the bi-directional sensor are experimentally evaluated, according to the air flow rates normally encountered during tidal breathing of infants with a mass lower than 10 kg. Experimental data of static calibration result in accordance with the proposed theoretical model: for the mono-directional configuration, the coefficient of determination r{sup 2} is equal to 0.997; for the bi-directional configuration, the coefficient of determination r{sup 2} is equal to 0.990 for positive flows (inspiration) and 0.988 for negative flows (expiration). Measurement uncertainty {delta}Q of air flow rate has been evaluated by means of the propagation of distributions and the percentage error in the arrangement of bi-directional sensor ranges from a minimum of about 0.5% at -18.0 l/min to a maximum of about 9% at -12.0 l/min.

  16. The immunological benefit of higher dose N-acetyl cysteine following mechanical ventilation in critically ill patients

    PubMed Central

    2014-01-01

    Background Sepsis complication is a major cause of death in multiple trauma critically ill patients. Defensin (cysteine rich anti-microbial peptides), as an important component of immune system, might play an important role in this process. There is also rising data on immunological effects of N-acetyl-cysteine (NAC), a commonly used anti-oxidant in oxidative stress conditions and glutathione (GSH) deficiencies. The aim of the present study was to evaluate the potential beneficial effects of NAC administration on multiple trauma patients with sepsis. Methods In a prospective, randomized controlled study, 44 multiple trauma critically ill patients who were mechanically ventilated and met the criteria of sepsis and admitted to the intensive care unit (ICU) were randomized into two groups . Control group received all standard ICU therapies and NAC group received intravenous NAC 3 gr every 6hours for 72hours in addition to standard therapies. Acute Physiology and Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA) scores, length of ICU stay, ICU mortality were recorded. Levels of serum Immunoglobulin M (IgM), Human ?-Defensin 2 (H?D2) and GSH were assessed at baseline and 24, 72, 120hours after intervention. Results During a period of 13-month screening, 44 patients underwent randomization but 5 patients had to be excluded. 21 patients in NAC group and 18 patients in control group completed the study. For both groups the length of ICU stay, SOFA score and systemic oxygenation were similar. Mortality rate (40% vs. 22% respectively, p?=?0.209) and ventilator days (Mean??SD 19.82??19.55days vs. 13.82??11.89days respectively, p?=?0.266) were slightly higher for NAC group. IgM and GSH levels were similar between two groups (p?=?0.325, 0.125 respectively), H?D2 levels were higher for NAC group (at day 3). Conclusion High dose of NAC administration not only did not improve patients outcome, but also raised the risk of inflammation and was associated with increased serum creatinine. PMID:25027749

  17. Intrathoracic blood volume accurately reflects circulatory volume status in critically ill patients with mechanical ventilation

    Microsoft Academic Search

    M. Lichtwarck-Aschoff; J. Zeravik; U. J. Pfeiffer

    1992-01-01

    Positive pressure ventilation in patients with acute respiratory failure (ARF) may render the interpretation of central venous pressure (CVP) or pulmonary wedge pressure (PCWP) difficult as indicators of circulating volume. The preload component of cardiac (CI) and stroke index (SI) is also influenced by the increased intrathoracic pressures of positive pressure ventilation. Moreover CI and SI do not indicate volume

  18. Relation of tricuspid annular displacement and tissue Doppler imaging velocities with duration of weaning in mechanically ventilated patients with acute pulmonary edema

    Microsoft Academic Search

    Vasilios E Papaioannou; Dimitrios A Stakos; Christos K Dragoumanis; Ioannis A Pneumatikos

    2010-01-01

    BACKGROUND: Liberation from the ventilator is a difficult task, whereas early echocardiographic indices of weaning readiness are still lacking. The aim of this study was to test whether tricuspid annular plane systolic excursion (TAPSE) and right ventricular (RV) systolic (Sm) and diastolic (Em & Am) tissue Doppler imaging (TDI) velocities are related with duration of weaning in mechanically ventilated patients

  19. A mathematical model approach quantifying patients' response to changes in mechanical ventilation: Evaluation in volume support.

    PubMed

    Larraza, S; Dey, N; Karbing, D S; Jensen, J B; Nygaard, M; Winding, R; Rees, S E

    2015-04-01

    This paper presents a mathematical model-approach to describe and quantify patient-response to changes in ventilator support. The approach accounts for changes in metabolism (V?O2, V?CO2) and serial dead space (VD), and integrates six physiological models of: pulmonary gas-exchange; acid-base chemistry of blood, and cerebrospinal fluid; chemoreflex respiratory-drive; ventilation; and degree of patients' respiratory muscle-response. The approach was evaluated with data from 12 patients on volume support ventilation mode. The models were tuned to baseline measurements of respiratory gases, ventilation, arterial acid-base status, and metabolism. Clinical measurements and model simulated values were compared at five ventilator support levels. The models were shown to adequately describe data in all patients (?(2), p>0.2) accounting for changes in V?CO2, VD and inadequate respiratory muscle-response. F-ratio tests showed that this approach provides a significantly better (p<0.001) description of measured data than: (a) a similar model omitting the degree of respiratory muscle-response; and (b) a model of constant alveolar ventilation. The approach may help predict patients' response to changes in ventilator support at the bedside. PMID:25686673

  20. 75 FR 48235 - Rural Health Care Universal Service Support Mechanism

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-09

    ...47 CFR Part 54 Rural Health Care Universal Service Support Mechanism; Proposed...02-60; FCC 10-125] Rural Health Care Universal Service Support Mechanism AGENCY...improve the quality and delivery of health care, and addresses each of the major...

  1. Role of the Fas/FasL system in a model of RSV infection in mechanically ventilated mice

    PubMed Central

    van den Berg, Elske; van Woensel, Job B. M.; Bos, Albert P.; Bem, Reinout A.; Altemeier, William A.; Gill, Sean E.; Martin, Thomas R.

    2011-01-01

    Infection with respiratory syncytial virus (RSV) in children can progress to respiratory distress and acute lung injury necessitating mechanical ventilation (MV). MV enhances apoptosis and inflammation in mice infected with pneumonia virus of mice (PVM), a mouse pneumovirus that has been used as a model for severe RSV infection in mice. We hypothesized that the Fas/Fas ligand (FasL) system, a dual proapoptotic/proinflammatory system involved in other forms of lung injury, is required for enhanced lung injury in mechanically ventilated mice infected with PVM. C57BL/6 mice and Fas-deficient (lpr) mice were inoculated intratracheally with PVM. Seven or eight days after PVM inoculation, the mice were subjected to 4 h of MV (tidal volume 10 ml/kg, fraction of inspired O2 = 0.21, and positive end-expiratory pressure = 3 cm H2O). Seven days after PVM inoculation, exposure to MV resulted in less severe injury in lpr mice than in C57BL/6 mice, as evidenced by decreased numbers of polymorphonuclear neutrophils in the bronchoalveolar lavage (BAL), and lower concentrations of the proinflammatory chemokines KC, macrophage inflammatory protein (MIP)-1?, and MIP-2 in the lungs. However, when PVM infection was allowed to progress one additional day, all of the lpr mice (7/7) died unexpectedly between 0.5 and 3.5 h after the onset of ventilation compared with three of the seven ventilated C57BL/6 mice. Parameters of lung injury were similar in nonventilated mice, as was the viral content in the lungs and other organs. Thus, the Fas/FasL system was partly required for the lung inflammatory response in ventilated mice infected with PVM, but attenuation of lung inflammation did not prevent subsequent mortality. PMID:21743025

  2. Role of the Fas/FasL system in a model of RSV infection in mechanically ventilated mice.

    PubMed

    van den Berg, Elske; van Woensel, Job B M; Bos, Albert P; Bem, Reinout A; Altemeier, William A; Gill, Sean E; Martin, Thomas R; Matute-Bello, Gustavo

    2011-10-01

    Infection with respiratory syncytial virus (RSV) in children can progress to respiratory distress and acute lung injury necessitating mechanical ventilation (MV). MV enhances apoptosis and inflammation in mice infected with pneumonia virus of mice (PVM), a mouse pneumovirus that has been used as a model for severe RSV infection in mice. We hypothesized that the Fas/Fas ligand (FasL) system, a dual proapoptotic/proinflammatory system involved in other forms of lung injury, is required for enhanced lung injury in mechanically ventilated mice infected with PVM. C57BL/6 mice and Fas-deficient ("lpr") mice were inoculated intratracheally with PVM. Seven or eight days after PVM inoculation, the mice were subjected to 4 h of MV (tidal volume 10 ml/kg, fraction of inspired O(2) = 0.21, and positive end-expiratory pressure = 3 cm H(2)O). Seven days after PVM inoculation, exposure to MV resulted in less severe injury in lpr mice than in C57BL/6 mice, as evidenced by decreased numbers of polymorphonuclear neutrophils in the bronchoalveolar lavage (BAL), and lower concentrations of the proinflammatory chemokines KC, macrophage inflammatory protein (MIP)-1?, and MIP-2 in the lungs. However, when PVM infection was allowed to progress one additional day, all of the lpr mice (7/7) died unexpectedly between 0.5 and 3.5 h after the onset of ventilation compared with three of the seven ventilated C57BL/6 mice. Parameters of lung injury were similar in nonventilated mice, as was the viral content in the lungs and other organs. Thus, the Fas/FasL system was partly required for the lung inflammatory response in ventilated mice infected with PVM, but attenuation of lung inflammation did not prevent subsequent mortality. PMID:21743025

  3. A randomised controlled trial of an automated oxygen delivery algorithm for preterm neonates receiving supplemental oxygen without mechanical ventilation

    PubMed Central

    Zapata, James; Gmez, John Jairo; Araque Campo, Robinson; Matiz Rubio, Alejandro; Sola, Augusto

    2014-01-01

    Aim Providing consistent levels of oxygen saturation (SpO2) for infants in neonatal intensive care units is not easy. This study explored how effectively the Auto-Mixer algorithm automatically adjusted fraction of inspired oxygen (FiO2) levels to maintain SpO2 within an intended range in extremely low birth weight infants receiving supplemental oxygen without mechanical ventilation. Methods Twenty extremely low birth weight infants were randomly assigned to the Auto-Mixer group or the manual intervention group and studied for 12h. The SpO2 target was 8593%, and the outcomes were the percentage of time SpO2 was within target, SpO2 variability, SpO2 >95%, oxygen received and manual interventions. Results The percentage of time within intended SpO2 was 584% in the Auto-Mixer group and 33.74.7% in the manual group, SpO2 >95% was 26.5% vs 54.8%, average SpO2 and FiO2 were 89.8% vs 92.2% and 37% vs 44.1%, and manual interventions were 0 vs 80 (p<0.05). Brief periods of SpO2<85% occurred more frequently in the Auto-Mixer group. Conclusion The Auto-Mixer effectively increased the percentage of time that SpO2 was within the intended target range and decreased the time with high SpO2 in spontaneously breathing extremely low birth weight infants receiving supplemental oxygen. PMID:24813808

  4. Effects of intravenous furosemide on mucociliary transport and rheological properties of patients under mechanical ventilation

    PubMed Central

    Kondo, Cludia Seiko; Macchionne, Maringela; Nakagawa, Naomi Kondo; de Carvalho, Carlos Roberto Ribeiro; King, Malcolm; Saldiva, Paulo Hilrio Nascimento; Lorenzi-Filho, Geraldo

    2002-01-01

    The use of intravenous (IV) furosemide is common practice in patients under mechanical ventilation (MV), but its effects on respiratory mucus are largely unknown. Furosemide can affect respiratory mucus either directly through inhibition of the NaK(Cl)2 co-transporter on the basolateral surface of airway epithelium or indirectly through increased diuresis and dehydration. We investigated the physical properties and transportability of respiratory mucus obtained from 26 patients under MV distributed in two groups, furosemide (n = 12) and control (n = 14). Mucus collection was done at 0, 1, 2, 3 and 4 hours. The rheological properties of mucus were studied with a microrheometer, and in vitro mucociliary transport (MCT) (frog palate), contact angle (CA) and cough clearance (CC) (simulated cough machine) were measured. After the administration of furosemide, MCT decreased by 17 19%, 24 11%, 18 16% and 18 13% at 1, 2, 3 and 4 hours respectively, P < 0.001 compared with control. In contrast, no significant changes were observed in the control group. The remaining parameters did not change significantly in either group. Our results support the hypothesis that IV furosemide might acutely impair MCT in patients under MV. PMID:11940271

  5. Fluctuations of inspired concentrations of nitric oxide and nitrogen dioxide during mechanical ventilation

    PubMed Central

    Kuhlen, Ralf; Busch, Thilo; Max, Martin; Reyle-Hahn, Matthias; Falke, Konrad J; Rossaint, Rolf

    1999-01-01

    Background: Nitric oxide (NO) is a very reactive agent with potentially toxic oxidation products such as nitrogen dioxide (NO2). Therefore, during NO inhalation a constant inspired concentration and accurate measurement of NO and NO2 concentrations are essential. The objective of this study was to test the NO concentrations at various positions along the inspiratory limb of the breathing circuit using a recently developed system to administer NO in phase with inspiratory flow during mechanical ventilation (Servo 300 NO-A, Siemens, Sweden). Furthermore, we tested whether an active heating system would interfere with inspired NO concentrations. Results: A sharp decline in the NO concentration was found between the respirator's inspiratory outlet and more distal points along the inspiratory limb of the circuit. This finding was most evident when an active heating system was mounted between those points. Conclusions: The concentrations of NO and NO2 should be measured as near to the patient as possible, as significant fluctuations of these concentrations might be found along the inspiratory limb of the respiratory circuit especially when an active heating system is used. PMID:11056715

  6. Unaffected contractility of diaphragm muscle fibers in humans on mechanical ventilation.

    PubMed

    Hooijman, Pleuni E; Paul, Marinus A; Stienen, Ger J M; Beishuizen, Albertus; Van Hees, Hieronymus W H; Singhal, Sunil; Bashir, Muhammad; Budak, Murat T; Morgen, Jacqueline; Barsotti, Robert J; Levine, Sanford; Ottenheijm, Coen A C

    2014-09-15

    Several studies have indicated that diaphragm dysfunction develops in patients on mechanical ventilation (MV). Here, we tested the hypothesis that the contractility of sarcomeres, i.e., the smallest contractile unit in muscle, is affected in humans on MV. To this end, we compared diaphragm muscle fibers of nine brain-dead organ donors (cases) that had been on MV for 26 5 h with diaphragm muscle fibers from nine patients (controls) undergoing surgery for lung cancer that had been on MV for less than 2 h. In each diaphragm specimen we determined 1) muscle fiber cross-sectional area in cryosections by immunohistochemical methods and 2) the contractile performance of permeabilized single muscle fibers by means of maximum specific force, kinetics of cross-bridge cycling by rate of tension redevelopment, myosin heavy chain content and concentration, and calcium sensitivity of force of slow-twitch and fast-twitch muscle fibers. In case subjects, we noted no statistically significant decrease in outcomes compared with controls in slow-twitch or fast-twitch muscle fibers. These observations indicate that 26 h of MV of humans is not invariably associated with changes in the contractile performance of sarcomeres in the diaphragm. PMID:25038190

  7. Mechanical ventilation enhances lung inflammation and caspase activity in a model of mouse pneumovirus infection

    PubMed Central

    Bem, Reinout A.; van Woensel, Job B. M.; Bos, Albert P.; Koski, Amy; Farnand, Alex W.; Domachowske, Joseph B.; Rosenberg, Helene F.; Martin, Thomas R.; Matute-Bello, Gustavo

    2009-01-01

    Severe infection with respiratory syncytial virus (RSV) in children can progress to respiratory distress and acute lung injury (ALI). Accumulating evidence suggests that mechanical ventilation (MV) is an important cofactor in the development of ALI by modulating the host immune responses to bacteria. This study investigates whether MV enhances the host response to pneumonia virus of mice (PVM), a mouse pneumovirus that has been used as a model for RSV infection in humans. BALB/c mice were inoculated intranasally with diluted clarified lung homogenates from mice infected with PVM strain J3666 or uninfected controls. Four days after inoculation, the mice were subjected to 4 h of MV (tidal volume, 10 ml/kg) or allowed to breathe spontaneously. When compared with that of mice inoculated with PVM only, the administration of MV to PVM-infected mice resulted in increased bronchoalveolar lavage fluid concentrations of the cytokines macrophage inflammatory protein (MIP)-2, MIP-1? (CCL3), and IL-6; increased alveolar-capillary permeability to high molecular weight proteins; and increased caspase-3 activity in lung homogenates. We conclude that MV enhances the activation of inflammatory and caspase cell death pathways in response to pneumovirus infection. We speculate that MV potentially contributes to the development of lung injury in patients with RSV infection. PMID:18996903

  8. Effects of age on the synergistic interactions between lipopolysaccharide and mechanical ventilation in mice.

    PubMed

    Smith, Lincoln S; Gharib, Sina A; Frevert, Charles W; Martin, Thomas R

    2010-10-01

    Children have a lower incidence and mortality from acute lung injury (ALI) than adults, and infections are the most common event associated with ALI. To study the effects of age on susceptibility to ALI, we investigated the responses to microbial products combined with mechanical ventilation (MV) in juvenile (21-d-old) and adult (16-wk-old) mice. Juvenile and adult C57BL/6 mice were treated with inhaled Escherichia coli 0111:B4 lipopolysaccharide (LPS) and MV using tidal volume = 15 ml/kg. Comparison groups included mice treated with LPS or MV alone and untreated age-matched control mice. In adult animals treated for 3 hours, LPS plus MV caused synergistic increases in neutrophils (P < 0.01) and IgM in bronchoalveolar lavage fluid (P = 0.03) and IL-1? in whole lung homogenates (P < 0.01) as compared with either modality alone. Although juvenile and adult mice had similar responses to LPS or MV alone, the synergistic interactions between LPS and MV did not occur in juvenile mice. Computational analysis of gene expression array data suggest that the acquisition of synergy with increasing age results, in part, from the loss of antiapoptotic responses and the acquisition of proinflammatory responses to the combination of LPS and MV. These data suggest that the synergistic inflammatory and injury responses to inhaled LPS combined with MV are acquired with age as a result of coordinated changes in gene expression of inflammatory, apoptotic, and TGF-? pathways. PMID:19901347

  9. Living with severe physical impairment, Duchenne's muscular dystrophy and home mechanical ventilation

    PubMed Central

    Dreyer, Pia S.; Steffensen, Birgit F.; Pedersen, Birthe D.

    2010-01-01

    Aim To study life-experiences of people living with Duchenne's muscular dystrophy (DMD), home mechanical ventilation (HMV) and physical impairment. Background Since the introduction of invasive HMV in the late 1980s people with DMD in Denmark live longer and have the experience of adulthood and a high degree of physical dependency. Method Nineteen patients with DMD and invasive HMV were interviewed in 2007. The interviews were recorded, transcribed verbatim and analysed according to a method inspired by Ricoeur's theory of interpretation. Findings HMV not only extended the participants lifespan, it also gave them the capacity to live an active life. They were totally dependent in everyday living, but in spite of this, they did not see themselves as physically impaired. They realised that there were activities that were physically impossible, but they considered themselves to be just the same person they had always been. This dependency was described as independent dependency. Conclusion The lived-experience of physical impairment is found to be independent dependency in an active life. To solve problems with loneliness, society needs to work with prejudice and misunderstanding and for better physical accessibility to enable full participation. PMID:20689774

  10. Diaphragm ultrasound as a new index of discontinuation from mechanical ventilation

    PubMed Central

    2014-01-01

    Background Predictive indexes of weaning from mechanical ventilation are often inaccurate. Among the many indexes used in clinical practice, the rapid shallow breathing index is one of the most accurate. We evaluated a new weaning index consisting in the diaphragm thickening fraction (DTF) assessed by ultrasound. Methods Forty-six patients were prospectively enrolled. All patients were ventilated in pressure support through a tracheostomy tube. Patients underwent a spontaneous breathing trial (SBT) when they met all the following criteria: FiO2??200, respiratory rate <30 breaths per minute, absence of fever, alert and cooperative, and hemodynamic stability without vaso-active therapy support. During the trial, the right hemi-diaphragm was visualized in the zone of apposition using a 10-MHz linear ultrasound probe. The patient was then instructed to perform breathing to total lung capacity (TLC) and then exhaling to residual volume (RV). Diaphragm thickness was recorded at TLC and RV, and the DTF was calculated as percentage from the following formula: Thickness at end inspiration?-?Thickness at end expiration / Thickness at end expiration. Also, the rapid shallow breathing index (RSBI) was calculated. Weaning failure was defined as the inability to maintain spontaneous breathing for at least 48h, without any form of ventilatory support. Results A significant difference between diaphragm thickness at TLC and RV was observed both in patients who succeeded SBT and patients who failed. DTF was significantly different between patients who failed and patients who succeeded SBT. A cutoff value of a DTF >36% was associated with a successful SBT with a sensitivity of 0.82, a specificity of 0.88, a positive predictive value (PPV) of 0.92, and a negative predictive value (NPV) of 0.75. By comparison, RSBI <105 had a sensitivity of 0.93, a specificity of 0.88, a PPV of 0.93, and a NPV of 0.88 for determining SBT success. Conclusions This study shows that in our cohort of patients, the assessment of DTF by diaphragm ultrasound may perform similarly to other weaning indexes. If validated by other studies, this method may be used in clinical practice. PMID:24949192

  11. 46 CFR 194.10-25 - Ventilation.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...2010-10-01 2010-10-01 false Ventilation. 194.10-25 Section 194.10-25...MATERIALS Magazines 194.10-25 Ventilation. (a) Integral magazines. ...be provided with natural or mechanical ventilation. Design calculations shall be...

  12. 46 CFR 194.10-25 - Ventilation.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...2011-10-01 2011-10-01 false Ventilation. 194.10-25 Section 194.10-25...MATERIALS Magazines 194.10-25 Ventilation. (a) Integral magazines. ...be provided with natural or mechanical ventilation. Design calculations shall be...

  13. 46 CFR 194.10-25 - Ventilation.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...2014-10-01 2014-10-01 false Ventilation. 194.10-25 Section 194.10-25...MATERIALS Magazines 194.10-25 Ventilation. (a) Integral magazines. ...be provided with natural or mechanical ventilation. Design calculations shall be...

  14. 46 CFR 194.10-25 - Ventilation.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...2012-10-01 2012-10-01 false Ventilation. 194.10-25 Section 194.10-25...MATERIALS Magazines 194.10-25 Ventilation. (a) Integral magazines. ...be provided with natural or mechanical ventilation. Design calculations shall be...

  15. 46 CFR 194.10-25 - Ventilation.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...2013-10-01 2013-10-01 false Ventilation. 194.10-25 Section 194.10-25...MATERIALS Magazines 194.10-25 Ventilation. (a) Integral magazines. ...be provided with natural or mechanical ventilation. Design calculations shall be...

  16. Air Distribution Effectiveness for Residential Mechanical Ventilation: Simulation and Comparison of Normalized Exposures

    SciTech Connect

    Petithuguenin, T.D.P.; Sherman, M.H.

    2009-05-01

    The purpose of ventilation is to dilute indoor contaminants that an occupant is exposed to. Even when providing the same nominal rate of outdoor air, different ventilation systems may distribute air in different ways, affecting occupants' exposure to household contaminants. Exposure ultimately depends on the home being considered, on source disposition and strength, on occupants' behavior, on the ventilation strategy, and on operation of forced air heating and cooling systems. In any multi-zone environment dilution rates and source strengths may be different in every zone and change in time, resulting in exposure being tied to occupancy patterns.This paper will report on simulations that compare ventilation systems by assessing their impact on exposure by examining common house geometries, contaminant generation profiles, and occupancy scenarios. These simulations take into account the unsteady, occupancy-tied aspect of ventilation such as bathroom and kitchen exhaust fans. As most US homes have central HVAC systems, the simulation results will be used to make appropriate recommendations and adjustments for distribution and mixing to residential ventilation standards such as ASHRAE Standard 62.2.This paper will report on work being done to model multizone airflow systems that are unsteady and elaborate the concept of distribution matrix. It will examine several metrics for evaluating the effect of air distribution on exposure to pollutants, based on previous work by Sherman et al. (2006).

  17. A simple breath sampling method in intubated and mechanically ventilated critically ill patients.

    PubMed

    Bos, Lieuwe D J; Wang, Yuanyue; Weda, Hans; Nijsen, Tamara M E; Janssen, Anton P G E; Knobel, Hugo H; Vink, Teunis J; Schultz, Marcus J; Sterk, Peter J

    2014-01-15

    Volatile organic compounds (VOCs) in breath may serve as biomarkers of pulmonary infection or inflammation. We developed and validated a new breath sampling method for VOC analysis in ventilated patients. Breath was collected from the ventilatory circuit using cheap disposables. VOCs were identified by gas-chromatography and mass-spectrometry (GC-MS) at various minute volumes during ventilation of an artificial lung (in vitro) and ventilated patients (in vivo). Sixty-four VOCs emendated from the ventilator and tubing. Their concentrations had an inverse correlation with minute volume in in vitro experiments (median correlation coefficient: -0.61 [25-75th percentile: -0.66 to -0.43]). Forty-four of these "ventilator-associated VOCs" were also observed in vivo, without correlations with minute volume. In vivo experiments showed that only positive end-expiratory pressure influenced the concentration of breath VOCs. The sampling method was highly reproducible (median intra-class correlation 0.95 [25-75th percentile: 0.87-0.97]). In conclusion, a novel, simple and repeatable sampling method was developed and validated for capturing exhaled VOCs in ventilated patients, which could allow for large-scale breath analysis in clinical studies. PMID:24239875

  18. Very Early Passive Cycling Exercise in Mechanically Ventilated Critically Ill Patients: Physiological and Safety Aspects - A Case Series

    PubMed Central

    Camargo Pires-Neto, Ruy; Fogaa Kawaguchi, Yurika Maria; Sayuri Hirota, Adriana; Fu, Carolina; Tanaka, Clarice; Caruso, Pedro; Park, Marcelo; Ribeiro Carvalho, Carlos Roberto

    2013-01-01

    Introduction Early mobilization can be performed in critically ill patients and improves outcomes. A daily cycling exercise started from day 5 after ICU admission is feasible and can enhance functional capacity after hospital discharge. In the present study we verified the physiological changes and safety of an earlier cycling intervention (< 72 hrs of mechanical ventilation) in critical ill patients. Methods Nineteen hemodynamically stable and deeply sedated patients within the first 72 hrs of mechanical ventilation were enrolled in a single 20 minute passive leg cycling exercise using an electric cycle ergometer. A minute-by-minute evaluation of hemodynamic, respiratory and metabolic variables was undertaken before, during and after the exercise. Analyzed variables included the following: cardiac output, systemic vascular resistance, central venous blood oxygen saturation, respiratory rate and tidal volume, oxygen consumption, carbon dioxide production and blood lactate levels. Results We enrolled 19 patients (42% male, age 5517 years, SOFA = 6 3, SAPS3 score = 58 13, PaO2/FIO2 = 22375). The median time of mechanical ventilation was 1 day (02), and 68% (n=13) of our patients required norepinephrine (maximum concentration = 0.47 g.kg-1.min-1). There were no clinically relevant changes in any of the analyzed variables during the exercise, and two minor adverse events unrelated to hemodynamic instability were observed. Conclusions In our study, this very early passive cycling exercise in sedated, critically ill, mechanically ventilated patients was considered safe and was not associated with significant alterations in hemodynamic, respiratory or metabolic variables even in those requiring vasoactive agents. PMID:24040200

  19. Analysis of mechanical ventilation and lipopolysaccharide?induced acute lung injury using DNA microarray analysis.

    PubMed

    Chen, Yuqing; Zhou, Xin; Rong, Ling

    2015-06-01

    Gene expression profiles of samples taken from patients with acute lung injury (ALI) induced by mechanical ventilation (MV) and lipopolysaccharide (LPS) were analyzed in order to identify key genes, and explore the underlying mechanisms. The GSE2411 microarray data set was downloaded from the Gene Expression Omnibus. This data set contained microarray data from 24 mouse lung samples, which were equally divided into four groups: Control group, MV group, LPS group and MV+LPS group. Differentially expressed genes (DEGs) were identified in the MV, LPS and MV+LPS groups, as compared with the control group, using packages of R software. Hierarchical clustering and between?group comparisons were performed for each group of DEGs. Overrepresented biological processes were revealed by functional enrichment analysis using the Database for Annotation, Visualization and Integrated Discovery. Unique DEGs in the LPS and MV+LPS groups were selected, and pathway enrichment analyses were performed using the Kyoto Encyclopedia of Genes and Genomes Orthology Based Annotation system. A total of 32, 264 and 685 DEGs were identified in the MV, LPS and MV+LPS groups, respectively. The MV+LPS group had more DEGs, as compared with the other two treatment groups. Genes associated with the immune and inflammatory responses were significantly overrepresented in both the LPS and MV+LPS groups, suggesting that LPS dominated the progression of ALI. Unique DEGs in the LPS and MV+LPS groups were associated with cytokine?cytokine receptor interaction. The Janus kinase?signal transducer and activator of transcription signaling pathway was shown to be enriched in the LPS+MV?unique DEGs. The results of the present study demonstrated that MV could exaggerate the transcriptional response of the lungs to LPS. Numerous key genes were identified, which may advance knowledge regarding the pathogenesis of ALI. PMID:25672411

  20. Mechanotransduction by GEF-H1 as a novel mechanism of ventilator-induced vascular endothelial permeability

    PubMed Central

    Fu, Panfeng; Xing, Junjie; Yakubov, Bakhtiyor; Cokic, Ivan; Birukov, Konstantin G.

    2010-01-01

    Pathological lung overdistention associated with mechanical ventilation at high tidal volumes (ventilator-induced lung injury; VILI) compromises endothelial cell (EC) barrier leading to development of pulmonary edema and increased morbidity and mortality. We have previously shown involvement of microtubule (MT)-associated Rho-specific guanine nucleotide exchange factor GEF-H1 in the agonist-induced regulation of EC permeability. Using an in vitro model of human pulmonary EC exposed to VILI-relevant magnitude of cyclic stretch (18% CS) we tested a hypothesis that CS-induced alterations in MT dynamics contribute to the activation of Rho-dependent signaling via GEF-H1 and mediate early EC response to pathological mechanical stretch. Acute CS (30 min) induced disassembly of MT network, cell reorientation, and activation of Rho pathway, which was prevented by MT stabilizer taxol. siRNA-based GEF-H1 knockdown suppressed CS-induced disassembly of MT network, abolished Rho signaling, and attenuated CS-induced stress fiber formation and EC realignment compared with nonspecific RNA controls. Depletion of GEF-H1 in the murine two-hit model of VILI attenuated vascular leak induced by lung ventilation at high tidal volume and thrombin-derived peptide TRAP6. These data show for the first time the critical involvement of microtubules and microtubule-associated GEF-H1 in lung vascular endothelial barrier dysfunction induced by pathological mechanical strain. PMID:20348280

  1. Upregulation of the tight junction protein occludin: effects on ventilation-induced lung injury and mechanisms of action

    PubMed Central

    2014-01-01

    Background Occludin, a tight junction protein, plays an important role in maintaining the integrity of the lung epithelial barrier; however, its role in ventilation-induced lung injury has not been explored. Here, we measured the expression of occludin with different tidal volumes. Our study indicated that the level of occludin was significantly decreased and alveolar permeability was increased owing to acute lung injury. Methods Thirty healthy Wistar rats (15 female, 15 male) weighing 250300g, were randomly divided into 5 groups (n?=?6 in each group): a control group (group C), a low tidal volume group (group L), a low tidal volume?+?protein kinase C(PKC) inhibitor group (group L?+?P), a high tidal volume group (group H) and a high tidal volume?+?PKC inhibitor group (group H?+?P). Tracheas of rats in the control group underwent incision without any special treatment. The other four groups were mechanically ventilated for 4h. The rats in groups L?+?P and H?+?P were treated with a PKC inhibitor (bisindolylmaleimide I, 0.12mg/kg) by intramuscular injection 1h before anesthesia. Rats were sacrificed after mechanical ventilation. Specimens of lung tissues were harvested. Lung pathological changes were observed using an optical microscope, and lung wet/dry weight ratio was measured. The occludin protein level was assayed by immunohistochemistry and Western blotting. Results HE staining and immunohistochemistry results showed that occludin was mainly located in alveolar epithelial cells and some alveolar endothelial cells. The lung injury and alveolar edema were more serious in high tidal volume groups than in low tidal volume groups. Occludin expression was reduced and PKC activation was increased in rats in the high tidal volume groups compared with rats in the low tidal volume groups. Rats that were pretreated with the PKC inhibitor had less pulmonary edema induced by the high tidal volume ventilation. Conclusion Mechanical ventilation can activate the PKC signaling pathway and tight junction proteins participate in this pathway. Up-regulation of occludin can reduce ventilation-induced lung injury. PMID:24884662

  2. Risk factors of ventilator-associated pneumonia in pediatric intensive care unit: a systematic review and meta-analysis

    PubMed Central

    Liu, Bo; Li, Song-Qin; Zhang, Su-Ming; Xu, Ping; Zhang, Xiang; Zhang, Yan-Hong; Chen, Wen-Sen

    2013-01-01

    Objective To identify risk factors of ventilator-associated pneumonia (VAP) in pediatric intensive care unit (PICU). Methods PubMed, Ovid, Web of Science, the Cochrane Library and references of retrieved articles were searched without language limitation. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated by using both the Mantel-Haenszel fixed-effect and the DerSimonian-Laird random-effects models. Results Out of the 205 initially retrieved articles, 9 papers were included. All 4,564 patients were enrolled, including 213 patients with VAP and 4,351 patients without VAP. Among fourteen risk factors, six factors had statistical significances. Risk factors of VAP and its value of OR were as follows: genetic syndrome (OR =2.04; 95% CI: 1.08-3.86), steroids (OR =1.87; 95% CI: 1.07-3.27), reintubation or self-extubation (OR =3.16; 95% CI: 2.10-4.74), bloodstream infection (OR =4.42; 95% CI: 2.12-9.22), prior antibiotic therapy (OR =2.89; 95% CI: 1.41-5.94), bronchoscopy (OR =4.48; 95% CI: 2.31-8.71). Conclusions Special methods of preventions should be taken in the light of risk factors of VAP in PICU so as to decrease the rate. PMID:23991312

  3. The respiratory system during resuscitation: a review of the history, risk of infection during assisted ventilation, respiratory mechanics, and ventilation strategies for patients with an unprotected airway

    Microsoft Academic Search

    Volker Wenzel; Ahamed H. Idris; Volker Drges; Jerry P. Nolan; Michael J. Parr; Andrea Gabrielli; Angelika Stallinger; Karl H. Lindner; Peter J. F. Baskett

    2001-01-01

    The fear of acquiring infectious diseases has resulted in reluctance among healthcare professionals and the lay public to perform mouth-to-mouth ventilation. However, the benefit of basic life support for a patient in cardiopulmonary or respiratory arrest greatly outweighs the risk for secondary infection in the rescuer or the patient. The distribution of ventilation volume between lungs and stomach in the

  4. Rotation of antimicrobial therapy in the intensive care unit: impact on incidence of ventilator-associated pneumonia caused by antibiotic-resistant Gram-negative bacteria

    Microsoft Academic Search

    E. Raineri; L. Crema; S. Dal Zoppo; A. Acquarolo; A. Pan; G. Carnevale; F. Albertario; A. Candiani

    2010-01-01

    The development of antibiotic resistance is associated with high morbidity and mortality, particularly in the intensive care\\u000a unit (ICU) setting. We evaluated the effect of an antibiotic rotation programme on the incidence of ventilator-associated\\u000a pneumonia (VAP) caused by antibiotic-resistant Gram-negative bacteria. We conducted a 2-year before-and-after study at two\\u000a medicalsurgical ICUs at two different tertiary referral hospitals. We included all

  5. An active one-lobe pulmonary simulator with compliance control for medical training in neonatal mechanical ventilation.

    PubMed

    Baldoli, Ilaria; Tognarelli, Selene; Cecchi, Francesca; Scaramuzzo, Rosa Teresa; Ciantelli, Massimiliano; Gentile, Marzia; Cuttano, Armando; Laschi, Cecilia; Menciassi, Arianna; Boldrini, Antonio; Dario, Paolo

    2014-06-01

    Mechanical ventilation is a current support therapy for newborns affected by respiratory diseases. However, several side effects have been observed after treatment, making it mandatory for physicians to determine more suitable approaches. High fidelity simulation is an efficient educational technique that recreates clinical experience. The aim of the present study is the design of an innovative and versatile neonatal respiratory simulator which could be useful in training courses for physicians and nurses as for mechanical ventilation. A single chamber prototype, reproducing a pulmonary lobe both in size and function, was designed and assembled. Volume and pressure within the chamber can be tuned by the operator through the device control system, in order to simulate both spontaneous and assisted breathing. An innovative software-based simulator for training neonatologists and nurses within the continuing medical education program on respiratory disease management was validated. Following the clinical needs, three friendly graphic user interfaces were implemented for simulating three different clinical scenarios (spontaneous breathing, controlled breathing and triggered/assisted ventilation modalities) thus providing physicians with an active experience. The proposed pulmonary simulator has the potential to be included in the range of computer-driven technologies used in medical training, adding novel functions and improving simulation results. PMID:24126618

  6. 76 FR 37280 - Rural Health Care Support Mechanism

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-27

    ...02-60; FCC 11-101] Rural Health Care Support Mechanism AGENCY: Federal...adopts an interim rule permitting health care providers that are located in a...funding commitment from the rural health care program prior to July 1,...

  7. A simplified model for estimating population-scale energy impacts of building envelope air-tightening and mechanical ventilation retrofits

    SciTech Connect

    Logue, J. M.; Turner, W. J.N.; Walker, I. S.; Singer, B. C.

    2015-01-01

    Changing the air exchange rate of a home (the sum of the infiltration and mechanical ventilation airflow rates) affects the annual thermal conditioning energy. Large-scale changes to air exchange rates of the housing stock can significantly alter the residential sector's energy consumption. However, the complexity of existing residential energy models is a barrier to the accurate quantification of the impact of policy changes on a state or national level. The Incremental Ventilation Energy (IVE) model developed in this study combines the output of simple air exchange models with a limited set of housing characteristics to estimate the associated change in energy demand of homes. The IVE model was designed specifically to enable modellers to use existing databases of housing characteristics to determine the impact of ventilation policy change on a population scale. The IVE model estimates of energy change when applied to US homes with limited parameterisation are shown to be comparable to the estimates of a well-validated, complex residential energy model.

  8. Association of Mechanical Ventilation and Flue Use in Heaters With Asthma Symptoms in Japanese Schoolchildren: A Cross-Sectional Study in Sapporo, Japan

    PubMed Central

    Cong, Shi; Araki, Atsuko; Ukawa, Shigekazu; Ait Bamai, Yu; Tajima, Shuji; Kanazawa, Ayako; Yuasa, Motoyuki; Tamakoshi, Akiko; Kishi, Reiko

    2014-01-01

    Background Use of fuel heaters is associated with childhood asthma. However, no studies have evaluated the associations of flue use and mechanical ventilation (ventilation) with asthma symptoms in schoolchildren. Methods This cross-sectional study investigated schoolchildren in grades 1 through 6 (age 612 years) in Sapporo, Japan. From November 2008 through January 2009, parents completed questionnaires regarding their home environment and their childrens asthma symptoms. Results In total, 4445 (69.5%) parents of 6393 children returned the questionnaire. After excluding incomplete responses, data on 3874 children (60.6%) were analyzed. The prevalence of current asthma symptoms and ever asthma symptoms were 12.8% and 30.9%, respectively. As compared with electric heaters, current asthma symptoms was associated with use of flued heaters without ventilation (OR = 1.62; 95% CI, 1.032.64) and unflued heaters with ventilation (OR = 1.77; 95% CI, 1.092.95) or without ventilation (OR = 2.23; 95% CI, 1.313.85). Regardless of dampness, unflued heaters were significantly associated with current asthma symptoms in the presence and absence of ventilation. Conclusions Use of unflued heaters was associated with current asthma symptoms, regardless of dampness. In particular, the prevalence of current asthma symptoms was higher in the absence of ventilation than in the presence of ventilation. Ever asthma symptoms was only associated with use of unflued heaters without ventilation. Consequently, use of fuel heaters, especially those that have no flue or ventilation, deserves attention, as their use might be associated with childhood asthma symptoms. PMID:24747197

  9. Targeted Minute Ventilation and Tidal Volume in an Animal Model of Acute Changes in Lung Mechanics and Episodes of Hypoxemia

    Microsoft Academic Search

    Nelson Claure; Cleide Suguihara; Jinghong Peng; Dorothy Hehre; Carmen DUgard; Eduardo Bancalari

    2009-01-01

    Background: Acute episodes of hypoxemia in ventilated preterm infants are triggered by changes in ventilation, lung volume (LV) and respiratory system compliance (CRS) that are not prevented by conventional synchronized intermittent mandatory ventilation (SIMV). Objective: To assess in a rabbit model of episodic hypoxemia the individual and combined efficacy of targeted tidal volume (VT) and minute ventilation (VE) by automatic

  10. Life expectancies and incidence rates of patients under prolonged mechanical ventilation: a population-based study during 1998 to 2007 in Taiwan

    PubMed Central

    2011-01-01

    Introduction The present study examined the median survival, life expectancies, and cumulative incidence rate (CIR) of patients undergoing prolonged mechanical ventilation (PMV) stratified by different underlying diseases. Methods According to the National Health Insurance Research Database of Taiwan, there were 8,906,406 individuals who obtained respiratory care during the period from 1997 to 2007. A random sample of this population was performed, and subjects who had continuously undergone mechanical ventilation for longer than 21 days were enrolled in the current study. Annual incidence rates and the CIR were calculated. After stratifying the patients according to their specific diagnoses, latent class analysis was performed to categorise PMV patients with multiple co-morbidities into several groups. The life expectancies of different groups were estimated using a semiparametric method with a hazard function based on the vital statistics of Taiwan. Results The analysis of 50,481 PMV patients revealed that incidence rates increased as patients grew older and that the CIR (17 to 85 years old) increased from 0.103 in 1998 to 0.183 in 2004 before stabilising thereafter. The life expectancies of PMV patients suffering from degenerative neurological diseases, stroke, or injuries tended to be longer than those with chronic renal failure or cancer. Patients with chronic obstructive pulmonary disease survived longer than did those co-morbid with other underlying diseases, especially septicaemia/shock. Conclusions PMV provides a direct means to treat respiratory tract diseases and to sustain respiration in individuals suffering from degenerative neurological diseases, and individuals with either of these types of conditions respond better to PMV than do those with other co-morbidities. Future research is required to determine the cost-effectiveness of this treatment paradigm. PMID:21457550

  11. Myocardial Injury after Surgery Is a Risk Factor for Weaning Failure from Mechanical Ventilation in Critical Patients Undergoing Major Abdominal Surgery

    PubMed Central

    Li, Shu; An, You-zhong; Ren, Jing-yi; Zhu, Feng-xue; Chen, Hong

    2014-01-01

    Background Myocardial injury after noncardiac surgery (MINS) is a newly proposed concept that is common among adults undergoing noncardiac surgery and associated with substantial mortality. We analyzed whether MINS was a risk factor for weaning failure in critical patients who underwent major abdominal surgery. Methods This retrospective study was conducted in the Department of Critical Care Medicine of Peking University People's Hospital. The subjects were all critically ill patients who underwent major abdominal surgery between January 2011 and December 2013. Clinical and laboratory parameters during the perioperative period were investigated. Backward stepwise regression analysis was performed to evaluate MINS relative to the rate of weaning failure. Age, hypertension, chronic renal disease, left ventricular ejection fraction before surgery, Acute Physiologic and Chronic Health Evaluation II score, pleural effusion, pneumonia, acute kidney injury, duration of mechanical ventilation before weaning and the level of albumin after surgery were treated as independent variables. Results This study included 381 patients, of whom 274 were successfully weaned. MINS was observed in 42.0% of the patients. The MINS incidence was significantly higher in patients who failed to be weaned compared to patients who were successfully weaned (56.1% versus 36.5%; P<0.001). Independent predictive factors of weaning failure were MINS, age, lower left ventricular ejection fraction before surgery and lower serum albumin level after surgery. The MINS odds ratio was 4.098 (95% confidence interval, 1.07 to 15.6; P?=?0.04). The patients who were successfully weaned had shorter hospital stay lengths and a higher survival rate than those who failed to be weaned. Conclusion MINS is a risk factor for weaning failure from mechanical ventilation in critical patients who have undergone major abdominal surgery, independent of age, lower left ventricular ejection fraction before surgery and lower serum albumin levels after surgery. PMID:25409182

  12. 13CO2 recovery fraction in expired air of septic patients under mechanical ventilation.

    PubMed

    Auxiliadora-Martins, M; Martins, M A; Coletto, F A; Martins-Filho, O A; Marchini, J S; Basile-Filho, A

    2008-07-01

    The continuous intravenous administration of isotopic bicarbonate (NaH13CO2) has been used for the determination of the retention of the 13CO2 fraction or the 13CO2 recovered in expired air. This determination is important for the calculation of substrate oxidation. The aim of the present study was to evaluate, in critically ill patients with sepsis under mechanical ventilation, the 13CO2 recovery fraction in expired air after continuous intravenous infusion of NaH13CO2 (3.8 micromol/kg diluted in 0.9% saline in ddH2O). A prospective study was conducted on 10 patients with septic shock between the second and fifth day of sepsis evolution (APACHE II, 25.9 +/- 7.4). Initially, baseline CO2 was collected and indirect calorimetry was also performed. A primer of 5 mL NaH13CO2 was administered followed by continuous infusion of 5 mL/h for 6 h. Six CO2 production (VCO2) measurements (30 min each) were made with a portable metabolic cart connected to a respirator and hourly samples of expired air were obtained using a 750-mL gas collecting bag attached to the outlet of the respirator. 13CO2 enrichment in expired air was determined with a mass spectrometer. The patients presented a mean value of VCO2 of 182 +/- 52 mL/min during the steady-state phase. The mean recovery fraction was 0.68 +/- 0.06%, which is less than that reported in the literature (0.82 +/- 0.03%). This suggests that the 13CO2 recovery fraction in septic patients following enteral feeding is incomplete, indicating retention of 13CO2 in the organism. The severity of septic shock in terms of the prognostic index APACHE II and the sepsis score was not associated with the 13CO2 recovery fraction in expired air. PMID:18719737

  13. Time course of diaphragm function recovery after controlled mechanical ventilation in rats

    PubMed Central

    Thomas, Debby; Maes, Karen; Agten, Anouk; Heunks, Leo; Dekhuijzen, Richard; Decramer, Marc; Van Hees, Hieronymus

    2013-01-01

    Controlled mechanical ventilation (CMV) is known to result in rapid and severe diaphragmatic dysfunction, but the recovery response of the diaphragm to normal function after CMV is unknown. Therefore, we examined the time course of diaphragm function recovery in an animal model of CMV. Healthy rats were submitted to CMV for 2427 h (n = 16), or to 24-h CMV followed by either 1 h (CMV + 1 h SB, n = 9), 2 h (CMV + 2 h SB, n = 9), 3 h (CMV + 3 h SB, n = 9), or 47 h (CMV + 47 h SB, n = 9) of spontaneous breathing (SB). At the end of the experiment, the diaphragm muscle was excised for functional and biochemical analysis. The in vitro diaphragm force was significantly improved in the CMV + 3 h SB and CMV + 47 h SB groups compared with CMV (maximal tetanic force: +27%, P < 0.05, and +59%, P < 0.001, respectively). This was associated with an increase in the type IIx/b fiber dimensions (P < 0.05). Neutrophil influx was increased in the CMV + 47 h SB group (P < 0.05), while macrophage numbers remained unchanged. Markers of protein synthesis (phosphorylated Akt and eukaryotic initiation factor 4E binding protein 1) were significantly increased (40%, P < 0.001, and 52%, P < 0.01, respectively) in the CMV + 3 h SB and CMV + 47 h SB groups and were positively correlated with diaphragm force (P < 0.05). Finally, also the maximal specific force generation of skinned single diaphragm fibers was increased in the CMV + 47 h SB group compared with CMV (+45%, P < 0.05). In rats, reloading the diaphragm for 3 h after CMV is sufficient to improve diaphragm function, while complete recovery occurs after longer periods of reloading. Enhanced muscle fiber dimensions, increased protein synthesis, and improved intrinsic contractile properties of diaphragm muscle fibers may have contributed to diaphragm function recovery. PMID:23845980

  14. Time course of diaphragm function recovery after controlled mechanical ventilation in rats.

    PubMed

    Thomas, Debby; Maes, Karen; Agten, Anouk; Heunks, Leo; Dekhuijzen, Richard; Decramer, Marc; Van Hees, Hieronymus; Gayan-Ramirez, Ghislaine

    2013-09-01

    Controlled mechanical ventilation (CMV) is known to result in rapid and severe diaphragmatic dysfunction, but the recovery response of the diaphragm to normal function after CMV is unknown. Therefore, we examined the time course of diaphragm function recovery in an animal model of CMV. Healthy rats were submitted to CMV for 24-27 h (n = 16), or to 24-h CMV followed by either 1 h (CMV + 1 h SB, n = 9), 2 h (CMV + 2 h SB, n = 9), 3 h (CMV + 3 h SB, n = 9), or 4-7 h (CMV + 4-7 h SB, n = 9) of spontaneous breathing (SB). At the end of the experiment, the diaphragm muscle was excised for functional and biochemical analysis. The in vitro diaphragm force was significantly improved in the CMV + 3 h SB and CMV + 4-7 h SB groups compared with CMV (maximal tetanic force: +27%, P < 0.05, and +59%, P < 0.001, respectively). This was associated with an increase in the type IIx/b fiber dimensions (P < 0.05). Neutrophil influx was increased in the CMV + 4-7 h SB group (P < 0.05), while macrophage numbers remained unchanged. Markers of protein synthesis (phosphorylated Akt and eukaryotic initiation factor 4E binding protein 1) were significantly increased (40%, P < 0.001, and 52%, P < 0.01, respectively) in the CMV + 3 h SB and CMV + 4-7 h SB groups and were positively correlated with diaphragm force (P < 0.05). Finally, also the maximal specific force generation of skinned single diaphragm fibers was increased in the CMV + 4-7 h SB group compared with CMV (+45%, P < 0.05). In rats, reloading the diaphragm for 3 h after CMV is sufficient to improve diaphragm function, while complete recovery occurs after longer periods of reloading. Enhanced muscle fiber dimensions, increased protein synthesis, and improved intrinsic contractile properties of diaphragm muscle fibers may have contributed to diaphragm function recovery. PMID:23845980

  15. Multidisciplinary Quality Improvement Initiative to Reduce Ventilator-Associated Tracheobronchitis in the PICU

    PubMed Central

    Muszynski, Jennifer A.; Sartori, James; Steele, Lisa; Frost, Randall; Wang, Wei; Khan, Nadeem; Lee, Anthony; Lin, Ada; Hall, Mark W.; Ayad, Onsy

    2013-01-01

    Objective To test the hypothesis that successful implementation of a care bundle designed to prevent nosocomial airway infection will be associated with decreased incidence of ventilator-associated tracheobronchitis. Design Prospective pre- and postinterventional. Setting PICU at an academic medical center Patients All patients admitted to the PICU who received invasive mechanical ventilation for greater than or equal to 48 hours between March 1, 2009, and December 31, 2011. Intervention Multidisciplinary, unitwide implementation of an evidence-based care bundle to prevent ventilator-associated airway infection. Measurements and Main Results There were 725 patients included in the analysis (338 patients preintervention and 387 patients postintervention). Baseline ventilator-associated tracheobronchitis rate in the preintervention period was 3.9 cases per 1,000 ventilator days compared with 1.8 cases per 1,000 ventilator days postintervention (p = 0.04, Fisher exact test). Compared with patients without ventilator-associated tracheobronchitis or ventilator-associated pneumonia, patients with ventilator-associated tracheobronchitis had fewer ventilator-free days in 28 days (4.9 vs 22; p < 0.0001, Mann-Whitney U test) and fewer ICU-free days in 28 days (0.5 vs 19; p < 0.0001, Mann-Whitney U test). These relationships remained significant after adjusting for covariates by multivariable linear regression. Conclusions Successful implementation of a care bundle to prevent ventilator-associated infection was associated with decreased incidence of ventilator-associated tracheobronchitis. Development of ventilator-associated tracheobronchitis was independently associated with adverse outcomes in our cohort of pediatric ICU patients. PMID:23628838

  16. Home Non-Invasive Mechanical Ventilation and Long-Term Oxygen Therapy in Stable Hypercapnic Chronic Obstructive Pulmonary Disease Patients: Comparison of Costs

    Microsoft Academic Search

    Enrico M. Clini; Giovanna Magni; Ernesto Crisafulli; Stefano Viaggi; Nicolino Ambrosino

    2009-01-01

    Background: A cost analysis of nocturnal non-invasive ventilation (NNV) in stable chronic obstructive pulmonary disease (COPD) patients would be helpful in decision making, when the balance between the increased demand and the availability of resources should be checked. Objectives: Based on data from the Italian trial in stable hypercapnic COPD patients, this study compares the cost of care associated with

  17. Outcome of COPD patients performing nocturnal non-invasive mechanical ventilation

    Microsoft Academic Search

    E. Clini; C. Sturani; R. Porta; C. Scarduelli; V. Galavotti; M. Vitacca; N. Ambrosino

    1998-01-01

    The role of non-invasive nocturnal domiciliary ventilation (NNV) in chronic obstructive pulmonary disease (COPD) patients with chronic hypercapnia is still discussed. The aims of this study were to evaluate the long-term survival, the clinical effectiveness and side-effects of NNV in these patients.Forty-nine stable hypercapnic COPD patients on long-term oxygen therapy (LTOT) were assigned to two groups: in Group 1, 28

  18. Indoor ozone concentrations: Ventilation rate impacts and mechanisms of outdoor concentration attenuation

    SciTech Connect

    Cano-Ruiz, J.A.; Modera, M.P.; Nazaroff, W.W.

    1992-07-01

    The classification of outdoor (ambient) air as fresh for the purposes of ventilation is not always appropriate, particularly in urban areas. In many cities of the world, urban air frequently violates health-based air quality standards due to high ozone concentrations. The degree of protection from exposure to ozone offered by the indoor environment depends on the relationship between indoor and outdoor ozone levels. Existing concentration data indicates that indoor/outdoor ozone ratios range between 10 and 80%. This paper analyzes several of the key issues influencing indoor ozone concentrations, including: (1) the degree of penetration of outdoor ozone indoors, (2) removal within the indoor environment (removal at surfaces and within air distribution systems), and (3) the correlation in time between outdoor ozone levels and ventilation rates. A model for calculating the degree of ozone removal in typical building leaks and air distribution systems is described and applied to a range of typical cases. This model indicates that the degree of removal is minimal for most wooden building cracks, but could be significant in leaks in concrete or brick structures, and is strongly dependent on the lining material for air distribution systems. Indoor ozone exposure estimates based on hourly outdoor ozone monitoring data and hour-by-hour weather-based simulations of infiltration rates and building operation are reported for a few residential scenarios. These estimates serve as a basis for exploring the impact of energy-efficient ventilation strategies on indoor ozone exposures.

  19. Immunosuppressive aspects of analgesics and sedatives used in mechanically ventilated patients: An underappreciated risk factor for the development of ventilator-associated pneumonia in critically ill patients

    PubMed Central

    Smith, Michael A.; Hibino, Maho; Falcione, Bonnie A.; Eichinger, Katherine M.; Patel, Ravi; Empey, Kerry M.

    2014-01-01

    Objective To evaluate the evidence describing the immunosuppressive and pharmacokinetic properties of commonly used analgesic and sedation agents in critically ill patients. Data sources MEDLINE (January 1980 September 2013) was searched. Study selection and data extraction All in vitro and in vivo studies that evaluated the immune modulating properties of analgesic and sedation agents commonly used in the critically ill. Full text articles and abstract only articles (noted) were included in this review. Inclusion criteria were met by 46 studies and were evaluated. Data synthesis Analgesia and sedation agents have been shown to be immunosuppressive in a variety of models. In vitro models use a variety of immune cells to demonstrate the immunosuppressive properties of opioids, benzodiazepines and, to a lesser extent, propofol. In each case, animal studies provide more robust data supporting the concept that opioids, benzodiazepines, and propofol exhibit immunosuppressive activities ranging from innate to adaptive immune alterations. Human studies, though more limited, provide further support that these agents inhibit the immune response. In contrast, data has shown that dexmedetomidine may attenuate the immune system. Clinical trial data evaluating the immunosuppressive properties of these agents is limited. Conclusions Analgesic and sedation agents have clearly been shown to alter cellular function and other mediators of the immune system yet the clinical impact remains to be fully elucidated. The mechanism by which sedation interruption reduces ventilator-associated pneumonia may in fact be a reduction in immunosuppressive effects. Studies linking the immune modulating effects of analgesic and sedation agents in critically ill patients are needed. PMID:24259637

  20. Prevention of ventilator-associated pneumonia.

    PubMed

    Oliveira, J; Zagalo, C; Cavaco-Silva, P

    2014-01-01

    Invasive mechanical ventilation (IMV) represents a risk factor for the development of ventilator-associated pneumonia (VAP), which develops at least 48h after admission in patients ventilated through tracheostomy or endotracheal intubation. VAP is the most frequent intensive-care-unit (ICU)-acquired infection among patients receiving IMV. It contributes to an increase in hospital mortality, duration of MV and ICU and length of hospital stay. Therefore, it worsens the condition of the critical patient and increases the total cost of hospitalization. The introduction of preventive measures has become imperative, to ensure control and to reduce the incidence of VAP. Preventive measures focus on modifiable risk factors, mediated by non-pharmacological and pharmacological evidence based strategies recommended by guidelines. These measures are intended to reduce the risk associated with endotracheal intubation and to prevent microaspiration of pathogens to the lower airways. PMID:24674617

  1. Assessing Data Quality in Manual Entry of Ventilator Settings

    Microsoft Academic Search

    DAVID K. VAWDREY; REED M. GARDNER; R. SCOTT EVANS; JAMES F. ORME; TERRY P. CLEMMER; LOREN GREENWAY; FRANK A. DREWS

    2010-01-01

    Objective: To evaluate the data quality of ventilator settings recorded by respiratory therapists using a computer charting application and assess the impact of incorrect data on computerized ventilator management protocols. Design: An analysis of 29,054 charting events gathered over 12 months from 678 ventilated patients (1,736 ventilator days) in four intensive care units at a tertiary care hospital. Measurements: Ten

  2. Ventilative cooling

    E-print Network

    Graa, Guilherme Carrilho da, 1972-

    1999-01-01

    This thesis evaluates the performance of daytime and nighttime passive ventilation cooling strategies for Beijing, Shanghai and Tokyo. A new simulation method for cross-ventilated wind driven airflow is presented . This ...

  3. Analyzing small data sets using Bayesian estimation: the case of posttraumatic stress symptoms following mechanical ventilation in burn survivors

    PubMed Central

    van de Schoot, Rens; Broere, Joris J.; Perryck, Koen H.; Zondervan-Zwijnenburg, Marille; van Loey, Nancy E.

    2015-01-01

    Background The analysis of small data sets in longitudinal studies can lead to power issues and often suffers from biased parameter values. These issues can be solved by using Bayesian estimation in conjunction with informative prior distributions. By means of a simulation study and an empirical example concerning posttraumatic stress symptoms (PTSS) following mechanical ventilation in burn survivors, we demonstrate the advantages and potential pitfalls of using Bayesian estimation. Methods First, we show how to specify prior distributions and by means of a sensitivity analysis we demonstrate how to check the exact influence of the prior (mis-) specification. Thereafter, we show by means of a simulation the situations in which the Bayesian approach outperforms the default, maximum likelihood and approach. Finally, we re-analyze empirical data on burn survivors which provided preliminary evidence of an aversive influence of a period of mechanical ventilation on the course of PTSS following burns. Results Not suprisingly, maximum likelihood estimation showed insufficient coverage as well as power with very small samples. Only when Bayesian analysis, in conjunction with informative priors, was used power increased to acceptable levels. As expected, we showed that the smaller the sample size the more the results rely on the prior specification. Conclusion We show that two issues often encountered during analysis of small samples, power and biased parameters, can be solved by including prior information into Bayesian analysis. We argue that the use of informative priors should always be reported together with a sensitivity analysis. PMID:25765534

  4. Analyzing small data sets using Bayesian estimation: the case of posttraumatic stress symptoms following mechanical ventilation in burn survivors.

    PubMed

    van de Schoot, Rens; Broere, Joris J; Perryck, Koen H; Zondervan-Zwijnenburg, Marille; van Loey, Nancy E

    2015-01-01

    Background : The analysis of small data sets in longitudinal studies can lead to power issues and often suffers from biased parameter values. These issues can be solved by using Bayesian estimation in conjunction with informative prior distributions. By means of a simulation study and an empirical example concerning posttraumatic stress symptoms (PTSS) following mechanical ventilation in burn survivors, we demonstrate the advantages and potential pitfalls of using Bayesian estimation. Methods : First, we show how to specify prior distributions and by means of a sensitivity analysis we demonstrate how to check the exact influence of the prior (mis-) specification. Thereafter, we show by means of a simulation the situations in which the Bayesian approach outperforms the default, maximum likelihood and approach. Finally, we re-analyze empirical data on burn survivors which provided preliminary evidence of an aversive influence of a period of mechanical ventilation on the course of PTSS following burns. Results : Not suprisingly, maximum likelihood estimation showed insufficient coverage as well as power with very small samples. Only when Bayesian analysis, in conjunction with informative priors, was used power increased to acceptable levels. As expected, we showed that the smaller the sample size the more the results rely on the prior specification. Conclusion : We show that two issues often encountered during analysis of small samples, power and biased parameters, can be solved by including prior information into Bayesian analysis. We argue that the use of informative priors should always be reported together with a sensitivity analysis. PMID:25765534

  5. Liberation and animation for ventilated ICU patients: the ABCDE bundle for the back-end of critical care

    PubMed Central

    2010-01-01

    Critically ill patients are frequently prescribed sedatives and analgesics to ensure patient safety, to relieve pain and anxiety, to reduce stress and oxygen consumption, and to prevent patient ventilator dysynchrony. Recent studies have revealed that these medications themselves contribute to worsening clinical outcomes. An evidence-based organizational approach referred to as the ABCDE bundle (Awakening and Breathing Coordination of daily sedation and ventilator removal trials; Choice of sedative or analgesic exposure; Delirium monitoring and management; and Early mobility and Exercise) is presented in this commentary. PMID:20497606

  6. Pressure support-ventilation versus spontaneous breathing with "T-Tube" for interrupting the ventilation after cardiac operations

    PubMed Central

    Loureno, Isabela Scali; Franco, Aline Marques; Bassetto, Solange; Rodrigues, Alfredo Jos

    2013-01-01

    Objective To compare pressure-support ventilation with spontaneous breathing through a T-tube for interrupting invasive mechanical ventilation in patients undergoing cardiac surgery with cardiopulmonary bypass. Methods Adults of both genders were randomly allocated to 30 minutes of either pressure-support ventilation or spontaneous ventilation with "T-tube" before extubation. Manovacuometry, ventilometry and clinical evaluation were performed before the operation, immediately before and after extubation, 1h and 12h after extubation. Results Twenty-eight patients were studied. There were no deaths or pulmonary complications. The mean aortic clamping time in the pressure support ventilation group was 62 35 minutes and 68 36 minutes in the T-tube group (P=0.651). The mean cardiopulmonary bypass duration in the pressure-support ventilation group was 89 44 minutes and 82 42 minutes in the T-tube group (P=0.75). The mean Tobin index in the pressure support ventilation group was 51 25 and 64.5 23 in the T-tube group (P=0.153). The duration of intensive care unit stay for the pressure support ventilation group was 2.1 0.36 days and 2.3 0.61 days in the T-tube group (P=0.581). The atelectasis score in the T-tube group was 0.6 0.8 and 0.5 0.6 (P=0.979) in the pressure support ventilation group. The study groups did not differ significantly in manovacuometric and ventilometric parameters and hospital evolution. Conclusion The two trial methods evaluated for interruption of mechanical ventilation did not affect the postoperative course of patients who underwent cardiac operations with cardiopulmonary bypass. PMID:24598949

  7. Emergence of carbapenem-resistant Acinetobacter baumannii as the major cause of ventilator-associated pneumonia in intensive care unit patients at an infectious disease hospital in southern Vietnam

    PubMed Central

    Nhu, Nguyen Thi Khanh; Lan, Nguyen Phu Huong; Campbell, James I.; Parry, Christopher M.; Thompson, Corinne; Tuyen, Ha Thanh; Hoang, Nguyen Van Minh; Tam, Pham Thi Thanh; Le, Vien Minh; Nga, Tran Vu Thieu; Nhu, Tran Do Hoang; Van Minh, Pham; Nga, Nguyen Thi Thu; Thuy, Cao Thu; Dung, Le Thi; Yen, Nguyen Thi Thu; Van Hao, Nguyen; Loan, Huynh Thi; Yen, Lam Minh; Nghia, Ho Dang Trung; Hien, Tran Tinh; Thwaites, Louise; Thwaites, Guy; Chau, Nguyen Van Vinh

    2014-01-01

    Ventilator-associated pneumonia (VAP) is a serious healthcare-associated infection that affects up to 30?% of intubated and mechanically ventilated patients in intensive care units (ICUs) worldwide. The bacterial aetiology and corresponding antimicrobial susceptibility of VAP is highly variable, and can differ between countries, national provinces and even between different wards in the same hospital. We aimed to understand and document changes in the causative agents of VAP and their antimicrobial susceptibility profiles retrospectively over an 11 year period in a major infectious disease hospital in southern Vietnam. Our analysis outlined a significant shift from Pseudomonas aeruginosa to Acinetobacter spp. as the most prevalent bacteria isolated from quantitative tracheal aspirates in patients with VAP in this setting. Antimicrobial resistance was common across all bacterial species and we found a marked proportional annual increase in carbapenem-resistant Acinetobacter spp. over a 3 year period from 2008 (annual trend; odds ratio 1.656, P?=?0.010). We further investigated the possible emergence of a carbapenem-resistant Acinetobacter baumannii clone by multiple-locus variable number tandem repeat analysis, finding a blaOXA-23-positive strain that was associated with an upsurge in the isolation of this pathogen. We additionally identified a single blaNDM-1-positive A. baumannii isolate. This work highlights the emergence of a carbapenem-resistant clone of A. baumannii and a worrying trend of antimicrobial resistance in the ICU of the Hospital for Tropical Diseases in Ho Chi Minh City, Vietnam. PMID:25038137

  8. Industrial ventilation

    NASA Astrophysics Data System (ADS)

    Goodfellow, H. D.

    Industrial ventilation design methodology, using computers and using fluid dynamic models, is considered. It is noted that the design of a ventilation system must be incorporated into the plant design and layout at the earliest conceptual stage of the project. A checklist of activities concerning the methodology for the design of a ventilation system for a new facility is given. A flow diagram of the computer ventilation model shows a typical input, the initialization and iteration loop, and the output. The application of the fluid dynamic modeling techniques include external and internal flow fields, and individual sources of heat and contaminants. Major activities for a ventilation field test program are also addressed.

  9. Meeting Residential Ventilation Standards Through Dynamic Control of Ventilation Systems

    SciTech Connect

    Sherman, Max H.; Walker, Iain S.

    2011-04-01

    Existing ventilation standards, including American Society of Heating, Refrigerating, and Air-conditioning Engineers (ASHRAE) Standard 62.2, specify continuous operation of a defined mechanical ventilation system to provide minimum ventilation, with time-based intermittent operation as an option. This requirement ignores several factors and concerns including: other equipment such as household exhaust fans that might incidentally provide ventilation, negative impacts of ventilation when outdoor pollutant levels are high, the importance of minimizing energy use particularly during times of peak electricity demand, and how the energy used to condition air as part of ventilation system operation changes with outdoor conditions. Dynamic control of ventilation systems can provide ventilation equivalent to or better than what is required by standards while minimizing energy costs and can also add value by shifting load during peak times and reducing intake of outdoor air contaminants. This article describes the logic that enables dynamic control of whole-house ventilation systems to meet the intent of ventilation standards and demonstrates the dynamic ventilation system control concept through simulations and field tests of the Residential Integrated Ventilation-Energy Controller (RIVEC).

  10. An automated and standardized neural index to quantify patient-ventilator interaction

    PubMed Central

    2013-01-01

    Introduction The aim of this study was to validate an automated, objective and standardized algorithm for quantifying and displaying patient-ventilator interaction. Methods Using a new method to detect patient-ventilator synchrony, the present study re-analyzed previously acquired and published data from 24 mechanically ventilated adult patients (Colombo et al., Crit Care Med. 2011 Nov;39(11):24527). Patient-ventilator interactions were evaluated by comparing ventilator pressure and diaphragm electrical activity (EAdi) waveforms, recorded during pressure support ventilation. The EAdi and ventilator pressure waveforms were analyzed for their timings (manually and automatically determined), and the error between the two waveforms was quantified. A new index of patient-ventilator interaction (NeuroSync index), which is standardized and automated, was validated and compared to manual analysis and previously published indices of asynchrony. Results The comparison of manual and automated detection methods produced high test-retest and inter-rater reliability (Intraclass correlation coefficient = 0.95). The NeuroSync index increased the sensitivity of detecting dyssynchronies, compared to previously published indices, which were found to only detect asynchronies. Conclusion The present study introduces an automated method and the NeuroSync index to determine patient-ventilator interaction with a more sensitive analysis method than those previously described. A dashboard-style of graphical display allows a rapid overview of patient-ventilator interaction and breathing pattern at the bedside. PMID:24131701

  11. Severe acute respiratory failure secondary to acute fibrinous and organizing pneumonia requiring mechanical ventilation: a case report and literature review.

    PubMed

    Lpez-Cuenca, Sonia; Morales-Garca, Silvia; Martn-Hita, Ana; Frutos-Vivar, Fernando; Fernndez-Segoviano, Pilar; Esteban, Andrs

    2012-08-01

    A 27-year-old woman was admitted to our ICU with acute hypoxemic respiratory failure and criteria for ARDS. Despite an F(IO(2)) of 1.0 and a lung protective strategy, the patient died on day 15 without any improvement. The relatives gave consent for post-mortem analysis. The histopathologic study of the lung showed findings typical of an acute fibrinous and organizing pneumonia. Apropos of this case we performed a PubMed search. We found 13 articles, including a total of 29 patients. Acute fibrinous and organizing pneumonia is an unusual cause of acute lung injury. The diagnostic criterion is histopathologic. There is little information regarding the pathophysiology of this illness. Important questions remain regarding this disease, including predisposing factors and management. Patients who require mechanical ventilation have poor outcomes. PMID:22348347

  12. Effects of Intravenous Indomethacin on Reduction of Symptomatic Patent Ductus Arteriosus Cases and Decreasing the Need for Prolonged Mechanical Ventilation

    PubMed Central

    Jannatdoust, Abdollah; Samadi, Mahmoud; Yeganehdoust, Saadollah; Heydarzadeh, Mohammad; Alikhah, Hossein; Piri, Reza; Naghavi-Behzad, Mohammad

    2014-01-01

    Introduction: We decided to investigate the effects of injecting Indomethacin on reducing complications of Patent Ductus Arteriosus (PDA) and the need for prolonged mechanical ventilation. Methods: During this randomized clinical trial, 70 premature infants with matched gestational age and birth weight were divided into case and control groups. In the study group, intravenous indomethacin started from the first 2-12 hours of birth. All patients were followed by echocardiography at the fourth day and skull ultrasound in the second week. Results: Symptomatic PDA rate was significantly higher in the control group (25.7% vs. 0%; P?0.001). Incidence of grade 1-3 intraventricular hemorrhage was higher in the control group and the ratio of needed time for respiratory support in the control group to the case group was approximately 2.1. Conclusion: Intravenous Indomethacin reduced the number of PDA cases and incidence of grade 2 and 3 intraventricular hemorrhage, without any short term side effects. PMID:25610559

  13. Clinical review: Allocating ventilators during large-scale disasters problems, planning, and process

    Microsoft Academic Search

    John L Hick; Lewis Rubinson; Daniel T O'Laughlin; J Christopher Farmer

    2007-01-01

    Catastrophic disasters, particularly a pandemic of influenza, may force difficult allocation decisions when demand for mechanical ventilation greatly exceeds available resources. These situations demand integrated incident management responses on the part of the health care facility and community, including resource management, provider liability protection, community education and information, and health care facility decision-making processes designed to allocate resources as justly

  14. Architectural design of an advanced naturally ventilated building form

    Microsoft Academic Search

    Kevin J. Lomas

    2007-01-01

    Advanced stack-ventilated buildings have the potential to consume much less energy for space conditioning than typical mechanically ventilated or air-conditioned buildings. This paper describes how environmental design considerations in general, and ventilation considerations in particular, shape the architecture of advanced naturally ventilated (ANV) buildings. The attributes of simple and advanced naturally ventilated buildings are described and a taxonomy of ANV

  15. 46 CFR 127.260 - Ventilation for accommodations.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...2012-10-01 2012-10-01 false Ventilation for accommodations. 127.260 ...Construction and Arrangements 127.260 Ventilation for accommodations. (a) Each...tons must be provided with a mechanical ventilation system unless the cognizant OCMI...

  16. 46 CFR 127.260 - Ventilation for accommodations.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...2010-10-01 2010-10-01 false Ventilation for accommodations. 127.260 ...Construction and Arrangements 127.260 Ventilation for accommodations. (a) Each...tons must be provided with a mechanical ventilation system unless the cognizant OCMI...

  17. 46 CFR 127.260 - Ventilation for accommodations.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...2014-10-01 2014-10-01 false Ventilation for accommodations. 127.260 ...Construction and Arrangements 127.260 Ventilation for accommodations. (a) Each...tons must be provided with a mechanical ventilation system unless the cognizant OCMI...

  18. 46 CFR 127.260 - Ventilation for accommodations.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...2011-10-01 2011-10-01 false Ventilation for accommodations. 127.260 ...Construction and Arrangements 127.260 Ventilation for accommodations. (a) Each...tons must be provided with a mechanical ventilation system unless the cognizant OCMI...

  19. 46 CFR 127.260 - Ventilation for accommodations.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...2013-10-01 2013-10-01 false Ventilation for accommodations. 127.260 ...Construction and Arrangements 127.260 Ventilation for accommodations. (a) Each...tons must be provided with a mechanical ventilation system unless the cognizant OCMI...

  20. 46 CFR 185.352 - Ventilation of gasoline machinery spaces.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... false Ventilation of gasoline machinery spaces. 185.352 Section 185...185.352 Ventilation of gasoline machinery spaces. The mechanical exhaust for the ventilation of a gasoline machinery space, required by ...

  1. 46 CFR 185.352 - Ventilation of gasoline machinery spaces.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... false Ventilation of gasoline machinery spaces. 185.352 Section 185...185.352 Ventilation of gasoline machinery spaces. The mechanical exhaust for the ventilation of a gasoline machinery space, required by ...

  2. 46 CFR 185.352 - Ventilation of gasoline machinery spaces.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... false Ventilation of gasoline machinery spaces. 185.352 Section 185...185.352 Ventilation of gasoline machinery spaces. The mechanical exhaust for the ventilation of a gasoline machinery space, required by ...

  3. 46 CFR 185.352 - Ventilation of gasoline machinery spaces.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... false Ventilation of gasoline machinery spaces. 185.352 Section 185...185.352 Ventilation of gasoline machinery spaces. The mechanical exhaust for the ventilation of a gasoline machinery space, required by ...

  4. 46 CFR 185.352 - Ventilation of gasoline machinery spaces.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... false Ventilation of gasoline machinery spaces. 185.352 Section 185...185.352 Ventilation of gasoline machinery spaces. The mechanical exhaust for the ventilation of a gasoline machinery space, required by ...

  5. Performance Characteristics of Seven Bilevel Mechanical Ventilators in Pressure-Support Mode with Different Cycling Criteria: A Comparative Bench Study

    PubMed Central

    Chen, Yuqing; Cheng, Kewen; Zhou, Xin

    2015-01-01

    Background Pressure support ventilation from a bilevel device is a standard technique for non-invasive home ventilation. A bench study was designed to compare the performance and patient-ventilator synchronization of 7 bilevel ventilators, in the presence of system leaks. Material/Methods Ventilators were connected to a Hans Rudolph Series 1101 lung simulator (compliance, 50 mL/cmH2O; expiratory resistance, 20 cmH2O/L/s; respiratory rate, 15 breaths/min; inspiratory time, 1.0 s). All ventilators were set at 15 cmH2O pressure support and 5 cmH2O positive end-expiratory pressure. Tests were conducted at 2 system leaks (1215 and 2528 L/min). The performance characteristics and patient-ventilator asynchrony were assessed, including flow, airway pressure, time, and workload. Results The Breas Vivo30 could not synchronize with the simulator (frequent auto-triggering) at a leak of 2528 L/min, but provided stable assisted ventilation when the leak was 1215 L/min. Missed efforts and back-up ventilation occurred for the Weinmann VENTImotion and Airox Smartair Plus, requiring adjustment of trigger effort. All ventilators had a short trigger delay time (<200 ms), but significant differences between devices were found in triggering workload, pressurization appearance, tidal volume, and peak inspiratory flow. Premature cycling was frequent when the inspiratory termination criteria were at the highest sensitivity. Cycling synchronization was considerably improved by modifying expiratory triggering sensitivity settings, when available. Conclusions Performance and triggering workload varied significantly between bilevel ventilators, possibly due to software algorithm differences. Adjusting the cycling criteria settings can alter the shape of the inspiratory phase and peak expiratory flow, and improve patient-ventilator synchrony. PMID:25619202

  6. Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: a randomised trial

    Microsoft Academic Search

    Mitra B Drakulovic; Antoni Torres; Torsten T Bauer; Jose M Nicolas; Santiago Nogu; Miquel Ferrer

    1999-01-01

    1851 Summary Background Risk factors for nosocomial pneumonia, such as gastro-oesophageal reflux and subsequent aspiration, can be reduced by semirecumbent body position in intensive-care patients. The objective of this study was to assess whether the incidence of nosocomial pneumonia can also be reduced by this measure. Methods This trial was stopped after the planned interim analysis. 86 intubated and mechanically

  7. Reducing ventilator-associated pneumonia rates through a staff education programme

    Microsoft Academic Search

    N Salahuddin; A Zafar; L Sukhyani; S Rahim; M. F Noor; K Hussain; S Siddiqui; M Islam; S. J Husain

    2004-01-01

    Ventilator-associated pneumonia (VAP) is the most common nosocomial infection in patients on mechanical ventilation and results in increases in mortality, prolonged hospitalization and costs. Preventive measures for VAP are well-documented and evidence-based, yet remain poorly implemented in most intensive care units. We undertook an observational pre and post-intervention study to assess whether an educational programme focusing on preventive practices for

  8. Effect of inhaled nitric oxide on respiratory mechanics in ventilated infants with RSV bronchiolitis

    Microsoft Academic Search

    N. R. Patel; J. Hammer; S. Nichani; A. Numa; C. J. L. Newth

    1999-01-01

    Objective: To evaluate the bronchodilator effect of inhaled nitric oxide (NO) in infants with respiratory failure caused by respiratory\\u000a syncytial virus (RSV) bronchiolitis and to compare the effect with the one obtained by salbutamol. Design: Prospective study. Setting: Pediatric intensive care unit of a university children's hospital. Patients: Twelve acutely ill, intubated infants (mean age 4.5 months, mean weight 4.9

  9. Paradoxical ventilator associated pneumonia incidences among selective digestive decontamination studies versus other studies of mechanically ventilated patients: benchmarking the evidence base

    PubMed Central

    2011-01-01

    Introduction Selective digestive decontamination (SDD) appears to have a more compelling evidence base than non-antimicrobial methods for the prevention of ventilator associated pneumonia (VAP). However, the striking variability in ventilator associated pneumonia-incidence proportion (VAP-IP) among the SDD studies remains unexplained and a postulated contextual effect remains untested for. Methods Nine reviews were used to source 45 observational (benchmark) groups and 137 component (control and intervention) groups of studies of SDD and studies of three non-antimicrobial methods of VAP prevention. The logit VAP-IP data were summarized by meta-analysis using random effects methods and the associated heterogeneity (tau2) was measured. As group level predictors of logit VAP-IP, the mode of VAP diagnosis, proportion of trauma admissions, the proportion receiving prolonged ventilation and the intervention method under study were examined in meta-regression models containing the benchmark groups together with either the control (models 1 to 3) or intervention (models 4 to 6) groups of the prevention studies. Results The VAP-IP benchmark derived here is 22.1% (95% confidence interval; 95% CI; 19.2 to 25.5; tau2 0.34) whereas the mean VAP-IP of control groups from studies of SDD and of non-antimicrobial methods, is 35.7 (29.7 to 41.8; tau2 0.63) versus 20.4 (17.2 to 24.0; tau2 0.41), respectively (P < 0.001). The disparity between the benchmark groups and the control groups of the SDD studies, which was most apparent for the highest quality studies, could not be explained in the meta-regression models after adjusting for various group level factors. The mean VAP-IP (95% CI) of intervention groups is 16.0 (12.6 to 20.3; tau2 0.59) and 17.1 (14.2 to 20.3; tau2 0.35) for SDD studies versus studies of non-antimicrobial methods, respectively. Conclusions The VAP-IP among the intervention groups within the SDD evidence base is less variable and more similar to the benchmark than among the control groups. These paradoxical observations cannot readily be explained. The interpretation of the SDD evidence base cannot proceed without further consideration of this contextual effect. PMID:21214897

  10. Child Care Subsidy Use and Child Development: Potential Causal Mechanisms

    ERIC Educational Resources Information Center

    Hawkinson, Laura E.

    2011-01-01

    Research using an experimental design is needed to provide firm causal evidence on the impacts of child care subsidy use on child development, and on underlying causal mechanisms since subsidies can affect child development only indirectly via changes they cause in children's early experiences. However, before costly experimental research is

  11. Long-Term Home Noninvasive Mechanical Ventilation Increases Systemic Inflammatory Response in Chronic Obstructive Pulmonary Disease: A Prospective Observational Study

    PubMed Central

    Paone, Gregorino; Conti, Vittoria; Biondi-Zoccai, Giuseppe; De Falco, Elena; Mollica, Corrado; Monaco, Gianluca; Giannunzio, Gilda; Brunetti, Giuseppe; Schmid, Giovanni; Ranieri, V. Marco

    2014-01-01

    Background. Long-term home noninvasive mechanical ventilation (NIV) is beneficial in COPD but its impact on inflammation is unknown. We assessed the hypothesis that NIV modulates systemic and pulmonary inflammatory biomarkers in stable COPD. Methods. Among 610 patients referred for NIV, we shortlisted those undergoing NIV versus oxygen therapy alone, excluding subjects with comorbidities or non-COPD conditions. Sputum and blood samples were collected after 3 months of clinical stability and analyzed for levels of human neutrophil peptides (HNP), interleukin-6 (IL-6), interleukin-10 (IL-10), and tumor necrosis factor-alpha (TNF-alpha). Patients underwent a two-year follow-up. Unadjusted, propensity-matched, and pH-stratified analyses were performed. Results. Ninety-three patients were included (48 NIV, 45 oxygen), with analogous baseline features. Sputum analysis showed similar HNP, IL-6, IL-10, and TNF-alpha levels (P > 0.5). Conversely, NIV group exhibited higher HNP and IL-6 systemic levels (P < 0.001) and lower IL-10 concentrations (P < 0.001). Subjects undergoing NIV had a significant reduction of rehospitalizations during follow-up compared to oxygen group (P = 0.005). These findings were confirmed after propensity matching and pH stratification. Conclusions. These findings challenge prior paradigms based on the assumption that pulmonary inflammation is per se detrimental. NIV beneficial impact on lung mechanics may overcome the potential unfavorable effects of an increased inflammatory state. PMID:24976687

  12. Clinical review: Long-term noninvasive ventilation

    Microsoft Academic Search

    Dominique Robert; Laurent Argaud

    2007-01-01

    Noninvasive positive ventilation has undergone a remarkable evolution over the past decades and is assuming an important role in the management of both acute and chronic respiratory failure. Long-term ventilatory support should be considered a standard of care to treat selected patients following an intensive care unit (ICU) stay. In this setting, appropriate use of noninvasive ventilation can be expected

  13. Ventilation Model

    SciTech Connect

    V. Chipman

    2002-10-05

    The purpose of the Ventilation Model is to simulate the heat transfer processes in and around waste emplacement drifts during periods of forced ventilation. The model evaluates the effects of emplacement drift ventilation on the thermal conditions in the emplacement drifts and surrounding rock mass, and calculates the heat removal by ventilation as a measure of the viability of ventilation to delay the onset of peak repository temperature and reduce its magnitude. The heat removal by ventilation is temporally and spatially dependent, and is expressed as the fraction of heat carried away by the ventilation air compared to the fraction of heat produced by radionuclide decay. One minus the heat removal is called the wall heat fraction, or the remaining amount of heat that is transferred via conduction to the surrounding rock mass. Downstream models, such as the ''Multiscale Thermohydrologic Model'' (BSC 2001), use the wall heat fractions as outputted from the Ventilation Model to initialize their post-closure analyses. The Ventilation Model report was initially developed to analyze the effects of preclosure continuous ventilation in the Engineered Barrier System (EBS) emplacement drifts, and to provide heat removal data to support EBS design. Revision 00 of the Ventilation Model included documentation of the modeling results from the ANSYS-based heat transfer model. The purposes of Revision 01 of the Ventilation Model are: (1) To validate the conceptual model for preclosure ventilation of emplacement drifts and verify its numerical application in accordance with new procedural requirements as outlined in AP-SIII-10Q, Models (Section 7.0). (2) To satisfy technical issues posed in KTI agreement RDTME 3.14 (Reamer and Williams 2001a). Specifically to demonstrate, with respect to the ANSYS ventilation model, the adequacy of the discretization (Section 6.2.3.1), and the downstream applicability of the model results (i.e. wall heat fractions) to initialize post-closure thermal models (Section 6.6). (3) To satisfy the remainder of KTI agreement TEF 2.07 (Reamer and Williams 2001b). Specifically to provide the results of post-test ANSYS modeling of the Atlas Facility forced convection tests (Section 7.1.2). This portion of the model report also serves as a validation exercise per AP-SIII.10Q, Models, for the ANSYS ventilation model. (4) To further satisfy KTI agreements RDTME 3.01 and 3.14 (Reamer and Williams 2001a) by providing the source documentation referred to in the KTI Letter Report, ''Effect of Forced Ventilation on Thermal-Hydrologic Conditions in the Engineered Barrier System and Near Field Environment'' (Williams 2002). Specifically to provide the results of the MULTIFLUX model which simulates the coupled processes of heat and mass transfer in and around waste emplacement drifts during periods of forced ventilation. This portion of the model report is presented as an Alternative Conceptual Model with a numerical application, and also provides corroborative results used for model validation purposes (Section 6.3 and 6.4).

  14. Pretest Predictions for Ventilation Tests

    SciTech Connect

    Y. Sun; H. Yang; H.N. Kalia

    2007-01-17

    The objective of this calculation is to predict the temperatures of the ventilating air, waste package surface, concrete pipe walls, and insulation that will be developed during the ventilation tests involving various test conditions. The results will be used as input to the following three areas: (1) Decisions regarding testing set-up and performance. (2) Assessing how best to scale the test phenomena measured. (3) Validating numerical approach for modeling continuous ventilation. The scope of the calculation is to identify the physical mechanisms and parameters related to thermal response in the ventilation tests, and develop and describe numerical methods that can be used to calculate the effects of continuous ventilation. Sensitivity studies to assess the impact of variation of linear power densities (linear heat loads) and ventilation air flow rates are included. The calculation is limited to thermal effect only.

  15. Incidence and diagnosis of ventilator-associated tracheobronchitis in the intensive care unit: an international online survey

    PubMed Central

    2014-01-01

    Introduction Several aspects of ventilator-associated tracheobronchitis (VAT)including diagnostic criteria, overlap with ventilator-associated pneumonia (VAP), and appropriate treatment regimensremain poorly defined. The objectives of this study were to survey reported practices in the clinical and microbiological diagnosis of VAT and to evaluate perceptions of the impact of VAT on patient outcomes. Methods We developed a questionnaire consisting of (a) characteristics of the respondent, the ICU, and hospital; (b) current clinical and microbiological diagnostic approach; (c) empirical antibiotic therapy; and (d) the perception of physicians regarding the clinical impact of VAT and its implications. Results A total of 288 ICUs from 16 different countries answered the survey: 147 (51%) from the Latin American (LA) group and 141 (49%) from Spain, Portugal, and France (SPF group). The majority of respondents (n?=?228; 79.2%) reported making the diagnosis of VAT based on clinical and microbiological criteria, and 40 (13.9%) by clinical criteria alone. Approximately half (50.3%) of the respondents agreed that patients should receive antibiotics for the treatment of VAT. Out of all respondents, 269 (93.4%) assume that a VAT episode increases ICU length of stay, and this perception is greater in the LA group (97.3%) than in the SPF group (89.4%, P <0.05). Half of the physicians considered that VAT increases the risk of mortality, and this perception is again greater in the LA group (58.5% versus 41.1%, P <0.05). Conclusions Given the possible high incidence of VAT and the perception of its importance as a risk factor for VAP and mortality, a large multicenter international prospective study would be helpful to validate a consensual definition of VAT, determine its incidence, and delineate its impact on subsequent VAP occurrence. PMID:24521533

  16. Hydrogen inhalation reduced epithelial apoptosis in ventilator-induced lung injury via a mechanism involving nuclear factor-kappa B activation

    SciTech Connect

    Huang, Chien-Sheng [Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA (United States) [Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA (United States); Division of Thoracic Surgery, Department of Surgery, Taipei-Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan (China); Kawamura, Tomohiro; Peng, Ximei [Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA (United States)] [Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA (United States); Tochigi, Naobumi [Department of Pathology, University of Pittsburgh Medical Center, PA (United States)] [Department of Pathology, University of Pittsburgh Medical Center, PA (United States); Shigemura, Norihisa [Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA (United States)] [Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA (United States); Billiar, Timothy R. [Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA (United States)] [Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA (United States); Nakao, Atsunori, E-mail: anakao@imap.pitt.edu [Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA (United States) [Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA (United States); Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA (United States); Toyoda, Yoshiya [Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA (United States)] [Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA (United States)

    2011-05-06

    Highlights: {yields} Hydrogen is a regulatory molecule with antiinflammatory and antiapoptotic protective effects. {yields} There is very limited information on the pathways regulated in vivo by the hydrogen. {yields} Antiapoptotic abilities of hydrogen were explained by upregulation of the antiapoptotic gene. {yields} NF{kappa}B activation during hydrogen treatment was correlated with elevated antiapoptotic protein. {yields} NF{kappa}B activation associated with increase Bcl-2 may contribute to cytoprotection of hydrogen. -- Abstract: We recently demonstrated the inhalation of hydrogen gas, a novel medical therapeutic gas, ameliorates ventilator-induced lung injury (VILI); however, the molecular mechanisms by which hydrogen ameliorates VILI remain unclear. Therefore, we investigated whether inhaled hydrogen gas modulates the nuclear factor-kappa B (NF{kappa}B) signaling pathway. VILI was generated in male C57BL6 mice by performing a tracheostomy and placing the mice on a mechanical ventilator (tidal volume of 30 ml/kg or 10 ml/kg without positive end-expiratory pressure). The ventilator delivered either 2% nitrogen or 2% hydrogen in balanced air. NF{kappa}B activation, as indicated by NF{kappa}B DNA binding, was detected by electrophoretic mobility shift assays and enzyme-linked immunosorbent assay. Hydrogen gas inhalation increased NF{kappa}B DNA binding after 1 h of ventilation and decreased NF{kappa}B DNA binding after 2 h of ventilation, as compared with controls. The early activation of NF{kappa}B during hydrogen treatment was correlated with elevated levels of the antiapoptotic protein Bcl-2 and decreased levels of Bax. Hydrogen inhalation increased oxygen tension, decreased lung edema, and decreased the expression of proinflammatory mediators. Chemical inhibition of early NF{kappa}B activation using SN50 reversed these protective effects. NF{kappa}B activation and an associated increase in the expression of Bcl-2 may contribute, in part, to the cytoprotective effects of hydrogen against apoptotic and inflammatory signaling pathway activation during VILI.

  17. Measuring Residential Ventilation System Airflows: Part 1 Laboratory

    E-print Network

    1 Measuring Residential Ventilation System Airflows: Part 1 ­ Laboratory Evaluation of Airflow: residential, mechanical ventilation, measurement, ASHRAE 62.2, flow hood ABSTRACT Building codes increasingly require tighter homes and mechanical ventilation per ASHRAE Standard 62.2. These ventilation flows must

  18. Cost-consequence analysis of remifentanil-based analgo-sedation vs. conventional analgesia and sedation for patients on mechanical ventilation in the Netherlands

    PubMed Central

    2010-01-01

    Introduction Hospitals are increasingly forced to consider the economics of technology use. We estimated the incremental cost-consequences of remifentanil-based analgo-sedation (RS) vs. conventional analgesia and sedation (CS) in patients requiring mechanical ventilation (MV) in the intensive care unit (ICU), using a modelling approach. Methods A Markov model was developed to describe patient flow in the ICU. The hourly probabilities to move from one state to another were derived from UltiSAFE, a Dutch clinical study involving ICU patients with an expected MV-time of two to three days requiring analgesia and sedation. Study medication was either: CS (morphine or fentanyl combined with propofol, midazolam or lorazepam) or: RS (remifentanil, combined with propofol when required). Study drug costs were derived from the trial, whereas all other ICU costs were estimated separately in a Dutch micro-costing study. All costs were measured from the hospital perspective (price level of 2006). Patients were followed in the model for 28 days. We also studied the sub-population where weaning had started within 72 hours. Results The average total 28-day costs were 15,626 with RS versus 17,100 with CS, meaning a difference in costs of 1474 (95% CI -2163, 5110). The average length-of-stay (LOS) in the ICU was 7.6 days in the RS group versus 8.5 days in the CS group (difference 1.0, 95% CI -0.7, 2.6), while the average MV time was 5.0 days for RS versus 6.0 days for CS. Similar differences were found in the subgroup analysis. Conclusions Compared to CS, RS significantly decreases the overall costs in the ICU. Trial Registration Clinicaltrials.gov NCT00158873. PMID:21040558

  19. Recent studies have documented the lung ventilation mechanics of aquatic salamanders (Brainerd et al., 1993;

    E-print Network

    Brainerd, Elizabeth

    ) Ambystoma tigrinum and discuss patterns of breathing mechanics in the three extant orders of amphibians (Anura, Caudata and Gymnophiona). Larval Ambystoma tigrinum are completely aquatic. In contrast, post of adult (post-metamorphic) tiger salamanders (Ambystoma tigrinum). Three results emerged: (i) under

  20. Noninvasive ventilation in acute respiratory failure

    PubMed Central

    Mas, Arantxa; Masip, Josep

    2014-01-01

    After the institution of positive-pressure ventilation, the use of noninvasive ventilation (NIV) through an interface substantially increased. The first technique was continuous positive airway pressure; but, after the introduction of pressure support ventilation at the end of the 20th century, this became the main modality. Both techniques, and some others that have been recently introduced and which integrate some technological innovations, have extensively demonstrated a faster improvement of acute respiratory failure in different patient populations, avoiding endotracheal intubation and facilitating the release of conventional invasive mechanical ventilation. In acute settings, NIV is currently the first-line treatment for moderate-to-severe chronic obstructive pulmonary disease exacerbation as well as for acute cardiogenic pulmonary edema and should be considered in immunocompromised patients with acute respiratory insufficiency, in difficult weaning, and in the prevention of postextubation failure. Alternatively, it can also be used in the postoperative period and in cases of pneumonia and asthma or as a palliative treatment. NIV is currently used in a wide range of acute settings, such as critical care and emergency departments, hospital wards, palliative or pediatric units, and in pre-hospital care. It is also used as a home care therapy in patients with chronic pulmonary or sleep disorders. The appropriate selection of patients and the adaptation to the technique are the keys to success. This review essentially analyzes the evidence of benefits of NIV in different populations with acute respiratory failure and describes the main modalities, new devices, and some practical aspects of the use of this technique. PMID:25143721

  1. Preferential skeletal muscle myosin loss in response to mechanical silencing in a novel rat intensive care unit model: underlying mechanisms

    PubMed Central

    Ochala, Julien; Gustafson, Ann-Marie; Diez, Monica Llano; Renaud, Guillaume; Li, Meishan; Aare, Sudhakar; Qaisar, Rizwan; Banduseela, Varuna C; Hedstrm, Yvette; Tang, Xiaorui; Dworkin, Barry; Ford, G Charles; Nair, K Sreekumaran; Perera, Sue; Gautel, Mathias; Larsson, Lars

    2011-01-01

    Abstract The muscle wasting and impaired muscle function in critically ill intensive care unit (ICU) patients delay recovery from the primary disease, and have debilitating consequences that can persist for years after hospital discharge. It is likely that, in addition to pernicious effects of the primary disease, the basic life support procedures of long-term ICU treatment contribute directly to the progressive impairment of muscle function. This study aims at improving our understanding of the mechanisms underlying muscle wasting in ICU patients by using a unique experimental rat ICU model where animals are mechanically ventilated, sedated and pharmacologically paralysed for duration varying between 6 h and 14 days. Results show that the ICU intervention induces a phenotype resembling the severe muscle wasting and paralysis associated with the acute quadriplegic myopathy (AQM) observed in ICU patients, i.e. a preferential loss of myosin, transcriptional down-regulation of myosin synthesis, muscle atrophy and a dramatic decrease in muscle fibre force generation capacity. Detailed analyses of protein degradation pathways show that the ubiquitin proteasome pathway is highly involved in this process. A sequential change in localisation of muscle-specific RING finger proteins 1/2 (MuRF1/2) observed during the experimental period is suggested to play an instrumental role in both transcriptional regulation and protein degradation. We propose that, for those critically ill patients who develop AQM, complete mechanical silencing, due to pharmacological paralysis or sedation, is a critical factor underlying the preferential loss of the molecular motor protein myosin that leads to impaired muscle function or persisting paralysis. PMID:21320889

  2. Oxidative metabolism of peripheral blood neutrophils in experimental acute hypercapnia in the mechanically ventilated rabbit

    Microsoft Academic Search

    Hanna Billert; Leon Drobnik; Danuta Podstawska; Marcin W?odarczyk; Maciej Kurpisz

    2003-01-01

    Background and aim: The aim of this study was to investigate the effect of acute hypercapnia due to the mechanical hypoventilation on the oxidative metabolism of peripheral blood neutrophils in the rabbit. Methods: The study was performed on 24 Chinchilla rabbits, randomized into normo- and hypercapnia groups (PaCO2 between 9 and 11 kPa over 180 min). At the baseline point

  3. 46 CFR 168.15-50 - Ventilation.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...2013-10-01 2013-10-01 false Ventilation. 168.15-50 Section 168.15-50... Accommodations 168.15-50 Ventilation. (a) All quarters must be adequately...the vessel. (b) When mechanical ventilation is provided for sleeping rooms,...

  4. 46 CFR 98.25-75 - Ventilation.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...2011-10-01 2011-10-01 false Ventilation. 98.25-75 Section 98.25-75...Anhydrous Ammonia in Bulk 98.25-75 Ventilation. (a) All enclosed spaces containing...connections shall be provided with mechanical ventilation of sufficient capacity to...

  5. 9 CFR 91.21 - Ventilation.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ...2012-01-01 2012-01-01 false Ventilation. 91.21 Section 91.21 Animals...Vessels and Accommodations 91.21 Ventilation. Each underdeck compartment on...equipped with a system of mechanical ventilation that will furnish a complete...

  6. 46 CFR 98.25-75 - Ventilation.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...2012-10-01 2012-10-01 false Ventilation. 98.25-75 Section 98.25-75...Anhydrous Ammonia in Bulk 98.25-75 Ventilation. (a) All enclosed spaces containing...connections shall be provided with mechanical ventilation of sufficient capacity to...

  7. 9 CFR 91.21 - Ventilation.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ...2011-01-01 2011-01-01 false Ventilation. 91.21 Section 91.21 Animals...Vessels and Accommodations 91.21 Ventilation. Each underdeck compartment on...equipped with a system of mechanical ventilation that will furnish a complete...

  8. 9 CFR 91.21 - Ventilation.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ...2013-01-01 2013-01-01 false Ventilation. 91.21 Section 91.21 Animals...Vessels and Accommodations 91.21 Ventilation. Each underdeck compartment on...equipped with a system of mechanical ventilation that will furnish a complete...

  9. 46 CFR 98.25-75 - Ventilation.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...2013-10-01 2013-10-01 false Ventilation. 98.25-75 Section 98.25-75...Anhydrous Ammonia in Bulk 98.25-75 Ventilation. (a) All enclosed spaces containing...connections shall be provided with mechanical ventilation of sufficient capacity to...

  10. 46 CFR 98.25-75 - Ventilation.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...2014-10-01 2014-10-01 false Ventilation. 98.25-75 Section 98.25-75...Anhydrous Ammonia in Bulk 98.25-75 Ventilation. (a) All enclosed spaces containing...connections shall be provided with mechanical ventilation of sufficient capacity to...

  11. 9 CFR 91.21 - Ventilation.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ...2014-01-01 2014-01-01 false Ventilation. 91.21 Section 91.21 Animals...Vessels and Accommodations 91.21 Ventilation. Each underdeck compartment on...equipped with a system of mechanical ventilation that will furnish a complete...

  12. 9 CFR 91.21 - Ventilation.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ...2010-01-01 2010-01-01 false Ventilation. 91.21 Section 91.21 Animals...Vessels and Accommodations 91.21 Ventilation. Each underdeck compartment on...equipped with a system of mechanical ventilation that will furnish a complete...

  13. 46 CFR 168.15-50 - Ventilation.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...2010-10-01 2010-10-01 false Ventilation. 168.15-50 Section 168.15-50... Accommodations 168.15-50 Ventilation. (a) All quarters must be adequately...the vessel. (b) When mechanical ventilation is provided for sleeping rooms,...

  14. 46 CFR 168.15-50 - Ventilation.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...2011-10-01 2011-10-01 false Ventilation. 168.15-50 Section 168.15-50... Accommodations 168.15-50 Ventilation. (a) All quarters must be adequately...the vessel. (b) When mechanical ventilation is provided for sleeping rooms,...

  15. 46 CFR 168.15-50 - Ventilation.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...2014-10-01 2014-10-01 false Ventilation. 168.15-50 Section 168.15-50... Accommodations 168.15-50 Ventilation. (a) All quarters must be adequately...the vessel. (b) When mechanical ventilation is provided for sleeping rooms,...

  16. 46 CFR 98.25-75 - Ventilation.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...2010-10-01 2010-10-01 false Ventilation. 98.25-75 Section 98.25-75...Anhydrous Ammonia in Bulk 98.25-75 Ventilation. (a) All enclosed spaces containing...connections shall be provided with mechanical ventilation of sufficient capacity to...

  17. The Severe Respiratory Insufficiency (SRI) Questionnaire A specific measure of health-related quality of life in patients receiving home mechanical ventilation

    Microsoft Academic Search

    Wolfram Windisch; Klaus Freidel; Bernd Schucher; Hansjrg Baumann; Matthias Wiebel; Heinrich Matthys; Franz Petermann

    2003-01-01

    Background and Objective: The objective of this study was to develop a specific instrument for measuring health-related quality of life (HRQL) in patients receiving home mechanical ventilation (HMV).Methods: The Severe Respiratory Insufficiency (SRI) Questionnaire was developed and tested for its psychometric properties following a multicentric clinical trial including 226 patients receiving HMV (mean age 57.314.0 years).Results: Forty-nine items passed the

  18. [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

  19. Pharmacokinetics and lung delivery of PDDS-aerosolized amikacin (NKTR-061) in intubated and mechanically ventilated patients with nosocomial pneumonia

    PubMed Central

    2009-01-01

    Introduction Aminoglycosides aerosolization might achieve better diffusion into the alveolar compartment than intravenous use. The objective of this multicenter study was to evaluate aerosol-delivered amikacin penetration into the alveolar epithelial lining fluid (ELF) using a new vibrating mesh nebulizer (Pulmonary Drug Delivery System (PDDS), Nektar Therapeutics), which delivers high doses to the lungs. Methods Nebulized amikacin (400 mg bid) was delivered to the lungs of 28 mechanically ventilated patients with Gram-negative VAP for 7-14 days, adjunctive to intravenous therapy. On treatment day 3, 30 minutes after completing aerosol delivery, all the patients underwent bronchoalveolar lavage in the infection-involved area and the ELF amikacin concentration was determined. The same day, urine and serum amikacin concentrations were determined at different time points. Results Median (range) ELF amikacin and maximum serum amikacin concentrations were 976.1 (135.7-16127.6) and 0.9 (0.62-1.73) ?g/mL, respectively. The median total amount of amikacin excreted in urine during the first and second 12-hour collection on day 3 were 19 (12.21-28) and 21.2 (14.1-29.98) ?g, respectively. During the study period, daily through amikacin measurements were below the level of nephrotoxicity. Sixty-four unexpected adverse events were reported, among which 2 were deemed possibly due to nebulized amikacin: one episode of worsening renal failure, and one episode of bronchospasm. Conclusions PDDS delivery of aerosolized amikacin achieved very high aminoglycoside concentrations in ELF from radiography-controlled infection-involved zones, while maintaining safe serum amikacin concentrations. The ELF concentrations always exceeded the amikacin minimum inhibitory concentrations for Gram-negative microorganisms usually responsible for these pneumonias. The clinical impact of amikacin delivery with this system remains to be determined. Trial Registration ClinicalTrials.gov Identifier: NCT01021436. PMID:20003269

  20. Long-term survival in elderly patients with a do-not-intubate order treated with noninvasive mechanical ventilation

    PubMed Central

    Scarpazza, Paolo; Incorvaia, Cristoforo; Amboni, Paolo; di Franco, Giuseppe; Raschi, Stefania; Usai, Pierfranco; Bernareggi, Monica; Bonacina, Cristiano; Melacini, Chiara; Cattaneo, Roberta; Bencini, Serena; Pravettoni, Chiara; Riario-Sforza, Gian Galeazzo; Passalacqua, Gianni; Casali, Walter

    2011-01-01

    Background: Noninvasive mechanical ventilation (NIMV) is an effective tool in treating patients with acute respiratory failure (ARF), since it reduces both the need for endotracheal intubation and the mortality in comparison with nonventilated patients. A particular issue is represented by the outcome of NIMV in patients referred to the emergency department for ARF and with a do-not-intubate (DNI) status because of advanced age or excessively critical conditions. This study evaluated long-term survival in a group of elderly patients with acute hypercapnic ARF who had a DNI order and who were successfully treated by NIMV. Methods: The population consisted of 54 patients with a favorable outcome after NIMV for ARF. They were followed up for 3 years by regular control visits, with at least one visit every 4 months, or as needed according to the patients condition. Of these, 31 continued NIMV at home and 23 were on long-term oxygen therapy (LTOT) alone. Results: A total of 16 of the 52 patients had not survived at the 1-year follow-up, and another eight patients died during the 3-year observation, with an overall mortality rate of 30.8% after 1 year and 46.2% after 3 years. Comparing patients who continued NIMV at home with those who were on LTOT alone, 9 of the 29 patients on home NIMV died (6 after 1 year and 3 after 3 years) and 15 of the 23 patients on LTOT alone died (10 after 1 year and 5 after 3 years). Conclusion: These results show that elderly patients with ARF successfully treated by NIMV following a DNI order have a satisfactory long-term survival. PMID:21814461

  1. Noninvasive mechanical ventilation with average volume assured pressure support (AVAPS) in patients with chronic obstructive pulmonary disease and hypercapnic encephalopathy

    PubMed Central

    2013-01-01

    Background Non-invasive mechanical ventilation (NIV) in patients with acute respiratory failure has been traditionally determined based on clinical assessment and changes in blood gases, with NIV support pressures manually adjusted by an operator. Bilevel positive airway pressure-spontaneous/timed (BiPAP S/T) with average volume assured pressure support (AVAPS) uses a fixed tidal volume that automatically adjusts to a patients needs. Our study assessed the use of BiPAP S/T with AVAPS in patients with chronic obstructive pulmonary disease (COPD) and hypercapnic encephalopathy as compared to BiPAP S/T alone, upon immediate arrival in the Emergency-ICU. Methods We carried out a prospective interventional match-controlled study in Guayaquil, Ecuador. A total of 22 patients were analyzed. Eleven with COPD exacerbations and hypercapnic encephalopathy with a Glasgow Coma Scale (GCS) <10 and a pH of 7.25-7.35 were assigned to receive NIV via BiPAP S/T with AVAPS. Eleven patients were selected as paired controls for the initial group by physicians who were unfamiliar with our study, and these patients were administered BiPAP S/T. Arterial blood gases, GCS, vital signs, and ventilatory parameters were then measured and compared between the two groups. Results We observed statistically significant differences in favor of the BiPAP S/T + AVAPS group in GCS (P = .00001), pCO2 (P = .03) and maximum inspiratory positive airway pressure (IPAP) (P = .005), among others. However, no significant differences in terms of length of stay or days on NIV were observed. Conclusions BiPAP S/T with AVAPS facilitates rapid recovery of consciousness when compared to traditional BiPAP S/T in patients with chronic obstructive pulmonary disease and hypercapnic encephalopathy. Trial registration Current Controlled Trials application ref is ISRCTN05135218 PMID:23497021

  2. 30 CFR 77.1911 - Ventilation of slopes and shafts.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ...2011-07-01 2011-07-01 false Ventilation of slopes and shafts. 77.1911...Slope and Shaft Sinking 77.1911 Ventilation of slopes and shafts. (a) All...shafts shall be ventilated by mechanical ventilation equipment during development....

  3. 30 CFR 77.1911 - Ventilation of slopes and shafts.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ...2012-07-01 2012-07-01 false Ventilation of slopes and shafts. 77.1911...Slope and Shaft Sinking 77.1911 Ventilation of slopes and shafts. (a) All...shafts shall be ventilated by mechanical ventilation equipment during development....

  4. 30 CFR 77.1911 - Ventilation of slopes and shafts.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ...2014-07-01 2014-07-01 false Ventilation of slopes and shafts. 77.1911...Slope and Shaft Sinking 77.1911 Ventilation of slopes and shafts. (a) All...shafts shall be ventilated by mechanical ventilation equipment during development....

  5. 30 CFR 77.1911 - Ventilation of slopes and shafts.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ...2013-07-01 2013-07-01 false Ventilation of slopes and shafts. 77.1911...Slope and Shaft Sinking 77.1911 Ventilation of slopes and shafts. (a) All...shafts shall be ventilated by mechanical ventilation equipment during development....

  6. Comparative evaluation of hemodynamic and respiratory parameters during mechanical ventilation with two tidal volumes calculated by demi-span based height and measured height in normal lungs

    PubMed Central

    Seresht, L. Mousavi; Golparvar, Mohammad; Yaraghi, Ahmad

    2014-01-01

    Background: Appropriate determination of tidal volume (VT) is important for preventing ventilation induced lung injury. We compared hemodynamic and respiratory parameters in two conditions of receiving VTs calculated by using body weight (BW), which was estimated by measured height (HBW) or demi-span based body weight (DBW). Materials and Methods: This controlled-trial was conducted in St. Alzahra Hospital in 2009 on American Society of Anesthesiologists (ASA) I and II, 18-65-years-old patients. Standing height and weight were measured and then height was calculated using demi-span method. BW and VT were calculated with acute respiratory distress syndrome-net formula. Patients were randomized and then crossed to receive ventilation with both calculated VTs for 20 min. Hemodynamic and respiratory parameters were analyzed with SPSS version 20.0 using univariate and multivariate analyses. Results: Forty nine patients were studied. Demi-span based body weight and thus VT (DTV) were lower than Height based body weight and VT (HTV) (P = 0.028), in male patients (P = 0.005). Difference was observed in peak airway pressure (PAP) and airway resistance (AR) changes with higher PAP and AR at 20 min after receiving HTV compared with DTV. Conclusions: Estimated VT based on measured height is higher than that based on demi-span and this difference exists only in females, and this higher VT results higher airway pressures during mechanical ventilation. PMID:24627845

  7. Injurious mechanical ventilation causes kidney apoptosis and dysfunction during sepsis but not after intra-tracheal acid instillation: an experimental study

    PubMed Central

    2014-01-01

    Background Intratracheal aspiration and sepsis are leading causes of acute lung injury that frequently necessitate mechanical ventilation (MV), which may aggravate lung injury thereby potentially increasing the risk of acute kidney injury (AKI). We compared the effects of ventilation strategies and underlying conditions on the development of AKI. Methods Spraque Dawley rats were challenged by intratracheal acid instillation or 24h of abdominal sepsis, followed by MV with a low tidal volume (LVT) and 5cm H2O positive end-expiratory pressure (PEEP) or a high tidal volume (HVT) and no PEEP, which is known to cause more lung injury after acid instillation than in sepsis. Rats were ventilated for 4hrs and kidney function and plasma mediator levels were measured. Kidney injury was assessed by microscopy; apoptosis was quantified by TUNEL staining. Results During sepsis, but not after acid instillation, MV with HVT caused more renal apoptosis than MV with LVT. Increased plasma active plasminogen activator inhibitor-1 correlated to kidney apoptosis in the cortex and medulla. Increased apoptosis after HVT ventilation during sepsis was associated with a 40% decrease in creatinine clearance. Conclusions AKI is more likely to develop after MV induced lung injury during an indirect (as in sepsis) than after a direct (as after intra-tracheal instillation) insult to the lungs, since it induces kidney apoptosis during sepsis but not after acid instillation, opposite to the lung injury it caused. Our findings thus suggest using protective ventilatory strategies in human sepsis, even in the absence of overt lung injury, to protect the kidney. PMID:25073618

  8. The evolution of neurocritical care.

    PubMed

    Korbakis, Georgia; Bleck, Thomas

    2014-10-01

    Although neurocritical care as a subspecialty is a relatively young field of medicine, its origins can be traced back to ancient times. This article focuses on the progression of neurocritical care from prehistoric trepanation procedures, through the development of mechanical ventilation, management of increased intracranial pressure, and traumatic brain injury, to the establishment of the first "real" intensive care units, and finally to modern monitoring in neurocritical care, management of post-cardiac arrest patients, and the diagnosis of brain death. This article also focuses on the future direction of neurocritical care. PMID:25257734

  9. Outcome of Concurrent Occult Hemothorax and Pneumothorax in Trauma Patients Who Required Assisted Ventilation

    PubMed Central

    Mahmood, Ismail; Tawfeek, Zainab; El-Menyar, Ayman; Zarour, Ahmad; Afifi, Ibrahim; Kumar, Suresh; Latifi, Rifat; Al-Thani, Hassan

    2015-01-01

    Background. The management and outcomes of occult hemopneumothorax in blunt trauma patients who required mechanical ventilation are not well studied. We aimed to study patients with occult hemopneumothorax on mechanical ventilation who could be carefully managed without tube thoracostomy. Methods. Chest trauma patients with occult hemopneumothorax who were on mechanical ventilation were prospectively evaluated. The presence of hemopneumothorax was confirmed by CT scanning. Hospital length of stay, complications, and outcome were recorded. Results. A total of 56 chest trauma patients with occult hemopneumothorax who were on ventilatory support were included with a mean age of 36??13 years. Hemopneumothorax was managed conservatively in 72% cases and 28% underwent tube thoracostomy as indicated. 29% of patients developed pneumonia, 16% had Acute Respiratory Distress Syndrome (ARDS), and 7% died. Thickness of hemothorax, duration of mechanical ventilation, and development of ARDS were significantly associated with tube thoracostomy in comparison to no-chest tube group. Conclusions. The majority of occult hemopneumothorax can be carefully managed without tube thoracostomy in patients who required positive pressure ventilation. Tube thoracotomy could be restricted to those who had evidence of increase in the size of the hemothorax or pneumothorax on follow-up chest radiographs or developed respiratory compromise. PMID:25785199

  10. Ventilator-associated pneumonia with or without toothbrushing: a randomized controlled trial.

    PubMed

    Lorente, L; Lecuona, M; Jimnez, A; Palmero, S; Pastor, E; Lafuente, N; Ramos, M J; Mora, M L; Sierra, A

    2012-10-01

    Certain guidelines for the prevention of ventilator-associated pneumonia (VAP) recommend oral care with chlorhexidine, but none refer to the use of a toothbrush for oral hygiene. The role of toothbrush use has received scant attention. Thus, the objective of this study was to compare the incidence of VAP in critical care patients receiving oral care with and without manual brushing of the teeth. This was a randomized clinical trial developed in a 24-bed medical-surgical intensive care unit (ICU). Patients undergoing invasive mechanical ventilation for than 24 h were included. Patients were randomly assigned to receive oral care with or without toothbrushing. All patients received oral care with 0.12?% chlorhexidine digluconate. Tracheal aspirate samples were obtained during endotracheal intubation, then twice a week, and, finally, on extubation. There were no significant differences between the two groups of patients in the baseline characteristics. We found no statistically significant differences between the groups regarding the incidence of VAP (21 of 217 [9.7?%] with toothbrushing vs. 24 of 219 [11.0?%] without toothbrushing; odds ratio [OR]?=?0.87, 95?% confidence interval [CI]?=?0.469-1.615; p?=?0.75). Adding manual toothbrushing to chlorhexidine oral care does not help to prevent VAP in critical care patients on mechanical ventilation. PMID:22422274

  11. Investigation of temperature and thermal stress in ventilated disc brake based on 3D thermo-mechanical coupling model

    Microsoft Academic Search

    Pyung Hwang; Xuan Wu

    2010-01-01

    Ventilated disc brakes are widely used for reducing velocity due to their braking stability, controllability and ability to\\u000a prove a wide-ranging brake torque. During braking, the kinetic energy and potential energies of a moving vehicle are converted\\u000a into thermal energy through friction heating between the brake disc and the pads. The object of the present study is to investigate\\u000a the

  12. Outcome of goal-directed non-invasive ventilation and mechanical insufflation\\/exsufflation in spinal muscular atrophy type I

    Microsoft Academic Search

    M. Chatwin; A. Bush; A. K. Simonds

    2011-01-01

    BackgroundThere are widely discrepant views on the respiratory management of infants with spinal muscular atrophy (SMA) type I. Typically, management is palliative.DesignA descriptive study of interventions and investigations is reported that were offered to a cohort of 13 children with SMA type I referred to our centre.Interventions and investigationsincluded sleep studies, provision of non-invasive positive pressure ventilation (NIPPV) for ventilatory

  13. Lung Function and Organ Dysfunctions in 178 Patients Requiring Mechanical Ventilation During The 2009 Influenza A (H1N1) Pandemic

    PubMed Central

    2011-01-01

    Introduction Most cases of the 2009 influenza A (H1N1) infection are self-limited, but occasionally the disease evolves to a severe condition needing hospitalization. Here we describe the evolution of the respiratory compromise, ventilatory management and laboratory variables of patients with diffuse viral pneumonitis caused by pandemic 2009 influenza A (H1N1) admitted to the ICU. Method This was a multicenter, prospective inception cohort study including adult patients with acute respiratory failure requiring mechanical ventilation (MV) admitted to 20 ICUs in Argentina between June and September of 2009 during the influenza A (H1N1) pandemic. In a standard case-report form, we collected epidemiological characteristics, results of real-time reverse-transcriptase--polymerase-chain-reaction viral diagnostic tests, oxygenation variables, acid-base status, respiratory mechanics, ventilation management and laboratory tests. Variables were recorded on ICU admission and at days 3, 7 and 10. Results During the study period 178 patients with diffuse viral pneumonitis requiring MV were admitted. They were 44 15 years of age, with Acute Physiology And Chronic Health Evaluation II (APACHE II) scores of 18 7, and most frequent comorbidities were obesity (26%), previous respiratory disease (24%) and immunosuppression (16%). Non-invasive ventilation (NIV) was applied in 49 (28%) patients on admission, but 94% were later intubated. Acute respiratory distress syndrome (ARDS) was present throughout the entire ICU stay in the whole group (mean PaO2/FIO2 170 25). Tidal-volumes used were 7.8 to 8.1 ml/kg (ideal body weight), plateau pressures always remained < 30 cmH2O, without differences between survivors and non-survivors; and mean positive end-expiratory pressure (PEEP) levels used were between 8 to 12 cm H2O. Rescue therapies, like recruitment maneuvers (8 to 35%), prone positioning (12 to 24%) and tracheal gas insufflation (3%) were frequently applied. At all time points, pH, platelet count, lactate dehydrogenase assay (LDH) and Sequential Organ Failure Assessment (SOFA) differed significantly between survivors and non-survivors. Lack of recovery of platelet count and persistence of leukocytosis were characteristic of non-survivors. Mortality was high (46%); and length of MV was 10 (6 to 17) days. Conclusions These patients had severe, hypoxemic respiratory failure compatible with ARDS that persisted over time, frequently requiring rescue therapies to support oxygenation. NIV use is not warranted, given its high failure rate. Death and evolution to prolonged mechanical ventilation were common outcomes. Persistence of thrombocytopenia, acidosis and leukocytosis, and high LDH levels found in non-survivors during the course of the disease might be novel prognostic findings. PMID:21849039

  14. 29 CFR 1926.353 - Ventilation and protection in welding, cutting, and heating.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...2010-07-01 2010-07-01 false Ventilation and protection in welding, cutting...Welding and Cutting 1926.353 Ventilation and protection in welding, cutting...and heating. (a) Mechanical ventilation. For purposes of this...

  15. 29 CFR 1926.353 - Ventilation and protection in welding, cutting, and heating.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ...2014-07-01 2014-07-01 false Ventilation and protection in welding, cutting...Welding and Cutting 1926.353 Ventilation and protection in welding, cutting...and heating. (a) Mechanical ventilation. For purposes of this...

  16. 29 CFR 1915.51 - Ventilation and protection in welding, cutting and heating.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ...2013-07-01 2013-07-01 false Ventilation and protection in welding, cutting...Cutting and Heating 1915.51 Ventilation and protection in welding, cutting...ship repairing. (b) Mechanical ventilation requirements. (1) For...

  17. 29 CFR 1915.51 - Ventilation and protection in welding, cutting and heating.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ...2012-07-01 2012-07-01 false Ventilation and protection in welding, cutting...Cutting and Heating 1915.51 Ventilation and protection in welding, cutting...ship repairing. (b) Mechanical ventilation requirements. (1) For...

  18. Night ventilation control strategies in office buildings

    SciTech Connect

    Wang, Zhaojun; Yi, Lingli; Gao, Fusheng [School of Municipal and Environmental Engineering, Harbin Institute of Technology, Harbin 150090 (China)

    2009-10-15

    In moderate climates night ventilation is an effective and energy-efficient approach to improve the indoor thermal environment for office buildings during the summer months, especially for heavyweight construction. However, is night ventilation a suitable strategy for office buildings with lightweight construction located in cold climates? In order to answer this question, the whole energy-consumption analysis software EnergyPlus was used to simulate the indoor thermal environment and energy consumption in typical office buildings with night mechanical ventilation in three cities in northern China. The summer outdoor climate data was analyzed, and three typical design days were chosen. The most important factors influencing night ventilation performance such as ventilation rates, ventilation duration, building mass and climatic conditions were evaluated. When night ventilation operation time is closer to active cooling time, the efficiency of night ventilation is higher. With night ventilation rate of 10 ach, the mean radiant temperature of the indoor surface decreased by up to 3.9 C. The longer the duration of operation, the more efficient the night ventilation strategy becomes. The control strategies for three locations are given in the paper. Based on the optimized strategies, the operation consumption and fees are calculated. The results show that more energy is saved in office buildings cooled by a night ventilation system in northern China than ones that do not employ this strategy. (author)

  19. Cytokines and ventilator-induced acute lung injury

    Microsoft Academic Search

    Bing HAN; Mingyao LIU

    2002-01-01

    Mechanical ventilation is an indispensable therapy for patients who need respiratory support. However, im- proper ventilation can lead to acute lung injury, which contributes to the mortality and morbidity of patients with respiratory distress. Mechanical ventilator-induced production of pro-inflammatory mediators, such as cytokines and chemokines, has been suggested to play an important role in mediating acute inflammatory responses in the

  20. Modeling buoyancy-driven airflow in ventilation shafts

    E-print Network

    Ray, Stephen D. (Stephen Douglas)

    2012-01-01

    Naturally ventilated buildings can significantly reduce the required energy for cooling and ventilating buildings by drawing in outdoor air using non-mechanical forces. Buoyancy-driven systems are common in naturally ...

  1. Study of natural ventilation in buildings with large eddy simulation

    E-print Network

    Jiang, Yi, 1972-

    2002-01-01

    With the discovery of many economic, environmental, and health problems in sealed and mechanically ventilated buildings, the concept of natural ventilation has been revived. "Buildings that breathe" have become more and ...

  2. Ventilation Requirements in Hot Humid Climates

    E-print Network

    Walker, I. S.; Sherman, M. H.

    2006-01-01

    VENTILATION REQUIREMENTS IN HOT, HUMID CLIMATES I.S. Walker M. H. Sherman Staff Scientist Senior Scientist Lawrence Berkeley National Laboratory Berkeley CA ABSTRACT In 2003 ASHRAE approved the nations first residential... ventilation standard, ASHRAE Standard 62.2. Meeting this standard in new construction requires the use of mechanical ventilation, which in turn can often significantly increase the latent load faced in new homes. As the thermal performance of houses...

  3. Update on the role of extracorporeal CO2 removal as an adjunct to mechanical ventilation in ARDS.

    PubMed

    Morimont, Philippe; Batchinsky, Andriy; Lambermont, Bernard

    2015-12-01

    This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2015 and co-published as a series in Critical Care. Other articles in the series can be found online at http://ccforum.com/series/annualupdate2015 . Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/8901 . PMID:25777891

  4. Development of a Residential Integrated Ventilation Controller

    SciTech Connect

    Staff Scientist; Walker, Iain; Sherman, Max; Dickerhoff, Darryl

    2011-12-01

    The goal of this study was to develop a Residential Integrated Ventilation Controller (RIVEC) to reduce the energy impact of required mechanical ventilation by 20percent, maintain or improve indoor air quality and provide demand response benefits. This represents potential energy savings of about 140 GWh of electricity and 83 million therms of natural gas as well as proportional peak savings in California. The RIVEC controller is intended to meet the 2008 Title 24 requirements for residential ventilation as well as taking into account the issues of outdoor conditions, other ventilation devices (including economizers), peak demand concerns and occupant preferences. The controller is designed to manage all the residential ventilation systems that are currently available. A key innovation in this controller is the ability to implement the concept of efficacy and intermittent ventilation which allows time shifting of ventilation. Using this approach ventilation can be shifted away from times of high cost or high outdoor pollution towards times when it is cheaper and more effective. Simulations, based on the ones used to develop the new residential ventilation requirements for the California Buildings Energy code, were used to further define the specific criteria and strategies needed for the controller. These simulations provide estimates of the energy, peak power and contaminant improvement possible for different California climates for the various ventilation systems. Results from a field test of the prototype controller corroborate the predicted performance.

  5. Energy recovery ventilator

    Microsoft Academic Search

    S. L. Schneider; K. Dravnieks

    1985-01-01

    An energy recovery ventilator adapted to be mounted on a roof and adapted to be connected to the outlet of an exhaust air duct of a building ventilation system and the inlet of an air supply duct of a building ventilation system. The energy recovery ventilator includes a housing having an exhaust air chamber and a supply air chamber separated

  6. Non invasive ventilation in cardio-surgical patients.

    PubMed

    Guarracino, F; Ambrosino, N

    2011-07-01

    Non invasive ventilation (NIV), primarily applied in cardiogenic pulmonary edema, decompensated COPD and hypoxemic respiratory failure, has also found a wide application in the postoperative period. The expanding indications to the transcatheter treatment of diseased left heart valves have led to an increase in cardiac interventional and diagnostic procedures in severely fragile cardiac patients. As an essential part of post cardiac surgery care is ventilatory support, NIV use has expanded to cardiosurgical patients. The objective of this study was to investigate the application and the results of preventive and curative NIV in patients after cardiac surgery. Despite limited data and the necessity of randomized trials, the NIV should be considered in selected patients with postoperative acute respiratory failure as a tool to both prevent and treat acute respiratory failure following patient weaning from mechanical ventilation and tracheal extubation. The knowledge and the real time assessment of the possible effects of positive pressure ventilation on cardiopulmonary interactions in the clinical scenario of cardiac surgery will prompt the intensivists to tailor the respiratory support by non invasive ventilation to the individual patient. The influence on the cardiovascular system of positive pressure and volume delivered through the airways, which can be highly favorable on the impaired left heart and less favorable on the diseased right heart, should be considered when applying NIV in a cardio-surgical patient. As a consequence, the application of NIV in this setting requires an expertly skilled team, continuous hemodynamic monitoring and echocardiographic assessment. PMID:21709660

  7. Policy Implications of Alternative Child Care Funding Mechanisms. Executive Summary.

    ERIC Educational Resources Information Center

    REAP Associates, Washington, DC.

    This study was designed to measure the economic impact on state agencies, AFDC recipients and child care providers if day care payments were calculated as income disregards rather than Title XX expenditures. The methodology, used in preliminary surveys in four states (North Carolina, Oregon, California and Maine) consisted of three major steps:

  8. The JAKSTAT Pathway Is Critical in Ventilator-Induced Diaphragm Dysfunction

    PubMed Central

    Tang, Huibin; Smith, Ira J; Hussain, Sabah NA; Goldberg, Peter; Lee, Myung; Sugiarto, Sista; Godinez, Guillermo L; Singh, Baljit K; Payan, Donald G; Rando, Thomas A; Kinsella, Todd M; Shrager, Joseph B

    2014-01-01

    Mechanical ventilation (MV) is one of the lynchpins of modern intensive-care medicine and is life saving in many critically ill patients. Continuous ventilator support, however, results in ventilation-induced diaphragm dysfunction (VIDD) that likely prolongs patients need for MV and thereby leads to major associated complications and avoidable intensive care unit (ICU) deaths. Oxidative stress is a key pathogenic event in the development of VIDD, but its regulation remains largely undefined. We report here that the JAKSTAT pathway is activated in MV in the human diaphragm, as evidenced by significantly increased phosphorylation of JAK and STAT. Blockage of the JAKSTAT pathway by a JAK inhibitor in a rat MV model prevents diaphragm muscle contractile dysfunction (by ~85%, p < 0.01). We further demonstrate that activated STAT3 compromises mitochondrial function and induces oxidative stress in vivo, and, interestingly, that oxidative stress also activates JAKSTAT. Inhibition of JAKSTAT prevents oxidative stress-induced protein oxidation and polyubiquitination and recovers mitochondrial function in cultured muscle cells. Therefore, in ventilated diaphragm muscle, activation of JAKSTAT is critical in regulating oxidative stress and is thereby central to the downstream pathogenesis of clinical VIDD. These findings establish the molecular basis for the therapeutic promise of JAKSTAT inhibitors in ventilated ICU patients. PMID:25286450

  9. M.H. Sherman, J.M. Logue, B.C. Singer, Infiltration Effects on Residential Pollutant Concentrations for Continuous and Intermittent Mechanical Ventilation Approaches -LBNL Report Number 3978-E

    E-print Network

    M.H. Sherman, J.M. Logue, B.C. Singer, Infiltration Effects on Residential Pollutant Concentrations for Continuous and Intermittent Mechanical Ventilation Approaches - LBNL Report Number 3978-E M.H. Sherman, J. Sherman, J.M. Logue, B.C. Singer Environmental Energy Technologies Division June 2010 Funding was provided

  10. Episodic ventilation lowers the efficiency of pulmonary CO2 excretion.

    PubMed

    Malte, Christian Lind; Malte, Hans; Wang, Tobias

    2013-11-01

    The ventilation pattern of many ectothermic vertebrates, as well as hibernating and diving endotherms, is episodic where breaths are clustered in bouts interspersed among apneas of varying duration. Using mechanically ventilated, anesthetized freshwater turtles (Trachemys scripta), a species that normally exhibits this episodic ventilation pattern, we investigated whether episodic ventilation affects pulmonary gas exchange compared with evenly spaced breaths. In two separate series of experiments (a noninvasive and an invasive), ventilation pattern was switched from a steady state, with evenly spaced breaths, to episodic ventilation while maintaining overall minute ventilation (30 mlmin(-1)kg(-1)). On switching to an episodic ventilation pattern of 10 clustered breaths, mean CO2 excretion rate was reduced by 6 5% (noninvasive protocol) or 20 8% (invasive protocol) in the first ventilation pattern cycle, along with a reduction in the respiratory exchange ratio. O2 uptake was either not affected or increased in the first ventilation pattern cycle, while neither heart rate nor overall pulmonary blood flow was significantly affected by the ventilation patterns. The results confirm that, for a given minute ventilation, episodic ventilation is intrinsically less efficient for CO2 excretion, thereby indicating an increase in the total bodily CO2 store in the protocol. Despite the apparent CO2 retention, mean arterial Pco2 only increased 1 Torr during the episodic ventilation pattern, which was concomitant with a possible reduction of respiratory quotient. This would indicate a shift in metabolism such that less CO2 is produced when the efficiency of excretion is reduced. PMID:23970538

  11. RECOMMENDED VENTILATION STRATEGIES FOR ENERGY-EFFICIENT PRODUCTION HOMES

    E-print Network

    LBNL-40378 UC-000 RECOMMENDED VENTILATION STRATEGIES FOR ENERGY-EFFICIENT PRODUCTION HOMES Judy A of Energy under Contract No. DE-AC03-76SF00098. #12;i Abstract This report evaluates residential ventilation mechanical ventilation strategies for new, low-infiltration, energy-efficient, single-family, ENERGY STAR

  12. Measuring Residential Ventilation System Airflows: Part 2 -Field

    E-print Network

    1 Measuring Residential Ventilation System Airflows: Part 2 - Field Evaluation of Airflow Meter Residential Ventilation System Airflows: Part 2 - Field Evaluation of Airflow Meter Devices and System Flow, mechanical ventilation, measurement, ASHRAE 62.2, flow hood ABSTRACT The 2008 California State Energy Code

  13. Breathing pattern and cost of ventilation in the american alligator

    Microsoft Academic Search

    Tobias Wang; Stephen J. Warburton

    1995-01-01

    The energetic cost of pulmonary ventilation is termed the cost of breathing and is commonly determined from the change in oxygen uptake with altered ventilation. Previous analyses of lung mechanics predicts increased tidal volume would be more expensive than increased breathing frequency. Existing studies on the oxidative cost of breathing have, however, not addressed breathing pattern. We stimulated ventilation in

  14. Ventilator-associated pneumonia in a teaching hospital in Tehran and use of the Iranian Nosocomial Infections Surveillance Software.

    PubMed

    Afhami, Sh; Hadadi, A; Khorami, E; Seifi, A; Bazaz, N Esmailpour

    2013-10-01

    Ventilator-associated pneumonia is the most common health-care-associated infection in the intensive care unit (ICU) and computer-assisted diagnosis and surveillance is called for. The frequency of ventilator-associated pneumonia was assessed prospectively during a 6-month period in the ICUs of a teaching hospital in Tehran, Islamic Republic of Iran. To determine the accuracy of the Iranian Nosocomial Infections Surveillance (INIS) system, patient data were input to the software and compared with physicians' judgement. The frequency of ventilator-associated pneumonia was 21.6%, or 9.96 episodes per 1000 ventilator days. The duration of admission to the ICU, duration of mechanical ventilator and number of re-intubations were significantly higher in patients who developed pneumonia. The INIS system identified 100% of cases, with no false-positive or false-negative results. Compared with developed countries, the frequency of ventilator-associated pneumonia was high in our ICUs, and INIS software was accurate in diagnosing nosocomial infection. PMID:24313153

  15. Infiltration in ASHRAE's Residential Ventilation Standards

    SciTech Connect

    Sherman, Max

    2008-10-01

    The purpose of ventilation is to dilute or remove indoor contaminants that an occupant could be exposed to. It can be provided by mechanical or natural means. ASHRAE Standards including standards 62, 119, and 136 have all considered the contribution of infiltration in various ways, using methods and data from 20 years ago. The vast majority of homes in the United States and indeed the world are ventilated through natural means such as infiltration caused by air leakage. Newer homes in the western world are tight and require mechanical ventilation. As we seek to provide acceptable indoor air quality at minimum energy cost, it is important to neither over-ventilate norunder-ventilate. Thus, it becomes critically important to correctly evaluate the contribution infiltration makes to both energy consumption and equivalent ventilation. ASHRAE Standard 62.2 specifies how much mechanical ventilation is considered necessary to provide acceptable indoor air quality, but that standard is weak on how infiltration can contribute towards meeting the total requirement. In the past ASHRAE Standard 136 was used to do this, but new theoretical approaches and expanded weather data have made that standard out of date. This article will describe how to properly treat infiltration as an equivalent ventilation approach and then use new data and these new approaches to demonstrate how these calculations might be done both in general and to update Standard 136.

  16. The Albany Medical College Ventilator Walker.

    PubMed

    Smith, T; Forrest, G; Evans, G; Johnson, R K; Chandler, N

    1996-12-01

    This report describes the design and use of a wheeled walker that can accommodate a ventilator and oxygen tanks. It is constructed of aluminum tubing. The front of the walker has receptacles to support a Mark 7 Bird Ventilator and oxygen tanks. The back end of the walker has a bench seat that is lifted to allow entry into the walker. The seat provides rigidity and stability to the frame of the walker. The walker has been used in the Medical Intensive Care Unit of the Albany Medical Center to facilitate early ambulation of patients who are ventilator dependent or who require a portable source of oxygen to begin ambulation training. PMID:8976320

  17. 47 CFR 54.602 - Health care support mechanism.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...Telecommunications Program. (b) Healthcare Connect Fund. Eligible health care...This support is referred to as the Healthcare Connect Fund. (c) Allocation...the Telecommunications Program or the Healthcare Connect Fund must be...

  18. 47 CFR 54.602 - Health care support mechanism.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...Telecommunications Program. (b) Healthcare Connect Fund. Eligible health care...This support is referred to as the Healthcare Connect Fund. (c) Allocation...the Telecommunications Program or the Healthcare Connect Fund must be...

  19. Infusion of 2.5meq/min of lactic acid minimally increases CO2 production compared to an isocaloric glucose infusion in healthy anesthetized, mechanically ventilated pigs

    PubMed Central

    2013-01-01

    Introduction Blood acidification by lactic acid infusion converts bicarbonate to CO2. This effect can be exploited to increase the transmembrane PCO2 gradient of an extracorporeal membrane lung, resulting in a significant increase of extracorporeal CO2 removal. Lactic acid, however, is an energetic substrate and its metabolism might increase total body CO2 production (VCO2), limiting the potential beneficial effects of this technique. The aim of our study was to compare VCO? during isocaloric infusion of lactic acid or glucose. Methods Six pigs (45??5kg) were sedated and mechanically ventilated. Estimated caloric needs were 2,3002,400 Kcal/die (95 to 100 Kcal/h). A sequence of two steps lasting four hours each was performed: 1) Glucose, 97kcal/h were administered as 50% glucose solution, and 2) Lactic Acid, approximately 48.5kcal/h were administered as lactic acid and approximately 48.5kcal/h as 50% glucose solution. This sequence was repeated three times with two-hour intervals. Every hour VCO?, arterial blood gases and lactate were measured. Blood glucose level was kept constant by titrating an insulin infusion, ventilation was adjusted to maintain arterial PCO2 at 50mmHg, a normal value for our animal model. Results During Lactic Acid steps VCO2 increased less than 5% compared to the Glucose steps (282 vs. 269ml/min, P?<0.05); blood glucose did not differ between the two groups (respectively 101??12 vs. 103??8mg/dl). Arterial lactate was always lower than 3mmol/L. Arterial pH was lower during Lactic Acid steps (7.422 vs. 7.445, P?<0.05). Conclusions Replacing 50% of the caloric input with lactic acid increased total CO2 production by less than 5% compared to an equal caloric load provided entirely by a 50% glucose solution. PMID:24209456

  20. Fracture ventilation by surface winds

    NASA Astrophysics Data System (ADS)

    Nachshon, U.; Dragila, M. I.; Weisbrod, N.

    2011-12-01

    Gas exchange between the Earth subsurface and the atmosphere is an important mechanism, affecting hydrological, agricultural and environmental processes. From a hydrological aspect, water vapor transport is the most important process related to Earth-atmosphere gas exchange. In respect to agriculture, gas transport in the upper soil profile is important for soil aeration. From an environmental aspect, emission of volatile radionuclides, such as 3H, 14C and Rd from radioactive waste disposal facilities; volatile organic components from industrial sources and Rn from natural sources, all found in the upper vadose zone, can greatly affect public health when emissions occur in populated areas. Thus, it is vital to better understand gas exchange processes between the Earth's upper crust and atmosphere. Four major mechanisms are known to transfer gases between ground surface and atmosphere: (1) Diffusion; (2) Pressure gradients between ground pores and atmosphere due to changes in barometric pressure; (3) Density-driven gas flow in respond to thermal gradients in the ground; and (4) Winds above the ground surface. Herein, the wind ventilation mechanism is studied. Whereas the wind's impact on ground ventilation was explored in several studies, the physical mechanisms governing this process were hardly quantified or characterized. In this work the physical properties of fracture ventilation due to wind blowing along land surface were explored and quantified. Both field measurements and Hele-Shaw experiments under controlled conditions in the laboratory were used to study this process. It was found that winds in the range of 0.3 m/s result in fracture ventilation down to a depth of 0.2 m. As wind velocity increases, the depth of the ventilation inside the fracture increases respectively, in a linear manner. In addition, the fracture aperture also affects the depth of ventilation, which grows as fracture aperture increases. For the maximal examined aperture of 2 cm and wind velocity of 1.25 m/s, fracture ventilation was deeper than 0.45 m. This study sheds new light on fracture ventilation, showing that moderate winds may increase evaporation and gas exchange between fractured media and the atmosphere. Even though wind impact is limited to the top 0.5 m below the ground surface, it is an important process as most of the biological activities, as well as important hydrological processes occur in this region. Wind effect should be considered when modeling mass and energy balances between the Earth upper crust and atmosphere.

  1. Complications of non-invasive ventilation techniques: a comprehensive qualitative review of randomized trials.

    PubMed

    Carron, M; Freo, U; BaHammam, A S; Dellweg, D; Guarracino, F; Cosentini, R; Feltracco, P; Vianello, A; Ori, C; Esquinas, A

    2013-06-01

    Non-invasive ventilation (NIV) has become a common treatment for acute and chronic respiratory failure. In comparison with conventional invasive mechanical ventilation, NIV has the advantages of reducing patient discomfort, procedural complications, and mortality. However, NIV is associated with frequent uncomfortable or even life-threatening adverse effects, and patients should be thoroughly screened beforehand to reduce potential severe complications. We performed a detailed review of the relevant medical literature for NIV complications. All major NIV complications are potentially life-threatening and can occur in any patient, but are strongly correlated with the degree of pulmonary and cardiovascular involvement. Minor complications can be related to specific structural features of NIV interfaces or to variable airflow patterns. This extensive review of the literature shows that careful selection of patients and interfaces, proper setting of ventilator modalities, and close monitoring of patients from the start can greatly reduce NIV complications. PMID:23562934

  2. Clinical review: Acute respiratory distress syndrome - clinical ventilator management and adjunct therapy

    PubMed Central

    2013-01-01

    Acute respiratory distress syndrome (ARDS) is a potentially devastating form of acute inflammatory lung injury with a high short-term mortality rate and significant long-term consequences among survivors. Supportive care, principally with mechanical ventilation, remains the cornerstone of therapy - although the goals of this support have changed in recent years - from maintaining normal physiological parameters to avoiding ventilator-induced lung injury while providing adequate gas exchange. In this article we discuss the current evidence base for ventilatory support and adjunctive therapies in patients with ARDS. Key components of such a strategy include avoiding lung overdistension by limiting tidal volumes and airway pressures, and the use of positive end-expiratory pressure with or without lung recruitment manoeuvres in patients with severe ARDS. Adjunctive therapies discussed include pharmacologic techniques (for example, vasodilators, diuretics, neuromuscular blockade) and nonpharmacologic techniques (for example, prone position, alternative modes of ventilation). PMID:23672857

  3. Infection prevention during anaesthesia ventilation by the use of breathing system filters (BSF): Joint recommendation by German Society of Hospital Hygiene (DGKH) and German Society for Anaesthesiology and Intensive Care (DGAI)

    PubMed Central

    Kramer, Axel; Kranabetter, Rainer; Rathgeber, Jrg; Zchner, Klaus; Assadian, Ojan; Daeschlein, Georg; Hbner, Nils-Olaf; Dietlein, Edeltrut; Exner, Martin; Grndling, Matthias; Lehmann, Christian; Wendt, Michael; Graf, Bernhard Martin; Holst, Dietmar; Jatzwauk, Lutz; Puhlmann, Birgit; Welte, Thomas; Wilkes, Antony R.

    2010-01-01

    An interdisciplinary working group from the German Society of Hospital Hygiene (DGKH) and the German Society for Anaesthesiology and Intensive Care (DGAI) worked out the following recommendations for infection prevention during anaesthesia by using breathing system filters (BSF). The BSF shall be changed after each patient. The filter retention efficiency for airborne particles is recommended to be >99% (II). The retention performance of BSF for liquids is recommended to be at pressures of at least 60 hPa (=60 mbar) or 20 hPa above the selected maximum ventilation pressure in the anaesthetic system. The anaesthesia breathing system may be used for a period of up to 7 days provided that the functional requirements of the system remain unchanged and the manufacturer states this in the instructions for use. The breathing system and the manual ventilation bag are changed immediately after the respective anaesthesia if the following situation has occurred or it is suspected to have occurred: Notifiable infectious disease involving the risk of transmission via the breathing system and the manual bag, e.g. tuberculosis, acute viral hepatitis, measles, influenza virus, infection and/or colonisation with a multi-resistant pathogen or upper or lower respiratory tract infections. In case of visible contamination e.g. by blood or in case of defect, it is required that the BSF and also the anaesthesia breathing system is changed and the breathing gas conducting parts of the anaesthesia ventilator are hygienically reprocessed. Observing of the appropriate hand disinfection is very important. All surfaces of the anaesthesia equipment exposed to hand contact must be disinfected after each case. PMID:20941333

  4. Midlevel ventilation's constraint on tropical cyclone intensity

    E-print Network

    Tang, Brian Hong-An

    2010-01-01

    Midlevel ventilation, or the flux of low-entropy air into the inner core of a tropical cyclone (TC), is a hypothesized mechanism by which environmental vertical wind shear can constrain a TC's intensity. An idealized ...

  5. Midlevel Ventilation's Constraint on Tropical Cyclone Intensity

    E-print Network

    Tang, Brian Hong-An

    Midlevel ventilation, or the flux of low-entropy air into the inner core of a tropical cyclone (TC), is a hypothesized mechanism by which environmental vertical wind shear can constrain a tropical cyclones intensity. An ...

  6. VENTILATION MODEL REPORT

    SciTech Connect

    V. Chipman

    2002-10-31

    The purpose of the Ventilation Model is to simulate the heat transfer processes in and around waste emplacement drifts during periods of forced ventilation. The model evaluates the effects of emplacement drift ventilation on the thermal conditions in the emplacement drifts and surrounding rock mass, and calculates the heat removal by ventilation as a measure of the viability of ventilation to delay the onset of peak repository temperature and reduce its magnitude. The heat removal by ventilation is temporally and spatially dependent, and is expressed as the fraction of heat carried away by the ventilation air compared to the fraction of heat produced by radionuclide decay. One minus the heat removal is called the wall heat fraction, or the remaining amount of heat that is transferred via conduction to the surrounding rock mass. Downstream models, such as the ''Multiscale Thermohydrologic Model'' (BSC 2001), use the wall heat fractions as outputted from the Ventilation Model to initialize their postclosure analyses.

  7. 78 FR 13935 - Rural Health Care Support Mechanism

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-01

    ...is administratively simple, predictable, and...regardless of the location or type of the HCP...manage firewalls at their locations, which allows the rural...equipment, or even a simple health care-related...member); the physical location of the...

  8. Single-use lancet and capillary loading mechanism for complete blood count point of care device

    E-print Network

    Zimmerman, Julia C

    2011-01-01

    As part of the development of a point of care complete blood count device, I designed a single use lancet integrated with a blood collection mechanism and interface and successfully tested a prototype. High speed video was ...

  9. VENTILATION TECHNOLOGY SYSTEMS ANALYSIS

    EPA Science Inventory

    The report gives results of a project to develop a systems analysis of ventilation technology and provide a state-of-the-art assessment of ventilation and indoor air quality (IAQ) research needs. (NOTE: Ventilation technology is defined as the hardware necessary to bring outdoor ...

  10. Cost effective combined axial fan and throttling valve control of ventilation rate

    E-print Network

    Sengun, Mehmet Haluk

    Cost effective combined axial fan and throttling valve control of ventilation rate C.J. Taylor 1 P with Proportional-Integral-Plus (PIP) control of ventilation rate in mechanically ventilated agricultural buildings ventilation. The new combined fan/valve configuration is compared with a commercially available PID

  11. Prolonged weaning: from the intensive care unit to home.

    PubMed

    Navalesi, P; Frigerio, P; Patzlaff, A; Huermann, S; Henseke, P; Kubitschek, M

    2014-01-01

    Weaning is the process of withdrawing mechanical ventilation which starts with the first spontaneous breathing trial (SBT). Based on the degree of difficulty and duration, weaning is classified as simple, difficult and prolonged. Prolonged weaning, which includes patients who fail 3 SBTs or are still on mechanical ventilation 7 days after the first SBT, affects a relatively small fraction of mechanically ventilated ICU patients but these, however, requires disproportionate resources. There are several potential causes which can lead to prolonged weaning. It is nonetheless important to understand the problem from the point of view of each individual patient in order to adopt appropriate treatment and define precise prognosis. An otherwise stable patient who remains on mechanical ventilation will be considered for transfer to a specialized weaning unit (SWU). Though there is not a precise definition, SWU can be considered as highly specialized and protected environments for patients requiring mechanical ventilation despite resolution of the acute disorder. Proper staffing, well defined short-term and long-term goals, attention to psychological and social problems represent key determinants of SWU success. Some patients cannot be weaned, either partly or entirely, and may require long-term home mechanical ventilation. In these cases the logistics relating to caregivers and the equipment must be carefully considered and addressed. PMID:24975297

  12. Impaired host defence mechanisms in intensive care unit patients

    Microsoft Academic Search

    W. Zimmerli

    1985-01-01

    ICU patients have defects in various host defence mechanisms. The significance of these defects remains unclear, as conflicting results are reported in the literature. The good correlation between impaired cellular-immunity or chemotaxis and septic complications is not necessarily a causal one, but rather an epiphenomenon. Determination of host defence mechanisms in ICU patients is therefore mainly of scientific value, since

  13. A Randomized Double-Blind Placebo-Controlled Dose-Escalation Phase 1 Study of Aerosolized Amikacin and Fosfomycin Delivered via the PARI Investigational eFlow Inline Nebulizer System in Mechanically Ventilated Patients

    PubMed Central

    Vallance, Shirley; Abuan, Tammy; Tservistas, Markus; Davies, Andrew

    2014-01-01

    Abstract Background: This clinical trial evaluated the pharmacokinetics and safety/tolerability of amikacin/fosfomycin solution using a vibrating plate nebulizer, in mechanically ventilated patients with ventilator-associated tracheobronchitis (VAT) or ventilator-associated pneumonia (VAP). Methods: Nine adult patients were consented to receive three escalating doses of a combination of 50?mg/mL amikacin and 20?mg/mL fosfomycin; doses were separated by 242?hr. On day 3, patients received two blinded, randomized treatments (amikacin/fosfomycin and volume-matched placebo), separated by 2?hr. All treatments were administered with a single-patient, multitreatment nebulizer (Investigational eFlow Inline Nebulizer System; PARI Pharma GmbH, positioned in the inspiratory limb tubing between the ventilator and the patient. The nebulizer remained in-line until all treatments had been delivered. Concentrations of amikacin and fosfomycin were measured in tracheal aspirate and plasma samples obtained during the 24?hr after each dose. Results: Fifteen minutes after dosing with the 300/120?mg amikacin/fosfomycin combination, tracheal aspirate amikacin concentrationsSD were 12,3903,986??g/g, and fosfomycin concentrations were 6,1742,548??g/g (n=6). Airway clearance was rapid. Plasma concentrations were subtherapeutic; the highest observed amikacin plasma concentration was 1.4??g/mL, and the highest observed fosfomycin plasma concentration was 0.8??g/mL. Administration time was approximately 2?min/mL. No adverse effects on respiratory rate, peak airway pressures, or oxygenation were observed during or following drug or placebo administration. Conclusions: High tracheal aspirate concentrations of amikacin and fosfomycin were achieved in mechanically ventilated patients with VAT or VAP after aerosolized administration with an inline nebulizer system. Airway clearance was rapid. No adverse respiratory effects were noted during or following drug administration. PMID:24383962

  14. DEMAND CONTROLLED VENTILATION AND CLASSROOM VENTILATION

    SciTech Connect

    Fisk, William J.; Mendell, Mark J.; Davies, Molly; Eliseeva, Ekaterina; Faulkner, David; Hong, Tienzen; Sullivan, Douglas P.

    2014-01-06

    This document summarizes a research effort on demand controlled ventilation and classroom ventilation. The research on demand controlled ventilation included field studies and building energy modeling. Major findings included: ? The single-location carbon dioxide sensors widely used for demand controlled ventilation frequently have large errors and will fail to effectively control ventilation rates (VRs).? Multi-location carbon dioxide measurement systems with more expensive sensors connected to multi-location sampling systems may measure carbon dioxide more accurately.? Currently-available optical people counting systems work well much of the time but have large counting errors in some situations. ? In meeting rooms, measurements of carbon dioxide at return-air grilles appear to be a better choice than wall-mounted sensors.? In California, demand controlled ventilation in general office spaces is projected to save significant energy and be cost effective only if typical VRs without demand controlled ventilation are very high relative to VRs in codes. Based on the research, several recommendations were developed for demand controlled ventilation specifications in the California Title 24 Building Energy Efficiency Standards.The research on classroom ventilation collected data over two years on California elementary school classrooms to investigate associations between VRs and student illness absence (IA). Major findings included: ? Median classroom VRs in all studied climate zones were below the California guideline, and 40percent lower in portable than permanent buildings.? Overall, one additional L/s per person of VR was associated with 1.6percent less IA. ? Increasing average VRs in California K-12 classrooms from the current average to the required level is estimated to decrease IA by 3.4percent, increasing State attendance-based funding to school districts by $33M, with $6.2 M in increased energy costs. Further VR increases would provide additional benefits.? Confirming these findings in intervention studies is recommended. ? Energy costs of heating/cooling unoccupied classrooms statewide are modest, but a large portion occurs in relatively few classrooms.

  15. Protective ventilation of patients with acute respiratory distress syndrome

    Microsoft Academic Search

    E. D. Moloney; M. J. D. Griffiths

    2004-01-01

    The majority of patients with acute respiratory distress syndrome (ARDS) require mechanical ventilation. This support provides time for the lungs to heal, but the adverse effects of mechanical ventilation significantly influence patient outcome. Traditionally, these were ascribed to mechanical effects, such as haemodynamic compromise from decreased venous return or gross air leaks induced by large transpulmonary pressures. More recently, however,

  16. On The Valuation of Infiltration towards Meeting Residential Ventilation Needs

    SciTech Connect

    Sherman, Max H.

    2008-09-01

    The purpose of ventilation is dilute or remove indoor contaminants that an occupant is exposed to. It can be provided by mechanical or natural means. In most homes, especially existing homes, infiltration provides the dominant fraction of the ventilation. As we seek to provide acceptable indoor air quality at minimum energy cost, it is important to neither over-ventilate nor under-ventilate. Thus, it becomes critically important to correctly evaluate the contribution infiltration makes to both energy consumption and equivalent ventilation. ASHRAE Standards including standards 62, 119, and 136 have all considered the contribution of infiltration in various ways, using methods and data from 20 years ago.

  17. Providing Support Services to Students Who Are Ventilator Dependent.

    ERIC Educational Resources Information Center

    Rapport, Mary Jane K.; Lasseter, David J.

    1998-01-01

    Discusses the provision of services to students who are ventilator-dependent. It provides an overview of legislation governing the education of students with disabilities, the health-care needs of students who are ventilator-dependent, position statements of nursing boards, rulings in recent cases, and suggestions for cost containment. (Author/CR)

  18. The Ventilator-Assisted Child: A Practical Resource Guide.

    ERIC Educational Resources Information Center

    Driver, Lynn E.; Nelson, Virginia Simson; Warschausky, Seth A.

    The 16 chapters comprising this manual are intended to provide a practical guide for meeting the needs of ventilator-assisted children. Chapters have the following titles and authors: (1)"Spectrum of Care" (Virginia Simson Nelson and Lynn E. Driver); (2) "Long-Term Airway Management for the Ventilator-Assisted Child" (Ann Marie Ramsey and

  19. High frequency oscillatory ventilation in children. What do we know so far?

    PubMed

    Diaz, F; Kalra, Y; Tofil, N M; Prabhakaran, P

    2015-04-01

    Respiratory failure in children continues to be a common and important indication for admission to intensive care units around the world. Acute respiratory distress syndrome represents the most severe form of respiratory failure in children and results from a variety of pulmonary and extra-pulmonary conditions. Despite important strides in our understanding and improved ventilator strategies of this very heterogeneous disease process, the mortality continues to be fairly high at 33%. High frequency oscillatory ventilation is an alternative form of mechanical ventilation with some attractive features in respect to attempting to improve gas exchange limiting ventilator induced lung injury. The objective of this review is to discuss the principles and the physiology of high frequency oscillatory ventilation, and its role in the management of children with respiratory failure. The adult literature will briefly be reviewed. The main emphasis on this review will be on the use of the "open lung" strategy in conditions that cause a reduction in functional residual capacity. In addition the "low volume" strategy that is useful in the setting of airleaks, such as pneumothorax and pneumomediastinum, will be briefly discussed. PMID:25658591

  20. A potential role of aminoglycoside resistance in endemic occurrence of Pseudomonas aeruginosa strains in lower airways of mechanically ventilated patients.

    PubMed

    Mzes, Julianna; Sz?cs, Ildik; Molnr, Dvid; Jakab, Pter; Fatemeh, Ebrahimi; Szilasi, Mria; Majoros, Lszl; Orosi, Piroska; Kardos, Gbor

    2014-01-01

    Altogether, 98 Pseudomonas aeruginosa isolates from a 5-bed intensive care unit were fingerprinted with pulsed-field gel electrophoresis and tested for aminoglycoside resistance genes aac(6')-Ib, aac(3?)-IIa, ant(2?)-Ia, armA, rmtA, and rmtB and integrons and virulence genes/operons phzI, phzII, phzM, phzS, apr, lasB, plcH, plcN, pilA, algD, toxA, exoS, exoT, exoY, and exoU. Two major clusters were identified (49 and 19 isolates), harbouring aac(6')-Ib, blaPSE-1, and ant(3?)-Ia genes or ant(2?)-Ia gene, respectively, on a class I integron. Most virulence genes except for exoU and pilA were found. Only 1 isolate of the minor cluster (8 isolates) and 1 of the 22 sporadic isolates carried integrons (without gene cassettes); virulence profile was highly variable. Comparing the resistance and virulence patterns of endemic and sporadic isolates suggests that integron-borne aminoglycoside resistance is more closely associated with the frequency than virulence. Consequently, aminoglycoside usage may have played a role in maintenance of the endemic clones. PMID:24183948

  1. A comparative study of continuous positive airway pressure (CPAP) and intermittent positive pressure ventilation (IPPV) in patients with flail chest

    PubMed Central

    Gunduz, M; Unlugenc, H; Ozalevli, M; Inanoglu, K; Akman, H

    2005-01-01

    Introduction: The role of non-invasive positive pressure ventilation delivered through a face mask in patients with flail chest is uncertain. We conducted a prospective, randomised study of continuous positive airway pressure (CPAP) given via a face mask to spontaneously breathing patients compared with intermittent positive pressure ventilation (IPPV) with endotracheal intubation (ETI) in 52 patients with flail chest who required mechanical ventilation. Method: The 52 mechanically ventilated patients were randomly divided into two treatment groups: the ET group (n = 27) received mechanical ventilation with ETI, whereas patients in the CPAP group (n = 25) received CPAP via a face mask with patient controlled analgesia (PCA). Major complications, arterial blood gas levels, length of intensive care unit (ICU) stay and ICU survival rate were recorded. Results: Nosocomial infection was diagnosed in 10 of 21 patients in the ET group, but only in 4 of 22 in the CPAP group (p = 0.001). Mean PO2 was significantly higher in the ET group in the first 2 days (p<0.05). There were no significant differences in length of ICU stay between groups. Twenty CPAP patients survived, but only 14 of 21 intubated patients who received IPPV (p<0.01). Conclusion: Non-invasive CPAP with PCA led to lower mortality and a lower nosocomial infection rate, but similar oxygenation and length of ICU stay. The study supports the application of CPAP at least as a first line of treatment for flail chest caused by blunt thoracic trauma. PMID:15843697

  2. Performance of ventilators for noninvasive positive pressure ventilation in children

    E-print Network

    Boyer, Edmond

    1 Performance of ventilators for noninvasive positive pressure ventilation in children Brigitte title: ventilators for noninvasive ventilation Supports and grants: The research of Brigitte Fauroux;2 Abstract The aim of the study was to evaluate the performance characteristics of all the ventilators

  3. Simulating Natural Ventilation in and Around Buildings by Fast Fluid Mingang Jin1

    E-print Network

    Chen, Qingyan "Yan"

    1 Simulating Natural Ventilation in and Around Buildings by Fast Fluid Dynamics Mingang Jin1-765-496-7562 Fax: +1-765-494-0539 ABSTRACT Natural ventilation is a sustainable technology that can provide a well-built environment and also save energy. The application of natural ventilation to buildings requires a careful

  4. Premium Ventilation Package Testing Short-Term Monitoring Report Task 7

    E-print Network

    Premium Ventilation Package Testing Short-Term Monitoring Report ­ Task 7 Review Draft Submittal. 00038702 RTU AirCarePlus & Premium Ventilation Program COTR - Jack Callahan (503) 230-4496 / jmcallahan Ventilation Package Testing PECI Short-Term Monitoring Report ­ Task 7 REVIEW DRAFT: 9/14/2009 2 Table

  5. Ventilation Model Report

    SciTech Connect

    V. Chipman; J. Case

    2002-12-20

    The purpose of the Ventilation Model is to simulate the heat transfer processes in and around waste emplacement drifts during periods of forced ventilation. The model evaluates the effects of emplacement drift ventilation on the thermal conditions in the emplacement drifts and surrounding rock mass, and calculates the heat removal by ventilation as a measure of the viability of ventilation to delay the onset of peak repository temperature and reduce its magnitude. The heat removal by ventilation is temporally and spatially dependent, and is expressed as the fraction of heat carried away by the ventilation air compared to the fraction of heat produced by radionuclide decay. One minus the heat removal is called the wall heat fraction, or the remaining amount of heat that is transferred via conduction to the surrounding rock mass. Downstream models, such as the ''Multiscale Thermohydrologic Model'' (BSC 2001), use the wall heat fractions as outputted from the Ventilation Model to initialize their post-closure analyses. The Ventilation Model report was initially developed to analyze the effects of preclosure continuous ventilation in the Engineered Barrier System (EBS) emplacement drifts, and to provide heat removal data to support EBS design. Revision 00 of the Ventilation Model included documentation of the modeling results from the ANSYS-based heat transfer model. Revision 01 ICN 01 included the results of the unqualified software code MULTIFLUX to assess the influence of moisture on the ventilation efficiency. The purposes of Revision 02 of the Ventilation Model are: (1) To validate the conceptual model for preclosure ventilation of emplacement drifts and verify its numerical application in accordance with new procedural requirements as outlined in AP-SIII-10Q, Models (Section 7.0). (2) To satisfy technical issues posed in KTI agreement RDTME 3.14 (Reamer and Williams 2001a). Specifically to demonstrate, with respect to the ANSYS ventilation model, the adequacy of the discretization (Section 6.2.3.1), and the downstream applicability of the model results (i.e. wall heat fractions) to initialize post-closure thermal models (Section 6.6). (3) To satisfy the remainder of KTI agreement TEF 2.07 (Reamer and Williams 2001b). Specifically to provide the results of post-test ANSYS modeling of the Atlas Facility forced convection tests (Section 7.1.2). This portion of the model report also serves as a validation exercise per AP-SIII.10Q, Models, for the ANSYS ventilation model. (4) To asses the impacts of moisture on the ventilation efficiency.

  6. Validating and improving CT ventilation imaging by correlating with ventilation 4D-PET/CT using {sup 68}Ga-labeled nanoparticles

    SciTech Connect

    Kipritidis, John, E-mail: john.kipritidis@sydney.edu.au; Keall, Paul J. [Radiation Physics Laboratory, Sydney Medical School, University of Sydney, Sydney NSW 2006 (Australia)] [Radiation Physics Laboratory, Sydney Medical School, University of Sydney, Sydney NSW 2006 (Australia); Siva, Shankar [Department of Radiation Oncology, Peter MacCallum Cancer Centre, and Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville VIC 3052 (Australia)] [Department of Radiation Oncology, Peter MacCallum Cancer Centre, and Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville VIC 3052 (Australia); Hofman, Michael S.; Callahan, Jason; Hicks, Rodney J. [Centre for Cancer Imaging, Peter MacCallum Cancer Centre and Department of Medicine, University of Melbourne, Melbourne VIC 3002 (Australia)] [Centre for Cancer Imaging, Peter MacCallum Cancer Centre and Department of Medicine, University of Melbourne, Melbourne VIC 3002 (Australia)

    2014-01-15

    Purpose: CT ventilation imaging is a novel functional lung imaging modality based on deformable image registration. The authors present the first validation study of CT ventilation using positron emission tomography with{sup 68}Ga-labeled nanoparticles (PET-Galligas). The authors quantify this agreement for different CT ventilation metrics and PET reconstruction parameters. Methods: PET-Galligas ventilation scans were acquired for 12 lung cancer patients using a four-dimensional (4D) PET/CT scanner. CT ventilation images were then produced by applying B-spline deformable image registration between the respiratory correlated phases of the 4D-CT. The authors test four ventilation metrics, two existing and two modified. The two existing metrics model mechanical ventilation (alveolar air-flow) based on Hounsfield unit (HU) change (V{sub HU}) or Jacobian determinant of deformation (V{sub Jac}). The two modified metrics incorporate a voxel-wise tissue-density scaling (?V{sub HU} and ?V{sub Jac}) and were hypothesized to better model the physiological ventilation. In order to assess the impact of PET image quality, comparisons were performed using both standard and respiratory-gated PET images with the former exhibiting better signal. Different median filtering kernels (?{sub m} = 0 or 3 mm) were also applied to all images. As in previous studies, similarity metrics included the Spearman correlation coefficient r within the segmented lung volumes, and Dice coefficient d{sub 20} for the (0 ? 20)th functional percentile volumes. Results: The best agreement between CT and PET ventilation was obtained comparing standard PET images to the density-scaled HU metric (?V{sub HU}) with ?{sub m} = 3 mm. This leads to correlation values in the ranges 0.22 ? r ? 0.76 and 0.38 ? d{sub 20} ? 0.68, with r{sup }=0.420.16 and d{sup }{sub 20}=0.520.09 averaged over the 12 patients. Compared to Jacobian-based metrics, HU-based metrics lead to statistically significant improvements in r{sup } and d{sup }{sub 20} (p < 0.05), with density scaled metrics also showing higher r{sup } than for unscaled versions (p < 0.02). r{sup } and d{sup }{sub 20} were also sensitive to image quality, with statistically significant improvements using standard (as opposed to gated) PET images and with application of median filtering. Conclusions: The use of modified CT ventilation metrics, in conjunction with PET-Galligas and careful application of image filtering has resulted in improved correlation compared to earlier studies using nuclear medicine ventilation. However, CT ventilation and PET-Galligas do not always provide the same functional information. The authors have demonstrated that the agreement can improve for CT ventilation metrics incorporating a tissue density scaling, and also with increasing PET image quality. CT ventilation imaging has clear potential for imaging regional air volume change in the lung, and further development is warranted.

  7. A bilateral integrative health-care knowledge service mechanism based on 'MedGrid'.

    PubMed

    Liu, Chao; Jiang, Zuhua; Zhen, Lu; Su, Hai

    2008-04-01

    Current health-care organizations are encountering impression of paucity of medical knowledge. This paper classifies medical knowledge with new scopes. The discovery of health-care 'knowledge flow' initiates a bilateral integrative health-care knowledge service, and we make medical knowledge 'flow' around and gain comprehensive effectiveness through six operations (such as knowledge refreshing...). Seizing the active demand of Chinese health-care revolution, this paper presents 'MedGrid', which is a platform with medical ontology and knowledge contents service. Each level and detailed contents are described on MedGrid info-structure. Moreover, a new diagnosis and treatment mechanism are formed by technically connecting with electronic health-care records (EHRs). PMID:18325488

  8. Improving Antibiotic Therapy of Ventilator Associated Pneumonia using

    E-print Network

    Lucas, Peter

    Improving Antibiotic Therapy of Ventilator Associated Pneumonia using a Probabilistic Approach and treating patients with pneumonia at the intensive care unit. The underlying probabilistic network model includes knowledge for diagnosing pneumonia on the basis of the likeli- hood of tracheobronchial

  9. Ventilating the English Channel Tunnel

    SciTech Connect

    Dodge, T.M. (Raxcrest Project Management Ltd., Birmingham (United Kingdom))

    1993-10-01

    This article describes a unique ventilation system design which ensures a supply of fresh air to 95 miles of tunnels under the English Channel. The topics of the article include a description of the tunnel, a description of the equipment cooling and ventilation systems including provisions for heating of the tunnel ventilation air, ventilation system operation, and ventilation control system.

  10. Randomized clinical trial of pressure-controlled inverse ratio ventilation and extracorporeal CO2 removal for adult respiratory distress syndrome.

    PubMed

    Morris, A H; Wallace, C J; Menlove, R L; Clemmer, T P; Orme, J F; Weaver, L K; Dean, N C; Thomas, F; East, T D; Pace, N L; Suchyta, M R; Beck, E; Bombino, M; Sittig, D F; Bhm, S; Hoffmann, B; Becks, H; Butler, S; Pearl, J; Rasmusson, B

    1994-02-01

    The impact of a new therapy that includes pressure-controlled inverse ratio ventilation followed by extracorporeal CO2 removal on the survival of patients with severe ARDS was evaluated in a randomized controlled clinical trial. Computerized protocols generated around-the-clock instructions for management of arterial oxygenation to assure equivalent intensity of care for patients randomized to the new therapy limb and those randomized to the control, mechanical ventilation limb. We randomized 40 patients with severe ARDS who met the ECMO entry criteria. The main outcome measure was survival at 30 days after randomization. Survival was not significantly different in the 19 mechanical ventilation (42%) and 21 new therapy (extracorporeal) (33%) patients (p = 0.8). All deaths occurred within 30 days of randomization. Overall patient survival was 38% (15 of 40) and was about four times that expected from historical data (p = 0.0002). Extracorporeal treatment group survival was not significantly different from other published survival rates after extracorporeal CO2 removal. Mechanical ventilation patient group survival was significantly higher than the 12% derived from published data (p = 0.0001). Protocols controlled care 86% of the time. Average PaO2 was 59 mm Hg in both treatment groups. Intensity of care required to maintain arterial oxygenation was similar in both groups (2.6 and 2.6 PEEP changes/day; 4.3 and 5.0 FIO2 changes/day). We conclude that there was no significant difference in survival between the mechanical ventilation and the extracorporeal CO2 removal groups. We do not recommend extracorporeal support as a therapy for ARDS. Extracorporeal support for ARDS should be restricted to controlled clinical trials. PMID:8306022

  11. Protective garment ventilation system

    NASA Technical Reports Server (NTRS)

    Lang, R. (inventor)

    1970-01-01

    A method and apparatus for ventilating a protective garment, space suit system, and/or pressure suits to maintain a comfortable and nontoxic atmosphere within is described. The direction of flow of a ventilating and purging gas in portions of the garment may be reversed in order to compensate for changes in environment and activity of the wearer. The entire flow of the ventilating gas can also be directed first to the helmet associated with the garment.

  12. Non-invasive positive pressure ventilation for acute respiratory failure: justified or just hot air?

    PubMed

    Crummy, F; Naughton, M T

    2007-02-01

    Non-invasive positive pressure ventilation (NIV) is the provision of mechanical positive airway pressure ventilatory support through the patient's upper airway through mask interface. Conditions in which it has been shown to be effective are acute cardiogenic pulmonary oedema and acute hypercapnic exacerbations of chronic obstructive pulmonary disease. In such conditions, NIV is associated with reduced intensive care unit demands, a reduction in intubation rates, reduced health-care expenditure and improved survival. Other conditions, such as hypercapnia of other cause, hypoxaemic respiratory failure and acute asthma, have supportive, but less conclusive data. Indications, contraindications and guidelines for the use of NIV are discussed. PMID:17229254

  13. Noninvasive ventilation in trauma

    PubMed Central

    Karcz, Marcin K; Papadakos, Peter J

    2015-01-01

    Trauma patients are a diverse population with heterogeneous needs for ventilatory support. This requirement depends mainly on the severity of their ventilatory dysfunction, degree of deterioration in gaseous exchange, any associated injuries, and the individual feasibility of potentially using a noninvasive ventilation approach. Noninvasive ventilation may reduce the need to intubate patients with trauma-related hypoxemia. It is well-known that these patients are at increased risk to develop hypoxemic respiratory failure which may or may not be associated with hypercapnia. Hypoxemia in these patients is due to ventilation perfusion mismatching and right to left shunt because of lung contusion, atelectasis, an inability to clear secretions as well as pneumothorax and/or hemothorax, all of which are common in trauma patients. Noninvasive ventilation has been tried in these patients in order to avoid the complications related to endotracheal intubation, mainly ventilator-associated pneumonia. The potential usefulness of noninvasive ventilation in the ventilatory management of trauma patients, though reported in various studies, has not been sufficiently investigated on a large scale. According to the British Thoracic Society guidelines, the indications and efficacy of noninvasive ventilation treatment in respiratory distress induced by trauma have thus far been inconsistent and merely received a low grade recommendation. In this review paper, we analyse and compare the results of various studies in which noninvasive ventilation was applied and discuss the role and efficacy of this ventilator modality in trauma. PMID:25685722

  14. Association of compliance of ventilator bundle with incidence of ventilator-associated pneumonia and ventilator utilization among critical patients over 4 years

    PubMed Central

    Al-Thaqafy, Majid S.; El-Saed, Aiman; Arabi, Yaseen M.; Balkhy, Hanan H.

    2014-01-01

    BACKGROUND: Several studies showed that the implementation of the Institute for Healthcare Improvement (IHI) ventilator bundle alone or with other preventive measures are associated with reducing Ventilator-Associated Pneumonia (VAP) rates. However, the association with ventilator utilization was rarely examined and the findings were conflicting. The objectives were to validate the bundle association with VAP rate in a traditionally high VAP environment and to examine its association with ventilator utilization. MATERIALS AND METHODS: The study was conducted at the adult medical-surgical intensive care unit (ICU) at King Abdulaziz Medical City, Saudi Arabia, between 2010 and 2013. VAP data were collected by a prospective targeted surveillance as per Centers for Disease Control and Prevention (CDC)/National Healthcare Safety Network (NHSN) methodology while bundle data were collected by a cross-sectional design as per IHI methodology. RESULTS: Ventilator bundle compliance significantly increased from 90% in 2010 to 97% in 2013 (P for trend < 0.001). On the other hand, VAP rate decreased from 3.6 (per 1000 ventilator days) in 2010 to 1.0 in 2013 (P for trend = 0.054) and ventilator utilization ratio decreased from 0.73 in 2010 to 0.59 in 2013 (P for trend < 0.001). There were negative significant correlations between the trends of ventilator bundle compliance and VAP rate (cross-correlation coefficients ?0.63 to 0.07) and ventilator utilization (cross-correlation coefficients ?0.18 to ?0.63). CONCLUSION: More than 70% improvement of VAP rates and approximately 20% improvement of ventilator utilization were observed during IHI ventilator bundle implementation among adult critical patients in a tertiary care center in Saudi Arabia. Replicating the current finding in multicenter randomized trials is required before establishing any causal link. PMID:25276241

  15. Economic value of caregiver effort in maintaining long-term ventilator-assisted individuals at home

    Microsoft Academic Search

    Mary Ann Sevick; Douglas D. Bradham

    1997-01-01

    OBJECTIVE: To estimate the economic value of caregivers' efforts in maintaining ventilator-assisted individuals at home.DESIGN: Nonexperimental, cross-sectional survey.SETTING: Households of home-based ventilator-assisted individuals residing in 37 statesPARTICIPANTS: Caregivers of 1404 ventilator-assisted individuals; 277 (19.7%) responses were received.OUTCOME MEASURES: The Home Ventilator Care Cost and Utilization Survey and the Modified Katz Index.METHODS: The economic value of caregiver effort was estimated deterministically

  16. Hyperbaric critical care patient data management system.

    PubMed

    Kronlund, Peter; Lind, Folke; Olsson, Daniel

    2012-06-01

    A patient data management system (PDMS) has been used for years in the intensive care unit (ICU) at the Karolinska University Hospital to provide bedside or remote clinical patient documentation and information. Data from monitors, mechanical ventilators and syringe pumps are fed into a central clinical information management system to monitor, display trends and record data of vital parameters, ventilator settings and drugs. In order to continue routine critical care monitoring and recording during hyperbaric oxygen therapy (HBOT), without endangering the safety demands of hyperbaric procedures, we have modified the PDMS system for hyperbaric use. Via an ethernet box placed inside the chamber, data are transmitted to the Clinisoft system through the local area network. By standardised risk-analysis procedures, in close cooperation between the hyperbaric and biomedical engineering departments, the chamber producer and the notifying body (Germanischer Lloyd), the ethernet box was modified to receive full safety approval by all parties. The PDMS is now functioning routinely during HBOT for intensive care patients so that data can be seen bedside and followed on-line in the ICU. Data are also continuously stored on the clinical information management system for later clinical or research purposes. Work continues to obtain CE approval for hyperbaric use for modern syringe pumps and mechanical ventilators connected to the PDMS system. Improved documentation of ICU care will improve quality of care during HBOT and facilitate research and development in hyperbaric medicine. PMID:22828816

  17. Effect of Ventilation Strategies on

    E-print Network

    1 Effect of Ventilation Strategies on Residential Ozone Levels Iain S. Walker ventilation used to reduce concentrations of indoor-generated pollutants. When assessing the effect of deliberate ventilation on occupant health one should consider not only

  18. Pulmonary ventilation/perfusion scan

    MedlinePLUS

    V/Q scan; Ventilation/perfusion scan; Lung ventilation/perfusion scan ... A pulmonary ventilation/perfusion scan is actually two tests. They may be done separately or together. During the perfusion scan, a ...

  19. Characteristics of coal mine ventilation air flows.

    PubMed

    Su, Shi; Chen, Hongwei; Teakle, Philip; Xue, Sheng

    2008-01-01

    Coal mine methane (CMM) is not only a greenhouse gas but also a wasted energy resource if not utilised. Underground coal mining is by far the most important source of fugitive methane emissions, and approximately 70% of all coal mining related methane is emitted to the atmosphere through mine ventilation air. Therefore, research and development on mine methane mitigation and utilisation now focuses on methane emitted from underground coal mines, in particular ventilation air methane (VAM) capture and utilisation. To date, most work has focused on the oxidation of very low concentration methane. These processes may be classified based on their combustion kinetic mechanisms into thermal oxidation and catalytic oxidation. VAM mitigation/utilisation technologies are generally divided into two basic categories: ancillary uses and principal uses. However, it is possible that the characteristics of ventilation air flows, for example the variations in methane concentration and the presence of certain compounds, which have not been reported so far, could make some potential VAM mitigation and utilisation technologies unfeasible if they cannot cope with the characteristics of mine site ventilation air flows. Therefore, it is important to understand the characteristics of mine ventilation air flows. Moreover, dust, hydrogen sulphide, sulphur dioxide, and other possible compounds emitted through mine ventilation air into the atmosphere are also pollutants. Therefore, this paper presents mine-site experimental results on the characteristics of mine ventilation air flows, including methane concentration and its variations, dust loadings, particle size, mineral matter of the dust, and other compounds in the ventilation air flows. The paper also discusses possible correlations between ventilation air characteristics and underground mining activities. PMID:17239518

  20. Impact of a continuous education program on the quality of assistance offered by intensive care physiotherapy

    PubMed Central

    Pinto, Walkyria Arajo Macedo; Rossetti, Heloisa Baccaro; Arajo, Abigail; Spsito Jnior, Jos Jonas; Salomo, Hellen; Mattos, Simone Siqueira; Rabelo, Melina Vieira; Machado, Flvia Ribeiro

    2014-01-01

    Objective To evaluate the role of quality indicators and adverse events registering in the quality assessment of intensive care physiotherapy and to evaluate the impact of implementing protocolized care and professional training in the quality improvement process. Methods A prospective before-after study was designed to assess 15 indicators of the quality of care. Baseline compliance and adverse events were collected before and after the implementation of treatment protocols and staff training. Results Eighty-nine patients admitted, being 48 in the pre-intervention period and 41 in the post-intervention period with a total of 1246 and 1191 observations respectively. Among the indicators related to the global population, there was a significant improvement in chest x-ray control, multidisciplinary rounds and shift changes as well as in compliance with these decisions. Indicators related to the population under mechanical ventilation, obtained by direct observation at bedside, showed a significant improvement in the compliance with the tidal volume of 6-8mL/Kg, plateau pressure <30cmH2O, adequate mechanical ventilation alarm setting, mechanical ventilation humidification control, adequate humidification line exchange and orotracheal tube position. Among the mechanical ventilation indicators collected through the physiotherapy records, there was significantly improved compliance with the predicted tidal volume registry and cuff pressure registry. There was a significant reduction in the number of adverse events. There was no impact on intensive care unit mortality, length of stay, duration of mechanical ventilation and ventilator-free days. Conclusion It is possible to measure the quality of physiotherapy care using indicators of quality control. The implementation of care protocols and training of the professionals can improve team performance. PMID:24770683

  1. Recent advances in multidisciplinary critical care.

    PubMed

    Blot, Stijn; Afonso, Elsa; Labeau, Sonia

    2015-01-01

    The intensive care unit is a work environment where superior dedication is crucial for optimizing patients' outcomes. As this demanding commitment is multidisciplinary in nature, it requires special qualities of health care workers and organizations. Thus research in the field covers a broad spectrum of activities necessary to deliver cutting-edge care. However, given the numerous research articles and education activities available, it is difficult for modern critical care clinicians to keep up with the latest progress and innovation in the field. This article broadly summarizes new developments in multidisciplinary intensive care. It provides elementary information about advanced insights in the field via brief descriptions of selected articles grouped by specific topics. Issues considered include care for heart patients, mechanical ventilation, delirium, nutrition, pressure ulcers, early mobility, infection prevention, transplantation and organ donation, care for caregivers, and family matters. PMID:25554557

  2. Multifamily Ventilation Retrofit Strategies

    SciTech Connect

    Ueno, K.; Lstiburek, J.; Bergey, D.

    2012-12-01

    In multifamily buildings, central ventilation systems often have poor performance, overventilating some portions of the building (causing excess energy use), while simultaneously underventilating other portions (causing diminished indoor air quality). BSC and Innova Services Corporation performed a series of field tests at a mid-rise test building undergoing a major energy audit and retrofit, which included ventilation system upgrades.

  3. Methodology for the evaluation of natural ventilation in buildings using a reduced-scale air model

    E-print Network

    Walker, Christine E. (Christine Elaine)

    2006-01-01

    Commercial office buildings predominantly are designed to be ventilated and cooled using mechanical systems. In temperate climates, passive ventilation and cooling techniques can be utilized to reduce energy consumption ...

  4. Reducing Mechanical Restraints in Acute Psychiatric Care Settings Using Rapid Response Teams

    Microsoft Academic Search

    David L. Prescott; Lynn M. Madden; Marilyn Dennis; Paul Tisher; Carrie Wingate

    2007-01-01

    This article describes the use of rapid response teams to reduce the use of mechanical restraints (i.e., restricting a persons\\u000a movement through the use of a mechanical device such as a backboard, net, or papoose) in an acute psychiatric care setting.\\u000a Rapid response teams have proven highly effective for emergent medical patients, but have not typically been used in behavioral

  5. Mechanical Ventilation and the Kidney

    Microsoft Academic Search

    Jay L. Koyner; Patrick T. Murray

    2010-01-01

    Acute lung injury (ALI) and acute kidney injury (AKI) are complications often encountered in the setting of critical illness. Both forms of end-organ injury commonly occur in similar settings of systemic inflammatory response syndrome, shock, and evolving multiple organ dysfunction. Recent elucidation of the pathobiology of critical illness has led to a more basic mechanistic understanding of the complex interplay

  6. European Home Mechanical Ventilation Registry

    ClinicalTrials.gov

    2014-12-08

    Pulmonary Disease, Chronic Obstructive; Amyotrophic Lateral Sclerosis; Spinal Cord Injury; Muscular Dystrophies; Obesity Hypoventilation Syndrome; Kyphoscoliosis; Congenital Central Hypoventilation Syndrome; Duchenne Muscular Dystrophy; Myopathies; Myotonic Dystrophy

  7. Di(2-ethylhexyl)-phthalate as plasticizer in PVC respiratory tubing systems: indications of hazardous effects on pulmonary function in mechanically ventilated, preterm infants

    Microsoft Academic Search

    B. Roth; P. Herkenrath; H.-J. Lehmann; H.-D. Ohles; H. J. Hmig; G. Benz-Bohm; J. Kreuder; A. Younossi-Hartenstein

    1988-01-01

    Several PVC medical devices contain the plasticizer Di-(2-ethylhexyl)-phthalate (DEHP) in high concentration. Taken systemically DEHP only has minor toxic effects in the human organism. In three preterm infants artifically ventilated with PVC respiratory tubes unusual lung disorders resembling those observed in hyaline membrane disease, verified both clinically and radiologically, were observed during the fourth week of life. It was assumed

  8. The effect of tidal volumes on the time to wean persons with high tetraplegia from ventilators

    Microsoft Academic Search

    WP Peterson; L Barbalata; CA Brooks; KA Gerhart; DC Mellick; GG Whiteneck

    1999-01-01

    Study design: Retrospective review of patient medical records comparing the outcomes of two groups of individuals with high-level (C3-4) tetraplegiathose with high-volume and those with low-volume mechanical ventilation. Objectives: To determine if higher volume mechanical ventilation contributes to faster weaning from the ventilator with fewer complications in individuals with ventilator dependent high-level tetraplegia. Setting: A Model Spinal Injury Center, located

  9. Time-dependent analysis of extra length of stay and mortality due to ventilator-associated pneumonia in intensive-care units of ten limited-resources countries: findings of the International Nosocomial Infection Control Consortium (INICC).

    PubMed

    Rosenthal, V D; Udwadia, F E; Muoz, H J; Erben, N; Higuera, F; Abidi, K; Medeiros, E A; Fernndez Maldonado, E; Kanj, S S; Gikas, A; Barnett, A G; Graves, N

    2011-11-01

    Ventilator-associated pneumonias (VAPs) are a worldwide problem that significantly increases patient morbidity, mortality, and length of stay (LoS), and their effects should be estimated to account for the timing of infection. The purpose of the study was to estimate extra LoS and mortality in an intensive-care unit (ICU) due to a VAP in a cohort of 69,248 admissions followed for 283,069 days in ICUs from 10 countries. Data were arranged according to the multi-state format. Extra LoS and increased risk of death were estimated independently in each country, and their results were combined using a random-effects meta-analysis. VAP prolonged LoS by an average of 203 days (95% CI 152-254 days), and increased the risk of death by 14% (95% CI 2-27). The increased risk of death due to VAP was explained by confounding with patient morbidity. PMID:21320374

  10. Flow-volume curves as measurement of respiratory mechanics during ventilatory support: the effect of the exhalation valve

    Microsoft Academic Search

    M. S. Lourens; B. van den Berg; H. C. Hoogsteden; J. M. Bogaard

    1999-01-01

    Objective: To assess the feasibility of expiratory flow-volume curves as a measurement of respiratory mechanics during ventilatory support:\\u000a to what extent is the shape of the curve affected by the exhalation valve of the ventilator? Design: Prospective, comparative study. Setting: Medical intensive care unit of a university hospital. Patients: 28 consecutive patients with various conditions, mechanically ventilated with both the

  11. Why we ventilate our houses - An historical look

    SciTech Connect

    Matson, Nance E.; Sherman, Max H.

    2004-05-14

    The knowledge of how to ventilate buildings, and how much ventilation is necessary for human health and comfort, has evolved over centuries of trial and error. Humans and animals have developed successful solutions to the problems of regulating temperature and removing air pollutants through the use of ventilation. These solutions include ingenious construction methods, such as engineered passive ventilation (termite mounds and passive stacks), mechanical means (wing-powered, fans), and an evolving effort to identify problems and develop solutions. Ventilation can do more than help prevent building occupants from getting sick; it can provide an improved indoor environment. Codes and standards provide minimum legal requirements for ventilation, but the need for ventilation goes beyond code minima. In this paper we will look at indoor air pollutant sources over time, the evolution of ventilation strategies, current residential ventilation codes and standards (e.g., recently approved ASHRAE Standard 62.2), and briefly discuss ways in which we can go beyond the standards to optimize residential ventilation, reduce indoor air quality problems, and provide corresponding social and economic benefit.

  12. Pretest Predictions for Phase II Ventilation Tests

    SciTech Connect

    Yiming Sun

    2001-09-19

    The objective of this calculation is to predict the temperatures of the ventilating air, waste package surface, and concrete pipe walls that will be developed during the Phase II ventilation tests involving various test conditions. The results will be used as inputs to validating numerical approach for modeling continuous ventilation, and be used to support the repository subsurface design. The scope of the calculation is to identify the physical mechanisms and parameters related to thermal response in the Phase II ventilation tests, and describe numerical methods that are used to calculate the effects of continuous ventilation. The calculation is limited to thermal effect only. This engineering work activity is conducted in accordance with the ''Technical Work Plan for: Subsurface Performance Testing for License Application (LA) for Fiscal Year 2001'' (CRWMS M&O 2000d). This technical work plan (TWP) includes an AP-2.21Q, ''Quality Determinations and Planning for Scientific, Engineering, and Regulatory Compliance Activities'', activity evaluation (CRWMS M&O 2000d, Addendum A) that has determined this activity is subject to the YMP quality assurance (QA) program. The calculation is developed in accordance with the AP-3.12Q procedure, ''Calculations''. Additional background information regarding this activity is contained in the ''Development Plan for Ventilation Pretest Predictive Calculation'' (DP) (CRWMS M&O 2000a).

  13. Ventilating Air-Conditioner

    NASA Technical Reports Server (NTRS)

    Dinh, Khanh

    1994-01-01

    Air-conditioner provides ventilation designed to be used alone or incorporated into cooling or heating system operates efficiently only by recirculating stale air within building. Energy needed to operate overall ventilating cooling or heating system slightly greater than operating nonventilating cooling or heating system. Helps to preserve energy efficiency while satisfying need for increased forced ventilation to prevent accumulation of undesired gases like radon and formaldehyde. Provides fresh treated air to variety of confined spaces: hospital surgeries, laboratories, clean rooms, and printing shops and other places where solvents used. In mobile homes and portable classrooms, eliminates irritant chemicals exuded by carpets, panels, and other materials, ensuring healthy indoor environment for occupants.

  14. Lung Ventilation/Perfusion Scan

    MedlinePLUS

    ... the NHLBI on Twitter. What Is a Lung Ventilation/Perfusion Scan? A lung ventilation/perfusion scan, or VQ scan, is a test ... A VQ scan involves two types of scans: ventilation and perfusion. The ventilation scan shows where air ...

  15. The Effect of a Nurse-Led Multidisciplinary Team on Ventilator-Associated Pneumonia Rates

    PubMed Central

    Dosher, W. Bradley; Loomis, Elena C.; Richardson, Sherry L.; Crowell, Jennifer A.; Waltman, Richard D.; Miller, Lisa D.; Nazim, Muhammad; Khasawneh, Faisal A.

    2014-01-01

    Background. Ventilator-associated pneumonia (VAP) is a worrisome, yet potentially preventable threat in critically ill patients. Evidence-based clinical practices targeting the prevention of VAP have proven effective, but the most optimal methods to ensure consistent implementation and compliance remain unknown. Methods. A retrospective study of the trend in VAP rates in a community-hospital's open medical intensive care unit (MICU) after the enactment of a nurse-led VAP prevention team. The period of the study was between April 1, 2009, and September 30, 2012. The team rounded on mechanically ventilated patients every Tuesday and Thursday. They ensured adherence to the evidence-based VAP prevention. A separate and independent infection control team monitored VAP rates. Results. Across the study period, mean VAP rate was 3.20/1000 ventilator days 5.71 SD. Throughout the study time frame, there was an average monthly reduction in VAP rate of 0.27/1000 ventilator days, P < 0.001 (CI: ?0.40?0.13). Conclusion. A nurse-led interdisciplinary team dedicated to VAP prevention rounding twice a week to ensure adherence with a VAP prevention bundle lowered VAP rates in a community-hospital open MICU. The team had interdepartmental and administrative support and addressed any deficiencies in the VAP prevention bundle components actively. PMID:25061525

  16. Mechatronics in medical engineering: advanced control of a ventilation device

    Microsoft Academic Search

    F. Simon; I. Jenayeh; H. Rake

    2000-01-01

    A typical mechatronics system consists of a mechanical process, electromechanical actuators, electronic sensors and a controller unit with the corresponding software. In this paper a microcontroller-based digital feedback control of a positioning device for a ventilation machine is presented. This kind of machine should allow either a volume- or a pressure-based controlled ventilation. The interdependence between the two important physiological

  17. Noninvasive Positive-Pressure Ventilation for Respiratory Failure after Extubation

    Microsoft Academic Search

    Andrs Esteban; Fernando Frutos-Vivar; Niall D. Ferguson; Yaseen Arabi; Carlos Apeztegua; Marco Gonzlez; Scott K. Epstein; Nicholas S. Hill; Stefano Nava; Marco-Antonio Soares; Gabriel D'Empaire; Inmaculada Ala; Antonio Anzueto

    2004-01-01

    background The need for reintubation after extubation and discontinuation of mechanical ventilation is not uncommon and is associated with increased mortality. Noninvasive positive- pressure ventilation has been suggested as a promising therapy for patients with respi- ratory failure after extubation, but a single-center, randomized trial recently found no benefit. We conducted a multicenter, randomized trial to evaluate the effect of

  18. Prototype ventilator and alarm algorithm for the NASA space station

    Microsoft Academic Search

    Josef X. Brunner; Dwayne R. Westenskow; Paul Zelenkov

    1988-01-01

    An alarm algorithm was developed to monitor the ventilator on the National Aeronautics and Space Administration space station. The algorithm automatically identifies and interprets critical events so that an untrained user can manage the mechanical ventilation of a critically injured crew member. The algorithm was tested in two healthy volunteers by simulating 260 critical events in each volunteer while the

  19. Ventilation Strategies for Energy-Efficient Production Homes

    Microsoft Academic Search

    Judy A. Roberson; Richard E. Brown; Jonathan G. Koomey; Jeffrey L. Warner; Steven E. Greenberg

    The Environmental Protection Agency's (EPA) ENERGY STAR Homes program seeks to reduce greenhouse gas emissions by encouraging U.S. production home builders to voluntarily improve the thermal quality of their construction by minimizing infiltration, improving insulation, and right-sizing HVAC equipment. Tight homes need active ventilation to maintain indoor air quality, but mechanical ventilation increases initial home cost as well as operating

  20. Recommended Ventilation Strategies for Energy-Efficient Production Homes

    SciTech Connect

    Roberson, J.; Brown, R.; Koomey, J.; Warner, J.; Greenberg, S.

    1998-12-01

    This report evaluates residential ventilation systems for the U.S. Environmental Protection Agency's (EPA's) ENERGY STAR{reg_sign} Homes program and recommends mechanical ventilation strategies for new, low-infiltration, energy-efficient, single-family, ENERGY STAR production (site-built tract) homes in four climates: cold, mixed (cold and hot), hot humid, and hot arid. Our group in the Energy Analysis Department at Lawrence Berkeley National Lab compared residential ventilation strategies in four climates according to three criteria: total annualized costs (the sum of annualized capital cost and annual operating cost), predominant indoor pressure induced by the ventilation system, and distribution of ventilation air within the home. The mechanical ventilation systems modeled deliver 0.35 air changes per hour continuously, regardless of actual infiltration or occupant window-opening behavior. Based on the assumptions and analysis described in this report, we recommend independently ducted multi-port supply ventilation in all climates except cold because this strategy provides the safety and health benefits of positive indoor pressure as well as the ability to dehumidify and filter ventilation air. In cold climates, we recommend that multi-port supply ventilation be balanced by a single-port exhaust ventilation fan, and that builders offer balanced heat-recovery ventilation to buyers as an optional upgrade. For builders who continue to install forced-air integrated supply ventilation, we recommend ensuring ducts are airtight or in conditioned space, installing a control that automatically operates the forced-air fan 15-20 minutes during each hour that the fan does not operate for heating or cooling, and offering ICM forced-air fans to home buyers as an upgrade.

  1. Why We Ventilate

    SciTech Connect

    Logue, Jennifer M.; Sherman, Max H.; Price, Phil N.; Singer, Brett C.

    2011-09-01

    It is widely accepted that ventilation is critical for providing good indoor air quality (IAQ) in homes. However, the definition of"good" IAQ, and the most effective, energy efficient methods for delivering it are still matters of research and debate. This paper presents the results of work done at the Lawrence Berkeley National Lab to identify the air pollutants that drive the need for ventilation as part of a larger effort to develop a health-based ventilation standard. First, we present results of a hazard analysis that identified the pollutants that most commonly reach concentrations in homes that exceed health-based standards or guidelines for chronic or acute exposures. Second, we present results of an impact assessment that identified the air pollutants that cause the most harm to the U.S. population from chronic inhalation in residences. Lastly, we describe the implications of our findings for developing effective ventilation standards.

  2. [Ventilator-associated pneumonia].

    PubMed

    Rosseau, S; Schtte, H; Suttorp, N

    2013-08-01

    Ventilator-associated pneumonia (VAP) is a severe, not entirely preventable complication of invasive ventilation. Timely and adequate antibiotic treatment is important; therefore, intensivists often initiate broad spectrum antibiotic regimens upon clinical suspicion of VAP. Criteria for the diagnosis of VAP are not perfect and a clear distinction of VAP from ventilator-associated tracheobronchitis is not always possible due to the limitations of chest x-rays in ventilated patients. The attributable mortality of VAP is likely overestimated. All these aspects increase the need to reevaluate the diagnosis of VAP on a daily basis. Microbiology data are helpful in the decision to de-escalate or stop antibiotics. The prudent use of antibiotics and implementation of a number of preventive measures are key for management of VAP in ICUs. These steps will help to minimize the development of multidrug-resistant pathogens and, in turn, may help guarantee more antibiotic options for future patients. PMID:23836252

  3. Research in the Intensive Care Unit

    MedlinePLUS

    ... ALI. Many patients who develop ALI need mechanical ventilation (a machine to help them breathe). ALI research ... can be reversed before a patient requires mechanical ventilation. We hope to have specific treatments that can ...

  4. Pulmonary ventilation teaching aid: part 2

    NSDL National Science Digital Library

    PhD Brad Stockert (University of the Pacific Department of Physical Therapy)

    2003-06-01

    Since writing the article titled "Pulmonary ventilation teaching aid" (Stockert B, Adv Physiol Educ 27: 41?42, 2003), we have continued to use the salad tongs and rubber band model to teach ventilation mechanics and several clinical correlates. The original article dealt primarily with normal ventilation mechanics and changes in the lungs, i.e., the rubber bands, that occur with common pulmonary disorders, e.g., pulmonary fibrosis and chronic obstructive pulmonary disease. We have developed several additional clinical correlates related to changes in the chest wall, i.e., the salad tongs. Those clinical examples are presented here. The materials needed for this demonstration are several rubber bands and a pair of metal salad tongs with a hinge.

  5. Protective Ventilation of Preterm Lambs Exposed to Acute Chorioamnionitis Does Not Reduce Ventilation-Induced Lung or Brain Injury

    PubMed Central

    Barton, Samantha K.; Moss, Timothy J. M.; Hooper, Stuart B.; Crossley, Kelly J.; Gill, Andrew W.; Kluckow, Martin; Zahra, Valerie; Wong, Flora Y.; Pichler, Gerhard; Galinsky, Robert; Miller, Suzanne L.

    2014-01-01

    Background The onset of mechanical ventilation is a critical time for the initiation of cerebral white matter (WM) injury in preterm neonates, particularly if they are inadvertently exposed to high tidal volumes (VT) in the delivery room. Protective ventilation strategies at birth reduce ventilation-induced lung and brain inflammation and injury, however its efficacy in a compromised newborn is not known. Chorioamnionitis is a common antecedent of preterm birth, and increases the risk and severity of WM injury. We investigated the effects of high VT ventilation, after chorioamnionitis, on preterm lung and WM inflammation and injury, and whether a protective ventilation strategy could mitigate the response. Methods Pregnant ewes (n?=?18) received intra-amniotic lipopolysaccharide (LPS) 2 days before delivery, instrumentation and ventilation at 1271 days gestation. Lambs were either immediately euthanased and used as unventilated controls (LPSUVC; n?=?6), or were ventilated using an injurious high VT strategy (LPSINJ; n?=?5) or a protective ventilation strategy (LPSPROT; n?=?7) for a total of 90 min. Mean arterial pressure, heart rate and cerebral haemodynamics and oxygenation were measured continuously. Lungs and brains underwent molecular and histological assessment of inflammation and injury. Results LPSINJ lambs had poorer oxygenation than LPSPROT lambs. Ventilation requirements and cardiopulmonary and systemic haemodynamics were not different between ventilation strategies. Compared to unventilated lambs, LPSINJ and LPSPROT lambs had increases in pro-inflammatory cytokine expression within the lungs and brain, and increased astrogliosis (p<0.02) and cell death (p<0.05) in the WM, which were equivalent in magnitude between groups. Conclusions Ventilation after acute chorioamnionitis, irrespective of strategy used, increases haemodynamic instability and lung and cerebral inflammation and injury. Mechanical ventilation is a potential contributor to WM injury in infants exposed to chorioamnionitis. PMID:25379714

  6. INFRASTRUCTURAL MECHANISMS LEADING TOWARD PRO-ACCOUNTABLE CARE ORGANISATION ORIENTATION: A SURVEY OF HOSPITAL MANAGERS

    PubMed Central

    Wan, Thomas T.H.; Masri, Maysoun Dimachkie; Ortiz, Judith

    2013-01-01

    Organisations across the country are transforming the way they deliver care, in ways similar to the accountable care organisation (ACO) model supported by Medicare. ACOs modalities are varying in size, type, and financing structure. Little is known about how specific infrastructural mechanisms influence hospital managers pro-ACO orientation. Using an electronic-survey of hospital managers, this study explores how pro-ACO orientation, as a latent construct, is captured from the perceptions of hospital managers; and identify infrastructural mechanisms leading to the formation of pro-ACO orientation. Of the total hospital respondents, 58% are moving toward the establishment of ACOs; 56% are planning to join in the next two years; 48% are considering joining ACOs; while 25% had already participated in ACOs during 2012. Urban hospitals are more likely than rural hospitals to be engaged in ACO development. The health provider network size is one of the strongest indicators in predicting pro-ACO orientation. PMID:25374609

  7. Successful Removal of Endobronchial Blood Clots Using Bronchoscopic Cryotherapy at Bedside in the Intensive Care Unit

    PubMed Central

    Lee, Hongyeul; Leem, Cho Sun; Lee, Jae Ho; Lee, Choon-Taek

    2014-01-01

    Acute airway obstruction after hemoptysis occurs due to the presence of blood clots. These conditions may result in life-threatening ventilation impairment. We report a case of obstruction of the large airway by endobronchial blood clots which were removed using bronchoscopic cryotherapy at the bedside of intensive care unit. A 66-year-old female with endometrial cancer who had undergone chemotherapy, was admitted to the intensive care unit due to neutropenic fever. During mechanical ventilation, the minute ventilation dropped to inadequately low levels and chest radiography showed complete opacification of the left hemithorax. Flexible bronchoscopy revealed large blood clots obstructing the proximal left main bronchus. After unsuccessful attempts to remove the clots with bronchial lavage and forceps extraction, blood clots were removed using bronchoscopic cryotherapy. This report shows that cryotherapy via flexible bronchoscopy at the bedside in the intensive of intensive care unit is a simple and effective alternative for the removal of endobronchial blood clots. PMID:25368667

  8. Intratracheal pulmonary ventilation provides effective ventilation in a near-drowning model.

    PubMed

    Burkhead, S R; Lally, K P; Bristow, F; Sndor, G J; Xue, H

    1996-03-01

    Overdistension of the lungs from high inspiratory pressure is increasingly recognized as a major contributor to lung injury and worsening respiratory failure in the child who requires prolonged mechanical ventilation. Many modes of ventilation (such as high-frequency ventilation) have been introduced in an attempt to decrease this lung injury. Recently, a new mode of tracheal ventilation, intratracheal pulmonary ventilation (ITPV), has been described. By using a catheter positioned at the carina with continuous gas flow, it is possible to achieve effective ventilation at very low pressures. The purpose of this study was to evaluate the usefulness of ITPV in a near-drowning model. Ten domestic Yorkshire swine underwent arterial, venous, and pulmonary arterial catheter as well as tracheotomy placement. All animals received 13 mL/kg of fresh water intratracheally to induce a pulmonary injury. Six pigs were ventilated for 4 hours using ITPV; the other four pigs received conventional mechanical ventilation (CMV). Circulatory and ventilatory pressures, hemodynamic variables, arterial blood gases, and end-tidal CO2 were measured before lung injury and every 30 minutes thereafter. Both proximal and distal peak and mean airway pressures were measured. The animals were ventilated as needed to maintain the arterial blood gases in the normal range. The authors found the expected changes in pulmonary compliance, oxygen requirement, and airway pressure after inducement of lung injury. The six animals treated with ITPV had significantly lower airway pressures than those of controls. Peak inspiratory pressures with ITPV were 8.2 +/- 1.9 cm H2O versus 17.8 +/- 3.7 with CMV (P < .001). Distal mean airway pressures using ITPV were 2.3 +/- 0.1 cm H2O versus 9.0 +/- 3.2 with CMV (P < .01). With respect to hemodynamic variables, there were no differences between experimental and control animals. In conclusion, ITPV can afford effective ventilation in a near-drowning model of lung injury at airway pressures significantly lower than those required with CMV. ITPV could be a very valuable addition to the currently available methods of mechanical ventilation. PMID:8708899

  9. Ventilation Requirements in Hot Humid Iain S. Walker and Max H. Sherman

    E-print Network

    LBNL-59889 Ventilation Requirements in Hot Humid Climates Iain S. Walker and Max H. Sherman residential ventilation standard, ASHRAE Standard 62.2. Meeting this standard in new construction requires the use of mechanical ventilation, which in turn can often significantly increase the latent load faced

  10. Study of natural ventilation in buildings by large eddy simulation Yi Jiang and Qingyan Chen*

    E-print Network

    Chen, Qingyan "Yan"

    1 Study of natural ventilation in buildings by large eddy simulation Yi Jiang and Qingyan Chen 02139 *Phone: (617) 253-7714, Fax: (617) 253-6152, Email: qchen@mit.edu Abstract Natural ventilation in the mechanical ventilation systems. Two subgrid-scale models of large eddy simulation (LES), a Smagorinsky

  11. Natural Ventilation in Buildings: Measurement in a Wind Tunnel and Numerical Simulation with Large Eddy Simulation

    E-print Network

    Chen, Qingyan "Yan"

    1 Natural Ventilation in Buildings: Measurement in a Wind Tunnel and Numerical Simulation@purdue.edu Abstract Natural ventilation in buildings can create a comfortable and healthy indoor environment, and can save energy compared to mechanical ventilation systems. In building design the prediction

  12. Low energy architecture for a severe US climate: Design and evaluation of a hybrid ventilation strategy

    Microsoft Academic Search

    Kevin J. Lomas; Malcolm J. Cook; Dusan Fiala

    2007-01-01

    Natural ventilation, relying on openings in the faade, is applicable to a limited range of climates, sites and building types. Advanced naturally ventilated buildings, such as those using stacks to encourage buoyancy driven airflow, or hybrid buildings, which integrate both natural and mechanical systems, can extend the range of buildings and climate within which natural ventilation might be used.This paper

  13. Unusual applications of noninvasive ventilation.

    PubMed

    Ambrosino, N; Guarracino, F

    2011-08-01

    The use of noninvasive ventilation (NIV) in acute hypercapnic respiratory failure, cardiogenic pulmonary oedema, acute lung injury/acute respiratory distress syndrome (ARDS), community-acquired pneumonia and weaning/post-extubation failure is considered common in clinical practice. Herein, we review the use of NIV in unusual conditions. Evidence supports the use of NIV during fibreoptic bronchoscopy, especially with high risks of endotracheal intubation (ETI), such as in immunocompromised patients. During transoesophageal echocardiography as well as in interventional cardiology and pulmonology, NIV can reduce the need for deep sedation or general anaesthesia and prevent respiratory depression induced by deep sedation. NIV may be useful after surgery, including cardiac surgery, and, with a lower level of evidence, in patients with pulmonary contusion. NIV should not be considered as an alternative to ETI in severe communicable airborne infections likely to progress to ARDS. NIV is being used increasingly as an alternative to ETI in end-stage symptomatic patients, especially to relieve dyspnoea. The role of assisted ventilation during exercise training in chronic obstructive pulmonary disease patients is still controversial. NIV should be applied under close monitoring and ETI should be promptly available in the case of failure. A trained team, careful patient selection and optimal choice of devices, can optimise outcome of NIV. PMID:21349915

  14. Systemic Microvascular Leak in an In Vivo Rat Model of Ventilator-induced Lung Injury

    Microsoft Academic Search

    Won-Il Choi; Deborah A. Quinn; Kwon Moo Park; Ramzi K. Moufarrej; Behrouz Jafari; Olga Syrkina; Joseph V. Bonventre; Charles A. Hales

    2003-01-01

    Positive pressure mechanical ventilation has significant systemic In the isolated rabbit lung ventilator-induced lung injury effects, but the systemic effects associated with ventilator-induced (VILI) model investigators have reported that the nitrite lung injury (VILI) are unexplored. We hypothesized that VILI would nitrate concentrations of bronchoalveolar lavage fluid in cause systemic microvascular leak that is dependent on nitric oxide high-pressure ventilation

  15. Clinical Foundations A Patient-focused Education Program for Respiratory Care Professionals

    Microsoft Academic Search

    Janet Boehm; Richard Branson; Richard Kallet; Donna Hamel; Neil MacIntyre; Tim Myers; Kathleen Deakins

    To aid respiratory care professionals in determining the most appropriate humidification device for mechanically ventilated patients, this article reviews humidification principles, standards regarding humidification devices, currently available humidification options, indications and contraindications for their use, and controversies related to optimum humidification. Heated pass-over and wick hu - midifiers, active heat and moisture exchangers (HMEs), and conventional heat and moisture exchang

  16. 46 CFR 111.103-1 - Power ventilation systems except machinery space ventilation systems.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 2010-10-01 false Power ventilation systems except machinery space ventilation systems. 111.103-1 Section 111...Systems 111.103-1 Power ventilation systems except machinery space ventilation systems. Each power ventilation...

  17. 46 CFR 111.103-1 - Power ventilation systems except machinery space ventilation systems.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 2013-10-01 false Power ventilation systems except machinery space ventilation systems. 111.103-1 Section 111...Systems 111.103-1 Power ventilation systems except machinery space ventilation systems. Each power ventilation...

  18. 46 CFR 111.103-1 - Power ventilation systems except machinery space ventilation systems.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 2012-10-01 false Power ventilation systems except machinery space ventilation systems. 111.103-1 Section 111...Systems 111.103-1 Power ventilation systems except machinery space ventilation systems. Each power ventilation...

  19. 46 CFR 111.103-1 - Power ventilation systems except machinery space ventilation systems.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 2011-10-01 false Power ventilation systems except machinery space ventilation systems. 111.103-1 Section 111...Systems 111.103-1 Power ventilation systems except machinery space ventilation systems. Each power ventilation...

  20. 46 CFR 111.103-1 - Power ventilation systems except machinery space ventilation systems.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 2014-10-01 false Power ventilation systems except machinery space ventilation systems. 111.103-1 Section 111...Systems 111.103-1 Power ventilation systems except machinery space ventilation systems. Each power ventilation...